Management of Public Health Incidents: Guidance on the Roles and Responsibilities of NHS led Incident Management Teams - October 2011 (Updated July 2013)

INTRODUCTION

1. When individuals find themselves in situations that may cause them harm they may be able to take action to protect themselves. However, circumstances can arise when the health of the population may be at risk because groups of individuals are exposed, or at risk of being exposed, to infectious disease, high levels of a harmful substance or adverse environmental conditions. These situations are public health incidents and NHS Boards must take action to protect public health.

2. This document provides guidance for the NHS in preparing for, and managing public health incidents in collaboration with partners, especially the Local Authorities.

3. The vast majority of public health incidents do not require a response co-ordinated through the Strategic Co-ordinating Group (SCG) structure. However, if the incident escalates and requires a SCG response this should be based on the guidance provided in 'Preparing Scotland'.

4. NHS Boards are accountable to the Scottish Government Health Directorate (SGHD) for protecting and improving the health of people living within their geographic areas. NHS Boards act to protect human health during incidents within the context of shared responsibility for improving health with Local Authorities and also within the multi-agency emergency planning structures. Both NHS Boards and Local Authorities are Category 1 responders under the Civil Contingencies Act 2004 and the Contingency Planning (Scotland) Regulations 2005. All organisations are required to work within an Integrated Emergency Management (IEM) approach incorporating police, fire and rescue services and other organisations.

5. The Public Health (Scotland) Act 2008 provides greater clarity over the roles and responsibilities of NHS Boards and Local Authorities and provides more extensive powers. Broadly, NHS Boards are responsible for people, and Local Authorities are responsible for premises. NHS Boards and Local Authorities have a duty to co-operate in exercising their functions under the Act, and to plan together to protect public health in their area. This includes the production of a Joint Health Protection Plan every 2 years.

Background

6. The first version of this guidance 'Managing incidents presenting actual or potential risk to the Public Health: Guidance on roles and responsibilities of Incident Control Teams' was published in 2003. The revised guidance has taken into account a number of changes since that time including:

• Health Protection Agency Act 2004 and the establishment of the Health Protection Agency with powers related to Scotland especially on chemicals, poisons, emergency planning and radiation (to be continued in due course by Public Health England);
• Civil Contingencies Act 2004;
• International Health Regulations 2005 (IHR);
• Establishment of the European Centre for Disease Prevention and Control (ECDC) in 2005 and public health duties placed on member states through EC Directives including notification of outbreaks likely to cross borders;
• Establishment of Health Protection Scotland (HPS) in 2005; and
• Public Health (Scotland) Act 2008.

7. A number of significant public health incidents have taken place in Scotland and elsewhere since 2003 and include:

• Buncefield explosion 2005;
• Polonium incident in England 2006;
• Anthrax Incidents in the Borders in 2006-2007 and amongst drug users in 2010;
• Outbreaks of measles in 2006 and 2009;
• Outbreak of Q Fever in Forth Valley in 2007;
• Outbreak of Clostridium difficile Infection at the Vale of Leven Hospital in 2009;
• Influenza Pandemic 2009/2010;
• Outbreaks of E. coli O157 infection in Fife, Borders, Aberdeenshire and Paisley plus significant outbreaks in Wales and England;
• Outbreak of E coli O104 in Europe in 2011; and
• White Powder and other potential bioterrorism incidents (including preparedness for the G8 summit).

8. A review of the evidence was undertaken to inform the development of this guidance, in collaboration with the Health Protection Network (HPN).

9. In revising this guidance the opportunity has been taken to move to an electronic version which will be updated every two years by Health Protection Scotland and reviewed by the SGHD as necessary. This will also allow the guidance to be revised as a result of lessons learnt from its use in incidents or exercises.

Further Update to Guidance - July 2013

10. Following the review of this guidance in October 2011, the SGHD CMO and Public Health Directorate made changes to their internal arrangements for handling calls from NHS Boards out of hours. The new arrangements require all out of hours contact in relation to public health incidents to be made with Scottish Government via an on call mobile on 07824 087787. This alerts the on call member of staff who will then telephone the Board contact as soon as practicably possible to seek an overview of the incident.

Aim of the Guidance

11. This guidance describes the generic organisational arrangements for managing public health incidents and the roles and responsibilities of Incident Management Teams (IMTs). It covers both planning and response based on a set of key principles and key functions. The guidance does not replicate that found elsewhere but sets out a hierarchy of existing guidance. It also illustrates how the response to an incident will change depending on the level and scale of that incident. It covers single and multi Board incidents and incidents where a national response is required.

12. In summary, this guidance should be regarded as a reference document for use by NHS Boards and Local Authorities to develop integrated local public health incident response plans and procedures. Local plans and procedures should be drawn up under the general direction of the NHS Board in close collaboration with Local Authorities and other partners, where appropriate. Further detail on statutory responsibilities and roles and responsibilities of the various agencies that lead and/or contribute to managing public health, where appropriate, can be found at Annex A and B respectively.