Management of Public Health Incidents: Guidance on the Roles and Responsibilities of NHS led Incident Management Teams - October 2011

ANNEX B ORGANISATIONAL ROLES AND RESPONSIBILITIES

Scottish Government Health Directorates

The Scottish Government's roles include the following:

• Strategic and Policy role (including CMO letters and HDLs);
• Performance management role - NHS territorial and special Health Boards

Performance Management Role

1. NHS Boards are accountable to the Scottish Government. Performance management of territorial NHS Boards is handled by the Performance Management Division who has a range of formal procedures in place agreed with Scottish Ministers. This includes an interim performance review and an end year review, which is held in public by the Cabinet Secretary for Health. NHS Boards work to an agreed set of indicators which are now managed under the auspices of the Quality Strategy. Similar arrangements are in place for the Special Health Boards including NSS (of which HPS is a part).

Strategic and Policy Role

2. The Scottish Government is responsible for setting policy and strategic direction and this includes policy and strategy issues that arise during the course of or because of an incident. The extent of the Scottish Government's involvement will depend on the scale of the incident - far less active involvement will be expected for a smaller single NHS Board incident than a national incident in which civil contingency procedures may be engaged. This section explains the Scottish Government's role in various different scenarios.

Notification

3. For many incidents, regardless of scale, the Scottish Government will, as a minimum, require notification as early as possible so that Ministers can be informed. The arrangements for notifying the Scottish Government of significant public health incidents are as set out in this guidance and the Ministerial protocol prepared in 2007 (and attached at Annex I). The protocol clearly sets out the circumstances in which NHS Boards and Health Protection Scotland should inform Scottish Government staff and when policy or professional staff in Scottish Government should inform Ministers of significant public health incidents.

4. The CMO & Public Health Directorate is the main point of Government contact for public health incidents (excluding HAI incidents in hospitals for which separate arrangements apply - see Annex D). NHS Boards (the CPHM or other nominated person) must notify the senior medical officer on call about incidents and continue to provide updates on any further significant developments.

5. The senior medical officers work very closely with the health protection policy team, who also operate a 24 hour on call rota. On receiving notification in hours the medical officer on call will normally inform the relevant policy team member. Out of hours the senior medical officer / senior public health professional will contact the policy on call officer. They will discuss and agree the need to inform Ministers and the need to inform and brief the duty Scottish Government press officer.

6. The Scottish Government has a Concordat with the Food Standards Agency. Both parties will ensure immediate communication on matters relating to outbreaks and incidents of foodborne or potentially foodborne disease and will establish lines of communication for the duration of the incident or outbreak.

7. Clear channels of communication will be established between Chief Medical Officer's directorate and the IMT. This will be the sole line of communication in terms of the progress of the public health incident. It is useful for the IMT chair to agree times for updating the senior medical officer on a regular basis. This can, for example, be agreed as 30 minutes following the IMT meeting. It is important that the parallel briefing with the inherent risk of conflicting data does not occur. It will also be important the IMT Chair contacts the senior medical officer if there are significant events of which the Scottish Government should be aware. Speed is essential in communicating important information to Ministers, particularly if it is likely to be of interest to the media.

8. In the majority of public health incidents in Scotland the response of senior medical officers and the policy team would be all that is necessary.

An incident affecting two or more NHS Boards with no major disruption of services or a Scotland or UK-wide outbreak or incident with some but no major disruption of services

9. In this scenario, the Scottish Government is likely to liaise more proactively with Health Protection Scotland, particularly if they are managing the incident on behalf of Scottish Government. They will seek to identify and resolve any policy or handling issues at an early stage and to communicate proactively with NHS Boards involved. If the incident involves another country within the UK, the policy team would establish links with opposite numbers in e.g. the Department of Health and set up a regular channel of communication. They would also liaise proactively with our own communications team and provide regular updates to Scottish Ministers. For a major incident, arrangements are in place to allow the Health Protection Policy Team to draw on additional health directorates resources.

10. The role of the Scottish Government team managing the response can be summarised as follows:

• providing regular and timely advice to Scottish Ministers;
• providing regular information and agreeing public lines with the Health Communications Team;
• providing information and advice to any other relevant area of health directorates and other Government directorates as required;
• liaising with other devolved administrations and UK Government as required;
• liaising with Health Protection Scotland;
• liaising with any other relevant agency in Scotland; and
• assessing the effectiveness of the local or national response (with HPS) and considering resource impact on national policy or strategy.

Incidents with major disruption of services requiring the mobilisation of significant surge capacity and the establishment of regional or national multi-agency strategic, tactical and operational management arrangements (e.g. pandemic flu)

11. In the circumstances of a national level emergency, Scottish Government emergency planning procedures may be implemented including establishment of the Scottish Government Resilience Room (SGoRR) with regular meetings of officers and Ministers. A lead Scottish Government department (and lead Minister) is likely to be designated according to the nature of the emergency. There may also be meetings of a cabinet level sub committee (CSC - SGoRR) supported by meetings of senior officials (SGoRR (O)). The Resilience Advisory Board for Scotland (RABS), which includes senior management from the SG and responders, may be convened depending on the nature of the emergency.

12. If this becomes or is part of a UK Major Incident then the Cabinet Office Briefing Room A (COBRA) may be established, and Scottish Government will link into COBRA at officer and Ministerial level. The UK Government would convene their Civil Contingencies Committee and Civil Contingencies Committee (officials). There may also be circumstances where an emergency in Scotland relates to an area of responsibility reserved to the UK Government (in which case a UK Govt department would be in the lead and would liaise with the Scottish Government).

13. All Scottish Government activity in a national level emergency is co-ordinated through the Scottish Government Resilience Room. It is supported by an Emergency Action Team of senior officials (EAT) and an Emergency Support Team (EST). From a health aspect this would be through the SGHD NHS Resilience Team. The Resilience Team is likely to produce regular situation reports (SitReps) which cover all aspects of an incident. It is likely that the Resilience Team would request information from the relevant Health Board/s for inclusion in the report. This would be in addition to the ongoing liaison between the Board and the Senior Medical Officers in Scottish Government.

Health Protection Scotland (HPS)

14. Health Protection Scotland is a Division of NHS National Services Scotland (NSS). Its aim is to work, in partnership with others, to protect the Scottish public from being exposed to hazards which damage their health and to limit any impact on health when such exposures cannot be avoided. It seeks to achieve this aim by:

• ensuring a consistent, efficient and effective approach in the delivery of health protection services by NHS and related agencies;
• co-ordinating the efforts of public health agencies in Scotland in health protection especially when a rapid response is required to a major threat;
• helping increase the public understanding of and attitudes to public health hazards and facilitating their level of involvement in the measures needed to protect them from these;
• being the source in Scotland of expert advice and support to government, NHS, other organisations and the public on health protection issues;
• helping develop a competent health protection workforce;
• improving the knowledge base for health protection through research and development.

15. HPS' key functions are as set out in an MOU with the Scottish Government:

• Monitoring the hazards and exposures affecting the people of Scotland and the impact they have on their health;
• Co-ordinating national health protection activity;
• Facilitating the effective response to outbreaks and incidents;
• Supporting the development of good professional practice in health protection;
• Monitoring the quality and effectiveness of health protection services;
• Research and development into health protection priorities;
• Providing expert impartial advice on health protection;
• Promoting the development of a competent and confident workforce in health protection; and
• Commissioning national reference laboratories.

16. HPS has the following responsibilities for facilitating the response to incidents as set out in its MOU with the Scottish Government:

17. A localised incident affecting a single NHS Board with no major disruption of services

• Maintain communication with and provide expert advice to the NHS Board;
• Liaise when necessary with the Scottish Government and/or Food Standards Agency;
• If available, provide additional personnel to facilitate the management of the incident who will be managed for the relevant period by the NHS Board; and
• Work with the NHS Board to assure the quality and effectiveness of the steps taken to manage the incident and in particular ensure that there is a structured debrief

Health alerts arising from an incident

• distribute information to relevant staff in the NHS and local authorities, if appropriate;
• copy information to Scottish Government; and
• respond to queries concerning the subject matter of the alert.

18. An incident affecting two or more NHS Boards with no major disruption of services

• agree with the NHS Boards the appropriate management arrangements (i.e. a single IMT or two or more IMTs). This may include as an option HPS assuming responsibility for leading the overall management of the incident on behalf of an NHS Board;
• on behalf of the parties to the joint arrangement, co-ordinate surveillance, investigation, risk assessment and management and risk communication; and
• Operational management locally will remain the responsibility of NHSBs.

19. A Scotland or UK-wide incident with some but no major disruption of services (e.g. an unusual salmonella)

• lead the management of the incident in Scotland and establish appropriate arrangements on behalf of SGHD;
• With regard to an incident affecting one or more of the countries in the UK, lead Scotland's participation in UK-wide management arrangements. This may involve leading in certain circumstances the UK response;
• co-ordinate surveillance, investigation, risk assessment and management and risk communication; and
• operational management locally will remain the responsibility of NHSBs.

20. Any of the above incidents with major disruption of services requiring the mobilisation of significant surge capacity and the establishment of regional or national multi-agency strategic, tactical and operational management arrangements (e.g. pandemic influenza)

• When an incident requires the activation of the SCG (based on the current emergency planning arrangements set up in each of the 8 police regions), HPS will support the NHS Board in discharging its functions regarding health protection advice to the SCG. As with an IMT, HPS will advise and support the Scientific Technical Advice Cells (STACs) on the health protection response with NHS Boards co-operating with, and taking advice from, HPS.
• When an incident requires the establishment of a national strategic multi-agency group by the Scottish Government, HPS will support Scottish Government (and in particular the CMO) in discharging its functions regarding health protection advice to the strategic lead. HPS will be responsible for coordinating the tactical health protection response by the NHS Boards (i.e. surveillance, investigation, risk assessment and management and risk communication). NHS Boards will remain responsible for the operational health protection response.

NHS BOARDS

21. Under the terms of the National Health Service (Scotland) Act 1978, the NHS in Scotland is charged with two statutory duties:

• securing improvement in the physical and mental health of the people of Scotland
• securing the prevention, diagnosis and treatment of illness

22. Under the terms of the Public Health (Scotland) Act 2008, NHS Boards have a duty to 'continue to make provision, or secure that provision is made, for protecting public health in its area, without prejudice to its general duty to promote the improvement of the health of the people of Scotland' and a duty to 'co-operate with any relevant person who appears to have an interest in or a function relating to the protection of public health'.

23. NHS Boards have a range of powers available to them under the Act which can be exercised by their designated 'competent person'

• receive notification of a disease or health risk state from a registered medical practitioner either orally or in writing, relating to a patient who usually resides within that area and a duty to send a return in writing to the Common Services Agency (HPS);
• receive notification from the director of a diagnostic laboratory, where the laboratory identifies a notifiable organism no later than 10 days after identification;
• undertake public health investigations including powers for investigators to enter premises, ask questions etc.;
• apply to a Sheriff to have a person medically examined;
• make an 'exclusion order' which will exclude a person from any place or type of place specified in the order, and impose such conditions (if any) on the person as is considered appropriate;
• make a 'restriction order' which will prohibit a person from carrying on any activity specified in the order, and impose such conditions (if any) on the person as is considered appropriate; and
• apply to a Sheriff for an order to require a person to be quarantined in their home or other setting, other than a hospital or to have a person detained in hospital.

24. In addition to the above, a SEHD/CMO (2007)2 is available setting out NHS Boards' Health Protection remit (currently being revised in 2011). The CMO letter clarifies that the operational responsibility for health protection services lies primarily with NHS Boards. Health Protection Scotland (HPS) has a role in ensuring a consistent, efficient and effective approach in the delivery of these arrangements. The role of NHS Boards will always focus on operational management of an incident, but the paragraphs above indicate how the lead role will change during escalation of an incident and in relation to the roles of HPS and the SGHD.

LOCAL AUTHORITIES

25. Under the terms of the Public Health (Scotland) Act 2008, Local Authorities have a statutory duty to 'continue to make provision, or secure that provision is made, for the purpose of protecting public health in its area' and 'co-operate with any relevant person who appears to have an interest in or a function relating to the protection of public health.' Similarly to NHS Boards, Local Authorities also have a duty to designate a sufficient number of persons who can exercise functions under the Act.

26. Under the terms of the Act, Local Authorities have powers to:

• undertake public health investigations including powers for investigators to enter premises, ask questions etc
• serve a notice on the occupiers of any premises in its area if any thing in or on such premises is infected, infested or contaminated and in order to prevent the spread of infectious disease, or contamination, disinfection, disinfestation, or decontamination of the premises or things in or on the premises, the destruction of a thing, or other connected operations is necessary
• to order a range of public health measures in relation to premises and things, including disinfection, disinfestation and decontamination, in order to prevent the spread of infectious disease or contamination.

27. In addition, Local Authorities have a range of duties and powers which they may invoke to protect the public health during an incident. These include those under the terms of:

• The Food Safety Act 1990
• The Health and Safety at Work etc. Act 1974
• The Environmental Protection Act 1990
• The Public Health etc. (Scotland) Act 2008
• International Health Regulations, 2006
• The Public Health (Ships) (Scotland) Regulations 1971-2007
• The Public Health (Aircraft) (Scotland) Regulations 1971-1978

28. Environmental Health Officers working in Environmental Services or other departments constitute the prime local authority resource in health protection. They also have the principal local responsibility for reducing the risks from many environmental hazards. They liaise closely with their NHS colleagues in the investigation and control of outbreaks of infections, often being the enforcement arm of the teams set up to manage these incidents.

NHS 24

29. NHS 24 is responsible for the delivery of clinical assessment and triage, health advice and information by telephone and online services providing the population of Scotland with care 24 hours a day, 365 days a year. Specifically, the role of NHS 24 is to:

• triage calls, assess patients' symptoms and refer patients to the most appropriate healthcare professional within an appropriate timescale based on clinical need;
• work in partnership with local health systems provided by NHS Boards, NHS staff organisations and local communities through integration with other parts of the NHS - in particular, the GP Out-of-Hours Services provided by NHS Boards throughout Scotland, the Scottish Ambulance Service and the Acute Hospitals' Accident and Emergency Departments;
• support the health improvement agenda across Scotland by working in partnership with local Boards to provide added value services where and when required, utilising the IT telephony and infrastructure to benefit patients 24 hours a day;
• provide other telephone-based and online Health Information and Advice Services:
• NHS Helpline, a Special Helpline service to support public health related alerts which generate a large volume of calls/interest from the general public, either locally or nationally. The helpline should only be used for the acute phase of the emergency (the first 5-7 days) to manage the peak in activity. A line can be set-up within 6 hours, if required, to address an emergency situation. Basic statistics can be generated around numbers of calls to the line etc, along with some caller details as requested by the Board;
• Healthy Living Advice Line, which currently provides advice on diet and physical activity;
• Breathing Space Service, which provides support for people suffering low mood and depression
• Care Information Service, which provides Community Care information for older people. This includes both national information, such as that published by the Scottish Government Health Directorates and the Care Commission, and information about locally delivered services.

Scottish Ambulance Service

30. At the frontline of NHSScotland, the Scottish Ambulance Service (SAS) provides an emergency, unscheduled and scheduled service to people across mainland Scotland and its island communities. As a national Board, they offer a vital link for patients and the wider NHS. Their core function is to respond to patients when they need them, provide clinical treatment and care, and ensure patients are routed quickly and efficiently to the care they need. To deliver this they have established strong links across the NHS and with other key partners, have higher skilled staff than ever before, and have invested in leading-edge technology.

31. Their vision is 'to deliver the best patient care for people in Scotland, when they need us, where they need us'. In delivering their vision SAS strive for the following:

• To put the patient at the heart of everything they do
• To ensure clinical excellence in the delivery of services
• To be a leading edge service, 24 hours a day, 7 days a week

32. The SAS employs 4,300 highly skilled staff. On a yearly basis, they respond to nearly 600,000 Accident & Emergency calls, around 450,000 of which are 999 emergency calls. Almost 1.6 million patients are taken to and from hospital and other healthcare premises by their Patient Transport Service each year. The Air Ambulance Service deals with more that 3,800 incidents per year and they transfer 96,000 patients between hospitals, by road and air annually. SAS also operate a number of specialist retrieval services both through the air ambulance and on road vehicles, for example, neo-natal transfers.

33. SAS have 3 Emergency Medical Dispatch Centres (EMDCs) based in Glasgow, Edinburgh and Inverness which handle in excess of 800,000 calls for help each year from public, GPs, police, NHS 24 and other NHS partners, ranging from life-threatening heart attacks requiring an immediate response to request from NHS partners to transfer patients between hospitals.

Special Operations Response Teams (SORT)

34. The SAS has developed three Special Operations Response Teams (SORT) in Edinburgh, Glasgow and Aberdeen, comprising 106 specially trained paramedics and ambulance technicians. The teams are now trained and equipped to work inside the inner cordon alongside police and fire and rescue services at large scale hazardous incidents. They have all completed an intensive training course that enables them to operate in chemical, biological, radiological, nuclear and explosives (CBRNE) incidents and other accidents that involve hazardous materials. The training includes additional clinical skills, risk assessment, forensic awareness and decontamination procedures. It covers the use of specialist personal protective equipment including self-contained breathing apparatus. Additional training in water rescue techniques means that ambulance staff can play a key role in flooding incidents.

OTHER AGENCIES

35. Other agencies have statutory responsibilities which overlap with those of NHS Boards and Local Authorities and may come into play in the investigation and control of communicable diseases and environmental hazards. These include:

• Food Standards Agency
• Animal Health and Veterinary Laboratories Agency
• Scottish Water
• Drinking Water Quality Regulator
• Police
• Fire and Rescue Service
• Health and Safety Executive
• Scottish Environmental Protection Agency
• HPA Centre for Radiation, Chemicals and the Environment (CRCE)
• Procurator Fiscal Service
• Commission for the Regulation of Care
• Foreign and Commonwealth Office

36. The Health Protection Agency, The European Centre for Disease Control (ECDC) and the World Health Organisation also have significant overall responsibilities through the HPA acting as the nominated UK body for the ECDC, and the use of the International Health Regulations (IHR).

The responsibilities of these agencies are detailed below:

Food Standards Agency (FSA)

37. The FSA is a non-ministerial UK Government department operating at arm's length from Ministers and governed by a board appointed to act in the public interest. The UK headquarters is in London but the Agency has a Scottish office in Aberdeen. The Agency's food safety and standards remit is one which is wholly devolved to Scottish Ministers. The Director in Scotland is responsible under the Chief Executive for ensuring activities of the Agency in Scotland are carried out effectively and efficiently. The FSA is the Central Competent Authority for food and animal feed law and ensures enforcement and monitoring activities are delivered effectively and consistently across the UK.

38. The FSA carries out Official Controls at slaughterhouses and cutting establishments and has oversight of Local Authority enforcement.

• 39. FSA uses the following definitions of food hazards:
• Localised food hazard - one in which food is not distributed beyond the boundaries of the Food Authority and is NOT deemed to be a serious localised food hazard;
• Serious localised food hazard - one in which food is not distributed beyond the boundaries of the Food Authority but which involves E. coli O157, other VTEC, C. botulinum, Salmonella typhii or Salmonella paratyphi or which the Food Authority considers significant because of, for example, the vulnerability of the population likely to be affected, the numbers involved or any deaths associated with the incident;
• Non-localised food hazard - one in which food is distributed beyond the boundaries of the Food Authority

Serious localised food hazards and non-localised food hazards should be reported to the FSA at the earliest opportunity. The FSA will handle food related incidents in accordance with the Incident Response Protocol: www.food.gov.uk/multimedia.

Animal Health and Veterinary Laboratories Agency (AHVLA)

40. The AHVLA, formerly known as the Animal Health Service, covers England, Wales and Scotland but not Northern Ireland. It is the lead agency responsible for animal health delivery by implementing the policies of Chief Veterinary Officers in Defra and the Devolved Administrations. It exercises the Scottish Government's statutory responsibilities for responding to notifiable diseases in animals including some which can be transmitted between animals and humans (zoonoses), working closely with veterinary and policy colleagues in the Scottish Government Animal Health and Welfare Division of Scottish Government, Rural Payments and Inspections Directorate (SGRPID).

Drinking Water Quality Regulator (DWQR)

41. The role of DWQR was created in 2002 by the Water Industry (Scotland) Act 2002 to monitor and regulate the quality of public water supplies in Scotland, and to supervise the discharge of local authority duties with respect to private water supplies. The work of the DWQR is supported by a small team of technical staff within the Drinking Water Quality Division of the Scottish Government. The DWQR's primary role during incidents is to brief Scottish Ministers and provide advice on technical matters to other stakeholders such as EHOs and CPHMs. Following conclusion of the incident, DWQR's focus shifts to investigating the cause of the incident and actions taken to prevent a recurrence, and would include the use of enforcement powers if appropriate.

Scottish Water

42. Scottish Water was created in 2002 to provide water and sewerage services throughout Scotland. Its general responsibilities and powers are set out under the Water Industry (Scotland) Act 2002. Scottish Water has a duty under the Water (Scotland) Act 1980 to provide a supply of wholesome water. The Water Supply (Water Quality) (Scotland) Regulations 2001 define what is meant by wholesome by setting the quality standards for a number of different parameters and also define the monitoring frequency to establish the quality of all supplies.

Police

43. Police Forces have a range of responsibilities which overlap with NHS Boards in managing public health incidents. The police will normally coordinate the activities of those responding at and around the scene of a land based sudden impact emergency. They liaise with NHS Boards in managing the coordinated provision of essential services to protect the public from exposure to hazards in chemical incidents and other public health emergencies.

Fire and Rescue Service

44. The statutory responsibilities and core functions of the FRS are the saving of life, protection of property and the environment from fire and other emergencies and providing humanitarian services. The FRS is also empowered to use their personnel and equipment for purposes other than fire fighting. The management of operations within the inner cordon is normally delegated to the FRS, including the safety of all personnel working within it. Recovery or rescue from within the inner cordon will, in all but exceptional circumstances, be the responsibility of the FRS.

45. The FRS, where appropriate, and working in collaboration with the relevant specialist advisors, will take principal responsibility within the inner cordon for detecting, identifying and monitoring the hazardous substance(s) involved in the incident.

46. In close consultation with other Emergency Services and scientific support, the FRS will take appropriate steps to identify the hazardous substance(s) involved in the incident (including Detection, Identification and Monitoring (DIM) equipment, and where appropriate, on-site collection of environmental samples for analysis). This relates particularly to matters of safety and operations at the scene and environmental protection. The Scottish Ambulance Service (SAS) will contribute to hazard identification by making an assessment of casualty symptomology in particular regard to NHS Scotland responsibilities.

47. The FRS will provide the SAS, Police and other agencies with relevant information on the nature of the incident including, where possible, the type of hazardous substance(s) involved.

Scottish Environmental Protection Agency (SEPA)

48. SEPA is a non-departmental public body, accountable through Scottish Ministers to the Scottish Parliament. Their main role is to protect and improve the environment, by being an environmental regulator, helping business and industry to understand their environmental responsibilities and helping customers to comply with legislation. SEPA protect communities by regulating activities that can cause harmful pollution and by monitoring the quality of Scotland's air, land and water. The regulations they implement also cover the keeping and use, and the accumulation and disposal, of radioactive substances. SEPA are responsible for delivering Scotland's flood warning system, helping to implement Scotland's National Waste Strategy and controlling, with the Health and Safety Executive, the risk of major accidents at industrial sites.

Health and Safety Executive (HSE)

49. The HSE is a non-departmental public body with Crown status. The Chair and members of HSE's Board are appointed by the Secretary of State to provide strategic direction for Great Britain's health and safety system. The Board reports to the Secretary of State for Work and Pensions, and to other Secretaries of State.

50. HSE's primary function is to secure the health, safety and welfare of people at work and to protect others including members of the public from risks to health and safety from work activity in accordance with the Health and Safety at Work etc Act 1974 (HSWA) and regulations made under it. HSE does this in partnership with Local Authorities (LAs) by applying an appropriate and proportionate mix of intervention techniques such as inspection, communication campaigns, advice and support and, where necessary, enforcement action. If a public health incident arises as a result of work activity, HSE could have a role in investigating the matter under HSWA and reporting its findings to the Crown Office and Procurator Fiscal Service.

51. Health and safety matters dealt with by HSE have not been devolved to the administrations in Scotland and Wales. Effective working arrangements have been developed, however, between HSE and the devolved administrations to ensure that areas of 'common and close interest' are managed appropriately.

Health Protection Agency Centre for Radiation, Chemical and Environmental Hazards (HPA CRCE)

52. CRCE provides a wide range of radiological protection services to industry, research, the medical sector, Government Departments and the public. These services include the provision of training courses, personal monitoring of occupational exposures, radiological protection advice, radiochemistry, radon assessments, instrument testing, dose assessments and specialised services covering medical and dental radiology. These services are provided across the UK from three CRCE locations: CRCE Chilton, CRCE Scotland (based in Glasgow) and CRCE Leeds. The provision of these services provides a benchmark for the standards of practical radiation protection in the UK and contributes to the restriction of exposure to workers, medical patients and members of the public.

53. The Health Protection Agency (HPA) provides support to the Scottish Government on incidents involving Radiation and Chemical hazards.

Radiation

54. The Health Protection Agency Act (2004) and related legislation, makes statutory provision for the HPA to provide advice and support to Scotland for incidents involving radiation and chemicals. This is available through the HPA's Centre for Radiation, Chemical and Environmental Hazards (CRCE), based in Chilton, Glasgow, and Leeds. The HPA's 'Radiation Emergencies Support Pack for Scotland' which has been made available to the NHS Boards and other relevant organizations in Scotland, provides information on national preparedness arrangements, early actions required to protect the public, and the mechanism for obtaining support from the HPA in the event of an emergency involving nuclear or radiological materials in Scotland. The CRCE also provides training courses, related to emergency planning and response in theses areas.

55. In the event of a radiation incident in Scotland, the HPA would provide advice to the Scottish Government and other responding organisations, including Health Boards, the emergency services, the SEPA, HPS and the Local Authorities. The HPA's laboratory in Glasgow, CRCE Scotland, might set up the Scottish Incident Room to facilitate communications between these responding agencies and various monitoring Groups within CRCE.

56. HPA expert advice would be available to the Scientific and Technical Advice Cell (STAC) and the Recovery Advisory Group (RAG) located at the strategic co-ordination centre.

57. Depending on the scenario, HPA staff would be deployed to a number of key locations including:

• The Strategic Co-ordination Centre (SCC)
• The Media Briefing Centre (MBC)
• Scottish Government Resilience Room (SGoRR)
• The scene of the incident or at survivor reception centres or decontamination facilities to assist in the coordination of radiation monitoring and decontamination provisions.

58. Contact details for the HPA Centre for Radiation, Chemical and Environmental Hazards can be found on their website – HPA Public Health Emergency Contact details.

Chemicals

59. For chemical incidents, in addition to the support available to the Scottish NHS Boards from Health Protection Scotland, the Health Protection Agency can provide advisory services to the NHS Boards and other responding agencies on the human health effects from chemicals and on protection from these effects.

60. In addition to provision of staff and laboratory resources in response to a chemical incident, the HPA also provides an online information resources for the public and for responding agencies including a 'Compendium of Chemical Hazards' which provides information on a wide range of hazardous substances including their physicochemical properties, health effects, and recommended methods of decontamination, and a 'Chemical Action Card' for use by on-call or public health staff faced with a chemical emergency.

61. The HPA's National Poisons Information Service (0844 892 0111) is a national service that provides expert advice on all aspects of acute and chronic poisoning. The NPIS Scottish Base at the Edinburgh Royal Infirmary manages TOXBASE, a clinical toxicology database which is specifically designed to provide healthcare professionals with information on clinical management of individuals who have been exposed to chemicals.

62. In England the HPA participates in a multi-agency Air Quality Cell (AQC), which can deploy mobile incident Response Teams to a chemical incident site to carry out real time air monitoring, provide air dispersion modeling, advise on the public health impact of the incident, and providing regular SITREPS to those managing the incidents. Extension of this function in Scotland is presently under consideration with HPS, SEPA and other relevant agencies.

The Crown Office and Procurator Fiscal Service (COPFS)

63. The COPFS is responsible for the prosecution of crime in Scotland, and the investigation of sudden, unexpected, accidental and suspicious deaths, which occur in Scotland.

64. The dedicated Health and Safety Division is responsible for overseeing the investigation of offences arising specifically from contraventions of the Health and Safety at Work etc Act 1974. Where such allegations of offences are received, COPFS is committed to ensuring that they are investigated thoroughly, sensitively, and prosecuted appropriately, where there is sufficient evidence and it is in the public interest to do so.

65. The principal aims of death investigation are to:

• minimise the risk of undetected homicide or other crimes;
• determine whether a death has resulted from the criminal actions of another and to take appropriate action in relation to such deaths;
• eradicate dangers to health and life in pursuance of the public interest;
• allay public anxiety;
• preserve evidence;
• determine whether a Fatal Accident Inquiry (FAI) or any other form of Public Inquiry is to be held;
• ensure that the deceased's nearest relative is kept advised of the progress of the investigation
• ensure that full and accurate statistics are compiled.

Social Care and Social Work Improvement Scotland (SCSWIS)

66. SCSWIS is a non-departmental public body set up by the Public Services Reform (Scotland) Act 2010 to scrutinise social services. SCSWIS took over the functions of the Scottish Commission for the Regulation of Care (the Care Commission) and the Social Work Inspection Agency (SWIA) on 1 April 2011.

67. SCSWIS's statutory duties include the registration, inspection, complaint investigation and enforcement in relation to care services; and inspection of Local Authority social work services. SCSWIS has general duty of furthering improvement in the quality of social services. Scrutiny by SCSWIS should be proportionate and risk based. In carrying out its statutory functions SCSWIS will take into account the National Care Standards which are developed and published by the Scottish Government and will set out what people using care services can expect from their service provider. There are 18 sets of Standards for care services and these can be downloaded from www.nationalcarestandards.org. More information about how SCSWIS carries out its functions can be found at www.scswis.com.

68. SCSWIS will advise care service providers which incidents need to be reported to SCSWIS, for example, outbreaks of any infectious diseases, death of people using the service and other serious incidents. This information will be used by SCSWIS to inform the scrutiny of services.

Strategic Co-ordinating Group (SCG)

69. In Scotland, the response to emergencies that require multi-agency management at a strategic level is coordinated by a Strategic Coordinating Group (SCG). Some emergencies will have significant health implications (e.g. accidents or hostile acts resulting in trauma) and some of these will be specifically relevant to public health (e.g. contamination hazards following a major industrial accident, deliberate release of pathogens).

70. The Civil Contingencies Act 2004 (CCA) and the Civil Contingencies Act 2004 (Contingency Planning) (Scotland) Regulations 2005 provided the context for the organisation and operation of Strategic Coordinating Groups. The legislation defines two categories of responders: Category 1 responders are the organisations that provide vital services in an emergency, including the emergency services, local authorities, territorial NHS boards and the Scottish Environment Protection Agency (SEPA); Category 2 responders are organisations that provide infrastructure services, including the utilities, transport operators and the Health and Safety Executive.

71. Legislation places the following duties on Category 1 responders to:

• co-operate with other local responders;
• share information with other local responders;
• assess the risk of emergencies occurring;
• maintain business continuity plans;
• maintain emergency plans;
• maintain arrangements to make information available for the public before, during, and in recovering from, an emergency; and
• provide advice and assistance on business continuity management for businesses and voluntary organisations (Local Authorities only).

72. Strategic Co-ordinating Groups are established in each Police area and comprise representative from all Category 1 agencies. Although they are not statutory bodies with legal personality and do not have powers to direct members, they provide a strategic forum to allow members' duties under the CCA to be carried out, including information sharing, multi-agency resilience planning as well as coordination of the emergency response. SCG therefore form the focal point for local resilience building.

73. Each member of the SCG should be prepared to lead the multi-agency response according to the nature of an emergency, although most scenarios indicate a Police lead. Any SCG member can activate the SCG and, during a health emergency of sufficient severity, where a multi-agency response was required, the SCG could be activated by the NHS Board representative.

74. SCGs often require expert advice on a range of public health, environmental, scientific and technical issues, in order to deal effectively with the immediate and longer term consequences of an emergency. This advice is normally provided and co-ordinated by a Scientific and Technical Advice Cell (STAC). Often this will relate to issues of public health, in which cases the NHS Board should provide a chairperson for the STAC, normally the Director of Public Health, or their deputy.