PROTOCOLS AND STANDARDS

Oliver BlatchfordDarren Ross

Martin DonaghyJanuary 2011

Presentation to Health Protection Stocktake

Contents

• DefinitionsDefinitions

• Health Protection Strategy: role of Health Protection Strategy: role of HPSHPS

• Effectiveness & efficiency: informationEffectiveness & efficiency: information

• Effectiveness & efficiency: quality Effectiveness & efficiency: quality assuranceassurance

• Key challenges: information and Key challenges: information and quality assurancequality assurance

Definitions

Protocols– what should be done, when, where and by

whom at a local level.  – a predetermined pathway for the provision of

a service – a set of standardized procedures for teams

Standards :– a standard statement explaining what is the

level of performance to be achieved;– a rationale providing the reasons why the

standard is considered to be important;– criteria, stating exactly what must be

achieved to demonstrate how the standard will be reached

HEALTH HEALTH PROTECTION PROTECTION STRATEGYSTRATEGY

Role of Health Protection Scotland

2002UK Policy Context

? Scotland

Health Protection Consultation

2002

• improve the co-ordination and implementation of the required range of health protection measures;

• improve the effectiveness and efficiency of the key health protection functions of surveillance, investigation, risk assessment, management and communication and managing emergencies.

• enhance the accountability of health protection services in Scotland by more closely aligning policy, resource allocation and performance management functions.

• facilitate collaboration with UK, European and international counterparts in protecting health, especially in securing the best possible specialist advice and in recognising and responding promptly to emerging infections and the deliberate release of biological and chemical agents.

• provide incentives for people working in health protection to improve their individual and collective performance through a continuing process of personal, professional and organisational development.

Structural Options to:

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

Health Protection Scotland Remit

2004/05

Strategic Priorities2005 to 2011

Influenza Pandemic, Seasonal and avian

Healthcare Associated Infection

Staphylococcus aureus, Clostridium difficile, norovirus, iatrogenic vCJD

Hepatitis C IVDU, liver disease

Vaccine Preventable Diseases

HPV infection (cervical cancer), Pneumococcal disease, Measles & mumps (MMR)

GI & Zoonoses E coli O157, Campylobacter, Salmonella

Environment and Health

Chronic and acute exposures, Good Places Better Health

Emerging Infections TB, HIV, Anthrax, Diphtheria, Listeria, Q Fever, iGAS, PVL, Vector borne infection

Scottish Government Health Directorate Policy, Performance ManagementPolicy, Performance Management

HPS

Local AuthoritiesLocal Authorities

Territorial NHS BoardsTerritorial NHS Boards

Co-ordination &Co-ordination &SupportSupportAccountabilityAccountability

ImplementationImplementation

HPAReference

Laboratories

AdviceAdvice

NSS

ECDC

Health Protection Advisory Group

Health Protection in Scotland

Other Scottish & UK Organisations*

* FSA, Animal Health, HSE, SEPA, SNH, Care Commission, Scottish Water, ACPO(S), PF, Media, SPS, GRO(S), Information Commissioner, Voluntary Sector, Universities, NHS (NHSQIS, NSD, ISD, Health Scotland, NES, NHS24, NISG, CLO)

Health ProtectionHealth Protection FunctionsFunctions

Investigation

SurveillanceSurveillance

AssessmentAssessment

Prevention & Response

CommunicationRisk Analysis

& Management

Workforce: Improve individual and collective

performance

Specialists

Practitioners

Wider Workforce

CPHM (CD/EH); Nurse Consultants;Consultant

Epidemiologists; General and Defined Specialists; EH Managers; Those in

formal specialist training;

Generic CPHMs (participating in on-call); Health Protection Nurses;

Epidemiologists; Infection Control Nurses; Environmental Health Officers; Infection Control Doctors & Managers

Microbiologists; Primary Health Care; Microbiologists; Primary Health Care; Secondary health care ; Veterinarians; Secondary health care ; Veterinarians;

“Blue light” services; Government Officials;“Blue light” services; Government Officials; Prison service; Occupational Health; Prison service; Occupational Health;

Environmental Protection; PharmacistsEnvironmental Protection; Pharmacists

COORDINATION, COORDINATION, COLLABORATION COLLABORATION

AND AND ACCOUNTABILITYACCOUNTABILITY

Health Protection in Scotland

• HPAG:HPAG: Secretariat, Reports

• Support to SG: Support to SG: Policy, circulars, Public Health Act, PQs, briefings

• Programmes & Projects: HAI (SA bacteraemias, C. difficile, hand hygiene, AMR); Immunisation (Flu, HPV, childhood); Hepatitis C

• Incidents and outbreaks: Civil Contingencies, organisational arrangements, input to local and co-ordination of national response

• UK/European Interfaces:UK/European Interfaces: UK Oversight, HPA, ECDC, UK scientific advice

• Support for Stakeholder groups: CPHMs, SMF, HP Nurses, TB Nurses, IC managers, ICNA, Travel, GI, NICG, Flu Co-ordinators, EHOs, HepC Coordinators

HPS Developments 2005-10

EFFECTIVENESS EFFECTIVENESS & EFFICIENCY& EFFICIENCY

Health Protection Functions

Surveillance New systems: Notifiable diseases and organisms, C. diff, SAB, Flu, HPV, Syndromes, STIs UK & Europe: NEPNEI, TESSy, EWRS , IHR New Reference laboratories (C. diff, HPV) & strategy

Investigation Burden of disease (HepC, IPD, MRSA) Prevalence of HAI; HPV in schoolchildren Outbreak investigations (Pandemic, C. diff, Q fever,

anthrax) Research Projects

Risk assessment

Modelling measles, pandemic, impact of HepC infection HTA: MRSA screening, HepC interventions

Prevention Immunisation: MMR, PCV/PPS, HPV, BCG, Flu Infection Control: Hand hygiene, decontamination, IC model policies, specific precautions, nurseries Risk reduction; Travel, IVDUs, STIs, at risk occupations, TB Prescribing; AMR strategy Public Policy: NHS, Food, Water, Environment, Care, Animals

Response Preparedness; pandemic, bioterrorism, poultry, environment, Hospitals, Offshore, Ports Incidents: pandemic, avian flu, anthrax, salmonellas, measles, vCJD, pollonium

Communication

Public: NHS24, Health Scotland, hand hygiene, media Service: alerts, guidance, newsletters, websites,

HPS Developments 2005-10

HPS Developments 2005-10

• Information: surveillance review, SHPIMS (support for NHS Board delivery), integrated Immunisation databases, governance & assurance

• Quality assurance (Quality assurance (Services) :: methodology, Pandemic Influenza preparedness, immunisation co-ordination, capacity and resilience

• Evidence based practice (Professionals):Evidence based practice (Professionals): support to Health Protection Network, Guidance, SHPIR, expert advice

• Research and Development: capacity, joint working, participation in national initiatives

• Commissioning laboratories: strategy, quality, developments, UK integration

• NHS Performance: input into SG HEAT Targets (MMR, HAI, C. diff), Project implementation & benefits (HPV), accountability reviews

EFFECTIVENESEFFECTIVENESS & S &

EFFICIENCYEFFICIENCYInformation: Scottish Health

Protection Information Management System

Background

• TB systems – Tayside– Argyll & Clyde

• SIDSS 2 – Notifications

• Outbreaks– Managing cases and data– Managing communications

• Resilience

Aims

• Management of infectious diseases– Cases– Contacts– Escalating for incidents & outbreaks

• Routine surveillance– Linking local and national surveillance– Consistent reporting– Standardised letters

• Knowledge management– From multiple sources– Supporting consistent practice

• Support audit of practice

Approach

Progress• Specification document (2007)

• Interim “solution” CDC

• SHPIMS funding sought– E-Health Board– Scottish Government

•Outline business case and initial agreement

• NHS Fife – HPZone (others?)

• Political / Economic climate

EFFECTIVENESS EFFECTIVENESS & EFFICIENCY& EFFICIENCY

Quality Assurance

Background

• Unified system: common response to common problems

• Concern about incident management: Baseline Audit of NHS systems to manage public health incidents in Scotland, April/May 2003

• SG policy on limiting variation in NHS provision

• Development of QA in related areas : LA EH Function, civil contingencies, health improvement, HAI related standards by NHSQIS

AimsMonitoring the quality and effectiveness of health

protection services by:

– setting and auditing standards to ensure that NHS Boards and HPS have systems in place to deliver surveillance, risk management and communication, outbreak management;

– reporting to the Scottish Executive and the Scottish Health Protection Advisory Group;

– Liaising with NHS Quality Improvement Scotland on the above.

DCMO Letter: HEALTH PROTECTION SCOTLAND, November 2004

Approach

• Assure organisational systems not operational protocols or procedures;

• Agreement with NHSQIS: health protection system to “self” assure; QIS to ensure fit for purpose QA methods and practice

• Working Group on common remit and approach (SEHD/CMO(2007)2; feedback to Boards - key recommendations not formal audits

• Develop and pilot methodology: SG & HPAG request: Pandemic Flu (2006/07)

• Respond to requests for work on HP quality related issues

Progress• Pandemic Flu preparedness: report to Minister, HPAG and Boards June 2007

• HPAG recommendations 2008/09;

– NHS HP capacity & resilience - WG 2008; standards set; piloted Lothian and Grampian, no progress as Pandemic

– Immunisation Programme Co-ordination - Standards agreed NICG 2008; no pilot because of lack of common governance

• Response to requests:– Haemophilia Directors: Review of TSE IC Measures in Hospitals 2007– HPS Travel: WHO Accreditation of Yellow Fever Immunisation Centres 2008– HAI Task Force: Survey of Infection Prevention and Control Support 2009– MRSA Screening National Steering Group: QA Pilot Programme 2009– HPS CMT: Vale of Leven Outbreak and consequences- Debriefing 2009/10– DPHs: Lessons Learned from PF Containment Phase 2009/10– HPV National Steering Group: Lessons Learnt from introducing Programme 2010– SG GPBH Project: Survey of Development of Interventions 2010– SG Managing Incidents Guidance: Review of Lessons Learned 2010/11

KEY CHALLENGESEffectiveness and Efficiency:

Information and Quality assurance

Effectiveness and Efficiency

Information

– Investment required: If SHPIMS funded, then procurement exercise & Implementation exercise. If not funded, then diverging systems/practices and continuation of alternative ways of working in different parts of Scotland.

– Protocols & Procedures: return from investment dependent on move to common assured, working methods

– Attracting investment: competition for more limited resources; need for savings and impact; ? profile of Health Protection

Effectiveness and Efficiency

Quality assurance

• Definitions: Organisational systems vs Operational protocols

• Variation in provision: relationship to cost and outcomes; reflection of local needs or professionals’ views

• Governance: common goals, common reporting, need for unified system

• Approach: Formal audits vs incrementally ensuring lessons are learned and applied

Conclusions

• Challenges and strategic aims for health protection changing but still roughly the same as for 2002

• Still a need for a unified system

• Experience of HPS since 2005 has shown that common goals, systems, standards and information

are key to achieving strategic aims

• Experience has shown that a lack of a common governance system and significant investment and

variations in provision are major obstacles to a unified health protection system