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

ANNEX A STATUTORY RESPONSIBILITIES

International Obligations

1. The International Health Regulations, 2006 are a legally binding international instrument to: 'prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international trade and traffic'.

The IHR define a list of diseases that must always be reported to WHO. These are:

• Smallpox;
• Poliomyelitis due to wild-type poliovirus;
• Human influenza caused by a new subtype; and
• Severe acute respiratory syndrome (SARS).

2. In addition, the UK has an obligation to assess other events using an IHR tool and to notify the WHO of those events that may constitute Public Health Emergencies of International Concern (PHEICs). This can include non-infectious events (chemical/radiological).

3. The UK Governments (including the devolved administrations) have designated the Health Protection Agency (HPA) to act as the National Focal Point (NFP) for all of the UK and only the HPA should communicate directly with the WHO on IHR matters. It has been agreed that following the abolition of the HPA and establishment of Public Health England, that the Department of Health will in future fulfil this role.

4. The European Commission established the Early Warning and Reports System (EWRS) in 1999. The EC Decisions on it have been updated on a number of occasions, most recently Commission Decision 2009/574/EC. The Decision sets out obligations on Member States to report specified threats to public health to each Member State so that they can determine if measures may be required to protect public health in their country. The information is transmitted by specified competent bodies through an accredited structure and process managed by the European Centre for Disease Prevention and Control (ECDC). The Competent Body for the UK is the HPA. HPS liaises with HPA if there is need to send out or respond to an EWRS relevant to Scotland. EWRSs originating from the UK are approved by the relevant Health Departments.

Events to be reported within the Early Warning and Response System are:

• Outbreaks of communicable diseases extending to more than one Member State.
• Spatial or temporal clustering of cases of disease of a similar type, if pathogenic agents are a possible cause and there is a risk of propagation between Member States.
• Spatial or temporal clustering of cases of disease of a similar type outside the Community, if pathogenic agents are a possible cause and there is a risk of propagation to the Community.
• The appearance or resurgence of a communicable disease or an infectious agent which may require timely, coordinated community action to contain it.

5. The Surveillance and Response Support Unit of ECDC aims at ensuring the timely detection of communicable disease threats, their assessment and the provision of support to enable Member States to control and mitigate them. As such it develops and maintains ECDC data bases and communication platforms including EWRS and the European Surveillance System (TESSy). The latter collects, validates, analyses and disseminates data and produces outputs for public health action. All EU Member States must report their available data on 49 communicable diseases to TESSy as described in EC Decision 2119/98/EC.

The Civil Contingencies Act 2004

6. The Civil Contingencies Act, 2004 and accompanying non-legislative measures, delivers a single framework for civil protection in the United Kingdom. The Act is separated into two substantive parts: local arrangements for civil protection (Part 1) and emergency powers (Part 2). Part 1 of the Act establishes a clear set of roles and responsibilities for those involved in emergency preparation and response at the local level. The Act divides local responders into two categories, imposing a different set of duties on each. Those in Category 1 are those organisations at the core of the response to most emergencies. This includes NHS Boards as well as emergency services and Local Authorities.

7. Category 1 responders are subject to the full set of civil protection duties. They will be required to:

• Assess the risk of emergencies occurring and use this to inform contingency planning;
• Put in place emergency plans;
• Put in place Business Continuity Management arrangements;
• Put in place arrangements to make information available to the public about civil protection matters and maintain arrangements to warn, inform and advise the public in the event of an emergency;
• Share information with other local responders to enhance co-ordination;
• Co-operate with other local responders to enhance co-ordination and efficiency; and
• Provide advice and assistance to businesses and voluntary organisations about business continuity management (Local Authorities only).

8. Category 2 organisations (e.g. Health and Safety Executive, transport and utility companies) are less likely to be involved in the heart of planning work but will be heavily involved in incidents that affect their sector. Category 2 responders have a lesser set of duties - co-operating and sharing relevant information with other Category 1 and 2 responders.

9. Category 1 and 2 organisations will come together to form Strategic Co-ordinating Groups (based on police areas) which will co-ordinate activities at a local level.

The Public Health etc (Scotland) Act 2008

10. The Public Health etc (Scotland) Act was passed in 2008 and sets out the public health duties of Scottish Ministers, NHS Boards and Local Authorities. Scottish Ministers have a duty to protect public health i.e. to protect the community from infectious disease, contamination and any other hazards which constitute a danger to human health. This includes the prevention of, control of, and provision of a public health response to such disease, contamination or other hazards. Under the Act 'contamination' means contamination with biological, chemical or radioactive substance; 'infectious disease' means an illness or medical condition caused by an infectious agent (including notifiable organisms).

11. Where a Health Board or Local Authority, in the view of Scottish Ministers, is considered to be failing to exercise a function under the Public Health Act or to exercise it acceptably, then Scottish Ministers have a power to issue a direction to the Health Board or Local Authority. This would require the function to be exercised and in the manner directed. In addition, the Scottish Ministers may require another party to exercise the function. These powers would be expected to be used rarely.

12. Under the Act, Health Boards and Local Authorities have a duty to protect public health. They also have a duty to co-operate. In addition, each Health Board and Local Authority must designate a 'competent person' or persons who have the necessary qualifications and experience to enact specific powers under the Act

13. The split of responsibilities under the Act between Health Boards and Local Authorities essentially falls into a responsibility of Health Boards in relation to 'people' and of Local Authorities in relation to 'premises'. The Act also requires Health Boards and Local Authorities to co-operate with each other and with the Common Services Agency (essentially National Service Scotland (NSS) and Health Protection Scotland (HPS) and the Scottish Ministers (Scottish Government)).

14. The Act also requires each Health Board to work with partner Local Authorities to prepare a biennial Joint Health Protection Plan and must consult the Local Authorities on that plan. The joint plans will set out the overall health protection priorities and out of hours arrangements of the NHS Board and Local Authority taking into account the local geography and infrastructure of the population served.

15. The Act sets out a new list of notifiable diseases (duties on registered medical practitioners) and notifiable organisms (duties on laboratories) and how and where notifications have to be made. In addition, it sets out a new category of 'health risk states' to be notified where a registered medical practitioner has grounds to suspect that a patient has been exposed to a 'health risk state'. 'Health Risk state' is not specifically defined in the Act but will allow the powers under the Act to be used for new and emerging organisms and other unanticipated health hazards.

16. Further information about the Act and accompanying Guidance can be found at the following link - http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/publicact