Health Board Health Protection

Dr Jackie HylandNHS Fife

Communications

What are we trying to do?Form Follows Function

UK Models England

•Fewer CCDC/head of population BUT

•CCDC job is different •PCT i.e Imm Co-ord, Flu co-ordinator, Emergency Planning etc  •Not involved in Hospital Infection control• Data is much better in Scotland. Some good things - some HPUs have EHOs on staff working as HP practitioners alongside nurses.   At least one HPU post Godstone now use HPU staff to interview serious GI illness e.g. E coli i.e similar to what we do in Grampian. 

Wales? N Ireland?

re

Environmental Public HealthParadigms & Practice

BIOLOGICALCHEMICALRADIATIONPHYSICAL

AIR (Inhalation)

WATER (Ingestion)FOOD (Ingestion)

PHYSICAL CONTACTIRRADIATION

CHILDRENPREGNANT WOMEN

ELDERLYSOCIALLY DEPRIVEDRURAL COMMUNITIES

ENVIRONMENTAL HAZARDS

EXPOSURE ROUTES

POPULATIONSAT RISK

OPPORTUNITIES FOR HEALTH PROTECTION INTERVENTION

SOURCE PATHWAY RECEPTOR

ELIMINATE HAZARDS

AT SOURCE

PREVENT ENVIRONMENTAL CONTAMINATION

PREVENT EXPOSURE VIA

CONTAMINATION PATHWAYS

PERSONAL/ POPULATION PROTECTIVE MEASURES

CONTROL CONTAMINANT

LEVELS

Ref. Dr. C Ramsay

How do we protect health? Refhttp://www.sehd.scot.nhs.uk/cmo/CMO(2007)02.pdf (accessed 07/05/09)

1. SurveillanceMonitor the health of the population and the hazards

and exposures affecting it.

Outcome 1 – The HP Team is able to collect and analyze data for surveillance purposesStatutory notifications, laboratory results of statutory notifiable diseases, immunization data, environmental public health data

Outcome 2 – The Health Protection Team regularly reviews data with relevant colleagues (ie at meetings, through reports)Chest Physicians (TB), GUM Physicians,Environmental Health officers, other serviceproviders as appropriate.Circulars/newsletters to local GPs etc

New and Renewed Threats• New (H1N1, iGAS, PVL MRSA), renewed (measles, TB)• Increase temperatures – vector borne diseases e.g. malaria• Flooding and drought• Post September 11th 2001 deliberate releases/bioterrorism• Insufficient control measures (imported food, health screening)

2. Investigation Investigate why and how people fall ill because of

exposure to hazards and what can be done to prevent this.

Outcome 3 - The Health Protection Team has capacity and expertise to provide support to priority areas of workE.g. Pandemic influenza; healthcare associated infections and antimicrobial resistance; vaccine preventable diseases and the impact on them of current and planned immunization programmes; environmental exposures which have an adverse impact on health; gastro-intestinal and zoonotic infections, hepatitis C and other blood borne viruses etc.

3. Risk Assessment)

Estimate the probability of the health of a community being damaged from exposure to a hazard.

“Bigger units means becoming call centres, withdrawn, losing local relationships with local authorities and other partners. No longer able to proactively raise awareness to support implementation of polices. No longer able to visit cases or sites. LA going own way losing co-operative approach.” CPHM

4. Risk ManagementPut in measures which reduce the risk of exposure to

hazards and the impact they have on health.

Outcome 4- The Health Protection Team is able to ensure that policies are regularly updated and reviewedSchools/Nurseries/childminders, Residential homes, TB, Pandemic Influenza plan, Meningitis, Infestations (Headlice/Scabies), Blood borne viruses, Emergency Incidents, Other policies relevant to Board

5. Risk communicationInform the public about the risks to their health and what

the individually or collectively can do to reduce these

Communication which is proportionate!

Outcome 5- The Health Protection Team is able to deal with out of hours incidents, outbreaks and emergency incidents. Production and regular update of on-call pack, Regular training for staff participating on on-call rota, Organisation or participation in table top simulation for exercises for Communicable Disease outbreaks , Other incidents (water borne, CBRN, air borne and radiation)

6. Emergency response and management

Respond to incidents and outbreaks so as to reduce the number of cases of illness and other consequences to a

minimum

• Outcome 6 - The Health Protection Team is able to maintain health protection skills and competenciesEmergency Incident Management, Media handling, Legal aspects of Health Protection, IT/Epidemiological techniques

• Outcome 7 - Health Protection Team is able to attend professional meetings to monitor and influence service developmentsLocal Immunisation meetings, Hospital Infection Control meetings, Emergency Planning meetings, National CDEH meetings, National Health Protection Conferences

• Outcome 8 - The Health Protection Team is able to participate in educational/audit activitiesParticipation in local/national audit/ surveys, Fulfilling own professional CPD requirements, Training of on-call staff, Training local colleagues/professional groups in aspect

• Outcome 9 - The Health Protection Team has the capacity and resilience to respond to individual reports, incidents and outbreaks in line with national and local guidanceCapacity and resilience issues picked up in Joint Health Protection Plans

• Outcome 10 - The Health Protection Team is well led Vision, values and aims shared by team, Health Protection team works well together , Health Protection team uses resources efficiently, Team members maintains good partnerships with local and national NHS colleagues and with local authorities

Main work-streams

Reactive - Stakeholder driven - operational response focus- non-negotiable e.g. chemical incident response

Proactive -- driven by Stakeholder perceptions of key issues- differing Stakeholder priorities and demands – competing

some

Maintaining a Balance- dependent on whose “priorities” weight greatest and the

availability of resources

Environmental Public Healthand Communicable disease Control

adapted from Dr C Ramsay presentation

Thank-you

Acknowledgements

David Breen

Helen Howie

Jayne Leith

Ken Oates

Tim Patterson

Colin Ramsay

Diana Webster