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.