Health Protection in Scotland - A Consultation Paper

Listen

Health Protection in Scotland - A Consultation Paper

Chapter 4 - Strengthening health protection services

  2. This chapter considers the various functions involved in health protection and suggests how they might be strengthened.

  3. Surveillance

  4. Surveillance involves the collection, collation, analysis and dissemination of information about health and its determinants. Its purpose is to recognise a change in the distribution of illnesses, exposures and hazards so as to alert health protection agencies of the need for specific measures or to inform them whether current policies are being effective in reducing exposure to hazards. Surveillance and research underpin risk assessment and the development of risk reduction measures.

  6. NHS agencies principally monitor the occurrence of episodes of ill health, death and the isolation of micro-organisms from samples taken from humans. A range of non-NHS agencies routinely collect, analyse and disseminate information on the occurrence of hazards in food, water, the air, and the general environment.

  8. The effectiveness of surveillance depends upon:

  • professional awareness of the value of the early recognition of actual and potential hazards and their notification to relevant protection agencies
  • accurate clinical and laboratory diagnosis of illness linked to hazards
  • a strong system of fully accredited diagnostic and reference laboratory services
  • information systems which permit the rapid transfer, processing and dissemination of data
  • the ability to link surveillance data from different sources to develop an overall picture of the risk presented to the public from exposure to a hazard.

  2. Against this background, there is a need for health protection surveillance to be strengthened in the following areas:

a. Monitoring unusual illnesses or syndromes

Since 11 September 2001, there has been an increased awareness of the need to detect rapidly outbreaks of communicable disease or clusters of unusual illness and to identify the implicated hazard. A Working Group has developed proposals to introduce a surveillance system for the detection of unusual illness in the population. This initiative is linked to participation in the development of UK-wide and international programmes to "horizon scan" for emerging infections.

b. Integrating different surveillance systems

A common criticism of surveillance systems is that they place greater importance on collecting than using information and thus become "data warehouses". One way of overcoming this would be through better linkage between datasets to facilitate their use in assessing the risk from exposures and their effects, in particular:

  • linking NHS information on episodes of ill health with that held on microbiological isolates;
  • developing an environmental health surveillance system which connects data on hazards and exposures with the occurrence of ill health;

c. Modernising the system for notifying communicable diseases

The Public Health (Notification of Infectious Diseases) (Scotland) Regulations 1989 place a duty on medical practitioners to notify the Chief Administrative Medical Officer (CAMO, now known as the Director of Public Health) of any patient they believe to be suffering from a notifiable disease which is specified in the regulations. There is a consensus that there is a need to expand notifiable diseases to include pathogenic micro-organisms and this is proposed within the current review of public health legislation.

d. Improving information technology for data transfer

There is a need to ensure that the gap between exposure of the population to hazards and the detection and diagnosis of any resultant illness is as small as possible. Key to this is the introduction of information systems which attempt to achieve "real time" surveillance by facilitating the rapid transfer of data on cases of ill health and their possible reasons for falling ill.

Investigation

  2. There are two approaches to health protection investigations. The first is the investigation of outbreak or incident; the second is specifically commissioned research. Epidemiological investigations attempt to establish the pattern of ill health associated with exposure to a hazard and its association with likely causes. Other types of investigation try to detail the ways in which the person was exposed to the hazard, or characterise the nature and properties of an implicated hazard. Health protection investigations are often multi-disciplinary and their utility depends on the collation of different types of data. Areas where further development of health protection investigations could take place are:

  3. a. Improving capability to carry out investigations into outbreaks or incidents

    Many NHS Boards lack the capacity to undertake structured investigations into outbreaks and incidents. There is a need for improved support from national agencies.

    b. Defining strategic priorities for research into health protection issues in Scotland

    The need for a more concerted and co-ordinated approach from research centres in Scotland to optimise output from research into health protection has long been recognised.

    c. Making better use of the findings from investigation and research

    A recent review of outbreak management has highlighted the need for improved collation of investigation findings from outbreak and incident investigation. The establishment of the Public Health Institute of Scotland provides a focus for the development of evidence-based practice in health protection.

    Risk Assessment

  4. Rigorously assessing the risk to the public health from exposures to hazards should be the cornerstone of advice to policymakers and regulators, the basis for accurately informing and communicating with the public and the platform for developing and evaluating control measures designed to reduce risk.

  6. Risk assessment is a key element of the practice of many of the agencies involved in health protection. However although its use is extensive, it has not been formally adopted as a tool for ongoing application in many areas, particularly those concerned with communicable disease control. Because of this it is proposed that health protection services should continue to:

    1. develop guidance on good practice in risk assessment in health protection agencies, particularly those working within the NHS;
    2. ensure that all policies developed to protect the public are formally founded on a rigorous approach to risk assessment.

Risk Management

  2. Risk management involves implementing and co-ordinating a series of interventions designed to reduce the risk from exposures to hazards. These include:

  • providing advice on how to avoid and minimise risks;
  • education and training about risks and how to reduce them;
  • producing guidance on good practice, policies and procedures to reduce the risk of exposure to hazards;
  • providing services which prevent the transmission and development of infections or their complications ;
  • providing hygiene services which reduce or eliminate contamination with hazards;
  • defining organisational and individual responsibility with regard to reducing risk and their consequent liabilities
  • setting standards to measure the performance of agencies and the quality of their services in reducing risk to the public
  • formulating and enacting regulations.

  2. NHS agencies are key players in managing the risks from exposure to hazards and in particular those related to the person-to-person transmission of micro-organisms. However, most measures to reduce the risk of exposure to hazards fall within the remit of other agencies.

  4. The following are highlighted as areas where developments in risk management could take place:

  5. a. Partnership working on health protection

    The recent introduction of community planning provides a focus for developing strong alliances to tackle issues such as accident prevention at a local level. The Public Health Institute of Scotland is taking forward the creation of a Healthy Environments Network, which will bring together key partners at national and local level, in order to develop environmental health policy, taking account of best practice arising from local initiatives, and contribute to ongoing work on health protection.

    b. Education on hygiene

    The growing numbers of healthcare associated infections and worries about the person-to-person spread of childhood infections have once more highlighted the need for improving hygiene education in the pre-school sector and in training programmes for healthcare professionals.

    c. Development of indicators to assess the performance of NHS agencies with health protection responsibilities and the impact of risk reduction measures on health

    There are few outcome measures to assess the overall impact on health of risk management programmes. Recently, the Food Standards Agency has developed a target for reduction in foodborne infections. There are opportunities to extend this model to other areas.

    Risk Communication

  6. Communicating about risk to the public health is of vital importance. People need to understand risks to make decisions about their and their families' health and to make proper enquiries of public bodies, which are charged with making decisions on their behalf. Communication needs to be considered by all those dealing with actual or potential public health risks, at all stages of the health protection processes. How to communicate about risk depends upon an understanding of how the population perceives risks and how the media and other factors exert an influence.

  8. The BSE Inquiry highlighted the dangers from what has been termed "communication by sedation", i.e. professionals and Government downplaying unknown risks. A key matter for health protection agencies is handling uncertainty and, in doing this, they require to be open and transparent to the public and their representatives.

  9. Priorities for the development of risk communication include:

    1. Developing guidance on risk communication for NHS agencies involved in health protection to be used in establishing communication plans and procedures.
    2. Commissioning research into understanding how certain risks become amplified and how the public can develop better means of comparing and contrasting risks which affect their personal life (risk literacy).

Emergency response and management

  2. The importance of this function has been given added priority after the events of 11 September. Extensive planning and guidance have already been put in place, including detailed guidance to health and local authority and other emergency services, raising clinical awareness and producing guidelines on the recognition and management of infections and exposures to chemical agents which give rise to unusual clinical presentations. The Scottish Executive Health Department has participated in establishing strategic stockpiles of drugs and vaccines and putting in place plans for their distribution.

  4. The multi-agency response to an emergency involving the deliberate release of a biological, chemical or radiological agent is in most ways the same as one arising accidentally or naturally. The key aim is to reduce to a minimum the number of cases of illness by recognising promptly the outbreak of the incident, defining how cases have been exposed and identifying and controlling the source of the exposure. Health protection agencies should strive to keep the public and media informed of the health risks associated with an incident.

  6. Incidents and outbreaks also provide an opportunity to collect information which will be of use in better understanding the nature and origin of exposure to toxic hazards and how best to present them.

  8. Experience suggests that emergency response and management could be strengthened by:

    1. Carrying out more regular joint exercises in all relevant types of incidents and improving the sharing of lessons learnt from them.
    2. Continuing to develop and improve the reporting of outbreaks and incident management and the collation of the key lessons learnt from them.
    3. Developing standards to audit organisations' performance in managing outbreaks and incidents.
    4. Developing on-going training for frontline staff in recognising and dealing with incidents.

Conclusion

  2. Surveillance, investigation, risk assessment, management and communication and managing emergencies are the key health protection functions. Improving them entails a series of developments, many of which are detailed in this chapter. It will require investment in organisational and staff development. To succeed in making health protection services more effective, more transparent and effective organisational, accountability and performance management arrangements need to be put in place.

Key Questions

  • Do consultees agree that health protection requires strengthening in the areas outlined above?

  • Could consultees indicate any other areas for health protection services, which they consider to be deficient and require strengthening and give the reasons why.

Page updated: Thursday, May 25, 2006