Scottish Health Protection Stocktake Working Group: capacity and resilience

Scottish Health Protection Stocktake Working Group:

capacity and resilience

Dr Syed Ahmed

CPHM, NHSGGC

15th November 2010

Health Protection Capacity and Resilience

• Routine business

• In an emergency– Pressures– Strengths– Weaknesses

Health Protection Service

• Emergency health protection service – easy to define

• What is routine service and where is the boundary with other (generic) public health service?

• What are the standards against which these services should be measured?

• Difficult to assess resilience and capacity unless these are defined and agreed in the context of resources available to health protection teams.

Health Protection Service:key elements

• Surveillance• Investigation• Control and prevention• Risk assessment• Risk management• Communication• Emergency preparedness• Audit and evaluation including research

Health Protection Service: standards

• National guidance on incident and outbreak management

• Quality Assurance Working Group set up in 2007: to set and develop an audit tool to measure standards

• Grampian standards

• Borders standards

Health Protection Teams in Boards

• Variation in resources between teams depending on size and location of boards

• Resources used need to be seen in context and the totality of the work done by the team

• Work of a health protection team may include other public health work such as health improvement and service planning but on health protection topics

• Staff per head of population is not a true reflection of workload and actual need

Health Protection in NHSGGC

• Hepatitis C - approximately 40% of all cases in Scotland

• TB – approximately 50% of all cases in Scotland

• Immunisation – approximately one third of all immunisations are done unscheduled

HIV cases on treatment in NHSGGC

0

200

400

600

800

1000

1200

1400

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Health Protection Teams in Boards

Work determined by:• Population size and structure• Epidemiology of diseases in the board• Management and planning structure of the

board• Number of local authorities• Ports/airports• Higher education establishments• Geography etc

Health Protection Team

Service planningon health

protection topicsHealth

Improvement

Health Protection

5% 90% 5%

Health Protection Team

Health Protection

40% 50% 10%

Service planning

on health protection

topics

Health Improvement

Health Protection Team

Why is service planning important?• To treat patients routinely and during an

emergency• To deliver programmes, eg immunisation• To build up relationships with local clinical

teams and other services in “normal” times• Capacity and resilience in health protection

should be seen as part of the bigger picture including capacity and resilience in clinical services in both primary and secondary care

Health Protection in Scotland:strengths (1)

• On the whole, Scotland has a good health protection service– Incidents and outbreaks in recent years– Routine service, eg immunisation

Completed primary immunisations (all antigens) by 24 months:

April to June 2010Country PCT/HB

Total

DTaP/IPV/Hib3

%

MenC2

%

PCV booster

%

Hib/MenC

%

MMR1

%

England 152 95.5 94.6 88.3 90.9 88.3

Wales 7 97.4 96.2 91.1 93.6 92.1

Northern

Ireland 4 99.0 97.4 93.3 95.7 92.4

Scotland 14 98.6 96.5 94.0 93.9 93.4

United

Kingdom 177 95.9 94.9 89.0 91.4 89.0

UK HPV vaccine coverage for females aged 12-13 years by country, 2008/09

HPV vaccine uptake %

Country Dose 1 Doses 1 and 2 All 3 dosesNorthern

Ireland89.6 85.9 83.9

Scotland93.7 92.7 89.4

Wales87.9 87.0 78.8

England88.1 86.0 80.1

United

Kingdom88.6 86.6 80.9

International HPV vaccine uptake

Country Third dose uptake

Delivery method

Start date Evaluation period

UK 80.9 Schools-based delivery to 12-13 year olds

Sept 08 Sept 08 to

Aug 09

USA 17.9 In general practice to 13-17 year olds

Jan 08 Jan 08 to

Dec 08

Belgium 44 Schools-based programme to 12-15 year olds

Nov 07 Nov 07 to

Nov 08

Australia 66.3 Schools-based programme to 12-18 year olds

Apr 07 Apr 07 to

Mar 08

Health Protection in Scotland:strengths (2)

• Local health protection team integral to the local NHS structure– Local knowledge, local network, soft intelligence

helps to recognise “out of the ordinary”– Local network with other partner agencies, eg

local authorities – Know each other’s strengths and weaknesses and

what is and isn’t possible– During major emergencies it is an organisational

response rather than just a health protection team response

Health Protection in Scotland:strengths (3)

• Good links and partnership working with Boards and national agencies and Scottish Government

• Small country with a reputable national health protection agency (HPS)

• Good national networks among CsPHM and HPNs

Health Protection in Scotland:weaknesses (1)

• Some boards are very small with limited health protection resource

• No dedicated 24/7 cover by health protection expertise and reliance on generic staff

• Capacity to deal with large incident/sustained pressure limited

• Informal “mutual aid” arrangements do not work

• Island health boards issue

Health Protection in Scotland:weaknesses (2)

• No national standards for health protection so difficult to assess how we are doing

• A variety of information management systems not linked to each other

• HPS role requires clarification– Co-ordination of health protection activity– Assuring quality

Health Protection in Scotland:weaknesses (3)

• Expertise available at all levels are not fully utilised to maximise public health gain

• Perception of health protection policy being made not based on evidence

• HPS’s involvement at an operational level at the expense of other roles eg., workforce development

Health Protection in Scotland:pressures (1)

• Health protection and other public health staff are grouped with management structure, pressure to reduce costs

• Unfilled posts and uncertain future

Health Protection in Scotland:pressures (2)

• Increasing pressure on the services for a variety of reasons – Public expectation– Political expectation– Disease epidemiology– More enhanced surveillance by HPS

Health Protection in Scotland:conclusions (1)

• Doing well but could do better• Need to protect existing resources from

management cost savings• Need to marry the strength of the local team

approach with some regional approach for critical mass, resilience and 24/7 cover by health protection specialists

• Need formal arrangement not informal “mutual aid”

Health Protection in Scotland:conclusions (2)

• Utilise all the expertise available better in national programmes

• Better stakeholders engagement and agreement on what is best done at national, regional/local levels and resource accordingly

• Define national standards and develop audit tool to monitor performance

• Work of Boards and HPS need to complement rather than duplicate to make health protection service in Scotland even better