PROTOCOLS AND STANDARDS

1. PROTOCOLS AND STANDARDS Oliver Blatchford Darren Ross Martin Donaghy January 2011 Presentation to Health Protection Stocktake

2. Contents • Definitions • Health Protection Strategy: role of HPS • Effectiveness & efficiency: information • Effectiveness & efficiency: quality assurance • Key challenges: information and quality assurance

3. 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

4. HEALTH PROTECTION STRATEGY Role of Health Protection Scotland

5. 2002UK Policy Context ? Scotland

6. Structural Options to: 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.

7. Health Protection Scotland Remit 2004/05 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

8. Strategic Priorities2005 to 2011

9. Health Protection in Scotland Local Authorities Scottish Government Health DirectoratePolicy, Performance Management Advice Health Protection Advisory Group NSS Reference Laboratories HPA HPS ECDC Other Scottish & UK Organisations* Co-ordination & Support Accountability Territorial NHS Boards Implementation * 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)

10. Health ProtectionFunctions Surveillance Investigation Risk Analysis & Management Communication Assessment Prevention & Response

11. Workforce: Improve individual and collective performance CPHM (CD/EH); Nurse Consultants;Consultant Epidemiologists; General and Defined Specialists; EH Managers; Those in formal specialist training; Specialists Generic CPHMs (participating in on-call); Health Protection Nurses; Epidemiologists; Infection Control Nurses; Environmental Health Officers; Infection Control Doctors & Managers Practitioners Microbiologists; Primary Health Care; Secondary health care ; Veterinarians; “Blue light” services; Government Officials; Prison service; Occupational Health; Environmental Protection; Pharmacists Wider Workforce

12. COORDINATION, COLLABORATION AND ACCOUNTABILITY Health Protection in Scotland

13. HPS Developments 2005-10 • HPAG:Secretariat, Reports • 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 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

14. EFFECTIVENESS & EFFICIENCY Health Protection Functions

15. HPS Developments 2005-10

16. HPS Developments 2005-10 • Information:surveillance review, SHPIMS(support for NHS Board delivery), integrated Immunisation databases, governance & assurance • Quality assurance (Services):methodology, Pandemic Influenza preparedness, immunisation co-ordination, capacity and resilience • Evidence based practice (Professionals):support toHealth 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

17. EFFECTIVENESS & EFFICIENCY Information: Scottish Health Protection Information Management System

18. Background • TB systems • Tayside • Argyll & Clyde • SIDSS 2 – Notifications • Outbreaks • Managing cases and data • Managing communications • Resilience

19. 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

20. Approach

21. 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

22. EFFECTIVENESS & EFFICIENCY Quality Assurance

23. 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

24. Aims Monitoring 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

25. 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

26. 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

27. KEY CHALLENGES Effectiveness and Efficiency: Information and Quality assurance

28. 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

29. 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

30. 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