Agenda Item 13
Meeting: Shetland NHS Board Date: 16 April 2019 Report Title: Joint Health Protection Plan 2019-2021 Reference Number: Board Paper 2019/20/09 Author / Job Title: Dr Susan Laidlaw, Consultant in Public Health Medicine (Executive Lead – Susan Webb, DPH for NHS Grampian and NHS Shetland)
Decisions / Action required:
The Board is asked to: (i) receive and approve the NHS Shetland Resilience and Business Continuity Strategy 2018-2021 (ii) continue to support health protection work within NHS Shetland
High Level Summary:
The Public Health etc (Scotland) Act 2008 requires NHS Boards to produce a Joint Health Protection Plan, which provides an overview of health protection (communicable disease and environmental health) priorities, provision and preparedness within the area.
The first plan was produced in 2010, and this is the third version of the plan which has been updated by the Public Health Team along with colleagues in Shetland Islands Council, with whom there is a statutory duty of co-operation on health protection issues.
The plan gathers information about existing health protection plans and resources, and reports on significant local activity. It also provides a useful resource for information on local arrangements for protecting against communicable disease and environmental health threats.
Corporate Priorities and Strategic Aims:
One of the Board’s Corporate objectives is ‘To improve and protect the health of the people of Shetland’
Key Issues:
Since the last version of the plan, there has been a service redesign of the public health team and therefore some significant changes in staffing and the way services are delivered (particularly out of hours arrangements).
Compared to the last plan, there is now an increased workload with regard to resilience, business continuity and emergency planning arrangements. (There is some overlap between this plan and the Resilience and Business Continuity strategy presented to the Board in 2018.) We have strengthened governance arrangements relating to health protection, with the introduction of a Health Protection Governance Group and systematic review of health protection incidents through this group.
A summary of the main health protection incidents and issues since 2016 is included in the plan, along with learning and actions taken as a result of these incidents.
It should be noted that there is the potential for changes to how health protection services are delivered in the future, depending on the outcome of the Public Health Review.
Implications : Service Users, Deficiencies in health protection plan could affect any / all Patients and service users, patients and staff, and the wider community. Communities: Human Resources It is essential to maintain health protection expertise within the and Organisational Board, which requires ongoing training and continual Development: professional development needs to be met. The public health workforce is currently stable, following the redesign in 2016, but should there be loss of key staff then Equality, Diversity No specific implications and Human Rights:
Partnership Working Partnership working is essential for planning and for responding to significant health protection incidents ; and also for training and exercising. There are good partnership arrangements in place particularly with the environmental health and resilience teams within Shetland Islands Council. We also have partnership working arrangements with other Boards in the North of Scotland and also with Health Protection Scotland as required. Legal: The Joint Health Protection Plan is a requirement of The Public Health etc (Scotland) Act 2008 Finance: There are financial implications for implementing this plan, particularly for training costs (which can be expensive) and releasing staff for training and exercising.
Assets and Property:
Environmental:
Risk Management: There will be significant risks to the organisation if health protection planning is not robust.
Policy and Delegated Authority: Previously Public Health Team considered by: SIC Environmental Health Team SIC Resilience Team
“Exempt / private” N/A item
SHETLAND HEALTH PROTECTION PLAN 2019-2021
SHETLAND JOINT HEALTH PROTECTION PLAN 2019 – 2021
Last version date: April 2019 Next Formal Review April 2021 Implementation Date April 2019 Author: Dr Susan Laidlaw, CPHM Patti Dinsdale Team Leader - Environmental Health Approval NHS Shetland Health Board Shetland Islands Council
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The Shetland Joint Health Protection Plan is available at the following web address: www.shb.scot.nhs.uk
A paper copy may be requested via:
Department of Public Health NHS Shetland Upper Floor, Montfield Burgh Road, LERWICK Shetland ZE1 0LA
Telephone: 01595 743340
E-mail: [email protected]
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SHETLAND HEALTH PROTECTION PLAN 2019-2021
Acronyms and Abbreviations BCP Business Continuity Plan C(s)PHM Consultant(s) in Public Health Medicine CD Communicable Disease CIEH Chartered Institute of Environmental Health CoIC Control of Infection Committee COMAH Control of Major Accident Hazards CPD Continuing Professional Development DPH Director of Public Health EHO Environmental Health Officer FSS Food Standards Scotland H&S Health and Safety HAI Healthcare Associated Infection HEAT Health Improvement, Efficiency, Access and treatment (Government NHS performance management targets) HEI Healthcare Environment Inspectorate HIV Human Immunodeficiency Virus HPS Health Protection Scotland ICT Infection Control Team KSF Knowledge and Skills Framework MEP Major Emergency Plan MRSA Meticillin Resistant Staphylococcus Aureus MSSA Meticillin Sensitive Staphylococcus Aureus NHSSh NHS Shetland PDP Personal Development Plan PFPI Patient Focus, Public Involvement PICT Pandemic Influenza Control Team PPE Personal Protective Equipment REHIS Royal Environmental Health Institute of Scotland SIC Shetland Islands Council SOPs Standard Operating Procedures TB Tuberculosis
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Contents 1 Overview of the populations served by NHS Shetland and Shetland Islands Council and of the health protection services provided ...... 6 1.1 Demography and geography of the population ...... 6 1.2 Overview of the health protection services provided ...... 8 2 Health protection planning infrastructure ...... 9 2.1 Key health protection guidance and plans (Communicable Disease & Environmental Health) ...... 9 3 Health protection national and local priorities ...... 14 3.1 National health protection priorities being addressed at local level ...... 14 3.2 Local health protection priorities ...... 17 3.3 Health protection risks specific to Shetland...... 19 3.4 Significant public health incidents and outbreaks during 2016-2018 ...... 20 4 Health protection: resources and operational arrangements ...... 21 4.1 Resources available to provide health protection services (CD & EH) .... 21 4.2 IT and Communication Technology available to facilitate health protection work ...... 23 4.3 Organisational arrangements in place to facilitate collaborative working between NHSShetland, Shetland Islands Council and other health protection agencies...... 25 4.4 Arrangements to respond out of hours ...... 26 4.5 Arrangements for reviewing health protection guidance ...... 26 4.6 Corporate arrangements for ensuring the maintenance of knowledge, skills and competencies for staff who have health protection duties ...... 27 5 Health protection services: capacity and resilience ...... 27 5.1 Assessment of the capacity and resilience of health protection services 27 5.2 Key findings ...... 28 5.3 Actions taken and planned ...... 28 5.4 Plans for further assessment of capacity and resilience ...... 28 5.5 Mutual aid arrangements ...... 29 6 Health protection: public involvement and feedback ...... 29 6.1 Public involvement in the planning and delivery of health protection services ...... 29
Appendix 1 Members of the Shetland Control of Infection Committee
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Foreword The Public Health etc. (Scotland) Act 2008 http://www.scotland.gov.uk/Topics/Health/Policy/Public-Health-Act required NHS Boards, in consultation with Local Authorities, to produce a Joint Health Protection Plan which provides an overview of health protection (communicable disease and environmental health) priorities, provision and preparedness for the NHS Board area. Guidance on the content of joint health protection plans is published by the Scottish Government.1 This is the third Shetland Joint Health Protection Plan and covers the period from 2019-2021. It is a public document and is available to members of the public on the NHS Shetland website www.shb.scot.nhs.uk and on request. We hope this plan will be of interest and value, and that its production will contribute to protecting the health of the people who live in and visit Shetland.
Susan Webb Director of Public Health NHS Shetland Upper Floor, Montfield Burgh Road, LERWICK Shetland ZE1 0LA
Patti Hammond-Dinsdale Team Leader - Environmental Health Environmental Health Services Infrastructure Services Department Old Anderson High School (temporary location) Lovers Loan Lerwick 01595 745250
1 www.scotland.gov.uk/Resource/Doc/924/0079967.doc
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1 Overview of the populations served by NHS Shetland and Shetland Islands Council and of the health protection services provided 1.1 Demography and geography of the population The Shetland Islands, or Shetland, is a collection of over 100 islands that lie 180 miles north east of mainland Scotland. In total, Shetland covers an area of 567 square miles (1468 square kilometers) with over 900 miles of coastline. Of the 100 + islands, 15 are inhabited. Shetland is remote and isolated and as close to Bergen in Norway as Aberdeen, which serves as the principal communication link with Scotland. It has a population of around 23,000 people. The population has slightly increased in recent years and it is predicted that there will be a continued increase in the older population (65+) and decrease in the working aged and younger age groups.
Unst
Yell Fetlar
Brae Out Skerries
Papa Stour Whalsay
LERWICK Bressay Foula Scalloway
Sumburgh
0 4.5 9 18 Miles Fair Isle
Practice populations show the spread of the population across Shetland, with Lerwick having the largest population. The islands of Yell, Unst and Whalsay have GP practices, and the smaller populated islands are covered for GP services by neighbouring practices. Bressay, Fair Isle, Fetlar, Foula and Skerries have resident community nurses, who work as part of local community nursing teams.
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Practice Registered patients 01/04/2019
Bixter 1204
Brae 2524
Hillswick 796
Lerwick 8622
Levenwick 2701
Scalloway 3728
Unst 594
Walls 686
Whalsay 1090
Yell 1029
Total 22974
By virtue of its geographical location, Shetland is classed as a remote and rural area. Remoteness and rurality can be defined in different ways, one useful measure focusing on distance to key healthcare facilities shows that a much greater proportion of households in Shetland live further away from healthcare facilities than people living in Scotland overall2. 15% of people in Shetland live greater than 60 minutes drive-time from an acute hospital compared to 0.6% in Scotland, and 4.4% live over 30 minutes drive-time from a GP compared to 0.2% in Scotland. Almost two thirds of Shetland’s population are spread out-with the main town of Lerwick. For some of these communities, their travel to acute hospital services in Lerwick is separated by at least one stretch of water and will either involve a journey by road and car ferry, or an air ambulance transfer. In the more remote isles, weather often disrupts transport links, with air and ferry connections cancelled for several days. In these circumstances, the Coastguard helicopter responds to emergencies. An exposed North Sea crossing (which takes a minimum of12 hours) and air travel disruption by high winds and fog, can sometimes find Shetland itself isolated from mainland Scotland. For these reasons, Shetland is defined as the most remote and isolated island group in Scotland. Many people in Shetland have two or three different jobs, which may include service jobs within the local community (such as a postman), along with self employment. The voluntary sector also plays a key part in Shetland life with many people undertaking extensive volunteering responsibilities, in addition to their everyday job.
2 Scottish Neighbourhood Statistics 2001, www.sns.gov.uk
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The 2011 census showed that 98.5% of the Shetland population identified themselves as white, and 96% of this group said they were white Scottish or British.3 1.53% (354 people) of the total population of Shetland defined themselves as non- white or mixed ethnicity. Two thirds described themselves as Asian.. In teems of language, 1.7% of the population said they did not speak English well (328) or did not speak it at all (44 people) . A health needs assessment exercise undertaken in 2006 showed 46 different languages spoken. Ethnicity and language may impact on ability and ease of accessing services. Shetland has traditionally welcomed a very wide range of incomers relating to its seafaring and fishing traditions and in more recent years there has been an , influx of people particularly from Eastern Europe mirroring immigration patterns in other parts of the UK. In addition, there are temporary residents working through the oil industry, and in summer a large number of visitors particularly associated with cruise liners. 1.2 Overview of the health protection services provided Health Protection can be defined as “protection of the public from being exposed to hazards which damage their health and to limit any impact on health when such exposures cannot be avoided”4 Health protection reduces the risk to health, primarily through: Diagnosis i.e. the detection, monitoring and investigation of risks to health (from infectious agents and environmental hazards), their actual or probable consequences and whether the management of them is working; Management i.e. the steps (including regulation) taken to reduce risks to the public health by prevention and by control of situations of increased risk and mitigation, when consequences have arisen; Communication i.e. the dialogue with public and professionals about the nature of the risks to health and what they can do about them. Health protection in Shetland is the responsibility of the Director of Public Health supported by the Public Health Team which provides a health protection service on behalf of NHS Shetland, working with the Environmental Health Department of Shetland Islands Council. Health protection is closely related to the control of infection within health and care settings, and there is representation from the Public Health Team on the Board’s Infection Control Team. Specific responsibility for Healthcare Associated Infection lies with Director of Nursing and Acute Services but close liaison with Public Health is in place for the surveillance and outbreak control functions, and the responsibilities are set out in the Board’s Communicable Disease Control Policy5. The Consultant in Public Health Medicine currently chairs the Board’s Control of Infection Committee. Within NHS Shetland, resilience and civil contingencies is the responsibility of the Director of Public Health (DPH) as Executive Lead, reporting to the Board’s Executive Management Team chaired by the Chief Executive, responsible ultimately to the Board. The detail of local Emergency Planning and Resilience is reported in
3 Scotland’s census 2011 www.scotlandscensus.gov.uk/ods-web/home.html 4 Health Protection Stocktake Interim Report 2011 www.gov.scot/Resource/Doc/356304/0120397.pdf 5 https://www.shb.scot.nhs.uk/board/policies/CDC-Policy.pdf
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SHETLAND HEALTH PROTECTION PLAN 2019-2021 the Board’s Resilience and Business Continuity Annual Report but links to relevant guidance and plans are provided within this plan. 2 Health protection planning infrastructure 2.1 Key health protection guidance and plans (Communicable Disease & Environmental Health) Shetland has a range of local plans in place which apply national planning guidance and best practice in health protection, and guide local responses. These link into the multi-agency plans on Emergency Planning and Resilience, and to the internal plans of key local organisations, specifically Shetland Islands Council. Much of the national guidance on resilience derives from the Civil Contingencies Act 2004 (Contingency Planning) (Scotland) Regulations 2005 and is contained in Preparing Scotland: Scottish Guidance on Resilience 20126. Key national guidance documents: NHS Board’s Health Protection Remit – issued as CMO guidance in 20077 Management of Public Health Incidents: Guidance on the Roles and Responsibilities of NHS led Incident Management Team, Updated July 20138 Guidance on the investigation and control of outbreaks of foodborne disease in Scotland (Cairns Smith Report) 9 CBRN Reference Resource 2008 10 Chemical, biological, radiological and nuclear incidents: clinical management and health protection 2018 (Public Health England)11 Preparing Scotland (Scottish Guidance on Preparing for Emergencies): STAC Guidance – Providing Public Health, Environmental, Scientific and Technical Advice to Emergency Co-ordinating Groups in Scotland12 There are also operational guidance documents produced by Health Protection Scotland (HPS) via the Scottish Health Protection Information Resource (SHPIR), on topics such as Drinking Water Quality, Blue-Green Algae, lead in water, Legionella incidents outbreaks and clusters, meningococcal disease, Tuberculosis prevention and control, the surveillance of healthcare associated infections and other specific diseases and hazards including rabies, leptospirosis, giardiasis, asbestos, E. Coli 0157, norovirus, viral haemorrhagic fevers; and strategic guidance documents produced for NHS Boards by the Scottish Government’s NHS Scotland Resilience Team.
6 www.scotland.gov.uk/Publications/2012/03/2940/0 7 www.show.scot.nhs.uk/sehd/cmo/CMO(2007)02.pdf 8 Management of Public Health Incidents: Guidance on the Roles and Responsibilities of NHS led Incident Management Team, Updated July 2013 www.gov.scot/Resource/0043/00430196.pdf 9 www.food.gov.uk/multimedia/pdfs/fooddesease23jun06.pdf 10 CBRN reference resource www.hps.scot.nhs.uk/web-resources-container/cbrn-reference-resource/ 11 Chemical, biological, radiological and nuclear incidents: clinical management and health protection 2018 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/712888/Chemi cal_biological_radiological_and_nuclear_incidents_clinical_management_and_health_protection.pdf 12 www.scotland.gov.uk/Publications/2008/11/20093421/0
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Key local plans are set out in the table below:
For emergency plans Name of plan Date of last Date of next Date of last Date of Areas for development review review test next test
NHS Shetland Resilience and Business Continuity Dec 2018 Dec 2021 N/A N/A Strategy NHS Shetland Business Continuity Plans 2018 2019 2018 2019 Continuing process of annual review & development NHS Major Emergency Procedure June 2014 Currently September 2020 All role descriptors under review 2017 C3 plan CBRN plan – CBRN Emergency Control final draft tabletop Room 2019 Training CBRN response NHS Shetland Communicable Disease Control 2018 2022 N/A N/A Policy (awaiting approval) Shetland Generic Public Health Incident / outbreak January 2011 In progress (Outbreak) 2020 Roles & Responsibilities plan re infection control in June 2018 healthcare settings Supply of PPE and other consumables to community settings Staff training
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SHETLAND HEALTH PROTECTION PLAN 2019-2021
NHS Shetland Hospital Outbreak Plan September In progress August 2014 TBA Update roles and 2012 responsibilities Shetland Pandemic Influenza Plan September In progress November TBA Mortuary capacity 2012 2017 Supply of PPE and other (Exercise consumables Odette) Deregulation Shetland Blue/Green Algae Monitoring and Action Jan 2018 In progress Incidents Not Awaiting reviewed Plan occur required national guidance annually Public Health Action following detection of raised 2004 N/A N/A Review if national concentrations of cryptosporidium in public drinking guidance updated water supplies Public Health Procedures for the management of May 2015 In progress N/A N/A National guidance legionnaire’s Disease followed Sexual Health and Blood Borne Virus (Ten Year) December December N/A N/A Strategy 2014 2024 Procedures for the prevention and control of May 2015 May 2018 N/A N/A Delayed Tuberculosis Plan for the Investigation and Control of Foodborne 2017 2020 N/A N/A . Disease Outbreaks Shetland Islands Council Major Emergency Plan Oct 2015 Due now December TBA Delayed 2018
Shetland multi-agency Initial Response Plan June 2014 Due now December TBA Delayed 2018
Shetland Islands Council Control of Major Accident Nov 2018 Nov 2021 December April 2019 SVT & SGP COMAH Hazards (COMAH) External Emergency plan - Plans were combined.
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Sullom Voe Oil Terminal & Shetland Gas Plant 2018 Latest plan is 01/11/18
Annual oil spill exercise June 2018
Shetland Islands Council Control of Major Accident March 2015 Due now Delayed Hazards (COMAH) of site plan Scottish Fuels North Ness
Delayed Shetland Islands Council Control of Major Accident Jan 2011 Due now Hazards (COMAH) of site plan Peterson SBS, Greenhead base
Delayed Shetland Islands Council Pipeline Safety Plan 2010 Due now (Brent, Ninian and Clair Pipelines)
SIC Marine Pollution Contingency Plan April 2015 No date
Due 2018 – Exercise overdue Tingwall Airport Emergency orders Jan 2019 No date medical services exercise
Last live 2019 Sumburgh Airport Multi-Agency Initial Response Feb 2019 No date exercise Plan 2017. Hi-jack exercise 2018.
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June 2018 2019 Scatsta Airport Multi-Agency Response Plan Sept 2018 Sept 2019
Highland CBRN (Chemical, Biological, Radiological and Sep 2016 No date exercise Nuclear) Joint Initial Response Plan (Highlands & September Islands Emergencies Coordinating Group) 2018
Where we do not have a specific local plan (eg for communicable diseases such as meningococcal meningitis, measles, Viral Heamorrhagic Fever) we follow national plans and guidance from Health Protection Scotland (https://www.hps.scot.nhs.uk/)
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3 Health protection national and local priorities 3.1 National health protection priorities being addressed at local level The Health Protection Advisory Group advises the Chief Medical Officer and National Services Scotland about the strategic framework and priorities for health protection in Scotland.13 National priorities How they are being addressed being addressed at local level Preparation for a The Shetland Pandemic Influenza Plan has been reviewed potential pandemic of and extensively updated in response to the publication of the influenza UK Contingency Plan in 2011 and subsequent exercises. Learning and developments following the local response to the H1N1 influenza pandemic have also been incorporated . The plan is currently being updated again. In response to the H1N1 pandemic in 2009, local resources and systems have been developed, as have national networks and systems, and members of staff involved in this work have developed knowledge, understanding and experience of the work required during an influenza pandemic. Further work is required to ensure that systems are maintained, for example training in the use of PPE, and an action plan is in place for this. Healthcare associated The Shetland Infection Control Team monitors HAI issues on infections (HAI) a monthly basis, reporting to the Control of Infection Committee (CoIC) and via the Infection Control Manager, to every meeting of Shetland NHS Board. Issues covered include Staphylococcus Aureus bacteraemias, Clostridium Difficile, antimicrobial prescribing, hand hygiene compliance, Surgical Site Infections, and Cleaning Standards. In addition the Shetland Infection Control Work Programme is used to manage additional local infection control and communicable disease priorities, and reports progress to the CoIC. Antimicrobial The Shetland Antimicrobial Management Team cover resistance antimicrobial sensitivity, resistance and prescribing, and undertake regular audits to comply with national policy. Vaccine preventable Continued implementation of established routine vaccination diseases and the programmes including the childhood and seasonal flu impact on them of vaccination programmes, and of new programmes such as current and planned Meningitis ACWY for teenagers in 2015, Meningitis B for immunisation babies in 2017 and HPV for teenage boys in 2020, overseen programmes by the Board’s Immunisation Co-ordinator (The Consultant in Public Health Medicine). There is currently extensive work to
13 www.sehd.scot.nhs.uk/cmo/CMO(2008)00a.pdf
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SHETLAND HEALTH PROTECTION PLAN 2019-2021
implement the national Vaccination Transformation programme. Environmental Environmental Services undertake monitoring of land and soil exposures which have quality, drinking water, food and noise. Also are consultees an adverse impact on for planning applications involving environmental exposure health, including (including noise) where development may result in adverse water-borne hazards long or short-term exposure. Specific local plans are in place to deal with blue-green algae which include risk assessments and response to incidents. Gastro-intestinal and National Guidelines for the Investigation of Zoonotic Disease zoonotic infections. in Scotland clarify the roles and responsibilities of the principle organisations involved in the investigation and control of zoonotic diseases, including examples of ‘good practice’ reporting protocols. In addition there are key guidance documents for the management of specific infections such as E coli, and rabies. NHS Shetland receives reports of gastrointestinal (GI) and other key infections that are notifiable or of public health concern, both from registered medical practitioners and laboratories, and undertakes local surveillance and management in collaboration with SIC Environmental Health Department. The Sexual Health Implementation of the new Framework which incorporates and Blood borne Virus sexually transmitted infections, HIV, Hepatitis b and Hepatitis Framework 2011-15 C is through the local Sexual Health and Blood borne Virus Strategy (2012-22). This is co-ordinated locally through the Public Health Department and includes the development of prevention, diagnosis, treatment and care services. The Environmental Health Department license skin piercing and tattooing operations under the Civic Government (Scotland) Act 1982 and following HPS and REHIS (Royal Environmental Health Institute of Scotland) implementation guidance. The Tuberculosis TB contact tracing in Shetland is managed by the Public Action Plan for Health Department in collaboration with clinical colleagues. Scotland 2011 There is a local plan for the prevention and management of TB which has recently been reviewed in response to the Tuberculosis Action Plan for Scotland 2011. Local procedures for prevention and management of TB have been updated in line with national guidance. During 2016-18 we have implemented these to carry out contact tracing and screening for individual cases of TB. Implementation of Joint working between NHS Shetland Public Health actions required by department and SIC to ensure appropriate and timely the Public Health etc implementation of the various parts of this legislation
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SHETLAND HEALTH PROTECTION PLAN 2019-2021
(Scotland) Act 2008 including review of mortuary facilities and arrangements, the development of a Joint Health Protection Plan (this document), the appointment of Health Board and Local Authority Competent Persons, and the development of systems to support duties regarding the notification and reporting of infectious diseases.
Effective information We use HPzone, a national IT system for managing cases, systems for managing incidents and outbreaks. incidents and outbreaks Capacity and Ongoing review of the capacity and resilience of local health resilience of health protection services takes place via exercising, testing and protection services in training, through internal and external quality assurance such responding to actual as audit and inspections, and in response to live events such or potential significant as the H1N1 influenza pandemic. Risks are recorded in the threats to public Board’s corporate risk register and Shetland community risk health register. Developing means to Assurance of the quality of health protection services takes assure the quality of place via reporting to clinical governance systems within the health protection Board, through exercising, testing and training, and through services and facilitate internal and external quality assurance such as audit and their continual inspections. improvement Continuing The consultant in Public Health Medicine (CPHM) participates professional in the Faculty of Public Health’s Continuing Professional development Development (CPD) system and Consultant appraisal. All especially with regard other members of the Infection Control Team and the Public to strengthening Health Department are compliant with national standards on evidence based good NHS Knowledge and Skills framework (KSF) appraisal and practice Personal Development Plans (PDPs). The Control of Infection Work Programme includes specific training related to health protection and HAI for specialist and generalist staff, and this is recorded within the Board’s Training Programme. Improving Involvement of and communication with the public regarding communications with perceived and actual risks to health is a strand of health the public on risks to protection and HAI work in Shetland as set out in the Control health and securing a of Infection work programme, and close working with the greater degree of their Board’s Patient Focus, Public Involvement (PFPI) involvement in health mechanisms takes place to promote good communication protection services with and involvement of the public. Recent examples have included awareness raising and advice regarding pertussis; norovirus and the flu vaccination programmes.
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3.2 Local health protection priorities Local health protection How they are being addressed priorities Healthcare Associated Infection: Included in the Control of Infection work including HEAT targets on programme with surveillance, response and MRSA/MSSA Bacteraemias and prevention activities co-ordinated through the Clostridium Difficile (C Diff) rates. Infection Control Team under the operational management of the Infection Control Manager. Local Air Quality Management Met office conduct continuous monitoring of air quality in Lerwick Tobacco Control including HEAT Through Public Health Ten Year Plan. target on smoking cessation. To improve the quality of housing (SIC activities) and the built environment Undertaking inspections to assess quality of housing with regard to the Tolerable Standard. Advise and can make third party referrals with regards to the Repairing Standard for private sector lets. Funding of a One Stop Shop at Hjaltland Housing Association to offer advice on housing repairs, improvements and adaptations. Use of statutory powers to require improvement of housing and resolution of statutory nuisances. Enforcement and in some cases mediation in relation to anti-social behaviour and environmental crime. Hoarding: Environmental Health advise and enforce statutory nuisance with regard to premises. Advice provided with regards to return to home after hospital admission. In addition advice and statutory action taken, as necessary, to enable vulnerable people to stay in their own homes in hygienic conditions which are not prejudicial to their health. Contaminated land (Environmental Health) Phased, risk-based approach to the identification and investigation of possible contaminated land sites.
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Food hygiene and food standards (Environmental Health) Implementation of enforcement effective inspection programming based upon a risk-rating approach to drive up overall food safety standards. Adherence to targeted inspection/sampling programme and co- ordination of national sampling surveys. Provision of food hygiene and food safety advice to business community. Participation in national campaigns as directed by FSS (Food Standards Scotland). Investigation of food- borne illnesses and food complaints. Private water supply sampling and (Environmental Health) Sampling and improvement inspection via risk based approach. Assistance to householders with grant applications in relation to the improvement of private water supplies. Enforcement of health and safety (Environmental Health) Delivery of an legislation. inspection programme based upon a risk-rating approach and topic inspections. Investigation of workplace accidents. Proactive visits with advice relating to Health and Safety at premises where resources allow. NHS links between internal Health and Safety (H&S) function and Infection Control Team to deal with infection control matters that pose H&S risk. Licensing of skin piercers and/or (Environmental Health) Framework in place to tattooists license all skin piercers and/or tattooists to ensure that they comply with statutory provisions in particular those relating to the cause/spread of infection. Control of use of sunbeds (Environmental Health) Arrangements in place to inspect and regulate sun beds premises in order to ensure they are complying with the provisions of Section 8 of the Public Health (Scotland) Act 2008. Control of sale of fireworks. Trading Standards colleagues conduct inspection and licensing of premises to ensure compliance with the Manufacture and Storage of Explosives Regulations 2005. Port Health responsibilities Respond to requests for ship sanitation certification of vessels and targeted inspections of vessels where Norovirus reported on Maritime Declaration of Health. Enacted through the Environmental Health service and the Consultant in Public Health.
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Dog Fouling Enforcement and campaigns.
Smoking in premises
Needle Sweeps (Environmental Health) Assisting Housing colleagues with needle sweeps of premises prior to cleaning Pick up hypodermic needles in public places when reported by members of the public Pest Control (Environmental Health) Provide advice and pest control service to residents Sudden Deaths (Environmental Health) Burials where no proper disposal has been arranged Travellers Advice & assistance to travelers to ensure their access to health advice and signposting to service. Fly tipping and littering (Environmental Health) Enforcement and removal of noxious waste. Septic Tanks (Environmental Health) Investigation of complaints and advice and enforcement with regards to defective drainage including septic tanks where public health may be at risk Shore line clean-up (Environmental Health) Removal of noxious waste or washed up deceased cetaceans which may impact on public health
3.3 Health protection risks specific to Shetland Health Protection risks specific to How these are managed Shetland Sullom Voe Oil Terminal A specific emergency COMAH plan which the Local Authority co-ordinates and manages. Airports: Sumburgh, Scatsta, Tingwall Each site has a specific emergency plan. Oil pipelines: Brent, Ninian, Clair Each site has a specific emergency COMAH plan which the Local Authority co-ordinates and manages. Sea Ports: Lerwick harbour and other Port Authority liaison with Public Health ports team and Environmental Health Dept. The Civil Contingencies Act 2004 places a legal duty on Category 1 responders within the Strategic Co-ordinating Group to co-operate with each other to compile a Community Risk Register. The Shetland Community Risk Register provides public
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SHETLAND HEALTH PROTECTION PLAN 2019-2021 information about the hazards that exist within the Shetland area and the control measures in place to mitigate their impact. The register is a public document and can be accessed on the Shetland Islands Council Emergency Planning & resilience website.14
3.4 Significant public health incidents and outbreaks during 2016-2018 Significant public health incidents and Learning Points and improvement outbreaks during 2016-2018 made to plans and services March 2016: Cluster of pertussis cases in Awareness raising re immunisation one geographical area August 2016: cluster of salmonella cases Repeat testing of asymptomatic carriers linked to a restaurant June 2017: raised levels of aluminum in island water supply January 2018: Gas Plant - outbreak of Testing of initial cases viral gastroenteritis Prepared response to media enquiries February 2018: Care home - flu outbreak Roles and responsibilities for infection control advice and implementation PPE supplies Testing of symptomatic patients and staff Staff working when unwell Staff flu vaccination March 2018: vaccine storage incident in New policy and standard operating a health centre procedures for medication storage and handling Learning points for future management of a PH incident requiring significant increased manpower May 2018: Care home - norovirus Joint action plan to embed roles and outbreak responsibilities for infection control advice and implementation PPE supplies Cleaning procedures and supplies Staff training August 2018: Family cluster Ecoli 0157 Medical staff vigilance re HUS Timing of samples
14 http://www.shetland.gov.uk/about_emergency_planning/
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Seasonal blue green algae blooms in Updating of risk assessments several lochs
4 Health protection: resources and operational arrangements 4.1 Resources available to provide health protection services (CD & EH) The Public Health team delivers the health protection function as described by the Chief Medical Officer.15 This includes routine surveillance and preparing for and responding to health protection inquiries, notifiable diseases, incidents, situations and outbreaks of foodborne disease; Tuberculosis; Meningococcal infection; blood borne viruses (HIV, Hepatitis C, Hepatitis B); sexually transmitted infections; the management of vaccination programmes; and health protection education and training. The Team is supported by the national resources available through Health Protection Scotland. The Environmental Health Service of Shetland Islands Council delivers relevant services within the Council and in collaboration with the Public Health Team. For incidents that would test the usual capacity of the services to respond, emergency planning arrangements are in place through the Shetland Emergency Planning Forum (SEPF) and Executive which provides the communities of the Shetland Islands with fully integrated, cohesive, efficient, and quality civil contingencies planning, management and response services. Shetland also participates in the Highlands and Islands Strategic Co-ordinating Group which acts at the strategic level to co-ordinate and support the response to any emergency within any part of the Highlands and Islands area, as defined in the Civil Contingencies Act 2004. It is formed from those agencies having primary responsibility to provide a response to any Major Incident or disaster within the Highlands and Islands area, and underpins local and regional preparedness. In addition, NHS Shetland has specific surge capacity arrangements in place across the North of Scotland for Public Health functions via the North of Scotland Public Health Network, and arrangements between the North of Scotland NHS Boards for clinical and support services. These are designed to ensure co-operation and collaboration between Shetland and the other northern NHS Boards in emergency situations where local demands outstrip local capacity, and are formalised through a Mutual Aid Agreement. NB All staff working in Public Health in NHS Shetland include health protection duties in their range of responsibilities and it is not possible to separate out specific time commitments: routine duties are recognised in job plans and annual objectives, and all staff respond as necessary to untoward incidents and emergencies.
15 www.sehd.scot.nhs.uk/cmo/CMO(2007)02.pdf
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Name Job title Health Protection Responsibilities NHS Shetland Public Health Team: Susan Webb Director of Public Health for Executive Responsibility for NHS Grampian and NHS Health Protection and Shetland Resilience Dr Susan Laidlaw Consultant in Public Health Designated Competent Person Medicine (CPHM) Consultant level responsibility (Part time) for HP Resilience Lead 2nd On Call Islands Rota Wendy Hatrick Public Health Specialist Nurse Health Protection Operational (Part time) Lead 1st on call rota Elizabeth Public Health Principal Cover for PH nurse Robinson 1st on-call rota Kim Govier Public Health Secretary Administration Surveillance databases etc Other NHS Shetland Staff Kathleen Carolan Director of Nursing and Acute Executive Lead for HAI Services 1st on call rota Carol Colligan Infection Control Manager 1st on call rota Kate Kenmure Service Manager Children’s 1st on call rota Services Shetland Islands Council Ingrid Gall Resilience Advisor Emergency planning, resilience and civil contingencies advice for NHS Shetland via a SLA Dawn Manson Lead Environmental Health Environmental Health Officer Patti Dinsdale Environmental Health Officer Environmental Health Team Leader – Environmental Health Hollie Liquorish Environmental Health Officer Environmental Health Louise Moar Food Safety Officer Environmental Health Other NHS Boards Emmanuel Okpo CPHM, Health Protection Cover when Shetland CPHM
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Team, NHS Grampian absent Diana Webster CPHM, Health Protection Cover when Shetland CPHM Team,NHS Grampian absent Maha Saeed CPHM NHS Grampian 2nd on call Islands Rota Louise Wilson Director of Public Health, NHS 2nd on call Islands Rota Orkney Sara Lewis CPH NHS Orkney 2nd on call Islands Rota Maggie Watts Director of Public Health, NHS 2nd on call Islands Rota Western Isles
NHSSh SIC Number of Health Board/Local Authority Competent 1 in 4 Persons, as designated by NHS Shetland under the Shetland Public Health etc. (Scotland) Act 2008 6 in other NHS Boards
4.2 IT and Communication Technology available to facilitate health protection work NHSSh SIC including Emergency Planning function Hardware Desktop and laptop computers Printers (black and white and colour) Photocopiers Fax machines Office and mobile telephones Single page scanner Document feed scanner Mobile broadband access Ipads Pagers (with text screen) Audio-teleconferencing equipment Video-conferencing equipment
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SHETLAND HEALTH PROTECTION PLAN 2019-2021
Hard copies of Health Protection Plans Software MS Office (Word, Excel, PowerPoint, Access) E-mail Dictaphone SIDSS (Scottish Infectious Disease Surveillance System) Access to local computer networks and to the world wide web Access to electronic information resources and databases –HPzone; ECOSS (Electronic Communication of Surveillance in Scotland), SIDSS (Scottish Infectious Disease Surveillance System), SCI Store (to access laboratory results), SCI Gateway, SHPIR (Scottish Health Protection Information Resource), TRAVAX (travel advice), Toxbase (toxicology database), SEISS (Scottish Environmental Incident Surveillance System), NHS Scotland e-library, NHS Education for Scotland. Access to Shetland e-health (IT) team. Access to, if required, a health protection operations room. Ability to convert a meeting room into a call centre to support a helpline with six lines being able to take calls from a single helpline number. Support from and access to members of organisation communications teams Access to resources provided by NHS24 FLARE system to record details of all premises along with enforcement actions. GIS Database of sites risk assessed for potential contamination
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4.3 Organisational arrangements in place to facilitate collaborative working between NHSShetland, Shetland Islands Council and other health protection agencies. Regular meetings Group Membership / Chairmanship Meeting frequency Shetland Control of Infection [See Appendix 1] Quarterly Committee Chaired by the Consultant in Public Health Medicine.
NHS Shetland Infection Chaired by Infection Control Manager. Two Control Team monthly NHS Shetland Health Open to Public Health Directorate and Quarterly Protection Governance all those on PH on call rotas Group Chaired by Public Health Specialist Nurse or Consultant in Public Health Medicine Shetland Public Health / Representatives of NHSShetland At least Environmental Health Joint Public Health Team, and SIC annually meeting Environmental Health. Usually chaired by CPHM Joint meeting with Scottish Involves NHS Shetland Pubic Health, Annually Water SIC Environmental Health, SIC Resilience Officer, Scottish Water Public Health, Resilience Team and local staff NHS Shetland Resilience Chaired by CPHM and Head of Quarterly and Business Continuity Planning and Modernisation Working Group Includes representatives from key NHS Shetland departments and the Resilience Advisor. Shetland Emergency All Category 1 & 2 responders and Twice a Planning Forum & Executive other local partners. year Chaired by the Resilience Advisor Meeting papers are circulated electronically to group members. All group members are able to put forward items for meeting agendas. Ad hoc meetings, phone calls and e-mails are used to ensure good collaborative working between regular meetings. Members of the Public Health Team and Environmental Health Team also participate in regional and national groups and meetings as appropriate, usually by teleconference or video conference.
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Ways in which incidents are reviewed and lessons learned locally Public health incidents are reviewed and lessons shared locally primarily through the Health Protection Governance Group and the meetings noted above, and if required by holding an incident specific meeting or debrief. All Communicable Disease incidents and outbreaks are reported through the Control of Infection Committee. Documents are shared among senior members of staff and then cascaded as appropriate to colleagues within organisations. Joint training and exercising also contribute to building and maintaining good working relationships. For example, exercises have taken place regarding pandemic flu, a food borne disease outbreak and water incidents. 4.4 Arrangements to respond out of hours Staffing: NHS Shetland –There is now a two tier on call system for Public Health advice and action out of hours. A first on call person is always available out of hours via Gilbert Bain Hospital switchboard. If the caller asks to speak to the person on call for public health the switchboard staff makes contact with the person who is first on call by pager, mobile phone or home phone. The first on call rota is staffed by public health staff and senior nurses. If Consultant advice is required, then there is a second on call ‘Islands ‘ rota. This is staffed by the CPHM for NHS Shetland, the DsPH for NHS Orkney and NHS Western Isles and a Public Health Consultant from NHS Grampian. This rota covers Shetland, Orkney and the Western Isles. The Gilbert Bain Hospital switchboard can contact the second on call person by pager, mobile phone or home phone. All first on call staff can access the NHS Shetland headquarters offices at Montfield either directly or via the Senior Manager on call. The Senior Manager on call can also be contacted by the first or second on call public health person if required. Shetland Islands Council Emergency Planning & Resilience team has an on-call service for dealing with major emergencies. The on-call officer can always be contacted by telephone via the police station. The officer on duty has the authority to deploy whatever resources are required to effectively respond to any emergency, if necessary. Shetland Islands Council Environmental Health Services does not have an out of hours on call system. Calls should be directed to Emergency Planning in an incident who will organise to contact relevant officers as required, if available. 4.5 Arrangements for reviewing health protection guidance NHS Shetland has several key documents which contain health protection guidance: National Health Protection guidance documents Shetland Infection Control webpages Health protection plans and check lists which cover the management of significant situations.
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Epidemiological questionnaires for the investigation of infectious diseases. These documents are reviewed in line with Board policy. In addition, internal and external audits of procedures have been undertaken periodically for quality assurance purposes (such as Internal Audit review of Infection Control policy & procedures, Audit Scotland review of HAI, Quality Improvement Scotland (QIS) reviews and HEI Inspection of HAI and the environment). Shetland Islands Council has a framework of operational policies and procedures in place which are used to ensure that enforcement officers undertake their duties in an effective and consistent manner. These documents are reviewed every 2 years or whenever amendments require to be made due to a change in legislation, whichever comes first. Details of current legislation and/or guidance is normally obtained from the Food Standards Agency and the Health and Safety Executive, or Office of Public Sector Information web sites. The Food Standards Scotland (FSS) undertake periodic audits of Food Safety/Food Standards Inspection and Enforcement carried out by this Service. 4.6 Corporate arrangements for ensuring the maintenance of knowledge, skills and competencies for staff who have health protection duties NHS Shetland – All NHS Shetland members of staff involved in daytime and out of hours health protection work are required to have a Personal Development Plan (PDP) and to maintain and develop their health protection knowledge, skills and competencies through continuing professional development activities. All staff have annual appraisal and objectives which include reference to their health protection duties, and link into their development needs as reflected in their PDPs. For NHS Shetland Health Board Competent Persons this process includes confirmation that they have knowledge and understanding of NHS Shetland’s Health Protection policies and procedures, undertake health protection continuing professional development (CPD) as part of any overall CPD activities, take part in peer review and audit of health protection activities, and have knowledge and understanding of the Public Health etc. (Scotland) Act 2008. Shetland Islands Council All Environmental Health staff involved in health protection work are required to have and maintain their professional competence with REHIS or CIEH through continuing Professional Development (CPD). All staff have annual appraisal and objectives which include reference to their health protection duties, and link into their development needs as reflected in their learning and Development Plans. 5 Health protection services: capacity and resilience 5.1 Assessment of the capacity and resilience of health protection services NHS Shetland’ health protection capacity and resilience was reviewed in 2015/2016 prior to the retirement of the Director of Public Health who held key strategic and operational roles, as part of an overall review of the public health team. There has been ongoing work primarily through the North of Scotland Public Heath Network with regard to local health protection functions in the context of the national Public Health Reform work. This is ongoing.
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Resilience capacity has been assessed through self assessments against the national Resilience Standards in 2016 and 2018; and there have been internal audits of business continuity planning specifically in 2014 and 2017. Healthcare infection prevention and control capacity and resilience has been assessed through self assessment against the national HAI Standards in 2015 AND 2016. The Board’s public health response to Pandemic Influenza was assessed in 2012 through participation in the H1N1 survey of NHS boards. A food Standards Agency Audit was undertaken of Environmental Health in 2007. An Internal Audit was undertaken by the Council’s Audit Section in 2010. 5.2 Key findings The way health protection services are delivered in Shetland had to change with the loss of an on island DPH / CPHM. There may be changes in the future depending on the outcome of the national Public Health Reform work. Capacity within the Public Health department was very limited , particularly for the ongoing work such as keeping plans up to date and testing plans and for covering an out of hours service. Resilience and Business Continuity in Shetland has progressed but there are still significant areas of work to complete to ensure that we can respond to major incidents effectively. There has been significant progress with infection prevention and control in the healthcare settings, although ongoing work is required to ensure environmental standards can be maintained.
5.3 Actions taken and planned The Public Health Team was redesigned in 2016, leading to changes in the local staff involved in health protection work, closer working arrangements with NHS Grampian and the development of a two tier on call system. Further redesign work may be required in future depending on out of the Public Health Reform work. Actions planned following all relevant audits, assessments and inspections are incorporated into the Control of Infection Committee work programme or the( newly created) Resilience and Business Continuity Working Group , workplan as appropriate. Actions in response to the Board’s internal audit reports are followed up through the Board’s governance arrangements via the Senior Management Team. 5.4 Plans for further assessment of capacity and resilience Feedback from the Government on the self assessment against resilience standards is awaited. A more robust programme of developing and exercising resilience and business continuity plans has been developed and is being implemented. It is anticipated that assessment of progress against HAI standards will be part of an overarching inspection process for healthcare services, rather than a dedicated proce4ss for infection prevention and control.
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5.5 Mutual aid arrangements The Civil Contingencies Act 2004 (Contingency Planning) (Scotland) Regulations 200516 details the duties that NHS Shetland and Shetland Islands Council and other Category 1 responders have to co-operate. Co-operation occurs within Shetland and across the NHS Boards and Local Authorities of the Highlands & Islands Regional Strategic Coordinating Group. There is a formal Memorandum of Understanding in place between the NHS Boards in the North of Scotland Public Health Network (Shetland, Orkney, Western Isles, Grampian and Highland) for mutual aid in the event of public health and major emergencies. 6 Health protection: public involvement and feedback 6.1 Public involvement in the planning and delivery of health protection services NHS Shetland Shetland NHS Board has a Patient Focus and Public Involvement Strategy and Action Plan, and the Board’s health protection work operates within this framework. The Board has a number of PFPI mechanisms which the Public Health and Infection Control Teams use, including: Lay membership on the Control of Infection Committee; Public involvement in the production of patient information and patient focused health improvement and prevention work – for instance the local hospital hand hygiene programme; Use of the Board’s web-site for the publication of information and consultation documents for planning purposes. www.shb.scot.nhs.uk Part of the management of the investigation and control of an outbreak involves asking those affected for feedback. This is usually done informally and not as part of a structured evaluation process. Shetland Islands Council After each inspection undertaken, a customer feedback questionnaire is provided to the business or individual to feedback on the staff. Any negative feedback or formal complaints are fully investigated and procedures reviewed to improve the service provided.
16 www.opsi.gov.uk/legislation/scotland/ssi2005/20050494.htm
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APPENDIX 1: Membership of Shetland Control of Infection Committee (April 2019)
Consultant in Public Health (Chair) Dr Susan Laidlaw
Director of Nursing and Acute Services / HAI Kathleen Carolan Executive Lead
Infection Control Manager Carol Colligan
Chief Nurse (Community) Edna Mary Watson
Chief Nurse (Acute & Specialist Services) Alison Mustard
Consultant Microbiologist Request support from Aberdeen Royal Infirmary Microbiology Department if required.
Head of Estates Lawson Bisset
Laboratory Representative Ian Pritchard
Senior Occupational Health Advisor Bernadette Dunne
Pharmacy Manager Mary McFarlane
Medical Director / Associate Medical Director Brian Chittick (Interim Medical Director)
SIC Environmental Health Services Rep Dawn Manson
Hotel Services Manager Valerie Adamson
Lay Representative Janet Manson
Administration Kim Govier
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