Appendix 1 - Tayside Joint Health Protection Plan 2025-27
Perth and Kinross Council · 11 June 2025
Back to Housing and Social Wellbeing Committee — 11 June 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Appendix 1 Appendix 1 Tayside Joint Health Protection Plan 2025 – 2027 NHS Tayside Health Protection Team dd/mm/yyyy
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2 Contents Preface....................................................................................................................................................3 1. Introduction to the Joint Health Protection Plan............................................................................4 1.1 Purpose .................................................................................................................................4 1.2 Context..................................................................................................................................4 1.3 Developments since the previous JHPP................................................................................5 2. Overview of the Tayside area.........................................................................................................7 2.1 Geography and demography.................................................................................................7 2.2 Particular health considerations for Tayside.........................................................................8 3. Health Protection Planning Infrastructure....................................................................................10 3.1 Remit of agencies................................................................................................................10 3.2 Health protection planning.................................................................................................12 3.3 Scottish Health Protection Network....................................................................................13 4. Health Protection Priorities and Emerging Issues.........................................................................14 4.1 National priorities................................................................................................................14 4.2 Local priorities.....................................................................................................................15 4.3 Our priorities for 2025-2027................................................................................................18 4.4 Health Protection Incidents.................................................................................................20 5. Resources and Operational Arrangements...................................................................................23 5.1 Staffing.................................................................................................................................23 5.2 IT and Communications Technology....................................................................................24 5.3 Collaborative working...........................................................................................................25 5.4 Standard Operating Procedures...........................................................................................25 5.5 Maintaining knowledge, skills and competencies................................................................26 6 Capacity and Resilience................................................................................................................28 6.1 NHS Tayside...........................................................................................................................28 6.2 Local Authorities....................................................................................................................28 7 Public involvement and feedback.................................................................................................29 8 Summary.......................................................................................................................................30
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3 Preface Health protection is the area of public health practice responsible for the surveillance, prevention, investigation and management of communicable diseases and environmental hazards, in addition to incident and outbreak management. It encompasses a set of activities which seek to protect the public from infectious and environmental threats to health, and where these threats cannot be avoided, to mitigate their impacts on population health and health inequalities. The health protection function for Tayside is jointly delivered by NHS Tayside Health Protection Team and the three local authorities of Angus, Dundee City, and Perth and Kinross. NHS boards and local authorities have a duty to co-operate in exercising their functions under the Public Health etc. (Scotland) Act 20081, and to plan together to protect public health. This includes the production of a Joint Health Protection Plan (JHPP) every two years, the main purpose of which is to provide an overview of health protection priorities, provision and preparedness for the NHS Board area. This is the fifth Tayside JHPP, with the first published in 2010. The previous JHPP (published in 2019) had been due for review and update in April 2021, but this was not possible to achieve due to the competing priorities of the COVID-19 pandemic and the challenges this placed upon each of the four organisations party to the production of the JHPP. This experience was not unique to Tayside, with similar challenges facing all NHS Boards and local authorities across Scotland. The current plan covers the period from 2025 to 2027 and will be next updated in two years’ time, in accordance with legislative guidance. The JHPP is a public document and is openly available on the NHS Tayside website and on request. We hope that you will find this plan to be of interest, and of value, and that its production will contribute to protecting the health of the people who visit, work and live in the Tayside area. Signatories Authority Authorised Signatory Position Approving Committees Date Chief Executive Team 17/02/2025NHS Tayside Emma Fletcher Director of Public Health Population Health Committee 11/03/2025 Angus Council Dundee City Council Perth and Kinross Council 1 Public Health etc. (Scotland) Act 2008. https://www.legislation.gov.uk/asp/2008/5/contents (accessed 15 October 2024).
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Appendix 1 1. Introduction to the Joint Health Protection Plan 1.1Purpose This Joint Health Protection Plan (JHPP) has been prepared in accordance with the requirements set out in the Public Health etc. (Scotland) Act 2008. The purposes of the plan are: i. To provide an overview of health protection priorities, provision and preparedness for NHS Tayside and partner local authorities. ii. To outline the joint arrangements which NHS Tayside and partner local authorities have in place for the protection of public health. iii. To improve the level of “preparedness” in relation to responding effectively to health protection incidents and emergencies. iv. To clarify local health protection priorities for the period of the plan (2025 -2027). v. To develop learning across the agencies. vi. To provide a mechanism for reviewing and recording outcomes and achievements. 1.2Context Health protection encompasses a set of activities within the Public Health function. It involves: ensuring the safety and quality of food, water, air and the general environment. preventing the transmission of communicable disease; and managing outbreaks and other incidents which threaten the health of the public.2 NHS Health Boards have a health protection function relating to the control of infectious disease and diseases arising from contact with substances hazardous to health. Similarly, local authorities have a health protection function, which is predominantly delivered through the local authority environmental health service. The NHS Board is coterminous with the three local authority areas of Angus, Dundee City and Perth & Kinross, and in practice, health board and local authority functions are co-ordinated. Tayside’s Joint Health Protection Plan (JHPP) 2025-2027 has been collated jointly by NHS Tayside, Angus Council, Dundee City Council and Perth and Kinross Council. 2 Public Health Scotland, Health Protection. https://publichealthscotland.scot/population-health/health- protection/
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5 1.3Developments since the previous JHPP Whilst the core function of health protection in both the NHS board and Tayside local authorities has largely remained the same since the last JHPP, there have been several key contextual changes nationally and internationally that are worth noting which have shaped and influenced the landscape of health protection in NHS Tayside. These have led to dynamic practices and new ways of working, with some of the key events and changes outlined below: COVID-19 Pandemic: Health protection and environmental health services across Scotland experienced an extended period of unprecedented increased workload and demand due to the emergence of the pandemic and its short- and longer-term impacts on population health and service delivery. Many non-urgent workstreams were paused, but reactive response to the management of other infectious diseases and environmental hazards continued. Despite the challenges faced, the nature of the pandemic led to strengthening of effective partnership working between the NHS board and local authorities, as well as other partnership agencies in social care, education and business. These partnerships have put health protection in good stead during the recovery phase. During the pandemic, other notifiable diseases, e.g. pertussis (whooping cough) and influenza, reduced in incidence as a result of the control measures and restrictions introduced to reduce transmission of COVID-19. The epidemiology of these infections has since rebounded and returned to pre-pandemic patterns within the UK and internationally, with some giving rise to notable surges in activity, such as measles and pertussis in 2024. Emerging from the pandemic, the spotlight on communicable disease and health protection has continued to shape the workload, with partners within and outside of the NHS generally having an appropriately lower threshold for seeking health protection expertise. In addition, preparatory planning for emerging new infectious diseases of concern continues as an important focus, e.g. Mpox and Avian Influenza. New public health agencies: Health Protection Scotland has amalgamated with the former Information Services Division of National Services Scotland and NHS Health Scotland, evolving into Public Health Scotland, with a renewed remit as the “lead national body for improving and protecting the health and wellbeing of all of Scotland’s people”3. Public Health England has transitioned into the UK Health Security Agency. Through the pandemic and the emergence of these new organisations, new relationships and ways of working were fostered, enhancing governance structures and improving 3 Public Health Scotland. Our vision and values. https://publichealthscotland.scot/about-us/who-we-are/our- vision-and-values/
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6 collaboration and communication in response to health protection issues. For example, there are now three weekly national meetings between Public Health Scotland and Health Boards’ Health Protection Teams (HPTs) facilitating dissemination of updates on national and local issues and shared responses to emerging issues and guidance. Service delivery changes: It was necessary to identify additional staff resource to manage the increased demand for specialist health protection input during the pandemic. Due to the sustained increased activity post-pandemic, a small proportion of this additional resource remains. Training and maintaining professional development have therefore been important foci, as well as maintaining relationships with partnership organisations between all team members. An introduction of more sensitive polymerase chain reaction (PCR) testing for gastrointestinal diseases in NHS Tayside has led to increased detection of gastrointestinal diseases, such as Shiga-toxin producing E. coli disease and Giardia. This has led to closer working between the HPT, laboratories and local authorities in co-ordinating an efficient and seamless response to these notifications. As diagnostic testing evolves, further collaboration with national organisations and guidance bodies will be required to ensure the health protection response remains adequate and proportionate.
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Appendix 1 2. Overview of the Tayside area 2.1Geography and demography The geographical area covered by Tayside comprises the three local authority areas of Angus, Dundee and Perth & Kinross (Figure 1). In 2023, the estimated total population of Tayside was 417,7704 living in an area of 7,527 sq. kilometres with a mixed urban and rural population distribution. The population of Tayside accounts for approximately 7.6% of the total Scottish population. A detailed population profile for the Tayside area is provided in the NHS Tayside Director of Public Health Annual Report 20235, with key population statistics summarised below (data sources: National Records of Scotland2 6 7, Scotland’s 2011 Census8, and the Scottish Index of Multiple Deprivation (SIMD) 2020v2 local and national share calculator9). 4 National Records of Scotland. Mid-2023 Population Estimates Scotland. https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by- theme/population/population-estimates/mid-year-population-estimates/mid-2023 (accessed 15 Oct 2024). 5 NHS Tayside Director of Public Health Annual Report 2023. https://www.nhstaysidecdn.scot.nhs.uk/NHSTaysideWeb/idcplg?IdcService=GET_SECURE_FILE&Rendition=web&RevisionSelectionMethod=LatestR eleased&noSaveAs=1&dDocName=prod_370969 (accessed 15 Oct 2024). 6 National Records of Scotland. Urban Rural Dashboard 2021. https://scotland.shinyapps.io/nrs-urban-rural-dashboard/ (accessed 15 Oct 2024). 7 National Records of Scotland. Sub-National Population Projections (2018 based). https://www.nrscotland.gov.uk/statistics-and- data/statistics/statistics-by-theme/population/population-projections/sub-national-population-projections (accessed 15 Oct 2024) 8 Scotland’s Census 2011. Ethnicity. https://www.scotlandscensus.gov.uk/census-results/at-a-glance/ethnicity/ (accessed 15 Oct 2024). 9 Scottish Government. Scottish Index of Multiple Deprivation 2020v2 local and national share calculator. https://www.gov.scot/publications/scottish-index-of-multiple-deprivation-2020v2-local-and-national-share-calculator-2/ (accessed 15 Oct 2024 Angus Total population = 114,820 (27% of Tayside) 28% live in rural areas (0.4% remote rural) and 72% in urban areas Popn density = 53 persons per square km 8% of the popn live in areas of greatest deprivation (SIMD1) Dundee City Total population = 150, 390 (36% of Tayside) 99% live in urban areas Popn density = 2,515 persons per square km 37% of the popn live in areas of greatest deprivation (SIMD1) NHS Tayside Total population = 417,770 (51% female, 49% male) 16% of the population are <16 years old and 21% are >65 years old Tayside has an ageing population, with the proportion of residents aged ≥75 years projected to increase by 33% between 2018 and 2033 Net migration into Tayside in 2023 was +5,460 persons (71% international) In 2011, 93% of the population self-identified as White Scottish, British or Irish Figure 1: Tayside population statistics by area Perth & Kinross Total population = 152,560 (37% of Tayside) 47.4% live in rural areas (10.3% remote rural) and 52.6% in urban areas Popn density = 29 persons per square km 6% of the popn live in areas of greatest deprivation (SIMD1) Large geographical area presents challenges e.g. response times
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8 2.2 Particular health considerations for Tayside While there are shared health protection risks nationwide, the unique profile of each local authority, health board and regional area across Scotland presents its own specific challenges. Some of the health protection considerations particularly relevant to Tayside are described below, alongside a note of the measures which can be taken to reduce the risk of harm or mitigate impacts (Table 1). Table 1: Health protection considerations for Tayside Consideration Relevance to health protection Mitigation measures Port Health Tayside is host to two large seaports and a domestic airport. Note aircraft from outwith the UK do use the airport. These locations may potentially serve as entry points for imported disease. In addition, Control of Major Accident Hazards (COMAH) sites are located at both Dundee and Montrose Ports. NHS Tayside works closely with Public Health Scotland’s Border Health and Emerging Infections team to monitor any emerging risks, as well as the Maritime and Coastguard Agency in the event of any coastal incidents. NHS Tayside also liaises with local authority Port Health colleagues. Host to several universities and colleges There are four higher educational institutions (HEIs) in Tayside with a combined UK and international student body of over 43,000. High numbers of students mixing and living in shared accommodation may increase opportunities for the introduction and spread of infection. NHS Tayside maintains close working relationships with HEIs regarding monitoring, prevention (including vaccination), and control of infection, such as mumps and meningitis. Local Authorities regulate HMOs, registration of private sector landlords and housing conditions including gas and electrical safety, Legionella risk assessments etc. Private water supplies There are around 2,000 private water supplies (PWSs) in the local authority areas of Angus and Perth and Kinross (9% of all PWSs in Scotland).10 These serve both commercial and private premises including holiday accommodation with a transient population. Compared to mains supplies, the consumption of water from PWSs is associated with an increased risk of contracting infection. Climate change related drier summers interspersed with heavy rain may increase the risk of raw water contamination and water-borne illness, whilst prolonged dry spells may lead to water scarcity impacting some PWSs. Local authorities maintain regular monitoring and review of private water supplies, with close liaison with NHS Tayside and Drinking Water Quality Regular for Scotland (DWQR) where problems arise. Response measures are co-ordinated through this partnership approach. Air quality In 2023, although 3 of the 5 highest monitoring locations in Scotland for nitrogen dioxide (NO2) annual mean were in Tayside, all were compliant with the current Scottish Air Quality Objective limit. 2 of the 5 highest monitoring locations for particulate matter (PM10) were in Tayside . Perth city, and up until recently Crieff Dundee City Council introduced a Low Emission Zone scheme in May 2022 with enforcement of the LEZ commencing in May 2024. Air quality remains a high priority for all 3 local authorities with Air Quality Action Plans and Air Quality Strategies being renewed/created during 2024/25 alongside 10 Drinking Quality Regulator for Scotland. Annual report 2023. https://dwqr.scot/information/annual-report/ (accessed 21 October 2024).
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9 regular monitoring and reporting in line with statutory duties. High prevalence of problematic drug use The prevalence of illicit drug use in Dundee is amongst the highest in Scotland.11 People who inject drugs are at increased risk of contracting infections due to blood borne viruses, invasive group A streptococcus, and other pathogens requiring public health management. A local early warning system, alongside an action plan, is in place for NHS Tayside relating to drug related harm events. NHS Tayside works alongside local authority alcohol and drug partnerships, and drug and alcohol recovery services, to enact these plans and respond to any incidents. NHS Tayside has also partnered with Dundee University to implement a targeted treatment intervention programme, progressing to Hepatitis C elimination. Agricultural work Tayside is a major producer of soft fruits and several farms within the area employ large numbers of seasonal agricultural workers from outside the UK. There has been an increase in the incidence of TB in migrant agricultural workers in recent years12, with people from this community at risk of experiencing intersectional difficulties in accessing healthcare, social support and stable accommodation. Tayside hosts several food processing facilities with substantial numbers of non-UK nationals in their workforces. Additionally, Tayside has the highest number of kept birds in Scotland, with an associated risk of avian influenza13 NHS Tayside maintains a multi-sectional approach to vulnerable communities, liaising with local authorities and partnership organisations and the third sector to enhance outreach and engagement, e.g. Perth & Kinross Council currently monitor and, when required, inspect all seasonal worker accommodations to ensure adequate living conditions. NHS Tayside also has a pandemic plan for high-risk communicable diseases, such as avian influenza, working closely with Public Health Scotland and the Animal and Plant Health Agency to keep abreast of guidance and response measures. Other vulnerable communities Perth and Kinross Council (PKC) have the highest number of Gypsy/Travellers within the settled community compared to other Scottish local authorities.14 Tayside’s local authorities host refugees and people seeking asylum in several hotels and other group setting placements arranged with the Home Office. Members of these communities often have complex health needs, including prior exposure to TB and other infectious disease. PKC officers monitor and manage Gypsy/ Traveller roadside encampments assisting with welfare needs. Provision of a transient site to provide better accommodation and access to services etc. is estimated to complete construction by 2026. NHS Tayside works with local authorities and other third- party sectors to improve health support (e.g. screening, vaccination) as needed for Gypsy/Traveller and migrant communities. 11 Dundee Health and Social Care Partnership. Drug and alcohol services indicators. [report to Performance & Audit Committee, 2022]. https://www.dundeecity.gov.uk/reports/reports/PAC33-2022.pdf (accessed 21 October 2024). 12 Ward E, Connell D, Allam M, et al. Complexities in Tuberculosis care in seasonal farm workers in Scotland. Thorax 2022;77:A165. https://thorax.bmj.com/content/77/Suppl_1/A165.2 (accessed 21 October 2024). 13 Scottish Kept Bird Register. https://keptbirdregister.service.gov.scot/ 14 National Records of Scotland Statistical Bulletin. Must-haves
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Appendix 1 3. Health Protection Planning Infrastructure 3.1 Remit of agencies The health protection function in Tayside is jointly provided by NHS Tayside Health Protection Team (HPT) and colleagues from the three local authority areas: Angus Council, Dundee City Council, and Perth and Kinross Council. The overall purpose of the health protection function across Tayside is “to maintain safe, resilient and effective communicable disease and environmental protection services, supported by continuous learning and improvement”.15 Further detail on the health protection remits of the health board and local authority environmental health departments within Tayside is provided below. 3.1.1 NHS Tayside The health protection remit for NHS Boards covers communicable diseases, environmental hazards and the deliberate release of biological, chemical, radiological and nuclear hazards. It is further described in the letter of 2 February 2007 from the Chief Medical Officer (CMO) of Scotland16 and has been clarified by the Public Health etc. (Scotland) Act 2008. NHS Tayside delegates this remit to the Director of Public Health, with statutory functions carried out by the Health Protection Team (HPT) in relation to surveillance, investigation, risk assessment, risk management and risk communication activities, amongst others. HPT are supported in executing these duties by colleagues from across the wider organisation and by partners from local authorities and other external agencies. Examples of areas of health protection work undertaken by NHS Tayside, together with relevant partners, include: The public health management of cases of notifiable diseases and notifiable organisms (alongside Environmental Health partners where appropriate) o Includes gastrointestinal and zoonotic infections, vaccine-preventable diseases, tuberculosis and other respiratory infections The management of public health incidents and outbreaks of communicable diseases (alongside Environmental Health partners where appropriate) Environmental public health (alongside Environmental Health partners) o Includes maintaining clean air, safe water, land quality etc. o Includes responding to environmental exposures with potential to adversely impact health Emergency planning, response, and management - particularly relating to pandemic planning, health protection incident planning and STAC planning, in conjunction with the Local Resilience Partnership Preparation and response to hazardous material incidents, and chemical, biological, radiological and nuclear incidents: in conjunction with Public Health Scotland and relevant national bodies 15 Tayside Joint Health Protection Plan 2019-2021. https://www.nhstaysidecdn.scot.nhs.uk/NHSTaysideWeb/idcplg?IdcService=GET_SECURE_FILE&Rendition=web&RevisionSelectionMethod=LatestR eleased&noSaveAs=1&dDocName=prod_281252 (accessed 22 Oct 2024). 16 Scottish Executive Health Department. (2007). NHS Boards’ Health Protection Remit. https://www.publications.scot.nhs.uk/files_legacy/sehd/cmo/CMO(2007)02.pdf (accessed 22 Oct 2024).
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11 Co-ordination and delivery of vaccination programmes – directed by the Immunisation Co- ordinator and vaccination team based in the Directorate of Public Health Healthcare associated infections – in conjunction with the NHS Tayside Infection Prevention and Control Team and Occupational Health team. Sexual health and blood borne viruses – primarily governed by the Sexual Health and Blood Borne Viruses Managed Clinical Network (MCN) Undertaking local surveillance and reporting and contributing to national and international monitoring of the evolving epidemiology of cases, clusters and outbreaks of notifiable diseases and pathogens 3.1.2 Local authorities Local authorities have a broad health protection remit, which is delivered by a range of professional staff including Environmental Health Officers (EHOs). Many aspects of local authority health protection work are requirements of statute, and may involve monitoring, inspection, surveillance, sampling, and the investigation and resolution of enquiries and complaints. In addition, local authorities work in collaboration with NHS Tayside to prepare for and respond to public health incidents and other emerging threats to health. Examples of local authority environmental health functions and areas of health protection related work undertaken by local authorities include: Directly related health protection functions: Investigation of reportable infectious diseases Investigation and response to suspected outbreaks of infectious disease Monitoring air quality / standards Contaminated land Pest control Drinking water quality – including Private Water Supplies Blue green algae surveillance and management Food safety – inspections, standards, investigation of complaints and incidents Food sampling Environmental incivilities (dog fouling, fly-tipping, litter etc). Regulating standards at public events Maintaining standards of premises licensed for alcohol sale and other purposes such as tattooists, skin piercers, cosmetic clinics Activities related to animal health Response to poor Health & Safety practices adversely impacting health e.g. COPD (for premises that are required under Local Authority delegation). Implementation of smoking legislation Indirectly related health protection functions: Housing standards Statutory nuisances – noise, odour, dust, light, accumulations, sewerage etc.
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12 Planning consultation Licensing (HMOs, events, caravan sites) Resettlement Gypsy/traveller community liaison 3.2 Health protection planning The prevention, investigation and control of communicable diseases and environmental hazards requires specialist health protection knowledge and skills. Whilst this knowledge and skill set can be applicable to a wide range of potential incidents or scenarios, the provision of an effective response is often facilitated by the existence of agreed plans or procedures. There are many such national and local plans. Health protection related plans commonly prepared by NHS Tayside, singly or in partnership with local authorities and other agencies, are detailed in Table 2. Health protection plans maintained by each local authority are detailed in Table 3. It has not been possible to update some of these plans in accordance with the normal timeframes due to the pandemic response and this is therefore a priority for teams over the period covered by the JHPP. Table 2: Summary of NHS Tayside health protection-related plans Plan Owner Last updated Review date Exercised STAC (Scientific and Technical Advice Cell) Response Plan Health Protection Incident Response Plan Pandemic Flu Plan Tayside Cyanobacteria (Blue- green algae) Plan Scottish Waterborne Hazard Plan Tayside Resilience Partnership/HPT NHS Tayside Health Protection Team/ Dr Simon Hilton CPHM Tayside Resilience Partnership/HPT HPT/Local authorities/Scottish Water/SEPA Scottish Water/HPT/Local Authorities Feb 2024 Dec 2021 June 2024 March 2024 December 2016 Feb 2026 Dec 2023 October 2025 March 2025 2025 Training sessions held between 2023-2024 Exercised regularly through real-time management of incidents and outbreaks Exercised in practice during the COVID-19 pandemic, with national work ongoing to develop learning and future exercise plans Not applicable Pre-pandemic. Next exercise planned early 2025
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13 Table 3: Summary of local authority plans applicable to health Angus Dundee City Perth and KinrossPlan / x / x / x Food Safety Service plan Air Quality strategy / Air Quality Action Plan Contaminated Land Strategy Ports Authority Emergency Plan x x All Tayside local authorities implement a variety of policies, procedures and plans associated with health protection legislation. Examples include the above plans. In addition, services are audited externally for food by Food Standards Scotland, private water supplies by DWQR, and air quality by Scottish Government and SEPA. Furthermore, for plans more directly linked to public health, Local Authorities (and NHS Tayside) contribute to the Local Resilience Partnership, which maintains a joint Pandemic Flu Plan, Mass Fatalities Plan and a Mass Casualties Plan. 3.3 Scottish Health Protection Network The Scottish Health Protection Network (SHPN) is an obligate and highly valued network of existing professionals, organisations and groups within the health protection community across Scotland. It aims to enable national and local health protection organisations, across sectors and disciplines, to work together cooperatively to promote and support a cohesive ‘health protection service for Scotland’.17 Through the Network, Public Health Scotland works with NHS Boards and other partners to write, review, adapt, publish and disseminate core guidance and resources covering the full breadth of health protection practice. Colleagues from Tayside participate in the SHPN, and parties to the JHPP recognise its role as a lynchpin in the national health protection planning infrastructure. 17 Public Health Scotland. (2023). Overview of the SHPN. https://publichealthscotland.scot/our-areas-of-work/health- protection/scottish-health-protection-network-shpn/overview-of-the-shpn/overview/ (accessed 22 Oct 2024).
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Appendix 1 4. Health Protection Priorities and Emerging Issues 4.1National priorities The Scottish Government and COSLA agreed a set of six public health priorities for Scotland in June 2018. These priorities (Table 4) are intended to provide a ten-year focus for improving population health, although it is acknowledged that they do not reflect all activities which contribute to the health and wellbeing of Scotland’s communities. Although there are no specific priority areas for health protection listed, the public health priorities report18 does reflect that “work to protect the health of the population from serious risks and infectious diseases through vaccination, infection control and incident response (health protection), will continue to be an essential public health function and must be maintained.” Table 4: Public health priorities for Scotland Priority 1 A Scotland where we live in vibrant, healthy and safe places and communities Priority 2 A Scotland where we flourish in our early years Priority 3 A Scotland where we have good mental wellbeing Priority 4 A Scotland where we reduce the use of and harm from alcohol, tobacco and other drugs Priority 5 A Scotland where we have a sustainable, inclusive economy with equality of outcomes for all Priority 6 A Scotland where we eat well, have a healthy weight and are physically active NHS Tayside and partners are also cognisant of health protection priorities as stated from time to time by the Scottish Government and Chief Medical Officer (CMO). Several of the national priorities for health protection listed in the CMO letter on health protection priorities published in 200819 (and outlined below), remain just as important today and are reflected within our selected local priorities. National priorities for health protection published in 2008 CMO letter: A potential pandemic of influenza; including preparation and planning. Healthcare associated infections and antimicrobial resistance. Vaccine preventable diseases. Environmental exposures which have an adverse impact on health, including incident response. Gastro-intestinal and zoonotic infections, including case and outbreak response. Public Health Scotland (PHS) is the national public health body and has a health protection remit to protect the people of Scotland from infectious and environmental hazards. The Clinical and Protecting Health directorate within PHS also notes a number of priority health protection topic areas in Scotland20, with those relevant to the core work of the HPT and/or local authority partners in Tayside including: Emerging infections – such as Mpox and Ebola. 18 Scottish Government and COSLA. (2018) Scotland’s Public Health Priorities. https://www.gov.scot/publications/scotlands-public-health-priorities/ (accessed 23 October 2024). 19 Scottish Government Chief Medical Officer Directorate. (2008). Priorities for Health Protection in Scotland 2008-2010. https://www.publications.scot.nhs.uk/files/cmo-2008-00a.pdf (accessed 23 October 2024). 20 Public Health Scotland. (2024). What is health protection? https://publichealthscotland.scot/our-areas-of-work/health-protection/overview-of- health-protection/what-is-health-protection/
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15 Environmental public health – such as responding to pollution or contamination incidents to preserve safe water and clean air. Gastrointestinal and zoonotic infections – such as E. coli and Campylobacter. Immunisations and vaccine-preventable diseases – such as measles and pertussis. Respiratory infections – such as COVID-19, tuberculosis and influenza (flu). Travel and international health – such as Middle East Respiratory Syndrome (MERS), Tick Borne Encephalitis, and vector-borne diseases associated with climate change. Blood borne viruses, such as Hepatitis B and HIV. 4.2 Local priorities 4.2.1 Review of Tayside JHPP 2019-2021 The 2019-2021 Tayside JHPP identified a number of priorities for NHS Tayside and for each of the local authority areas.12 These included two joint health priorities which were shared by the health board and all three local authorities, and related to: i) the management of incidents and outbreaks in line with national guidance; and ii) air quality improvement. For both of these priorities, a series of actions and intended outcomes were proposed, with the current assessment of the progress against these outcomes detailed below (Table 5). Table 5: Review of joint health protection priorities identified in 2019-21 Tayside JHPP Priority (2019-2021 JHPP) Assessment of progress Management of incidents and outbreaks in line with national guidance 24/7 local disease and incident surveillance service maintained, with the structures and response facility of the health protection response plan maintained. This was due to be rehearsed regularly, however, in light of the COVID-19 pandemic this was implemented in practice at a far greater frequency than pre-pandemic levels with subsequent improved understanding and response to incidents. Additionally, further experiential learning opportunities were made available, as well as strengthened collaboration and communication pathways. The NHS HPT and local authorities have continued to prioritise responding to notifications of notifiable disease in accordance with the local Communication Pathway for gastrointestinal disease, and further developed this in a mutually beneficial manner as PCR testing for gastrointestinal infections has been onboarded in Tayside, resulting in an increased detection rate of certain notifiable gastrointestinal diseases. Preventative work (including routine premises inspections) to reduce the risk of future outbreaks, have returned to normal operations after a period of disruption during the COVID-19 pandemic, where local authorities enhanced their focus on prevention and response to premises in context of COVID-19. This has now returned to an increased focus on food-preparation and reducing risks of food- borne illness, as well as the usual wider Environmental Health remit as mentioned previously. Additionally, implementation of the nationally directed Vaccination Transformation Programme was completed in April 2022, centralising arrangements for the delivery of all routine and targeted childhood and adult
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16 immunisations by NHS Tayside, including those offered for post-exposure protection and as part of specific health protection incident and outbreak response. A risk framework for care homes responding to COVID-19 was produced by the SHPIR network21, and is being developed into a new PHS-led guidance for the public health management of Acute Respiratory Infections (ARI) in community, social and residential care settings. This will provide a robust, cohesive overview of how to respond to respiratory disease in care homes, working with partners to enable this response, and has been developed through collaborative input of the NHS boards. Areas for progress which remain ongoing include meeting performance review framework targets of 100% of IMT reports and completed actions to be within 6 months of the incident. This has been in part impacted by the COVID-19 pandemic, and subsequent public health emergencies of international concern, such as Mpox. However, it remains a priority area. Air quality improvement Dundee City Council successfully introduced a low emission zone 22 in May 2022, with enforcement commencing in May 2024. Improvements to bus fleets and the removal of LEZ non-compliant vehicles in readiness for the commencement of enforcement are considered to be main contributors to the reduction in NO2 annual mean levels in recent years, with all NO2 monitoring locations now complying with current Scottish Air Quality Objective levels. Perth and Kinross Council revoked the Crieff Air Quality Management Area in December 2024 due to compliance with air quality objectives. However, implementation of Crieff’s Air Quality action plan will continue to avoid any future exceedances. Across Perth & Kinross as a whole, there have been no air quality exceedances since 2018, with the exception of Atholl Street, although this is thought to be due to building works in the vicinity of the Real Time Monitor and less likely due to road traffic congestion. The local authorities remain committed to improving air quality, implementing and working with partners to deliver actions contained within the Scottish Government’s initial 2016 Cleaner Air for Scotland strategy and revised 2021 Cleaner Air for Scotland 2 strategy, while also continuing to regularly monitor and report on air quality 23. Local authorities are working towards the revocation of Air Quality Management Areas. NHS Tayside remains committed to supporting growing the evidence on health impacts of air pollution. NHS Tayside and the Local Authorities continue to work in co-ordination to responding to environmental incidents, such as large fires or hazard materials incidents, that may impact air quality and require a multi-sectoral response to effectively manage. 21 Scottish Health Protection Information Resource. COVID-19 - information and guidance for social and residential care settings. https://www.shpir.hps.scot.nhs.uk/web-resources/covid-19-information-and-guidance-for-social-and- residential-care-settings-version-29/ 22 Dundee City Council. Dundee Low Emission Zone Scheme. https://www.dundeecity.gov.uk/service-area/city- development/sustainable-transport-and-roads/dundee-low-emission-zone-scheme-lez 23 Cleaner Air for Scotland 2 - Towards a Better Place for Everyone . Scottish Government. https://www.gov.scot/publications/cleaner-air-scotland-2-towards-better-place-everyone/
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17 4.2.2 Selection of priorities Key partners from NHS Tayside and each of the local authority areas were consulted in selecting the health protection priorities listed in this updated JHPP. This process included discussion with senior Environmental Health colleagues as well as a survey of core HPT members and other public health professionals who contribute to the on-call health protection rota. The selection of priorities was informed by national and local context, and takes account of current work, challenges, and emerging issues, as well as the degree to which the priorities presented in the previous version of the JHPP were considered to remain relevant. Priorities from the NHS Tayside HPT and Local authorities were compiled and overlapping areas used to inform the joint health protection priorities for 2025-2027: Our joint health protection priorities for 2025-2027 and how these will be addressed are discussed in section 4.3. It is recognised that there are a number of important areas of health protection work which are not captured within the priorities of this plan, including Sexual Health and Blood Borne Viruses (SHBBV), Healthcare Associated Infection (HAI), and Antimicrobial Resistance (AMR). These topics have purposively not been included because in Tayside the strategic oversight and primary responsibility for progressing work on these areas does not sit with the HPT or local authority environmental health, as outlined below. SHBBV: The Tayside Sexual Health and Blood Borne Virus Managed Care Network (SH & BBV MCN) is a multi-agency group which provides strategic direction and governance regarding work to improve population sexual health and wellbeing and the prevention, identification and treatment of BBVs. The group is responsible for ensuring the outcomes in the national SH & BBV Framework are delivered locally, and for the delivery of Healthcare Improvement Scotland (HIS) Sexual Health Standards, HIV Standards and Hepatitis C Quality Indicators. HAI: The NHS Tayside Infection Prevention and Control Team, under the management of the Nurse Director, provides direction, leadership, monitoring and guidance to support the response to Hospital Acquired Infections. This is directed under the Scottish Government Healthcare Associated Infection Strategy 2023-2025 and facilitated by deliverables for the phases of the response . • Reducing incidence of vaccine preventable diseases • Pandemic preparedness • Inclusion health NHS Tayside HPT Priorities • Investigate communicable disease cases and outbreaks within required timescales • Food Hygiene and Standards Enforcement • Monitor air, water and land quality and respond to related incidents Local Authority Priorities • Outbreak management of communicable disesases • Incident management of environmental health hazards • Horizon scanning and emerging threats Shared Priorities
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18 AMR: The NHS Tayside Infection Prevention and Control Team similarly supports the response to antimicrobial resistance, in collaboration with Microbiology and Infectious Diseases teams. This is guided by the UK government UK 5-year action plan for antimicrobial resistance 2019 to 202424 and the UK government policy paper on Confronting antimicrobial resistance 2024 to 202925. 4.3 Our priorities for 2025-2027 Table 6: Joint health protection priorities in Tayside for 2025-2027 Priority W hy is this a priority? How will this priority be addressed: ACTIONS Expected achievements/outcomes at end of JHPP 25-27 Outbreak management and prevention of communicable diseases Co-ordinated efforts to limit the spread of infectious diseases are essential in minimising harm within the local and wider population. This remains both relevant and subject to increased focus as new threats emerge (e.g. Mpox, Avian Influenza), and the incidence of older, highly infections vaccine- preventable diseases, such as measles and pertussis, exhibit resurgence. This is also a core remit of Local authorities, particularly where infections are GI or zoonotic related, and premises and food hygiene standards may be implicated. Similarly, other infectious diseases, such as Legionella, may be related to premises, requiring co- ordinated actions between the HPT and local authorities to effectively control. Demonstrate effective HP incident responses, involving local authority partners at an early stage wherever relevant. Aim to respond in line with national guidance and ensure effective partnership working and sharing of learning. Further strengthen collaborative approach and partnership working through shared training and exercising of plans. Enhanced opportunistic and proactive work with partners to increase vaccine uptake of relevant notifiable diseases. Effective collaborative response to outbreaks, within nationally recommended and locally agreed timelines26. Continued quarterly HPT and local authority joint meetings to discuss preparedness and response. At least one joint exercise of a Health Protection Incident relating to communicable disease (aiming to be held before the end of 2025). Formal debriefing and learning events from any jointly managed outbreaks. Incident management and prevention of Environmental health hazards have both short- and long-term impacts on population health, with added critical importance Incidents to be responded to in line with national guidance on the management of public health incidents . This includes Effective collaborative response to incidents, within nationally recommended and locally agreed timelines. 24 Department of Health and Social Care. UK 5-year action plan for antimicrobial resistance 2019 to 2024. https://www.gov.uk/government/publications/uk-5-year-action-plan-for-antimicrobial-resistance-2019-to-2024 25 UK Government Policy Paper. Confronting antimicrobial resistance 2024 to 2029. https://www.gov.uk/government/publications/uk-5-year-action-plan-for-antimicrobial-resistance-2024-to- 2029/confronting-antimicrobial-resistance-2024-to-2029 26 Example of monitoring of targets can be found in Dundee Council planning documents. Neighbourhood Services Service Plan, p. 27. https://www.dundeecity.gov.uk/sites/default/files/publications/neighbourhood_services_service_plan_2023_-_27.pdf
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19 environmental health hazards in context of planetary health, biodiversity and climate change. The frequency of environmental hazards relating to Pollution & Waste Services is also anticipated to increase due to impacts of climate change, e.g. flooding, storms or algae blooms. Climate change and associated environmental health hazards are an increasing public health priority.27 Develop and consult on the development / update of relevant strategies as required e.g. Contaminated Land strategies Increase working relationships with wider partners, e.g. SEPA, to ensure appropriate actions are taken and enforced At least one joint exercise of a Health Protection Incident relating to environmental health hazards (aiming to be held by mid-2026). Formal debriefing and learning events from any jointly managed incidents. Horizon scanning and emerging threats Resilience and emergency planning are integral to both the response to emerging threats, and the recovery of organisations to core functioning. The COVID-19 pandemic emphasised the need for this, in addition to the international outbreaks of Mpox in recent years. Pandemic preparedness is included in this, particularly in context of the continued threat of avian influenza. Inclusion health is also important to consider as part of horizon scanning, in view of the increased risks posed to vulnerable populations, including TB, BBV, vaccine- preventable diseases and climate change. NHS Tayside HPT to consult and collaboratively involve local authorities on relevant sections of health protection plans, e.g. the Pandemic flu plan. NHS Tayside HPT to keep local authorities abreast of any emerging threats/ infections from national and international intelligence, and vice-versa. NHS Tayside and local authorities to strengthen working relationships with wider partners, e.g. APHA, to ensure appropriate planning and preparedness. All partners to ensure business continuity/ resilience plans are in place, particularly with any consideration of potential impacts on service delivery. Increased attention, proactive actions and targeting of preventative actions to be considered for vulnerable communities at specific and increased risk from emerging outbreaks and threats, including collaboration with Up to date emergency and resilience plans for all partners, e.g. pandemic flu plan. A tabletop exercise or learning event focussed on responding to emerging threats, pandemic planning and considering other potential threats (including resource limitations). Aiming to be held before the end of 2026. Increased consideration of inclusion health in regular preventative work, e.g. in preparations for the resettlement of people who are refugees or asylum seekers (including living conditions, vaccination, access to health services). 27 Public Health Scotland. Climate Emergency and Environmental Health. https://www.publichealthscotland.scot/population-health/environmental-health-impacts/climate-emergency/phs-s- strategic-approach-to-climate-and-sustainability/delivering-phs-s-strategic-approach/
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20 wider partners and third sector. 4.4 Health Protection Incidents The NHS Tayside HPT, alongside the local authorities and wider partners, manage numerous cases, outbreaks and incidents each year to limit actual and potential harm to the wider population. A number of recent situations and incidents are outlined below, along with lessons learned and subsequent improvements made. Table 7: Overview of significant health protection incidents since last JHPP Situation Date Description, Lessons Learned, and improvements made to plans and services where applicable to better address future incidents Significant infectious disease incidents/outbreaks COVID-19 pandemic 2020-2023 Learning on local and national resilience has been developed in light of the pandemic, with considerations of future pandemic preparations, staffing capacity, response pathways and co-ordination of resources and guidance. Relationships with local authorities were also strengthened during this time, with inspection of premises complementing outbreak response management. Mpox 2022-2024 The Mpox outbreak highlighted the need for collaborative working, particularly with sexual health and the third sector to effectively respond to this incident in view of the associated stigma, and difficulties with effectively communicating messaging. Pathways for managing high consequence infectious diseases (HCID) cases have also been discussed and worked through at local and national level to better respond to any future possible cases of infections such as Ebola or MERS. Measles preparedness 2023-2024 Single cases have been managed in Tayside over recent years, often requiring Problem Assessment Groups and Incident Management Teams to effectively facilitate the response, co-ordinate actions, and limit spread through robust contact tracing. An emphasis on vaccination uptake has been highlighted by the upsurge in cases in other parts of the UK and internationally, with improved working with the vaccination team developed to facilitate post-exposure vaccination when needed. Other infectious diseases and Food-borne incidents Increase in Shiga toxin producing E. coli (STEC) cases, and associated clusters 2022-2024 Since the introduction of PCR testing in NHS Tayside, there has been an increased detection rate of STEC cases. This has required a revised way of working with local authorities to facilitate effective case response. These new processes have been well received with NHS Tayside and the Local Authorities, allowing cases to be adequately responded to without overwhelming either team. Additionally, this shared working and learning has led to closer working relationships between HPT, local authorities and the microbiology teams. Research into the most appropriate actions for the different subtypes and serotypes of STEC has also been carried out, along with collaborative input into national meetings when national clusters of certain E. coli subtypes have been identified.
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21 Pertussis 2024 Over 2024 there has been a significant rise in the number of pertussis cases. Pertussis is a cyclical infection with increases seen every 3-5 years. This is also in the context of a reduction in the uptake of routine childhood vaccinations. While uptake in Scotland remains above that in other areas of the UK, this reduction emphasises a continued requirement to encourage the uptake of routine vaccinations. The HPT has worked to streamline management of pertussis cases, as well as working with GPs and OOHs to arrange treatment where needed. Avian influenza 2022-2024 Avian influenza remains an annual threat, with infected wild and domestic birds identified each year. NHS Tayside HPT works closely with the Animal and Plant Health Agency to respond to relevant situations. Of particular concern is spread to humans, with cases of Avian influenza in wild birds as well as farms being identified in Tayside in recent years, requiring extensive and detailed follow up, and co-ordination with national bodies. Streamlining communication between agencies remains a priority to enable rapid and effective responses. In 2023, the HPT was called on to manage a temporary resident of Tayside who had been exposed to highly pathogenic avian influenza in an incident in England, which generated an extensive response and considerable media interest. The HPT contributed to subsequent whole system UK-level debrief and process improvement discussions. Other hazards Environmental situations 2024 NHS Tayside HPT has worked closely with local authorities and the Scottish Environmental Protection Agency to respond to environmental situations with the potential to impact human health, e.g. fuel spills with risk of contaminating land, or blue-green algae impacting lochs and reservoirs. Due to there being a theoretical risk but no actual documented harms to human health in the specific situations concerned, enforcement of actions relating to such incidents on private land remains difficult, but an area of continued focus. Infections relating to water bodies 2020-2024 Infection, and the risk of wider transmission, of water bodies poses a relatively common threat to Tayside, requiring an assessment of risk, involvement of local authorities and Scottish Water, and potential actions where relevant. Examples include contaminated private water supplies, failed samples from holiday complexes, and infections relating to swimming pools (e.g. cryptosporidium). Occasionally, this has necessitated closure of premises with close working with the local authorities, and tailored advice to the public to minimise the potential threat. Local authorities carry out regular sampling of recreational water bodies (including blue-green algae) and private water sources to minimise this threat, whilst water-related infections are investigated for potential sources by the HPT to minimise risks. Additionally, SEPA also undertake sampling of bathing waters during the bathing season (sampling takes place May – September), with a number of Tayside beaches included 28. Chemical incidents 2020-2024 NHS Tayside has managed several chemical incidents in recent years, with close collaboration with the Scottish Fire and Rescue service, and police authorities. Often these are contained rapidly by these services without requiring HPT input. However, there have been a few incidents requiring specific public health input to ascertain the risk and consider 28 SEPA. https://beta.sepa.scot/news/2024/record-number-of-excellent-bathing-waters-in-scotland-for-2025/
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22 wider actions. Key learning from these events has centred around communication between various partners and organisations, and the involvement of the Local Resilience Partnership where appropriate to help co-ordinate the response. Reports of the Incident Management Teams (IMT) established to coordinate the management of such incidents are reviewed through clinical governance structures within NHS Tayside, including the Health Protection Management group and Public Health Governance group, and are available on request. Debrief events following such incidents are usually held to help capture learning and improve processes going forward. Joint meetings between HPT and Local Authorities, alongside other partners e.g. Scottish Water and SEPA, are also held quarterly as a means of improving collaboration, reviewing processes, sharing good practice and reflections, providing advice and learning, and discussing recent incidents to improve future responses.
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Appendix 1 5. Resources and Operational Arrangements 5.1 Staffing As outlined previously, the health protection function in Tayside is provided jointly by NHS Tayside and the three partner local authority areas of Angus, Dundee City, and Perth and Kinross. Across these four organisations there are almost 50 people designated as “competent persons” under the Public Health etc. (Scotland) Act 2008, and who are able to exercise the relevant powers specified in the Act. The staffing provision for delivering health protection services within each organisation is outlined below. However, it should be noted that these figures may fluctuate during the period of time covered by the JHPP. Further details of individual roles and responsibilities are available from each department if required. 5.1.1 NHS Tayside Health Protection Team The NHS Tayside Health Protection function is continuously operational 24 hours a day, 7 days a week. There are 10 Consultants in Public Health (Medicine) (CPH(M)), and 1 Advanced Specialist Nurse designated as competent persons under the Public Health etc. (Scotland) Act 2008 within NHS Tayside. In-hours: During office hours (Monday to Friday, 9am to 5pm, excluding public holidays), a small multidisciplinary team operates to deliver the full range of services (Table 8). Table 8: NHS Tayside HPT staff contributing to the provision of health protection function (in hours) Role FTE Consultant in Public Health (Health Protection) 2.4 Health Protection Nurse Specialists 6.5 (1 WTE Band 8a Advanced Specialist Nurse; 1 WTE Band 7 Senior Specialist Nurse; 4.5 WTE of Band 6 Specialist Nurse) Personal Assistants 1 Administrative Assistant 1 Out-of-hours: A named CPH(M) is available at all times out of hours and can be contacted via Ninewells Hospital switchboard. To provide this on-call service, the Consultants in Health Protection participate in a weekly rota together with the Director of Public Health (DPH) and other CPH(M)s who do not work within the HPT during weekdays. The on-call CPH(M) is supported by a Health Protection Nurse during the hours of 9am-5pm on weekends and on public holidays, and at times by a training grade specialty registrar contributing to the on-call rota on a 1 in 7 FTE basis (Table 9). Table 9: NHS Tayside staff contributing to the provision of health protection function (out of hours) Role Period covered CPH(M) / DPH 24/7 evenings and weekends Health Protection Nurse Specialists 9am-5pm weekends and public holidays Specialty Registrars in Public Health Variable ‘first on’ coverage, typically 1-2 evening or weekend shifts per week Personal Assistants / Public Health Surveillance Officers No on-call coverage
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24 5.1.2. Angus Council In-hours: Angus Council has 13.5 FTE Environmental Health Officers (EHO) who are designated as competent persons under the Public Health etc. (Scotland) Act 2008. Additional members of staff who contribute to the provision of the public health function in Angus include: one Food Safety Officer, two Environmental Health Technicians, one Contaminated Land Officer and 1.4 FTE Animal Health Officers. Out-of-hours: There is no formal on-call arrangement or standby Environmental Health coverage out of hours. However, in the event of a major public health outbreak or incident with the potential to impact Angus, a locally agreed process is in place for on-call Public Health to attempt to make contact with senior members of staff within the Vibrant Communities or Environmental Health teams. 5.1.3. Dundee City Council In-hours: Dundee City Council has 14 FTE Environmental Health Officers (EHO) who are designated as competent persons under the Public Health etc. (Scotland) Act 2008, including three middle managers, and three supervisory posts / senior EHOs. There are a further 22.6 FTE staff who contribute to public health protection functions including: Food Safety Officers, Licensing Standards Officers, Contaminated Land Officers, Pest Control Officers, Public Health Technician, and Environmental Compliance Officers, etc. Out-of-hours: A locally agreed process is in place for on-call Public Health to attempt to make contact with senior EHOs or other members of the Regulatory Services team in the event of a major public health outbreak or incident with the potential to impact Dundee. 5.1.4 Perth and Kinross Council In-hours: Perth and Kinross have 7.0 FTE Environmental Health Officers (EHOs) who are designated as competent persons under the Public Health etc. (Scotland) Act 2008. In addition, there are a further 11 FTE officers who contribute to public health protection functions including: Environmental Health, Contaminated Land, Food Safety, Air Quality, Private Water Supplies. It is noted that animal welfare/licencing/dog control is currently enforced by PKC’s Trading Standards service. Out-of-hours: There is an informal Environmental Health on-call arrangement out of hours. In the event of a public health incident with the potential to impact Perth and Kinross, a local emergency response process is in place whereby on-call Public Health can contact senior management to advise relevant Environmental Health officers. 5.2 IT and Communications Technology All partners have access to IT equipment and tools relevant to their roles, including desktop and laptop computers, mobile telephones and e-mail. In common with all other territorial NHS boards in Scotland, NHS Tayside HPT and on-call health protection staff use the HPZone case and incident management system to manage workflow and to act as the formal record of HPT activity.
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25 5.3 Collaborative working NHS Tayside HPT and Environmental Health partners from each of the local authority areas work closely together and with wider partners to deliver statutory health protection functions in Tayside. Organisational arrangements in place to facilitate effective collaborative working include the participation of NHS, local authority and other partners in health protection related multi-agency groups such as the Joint Environmental Health & Health Protection Team Group for Tayside and the Tayside Water and Blue-Green Algae Group (Table 10). A number of other formal and informal arrangements are in place to facilitate collaborative working including ad hoc meetings, phone calls, teleconferencing and emails, as well as occasional joint training exercises. Table 10: Inter-organisational health protection groups in Tayside Group Remit Membership Joint Environmental Health & Health Protection Team Group for Tayside (meeting frequency: four- monthly) Overseeing the development, publication, dissemination and implementation of the JHPP, or subsequent alternative planning processes. Discussing case management and sharing good practice Collaborating in the development and implementation of local policies and protocols for the investigation, management and communication of communicable disease and environmental hazards where joint working is required to protect the public. NHS Tayside HPT, Environmental Health from Angus, Dundee, and Perth & Kinross councils Scottish Water SEPA NHS Tayside microbiology Others invited as necessary where attendance is felt likely to bring experience of expertise beneficial to the group Tayside Water and Blue-Green Algae Group (meeting frequency: annual) Overseeing the development, publication, dissemination and implementation of the Tayside Cyanobacteria (Blue-Green Algae) Action Plan Providing a forum for discussing guidance updates, sharing good practice, and reflecting on learning from significant water events NHS Tayside HPT Environmental Health from Angus, Dundee, and Perth & Kinross councils Scottish Water Scottish Environment Protection Agency (SEPA) Drinking Water Quality Regulator (DWQR) 5.4 Standard Operating Procedures Within NHS Tayside, Health Protection Standard Operating Procedures are formulated within a Health Protection Manual that outlines the respective actions and guidance required for each notifiable disease, as well as commonly encountered environmental, chemical and other incidents, and infectious diseases. Members of the Health Protection Team are responsible for different sections within this manual, with a requirement to update these sections whenever there are national updates to the relevant guidance, emerging evidence, or on an approximate biennial basis.
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26 5.5 Maintaining knowledge, skills and competencies This section outlines the corporate arrangements for the maintenance of knowledge, skills and competencies of staff within the health board and local authorities who have health protection duties. 5.5.1 NHS Tayside NHS Tayside staff who contribute to the delivery of health protection functions undergo an annual appraisal to ensure their knowledge and skills remain up to date. All Consultants and Specialty Registrars who participate in the day duty and on-call rotas are required to maintain their skills and record continuing professional development (CPD) activities with the Faculty of Public Health (FPH) or alternative Royal College. Similar arrangements are in place for Health Protection Nurses, in accordance with the Agenda for Change Knowledge and Skills Framework process and nursing revalidation requirements set out in The Code (Nursing and Midwifery Council standards of practice and behaviour). HPT run monthly update and education sessions for core health protection staff and all Consultants and Registrars who contribute to the on-call rota, as well as any other colleagues across the Directorate of Public Health with a health protection related role. Staff from NHS Tayside’s laboratory services are regularly invited to join these meetings and will occasionally lead teaching sessions on microbiology or virology related topics. Environmental Health teams from local authorities are also invited to relevant meetings to share their experience and input, helping build a shared understanding and approach on topics. All staff are encouraged to identify their own learning needs and to attend external conferences, meetings, and events when able as part of wider CPD activities. 5.5.2 Local authorities Local authority Environmental Health professionals generally follow a Performance Development Review appraisal process, or equivalent, on a regular basis, E.g. the Employee Review Development process in Perth and Kinross Council Regular ‘in-house’ training and CPD activities covering a range of public health and environmental matters are available for new starts and established staff members Meet Food Standards Scotland’s terms of ongoing CPD and experience required for food enforcement (Food Law Code of Practice (Scotland) is under review at the moment) Voluntary participation in Royal Environmental Health Institute of Scotland (REHIS) scheme of CPD Participation in external meetings/events/conferences/liaison groups/working groups e.g. REHIS Public Health & Housing Working Group, The REHIS Scottish Pollution Control Co-ordinating Committee, the East of Scotland Liaison Group which is a subgroup of Scottish Food Enforcement Liaison Committee. Planning, training and exercising public health plans at the Local Resilience Partnership level, arranged jointly with resilience teams.
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27 5.5.3 Joint training NHS Tayside and local authority partners aim to ensure that details of relevant training opportunities and conferences that may be of interest are shared between agencies. There are occasional joint training sessions between NHS Tayside HPT, local authority environmental health staff, and other partners. For example, since the publication of the last JHPP, staff contributing to health protection functions in Tayside have had the opportunity to attend a Scientific and Technical Advice Cell (STAC) training session. All partners consulted in the preparation of this updated plan considered joint training exercises to be helpful, and one of the actions for the joint priorities, as outlined in Table 6, is to have more shared training exercises to further enhance learning and collaboration.
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Appendix 1 6 Capacity and Resilience 6.1 NHS Tayside NHS Tayside Public Health Directorate has a business continuity plan and an escalation plan which incorporates the Health Protection Team, and priorities this service in the event of major disruption. For example, during the COVID-19 pandemic, core HPT staffing levels were increased to enable the service to respond to a sustained rise in workload associated with the pressures of the pandemic response. Staffing capacity and resilience were last reviewed within the plan in April 2024 with contingencies measures and preparations put in place. The Director of Public Health and Assistant Directors of Public Health provide added resilience in the event of the duty HPT consultants being unable to fulfil their duties. Further considerations relating to resilience are within the Business Continuity Plan, with actions being taken to ensure future resilience, including mutual aid at a local level and prioritisation of areas of delivery across the Directorate. The business continuity plan is reviewed on an annual basis, with the next review planned for April 2025. In addition, Tayside is an active member of the North of Scotland Regional Resilience Partnership, as part of the ‘Ready Scotland’ initiative29, (alongside Grampian, Highland and the Island Health Board Areas), with mutual aid arrangements in place for the North of Scotland Public Health Network should further capacity be required, e.g. in the event of a major outbreak or incident30 . 6.2 Local Authorities Each local authority has its own resilience team, and associated resilience and business continuity plans. This includes their public health function remit, and abilities to maintain this service aspect in the event of future challenges. Staffing capacity and resilience is reviewed on an ongoing basis. Key resilience considerations relating to significant public health threats, relate to Local Resilience Partnership (LRP) arrangements, which are also in place in Tayside. NHS Tayside and the Local Authorities contribute to this arrangement, including preparations and planning for any major incidents or emergencies affecting the local region. This includes the LRP Working Group and the LRP Strategic Group as well as specific constituents, e.g. the Pandemic Flu, Mass Fatalities and Mass Casualty plans. The aim is to provide clear structures, pathways and roles in the event of an incident. 29 Ready Scotland. Preparing for and dealing with emergencies. https://ready.scot/how-scotland- prepares/preparing-scotland-guidance/purpose-regional-resilience-partnerships-risk/regional-resilience- partnerships-risk-preparedness 30 Scottish Government. Scottish Regional Resilience Partnerships' framework: August 2022. https://www.gov.scot/publications/scottish-regional-resilience-partnerships-framework-exotic-notifiable- animal-diseases-contingency-plans-august-2022/pages/7/
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29 7 Public involvement and feedback Typically, there is no direct public involvement in the planning and delivery of health protection services. However, vaccination programmes, which are closely linked to health protection services, typically seek public involvement and user experience, such as focus groups, to understand how best to deliver services to meet the needs of the local population 31. Additionally, in line with the Patient Rights (Scotland) Act 2011, NHS Tayside seeks patient feedback, comments, complaints and concerns on an ongoing basis and through a range of different methods, to improve patient experience of using health services, and to support people to become more involved in their health and health care. The range of different methods used to elicit feedback and the governance structure, as well as findings on common themes and actions taken in response are published annually.32 Feedback and complaints received from the public on case management and incidents are responded to promptly and used to reflect on practices, develop learning and improve the service wherever possible, for example, strengthening consistent and transparent communications, or how pathways between services, including the laboratories, are organised. The Tayside HPT and local authorities also provide opportunity as a matter of course for questions/concerns when following up and interviewing members of the public about health protection issues. Furthermore, the three local authorities have inbuilt mechanisms to engage with the public/offer the opportunity to provide feedback. This includes public consultation on various environmental plans and strategies, community engagement events, directed surveys and open invites though web services and social media. Similarly, local authorities often provide direct advice and awareness on health protection precautions to the public through social media e.g. attendance at petting farms/zoo’s, blue green algae incidents, food alerts etc. 31 Public Health Scotland. Scotland's 5-year Vaccination and Immunisation Framework and Delivery Plan. https://publichealthscotland.scot/publications/scotlands-5-year-vaccination-and-immunisation-framework- and-delivery-plan/ 32 NHS Tayside. Feedback Report (2021-2022). https://www.nhstaysidecdn.scot.nhs.uk/NHSTaysideWeb/idcplg?IdcService=GET_SECURE_FILE&Rendition=we b&RevisionSelectionMethod=LatestReleased&noSaveAs=1&dDocName=prod_368529 (accessed 22 Oct 2024).
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Appendix 1 8 Summary The landscape of health protection has seen several significant changes over recent years, not least in context of the COVID-19 pandemic. These have shaped processes, plans, and collaboration opportunities. Consequently, the Joint Health Protection Plan for 2025-2027 provides an opportunity to strengthen the networks established over recent years and build on developments and progress. The shared priorities for the next two years encompass this and consider the recent and present health protection context. The priorities focussing on outbreak management and prevention of communicable diseases, incident management and prevention of environmental health hazards, and horizon scanning and emerging threats, reflect the shared focus of NHS Tayside HPT and local authorities on being able to effectively respond to situations and threats to public health, and strengthen activities and plans to prevent them. The actions and outcomes encapsulate the importance of planning, and joint preparation and learning, to enable this, particularly where situations can be unpredictable. Moreover, critical to any response is good communication, and this plan seeks to build on established relationships to effectively deliver the shared health protection activities and responsibilities in NHS Tayside. The JHPP will aim next to be reviewed and updated in consultation with colleagues in the local authorities in 2027, with the current priorities and actions being kept under review to facilitate implementation.