Inspection Report

Public Health England

Wellington House, 133-155 Waterloo Road, London SE1 8UG

Inspection date(s) 17 & 24 February 2014

Publication date 2014

We inspected the following standards as part of a routine inspection. This is what we found:

Respecting and involving people who use Met this standard services

Care and welfare of people who use services Met this standard

Requirements relating to workers Met this standard

Assessing and monitoring the quality of service Met this standard provision

Complaints Met this standard

Inspection report Public Health England March 2014 www.cqc.org.uk 1

Details about this organisation

Organisation Public Health England

Overview of the Public Health England (PHE) was established as an service executive agency of the Department of Health on 1 April 2013 to protect and improve the nation’s health and wellbeing and reduce health inequalities. PHE brings together a range of functions and responsibilities previously delivered through a number of other organisations, including functions of the Health Protection Agency (HPA). The HPA was abolished on 1 April 2013.

PHE’s national and local health protection functions were the focus of this inspection. These functions set out to protect the public from threats to their health from infectious diseases and environmental hazards. It does this by providing advice and information to the general public, to health professionals such as doctors and nurses, and to national and local government.

Inspection report Public Health England March 2014 www.cqc.org.uk 2 Contents

When you read this report, you may find it useful to read the sections towards the back called ‘About CQC inspections’ and ‘How we define our judgements’.

Page Summary of this inspection: 4 Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the organisation 4

Our judgments for each standard inspected:

Respecting and involving people who use services 5 Care and welfare of people who use services 6 Requirements relating to workers 7 Assessing and monitoring the quality of service provision Complaints 8 9

About CQC inspections 11

How we define our judgements 12

Glossary of terms we use in this report 13

Contact us 14

Inspection report Public Health England March 2014 www.cqc.org.uk 3 Summary of this inspection

Why we carried out this inspection

We carried out this inspection in accordance with the agreement between CQC and PHE that CQC will, on a non-statutory basis, inspect those services that were previously provided by HPA but which have statutorily transferred to PHE with effect from 1 April 2013.

This was an announced inspection.

How we carried out this inspection

We reviewed records and documentation relating to the management and running of the service, carried out visits on 17 and 24 February 2014 and talked with staff.

What people told us and what we found This inspection was a governance based inspection. This meant that we did not speak directly to people who had used Public Health England’s (PHE’s) services. We did however review how PHE consulted people and organisations who used its services. We found that this information was used in a meaningful way to improve the service.

We also found that PHE based service delivery on assessed need and risks were appropriately managed. Arrangements were in place to ensure that appropriate pre- employment checks were carried out. PHE has a complaints process and complaints had been responded to appropriately and in line with their policy. The provider had an effective system to regularly assess and monitor the quality of service that people received.

You can see our judgements on the front page of this report.

More information about the organisation Please see our website www.cqc.org.uk for more information, including our most recent judgments against the essential standards. You can contact us using the telephone number on the back of the report if you have any additional questions.

There is a glossary at the back of this report, which has definitions for words and phrases we use in the report.

Inspection report Public Health England March 2014 www.cqc.org.uk 4

Our judgements for each standard inspected

Respecting and involving people who use services Met this standard

People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run

Our judgement The provider was meeting this standard. People’s views and experiences were taken into account in the way the service was provided and delivered.

Reasons for our judgement People’s views and experiences were taken into account in the way the service was provided and delivered in relation to a variety of public health issues. A key objective, identified in the service’s ‘equality objectives’ was to actively give a voice to the public.

Public Health England (PHE) has a ‘people’s panel’ which is comprised of people who indicated, to a market research organisation, that they would be interested in providing views on the organisations work. Consultation took place in workshops, on line projects and working groups. An equality forum met quarterly and was made up of members of the ‘people’s panel’ who had self-identified as having a characteristic protected by the Equality Act 2010. We saw evidence that workshops had taken place this year. They included discussions about the language, accessibility and content of PHE’s equality objectives and how they could be improved.

PHE had a stakeholder engagement strategy and a voluntary and community sector involvement strategy. The objectives were to involve people and groups in the way services were planned and delivered. This was carried out in a variety of ways. The service had identified a number of ‘strategic partners’ such as the Mental Health Providers Forum and Age UK. It also worked with a market research organisation survey stakeholders to establish how well they felt their views were listened to.

We were given a number of examples of this. One local stakeholder report we saw demonstrated that the organisation had carried out a survey of care home staff who had telephoned for advice in relation to an outbreak of diarrhoea and vomiting. Recommendations from the survey showed that the organisation had taken steps to ensure that verbal infection control advice was more consistently provided. They had

Inspection report Public Health England March 2014 www.cqc.org.uk 5 also carried out of a survey of people who had used PHE’s acute response service. From this survey, PHE had identified sharing information and improving response times as ways to provide a better service. This meant that people’s views were taken in to account in the way the service was provided and delivered.

Care and welfare of people who use services Met this standard

People should get safe and appropriate care that meets their needs and supports their rights

Our judgement The provider was meeting this standard. Assessments were planned and delivered in a way that was intended to ensure people's safety and welfare.

Reasons for our judgement

There were two levels of assessment. The first was based on individual case assessment of disease or exposure to a hazard such as germs, chemicals and environmental issues. We were given an example of the type of assessments carried out regarding recent flooding. Staff attended flood areas and produced site reports (sit reps) which were assessments of risks and hazards such as gastro intestinal infection, drinking water sanitisation and advice on long term psychological effects. These were provided to emergency services, local and national government, healthcare professionals and the public.

Examples of sit reps showed that reports were prepared up to four times a day and reported on live and ongoing issues. These were assessments of concerns and issues. Surveillance reports were also produced to look for trends and abnormalities that may be attributed to the effects of flooding, such as gastro intestinal issues on the rise in specific areas or an institution such as school or care home. This meant that they could assess where work needed to be prioritised.

A second level of assessment involved working with local incidents. Cases were managed by local teams where there was a duty consultant or director of the health protection team in charge. Local teams used an assessment framework called Health Protection Zone (HP Zone) which managed cases, enquiries and incidents on an electronic system. Assessment, nature of enquiry, action to be taken and by who were all recorded. All cases were reviewed daily by a caseworker and weekly at a multidisciplinary review which included nurses, doctors, health protection specialists in science and a unit manager.

Inspection report Public Health England March 2014 www.cqc.org.uk 6 We were provided with examples where PHE had assessed local incidents and provided advice. For instance, advice had been provided to a district nurse on the risks and hazards associated with a human bite. It showed that information had been recorded within the assessment framework and reviewed by the multidisciplinary team.

There were arrangements in place to deal with foreseeable emergencies. If local cases were more serious they were risk assessed and escalated. A national incident management team would then agree on an appropriate course of action. For instance, in a case of rabies where assessment and management of the incident required working across PHE regions and centres.

Care and treatment reflected relevant research and guidance. Health protection assessments were based on previous experiences of similar events and national guidance written by Public Health England (PHE) in collaboration with other experts.. For instance, health protection advice on the management of meningococcal disease was written by a specialist forum that included the PHE’s head of immunisation, the Department of Health, Imperial College and The London School of Hygiene and Tropical Medicine. Guidance, information and frequently asked questions (FAQs) on specific topics were available on their internet site and were typically written for healthcare professionals and the public.

Requirements relating to workers Met this standard

People should be cared for by staff who are properly qualified and able to do their job

Our judgement The provider was meeting this standard. People were supported by suitably qualified, skilled and experienced staff.

Reasons for our judgement

Appropriate checks were undertaken before staff began work. We were told by the head of human resources that Public Health England (PHE) followed the NHS employment checks process and the ‘Her Majesty’s Government (HM) Baseline Personnel Security Standard’. PHE’s recruitment and selection policy and guidance notes set out these recruitment processes. They included carrying out the following pre-employment checks: sponsorship approval (where required), occupational health check, qualifications and identity checks, CRB/DBS checks, reference checks and nationality checks.

Inspection report Public Health England March 2014 www.cqc.org.uk 7 PHE policy also stated that as part of the recruitment process, it was the responsibility of managers to check identity, qualifications, professional registration, security clearance and driving license for those required to drive at interview stage. HR had organised training for managers so they could complete this task appropriately.

As a new organisation PHE had a relatively high number of advertised posts to recruit to. HR had put measures in to place to ensure the service could meet its commitment to safe and secure recruitment. It recorded the numbers of applications, interviews and recruitment that took place each quarter. This enabled them to identify the resources needed to plan and deliver safe and secure recruitment.

We viewed a sample of personnel files. They showed that a checklist was used to ensure that all the pre-employment checks stated in the policy had taken place. Following completion of the pre-employment checking process an ‘authority to recruit’ form was used by a second HR officer to double check that all pre-employment procedures had been followed. This meant that the service ensured that all checks were undertaken before staff began work.

Assessing and monitoring the quality of service Met this standard provision

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care

Our judgement The provider was meeting this standard. The provider had an effective system to regularly assess and monitor the quality of service that people receive.

Reasons for our judgement The provider had an effective system to regularly assess and monitor the quality of service people received. This was applied through a framework separated in to four areas: quality standards, supporting system delivery, assurance of delivery and systems and communication. Quality standards focussed on the key areas of acute services and developing national standards. Supporting system delivery focussed on training staff, team development and learning lessons from events. Assurance of delivery related to a programme of audit, stakeholder surveys and running a peer review system. Each local team carried out a peer review inspection of another area team to check on quality and identify actions to take on quality improvement. Systems and communication developed inspection tools for audits and measured the productivity of the IT system.

Inspection report Public Health England March 2014 www.cqc.org.uk 8 An action plan set out quality improvement under these headings and quarterly progress reports were sent to the senior management team within the health protection division who reported to the national executive. Documentation demonstrated specific pieces of work being reported to the senior management team. For instance, an evaluation of the peer review project detailed outcomes and recommendations, including continuing the project, making it more multidisciplinary and achieving a consistent approach.

The annual audit data return for health protection showed a comprehensive number of audits at both local and national level had been completed. This included respiratory outbreaks audit in care homes and a neonatal hepatitis B audit. Audit returns also showed that improvements had been made as a result of audits, such as trigger levels for the reporting norovirus. This meant that where checks had identified areas for improvement, they had been acted on.

There was evidence that learning from incidents and investigations took place and appropriate changes had been implemented. Adverse incident and serious untoward incident policy and procedures outlined the responsibilities within the organisation for reporting and investigating. They had recently been revised to ensure that a national executive member was nominated to manage any serious untoward incident (SUI). This was to ensure that high level responsibility was taken for all SUIs and investigations. We were given examples of risk alert bulletins and of lessons learnt reports which related to specific incidents that had been investigated.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. A customer satisfaction survey had been developed for local teams to carry out annually. Health professionals and others who had been in contact with the health protection division of PHE were surveyed in relation to the responsiveness and effectiveness of the service. We saw examples of this and outcomes were very positive and people felt listened to and confident with the advice given. Results were reported to monthly audit meetings. Also following outbreaks, as part of the debrief people were asked if they felt anything else needed addressing as part of the debrief process. We were given an example of this with an action plan produced following a measles outbreak.

Complaints Met this standard

People should have their complaints listened to and acted on properly

Our judgement The provider was meeting this standard. There was an effective complaints system available and complaints people made were responded to appropriately.

Inspection report Public Health England March 2014 www.cqc.org.uk 9 Reasons for our judgement

There was an effective complaints system in place. A protocol with the Department of Health set out the management of complaints and stated that Public Health England (PHE) must have a robust complaints system that followed the Parliamentary health Service Ombudsmen’s (PHSO’s) principles of good complaints handling.

People’s complaints were fully investigated and resolved where possible to their satisfaction. We were told that PHE had a decentralised complaints process in place, which meant that complaints made centrally would be allocated to the relevant PHE region for investigation and resolution.

All complaints were recorded and tracked centrally. When a complaint had been received, who had led the investigation and when it had been closed/resolved were all recorded along with a summary of the issues. We were given examples of regional health protection team meetings where complaints were a standing item on their agenda. Minutes demonstrated that complaints had been discussed and learnt from. Other documentation demonstrated that a summary of complaints and issues they raised were regularly reported to PHE’s audit and risk committee so that issues were risk assessed.

Letters to people who had complained demonstrated they were informed of the outcome of any investigation and what action had been taken as a result. For instance, one example showed what steps were taken to rectify an individual error. Another example showed the person received a report on investigations made and actions taken.

Training schedules showed that as part of the mandatory training all public facing staff such as receptionists and staff who answered phone calls from the public, had training in resolving problems and complaints. Staff with responsibility for investigating and managing complaints locally had training in customer service. Regional health protection team induction packs showed complaints handling as part of the induction process.

Inspection report Public Health England March 2014 www.cqc.org.uk 10 About CQC inspections

We are the regulator of health and social care in England.

There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. We may check fewer key areas in the case of a dentist and some other services.

When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service’s records and check whether the right systems and processes are in place.

We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on health, safety and welfare of people who use the service and the experience they have whilst receiving it. Where providers are non compliant, we ask the service to submit an action plan.

In between inspections we monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers.

Inspection report Public Health England March 2014 www.cqc.org.uk 11 How we define our judgements

Our judgements are based on the ongoing review and analysis of the information by CQC about this organisation and the evidence collected during this inspection.

We reach one of the following judgements for each essential standard inspected.

This means that the standard was being met in that the  Met this standard organisation was compliant. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the organisation and to the public about minor improvements that could be made.

This means that the standard was not being met in that the Action needed X organisation was non compliant. We set a compliance action advising the organisation to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans.

Where we find non-compliance with an essential standard, our report will usually include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact.

Minor impact – people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly.

Moderate impact – people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly.

Major impact – people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly.

Inspection report Public Health England March 2014 www.cqc.org.uk 12 Glossary of terms we use in this report

Essential standard

The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. These standards describe the levels of quality and safety that people who use the service have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19)

Records - Outcome 21 (Regulation 20)

Regulated activity

These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided.

Inspection report Public Health England March 2014 www.cqc.org.uk 13 Contact us

Phone: 03000 616161

Email: [email protected]

Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA

Website www.cqc.org.uk

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Inspection report Public Health England March 2014 www.cqc.org.uk 14