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

ANNEX I

PROTOCOL FOR INFORMING MINISTERS ABOUT SIGNIFICANT PUBLIC HEALTH INCIDENTS AND OUTBREAKS

1. The following is the range of circumstances in which Scottish Ministers should be notified about significant public health incidents and outbreaks.

2. In accordance with existing guidance 'Management of Public Health Incidents - Guidance on the Roles and Responsibilities of NHS led Incident Management Teams', Scottish Ministers should be notified about significant public health incidents and outbreaks where, after discussion with the local Health Board Consultant in Public Health Medicine (CPHM) leading the investigation, the professional adviser in the CMO's team concludes that:

• There is an outbreak: i.e. two or more linked cases of the same illness or observed cases of an illness exceed the expected number, and there is considered to be a serious threat to public health;
• The incident involves:
  • A single case of a serious illness with major public health implications;
  • A situation where there is a high likelihood of a population being exposed to a hazard at levels sufficient to cause illness, even though no cases have yet occurred;
• The incident has the potential to have a major impact on the provision of NHS services;
• The local or national media is to be notified by the NHS Board.

3. Notification to Ministers might also be appropriate where the CPHM leading the investigation and the professional adviser in the CMO's team are of the opinion that:

• Two or more linked cases of unexplained illness could indicate that the same unknown agent or exposure may have caused them both;
• A death is linked to a food borne illness or to another significant infectious disease e.g. anthrax, diphtheria or environmental hazard;
• There is a risk of the matter being made public.

4. There may be other circumstances when the CPHM is of the view that Health Protection Scotland (HPS) and the Scottish Government should be notified. The criteria set out above gives guidance but should not be taken to be exclusive.

5. Please note that separate arrangements are in place for the management of Healthcare Acquired Infection (HAI) related incidents and outbreaks. Refer to paragraph 10 for further details.

HANDLING INITIAL CONTACT

6. Although the existing guidance 'Management of Public Health Incidents - Guidance on the Roles and Responsibilities of NHS led Incident Management Teams' includes guidance on communication between different agencies - eg NHS Boards, HPS and the Scottish Government - there is a need to ensure the guidance is followed and that the following initial contacts are made. These contacts would be made in the circumstances set out above:

• NHS Boards (namely the CPHM), once they have assessed that an incident or outbreak that meets the circumstances outlined above has occurred, should contact both HPS and the appropriate member of the CMO's team within the Scottish Government. This contact should be made by telephone and it can take place at any time, day or night. During office hours the appropriate member of the CMO's team should be contacted but another officer contacted if they are not available. Out of hours, the on call officer for public health from the CMO's team should be contacted.
• Should the conclusion of the CMO's team member be that the criteria above are met, it will then be the responsibility of the CMO's team to discuss the outbreak with a member of the Health Protection Team (HPT) within the Public Health Division, Scottish Government. Out of hours, the on call member of staff should be contacted.
• The HPT, on receiving the call, and following discussion with the CMO team member should reach a view on briefing Ministers. The HPT should immediately contact the Communications Health & Wellbeing Team (or out of hours the Duty Press Officer) to alert and discuss with them.
• For foodborne incidents or outbreaks, the HPT should immediately contact the Food Standards Agency. FSA and Communications Health & Wellbeing

7. Once this has been done a submission for Ministers should be drafted quickly, cleared with the FSA if appropriate, and sent to the Minister for Public Health, copied to the Cabinet Secretary.

8. In some circumstances the HPT and/or CMOs team may receive notification from HPS rather than from the NHS Board. In those circumstances CMOs team will make contact with the NHS Board to discuss and the procedures noted above would then be followed.

9. In all cases, for Scottish Government interests, the CMO's team would be the single point of contact with the NHS Board.

10. The HPT do not deal with any Healthcare Associated Infections (HAIs) such as norovirus, legionella in a hospital setting etc. All related outbreaks in hospital wards are dealt with by the HAI team rather than the HPT who deal only with outbreaks in the community setting. Separate on call procedures are in place for HAIs.