New national public health body 'Public Health Scotland': consultation

Chapter 6: Health Protection

1. Health protection is a critical element of the national public health infrastructure because an effective health protection function protects the population from risks and threats. The health protection function in Scotland is currently strong, and in establishing Public Health Scotland it is important current protections are not compromised. Specific Scottish policies on infectious and environmental hazards are usually set within a UK and European context. The parameters for action in this sphere of public health are underpinned by legislation, principally the Public Health (Scotland) Act 2008.

2. Health Protection Scotland (HPS) currently provides the national-level health protection function in Scotland. HPS is currently organised into three specialist groups with expertise provided by a multi-disciplinary workforce, which includes public health specialists, doctors, nurses, scientists and information staff, all of whom are supported by core business and Information Management and Technology teams. The specialist groups are:

• Antimicrobial Resistance and Healthcare Associated Infection (ARHAI); 
• Blood Borne Viruses and Sexually Transmitted Infections, Immunisation, and Respiratory and Vaccine Preventable Diseases; 
• Gastrointestinal and Zoonoses, Travel, and Environmental Public Health. 

3. In light of recent infection incidents and the associated independent external review that has been commissioned, the Cabinet Secretary for Health and Sport is considering what provision may be needed at the national level in future in relation to infection prevention and control. Decision-making around the ARHAI component of HPS will therefore require further consideration.

4. It is proposed that the relevant Health Protection Scotland functions to be transferred to Public Health Scotland will include: 

• Surveillance; 
• Co-ordination of agreed national health protection programmes (e.g. Immunisation); 
• Expert advice and horizon scanning; 
• Effective preparation and response to outbreaks and incidents; 
• Enabling good professional practice; 
• Supporting the ongoing development of a confident and competent health protection workforce; 
• Monitoring the quality and effectiveness of health protection services;
• Support for commissioning specialist/reference lab services; 
• Research and innovation to provide evidence for action.

5. Public Health Scotland will become responsible for the implementation of the relevant health protection programmes and policies, including the provision of expert advice on policy development; the development and implementation of a quality assurance framework for health protection at a local, regional and national level; public communication and advice on health protection issues and leading the coordination of the national health protection operational response to incidents requiring Scotland wide action. 

6. Local authorities and NHS Boards have a critical role in working together to protect the health and wellbeing of their population, both in terms of planning to prevent threats arising, and in ensuring appropriate and coordinated responses when risks emerge. Future health protection effectiveness will depend on how well Public Health Scotland links with the many key stakeholders in health protection.

7. These fall into four categories:

• Local bodies, such as NHS Boards or Local Authorities;
• Special NHS Boards with national responsibilities;
• other organisations with Scotland or UK-wide remits which overlap with health protection; and

• UK and international health protection partners.

8. The wide range of stakeholders in Scotland who have an interest in Health Protection are supported and engaged via the Scottish Health Protection Network (SHPN), a national multi-disciplinary obligate network that is supported by HPS. The SHPN involves a wide range of stakeholders from NHS and non-NHS organisations, and is a model for the cross-system collaboration that Public Health Scotland will seek to support and promote more generally.

9. Public Health Scotland will build on the existing strengths of the SHPN to deliver its Health Protection leadership role in partnership with the multiple agencies involved across the system. The SHPN will continue to be supported, and Public Health Scotland will plan and deliver effective and specialist national services which co-ordinate, strengthen and support activities aimed at protecting the people of Scotland from infectious and environmental hazards. This means: 

• Assessing the risks to public health associated with exposure to environmental hazards and working to minimise the adverse health impacts of these and other environmental factors. 
• Evaluating and characterising the epidemiology of communicable diseases in Scotland; and strategies to reduce their incidence, using surveillance data and evidence based intelligence; . 
• Investigating and managing outbreaks of communicable disease and environmental incidents to limit the impact on the public’s health and wellbeing. 

10. The new body will continue to provide a comprehensive range of scientific advice and interventions to protect the public’s health and wellbeing against a range of domestic and international threats. It will work to strengthen the resilience of our scientific response to threats to the public’s health and wellbeing through ongoing scientific advances and contributing to UK-wide preparedness.

Question 9: (a) What are your views on the health protection functions to be delivered by Public Health Scotland?
(b)What more could be done to strengthen the health protection functions?