1.1 to Date, Specialist Public Health Protection Responsibilities Relating to Chemicals

1Background

1.1 To date, specialist public health protection responsibilities relating to chemicals, radiation, poisons and environmental hazards (resting mainly with the National Public Health Service for Wales (NPHS) and Health Protection Agency (HPA))have not been definedas well as they could have.Not all local stakeholders are aware of the type and level of specialist public health protection resource available across Wales to help deal with complex environmental health protection issues and incidents. Similarly, some uncertainty exists amongst stakeholders about how the resourceis most appropriately accessed and used.

1.2The NHS restructure and the proposed development of a Public Health Wales NHS Trustin Waleshas provided an opportunity to clarify these issues and maximise stakeholder awareness of the services available to them. It is also an opportune time to inform stakeholders of the developments that have recently taken place to improve the specialist environmental public health protection resource in Wales.

1.3This report therefore defines specialist public health protection responsibilities in Wales. It provides details of the services in place to provide stakeholders with appropriate and timely information, advice and support to help deal with acute and chronic threatsassociated with chemicals, radiation, poisons and other environmental hazards. In addition, it proposes a model framework designed to facilitate effective stakeholder use of the resource and highlights the added value introduced into the service as a result of recent developments, risks, currentwork-streams and opportunities for future work.

1.4It should be noted that this report focuses on the specialist public health services available to assist local stakeholders deal with complex acute and chronic chemical, radiological, poison and other environmental-hazards related issues and events. Public health specialists will continue to work closely with, and rely upon support from, generalist public health staff working in Local Public Health Teams. These arrangements will ensure that local knowledge and understanding influence the response provided and the communication flowswith other local stakeholders (such as Local Health Boards and Local Authorities). Similarly, public health specialists will continue to use existing regional and national formal partnerships (e.g. the Welsh Assembly Government’s Chemicals and Health in the Environment Advisory Committee and the Directors of Public Protection in Wales Group) to raise awareness, engage wider stakeholders, influence policy and develop/disseminate best practice.

2Stakeholders

2.1This report is intended for use by those individuals and agenciesrequiring specialist public health information, advice and support in relation to chemical, radiological, poison and environmental hazard-related public health protection issues. Such stakeholders include local authorities in Wales, NHS organisations, the Environment Agency (Wales), Food Standards Agency (Wales), Health and Safety Executive (Wales), Welsh Assembly Government and emergency response services.

3Collective specialist public health protection responsibilities

3.1The collective specialist public health protection responsibilities relating to chemicals, radiation, poisons and other environmental hazards for the NPHSand the HPA in Wales, are as follows:

• Undertaking risk assessments and providing consistent specialist public health information, advice and support in respect of acute and chronic environmental public health protection issues (covering land/water/air quality, noise, waste and radiation incidents and events), including statutory responsibilities;
• Providing specialist advice and support in respect of effective risk communication around environmental public health protection issues;
• Providing consistent specialist public health advice to inform the development of emergency preparedness and response plans for environmental incidents;
• Providing specialist epidemiological expertise, information and advice to support the investigation of community concerns and follow-up exercise in relation to acute/chronic environmental hazard exposures;
• Providing clinical toxicological information for chemical/poison exposures;
• Providing specialist advice whereenvironmental and biological sampling is required and facilitating analysis by accredited laboratories;
• Through well established laboratory networks, providing specialist advice on both the planning for, and operational responses to, environmental incidents in terms of appropriate sampling and analytical techniques;
• Developing ongoing surveillance and environmental public health tracking programmes to help assess the relationship between environmental hazards, exposures and public health outcomes;
• Developing a prioritised programme of research and development in respect of environmental hazards, population exposures and health outcomes;
• Reducing inequalities through working with groups at high risk of environmental hazard exposure;
• Influencing policy/impact assessments to ensure that environmental public health protection matters (and health inequalities) are adequately addressed;
• Co-ordinating the public health response to the environmental effects of climate change that have the potential to impact on public health;
• Supporting and delivering appropriate environmental public health protection-related training and education;
• Where relevant, supporting to address environmental health improvement issues.

3.2For the purposes of this report, specialist public health protection responsibilities relating to chemicals, radiation and environmental hazards, do not include:

• Biological environmental hazards that may give rise to communicable diseases;
• Aspects of the built environment that may adversely impact on public health;
• Aspects of the wider physical environment that could adversely impact on public health e.g. community and neighbourhood design and layout.

Environmental health improvement issues such as these are dealt with via a separate mechanism. However, where overlaps exist, public health protection professionals will support others to address such issues.

4Specialist public health protection resource in Wales

4.1The NPHS and the HPA have specialist skills and expertise in different aspects of dealing with chemicals, radiation, poisons and other environmental hazards. The two organisations work collaboratively to deliver the aforementioned collective responsibilities and both are able to draw on specialist national expertise to plan/ prepare for, and respond to, local acute and chronic issues and incidents.

4.2The NPHS represents the largest specialist public health resource in Wales. It has a remit to provide the resource, information and advice to enable the Welsh Assembly Government, local authorities and NHS bodies to discharge their statutory public health functions. The organisation has a crucial role to play in terms of health protection, meeting its responsibilities through:

• Consultants in Communicable Disease Control and Health Protection Teams (South East, Mid & West and North Wales). Responsibilities extend beyond communicable disease control and includechemical, radiation, environmental hazards and emergency preparedness);
• Consultant in Environmental Public Health Protection (with all-Wales environmental public health protection responsibilities);
• The Communicable Disease Surveillance Centre (providing specialist advice in relation to epidemiological studies and investigations, incident management and epidemiological surveillance techniques);
• A microbiology laboratory network;
• A out of hours health protection service;
• Wider public health professionals working for the NPHS, but outside of the health protection discipline. This wider public health resource contributes to the organisation’s out of hours health protection service and is available in times when surge capacity is required to deal with major acute events;
• A dedicated public health communications team.

Through this resource, further specialist public health skills and expertise can be accessed through national and international expert network links.

4.3 The HPA provides authoritative scientific and medical advice to a broad range of stakeholders. The organisationcomprises a Centre for Emergency Preparedness and Response, a Centre for Infections, a Centre for Radiation, Chemicals and Environmental Hazards, a Regional Microbiology Network as well as Local and Regional Services. The Centre for Radiation, Chemicals and Environmental Hazards has a Radiation Protection Division and a Chemical Hazards and Poisons Division (including a commissioned National Poisons Information Service), responsible for providing advice about the known health effects of chemicals, radiation, poisons and other environmental hazards. The HPA operates a 24-hour dedicated chemical response hotline.

Whilst the HPA’s Centre for Radiation, Chemicals and Environmental Hazards has responsibilities across England and Wales, it has a physical presence in Walesthrough the Chemical Hazards and Poisons Division and National Poisons Information Service offices located in Cardiff. The Chemical Hazards and Poisons Division team based in Cardiff comprisesenvironmental public health scientists and medical staff with expertise in dealing with emergency preparedness and response and providing information and advice on public health risk assessments associated with contaminated land, integrated pollution prevention and control, noise, air and water quality issues.

Through this resource, further specialist public health skills and expertise can be accessed through national and international expert network links.

5 Other available expertise

5.1In addition to the NPHS and HPA, it may be appropriate and necessary for other agencies to also contribute to, and inform, the specialist public health response to chemical, radiological, poisons and environmental hazard-related issues and incidents.

5.2For example, the Environment Agency (Wales) has the potential to be a key contributor due to their environmental protection regulatory responsibilities, the specialist services they can deliver in respect of air quality sampling and monitoring and also their ability to provide comprehensive environmental emission data.

5.3Depending on the nature of the query or incident, information and advice may be provided by a broad range of other partner agencies, including emergency services, local authorities, Food Standards Agency (Wales), Health and Safety Executive (Wales), Welsh Assembly Government and private agencies such as water companies.

6 Specialist public health protection resource response

6.1 Since the specialist environmental health protection resource in Wales has developed significantly over the last five years or so, it now has a number of key roles to play in responding to a broad range of chemical, radiological, poison and environmental hazard-related issues and incidents. The manner in which the specialist public health resource responds, and the agencies it works with, will depend on the nature and scale of the issue or incident in question.

6.2The collective specialist public health resource (described earlier in this report) is able to provide atimely response to acute incidents on a 24/7/365 basis, when public health specialists will work closely with all relevant agencies. Should a major incident be declared, public health protection specialists will take directions initially from the emergency services (particularly fire service colleagues) and then actively contribute to the public health management of the incident (including any appropriate follow-up). For chronic or routine chemical, radiological, poison and environmental hazard-related issues or events, the collective specialist public health resource will provide a co-ordinated routine health protection/health gain response. In addition, public health specialists are able to provide a strategic response to support the development of relevant policy

6.3 Case study examples of collaborative action and responses provided by the collective specialist public health protection resource to chemicals, radiation and environmental hazards are provided in Appendix 1 of this report.

7 Using the specialist public health protection resource

7.1Stakeholders are encouraged to use to the specialist resource whenever specialist public health information, advice and/or support is required to assist them in dealing with complex environmental public health protection issues. It is important that stakeholders liaise with environmental public health protection specialists at the earliest opportunity as this will maximise the contribution of specialist public health professionals.

7.2The algorithm in Appendix 2 of this report proposes a framework to facilitate effective stakeholder use of the specialist environmental public health protection resource in Wales. It ishoped that such a framework will ensure that environmental public health protection issues are dealt with collaboratively, and in a timely, consistent and thorough manner across Wales.

7.3Contact details for the specialist public health protection resource are provided below:

National Public Health Service for Wales

During normal office working hours (09:00 to 17:00 weekdays):

• North Wales Health Protection Team

Telephone: 01352 803234 (Anglesey, Conwy, Denbighshire, Flintshire, Gwynedd, Wrexham).

• Mid & West Wales Health Protection Team

Telephone: 01792 607387 (Bridgend, Neath/Port Talbot, Swansea).

Telephone: 01267 225220 (Carmarthenshire, Ceredigion, Powys, Pembrokeshire).

• South East Wales Health Protection Team

Telephone: 02920 402478 (Cardiff, Merthyr Tydfil, Rhondda Cynon Taff, Vale of Glamorgan).

Telephone: 01495 332219 (Blaenau Gwent, Caerphilly, Monmouthshire, Newport, Torfaen).

• Consultant in Environmental Public Health Protection(02920 402478).

Outside of normal office working hours (17.00 to 09.00 weekdays, weekends and bank holidays), the NPHS can be contacted via:

• North Wales Ambulance Control. Telephone: 01248 689123
• Mid & West Wales Ambulance Control. Telephone: 01267 222555
• South East Wales Ambulance Control. Telephone: 01633 626118

Health protection Agency

• HPA CHaPD, Cardiff

Telephone: 02920 416388 (09:00 to 17:00 weekdays).

• HPA Chemical Hazards and Poisons Division 24 hour hotline

Telephone: 0844 892 0555

• Radiation Protection Division

Telephone: 01235 831600

8 Specialist resource developments, added value and risks

8.1A number of developments have continued to improve, and add value to, the specialist public health protection resource available to stakeholders.

8.2 Closer and stronger working links have been forged between the NPHS and the HPA. As a result of this, and due to each agency having specialist skills and expertise in different aspects of chemical, radiological, poison and environmental hazard-related public health protection, a greater focus has been given to developing agency-specific roles and responsibilities. Consequently, more effective and efficient ways of working have been established that allow aclosely integrated serviceto be delivered to those that need it wherever they are in Wales.

8.3 The recent appointment of a Consultant in Environmental Health Protection has contributed to this inter-agency collaboration and has increased capacity within the specialist resource. In addition, NPHS Health Protection Teams are now undertaking more public health protection work relating to chemicals, radiation, poisons and environmental hazards (alongside more traditional infectious disease control roles).

8.4 Whilst a significant amounthas been done to build capacity, sustainability and resilience within the specialist resource, there remains much work to do to ensure that these risks do not compromise or hinderservice developments in the longer-term.

9 Current and future workstreams

9.1The more streamlined and efficient ways in which the NPHS and HPA now operate mean that, in addition, to routine work, a greater emphasis can be given to providing a specialist public health input into relevantprojects. Currently, these include:

• mapping potentially hazardous sites across Wales (including COMAH sites);
• developing environmental sampling capabilities in Wales;
• developing exposure assessment toolkits;
• developing dose assessment and biological sampling frameworks;
• developing response arrangements to maritime hazardous & noxious substances;
• supporting implementation of the Children’s Environmental Health Action Plan;
• describing the nature of accidental misuse of chemicals and chemical products;
• developing the public health response to chemical incident emergencies toolkit;
• developing a forecasting/alert system for poor air quality in Wales;
• developing an alerting system for chemical health threats;
• supporting the Wales Water for Health project.

9.2There are, however, several identified priority areas for action,upon which the collective specialist public health resource will need to focus. These areas include the need to develop a programme of prioritised and targeted training and education for stakeholders, more emphasis on formally writing up work undertaken coupled with the ongoing dissemination of lessons learned from routine and non-routine work undertaken and the need to develop a formal network across Wales where relevant chemical, radiation, poison and other environmental hazard-related issues can be raised and discussed.

9.3 An issue of particular importance is that of governance, and the aforementioned developments have introduced greater opportunities to develop standardised arrangements to support service delivery and activity-related evaluations,reviews and audits. In turn, this will ensure continuous service quality improvement and assurance.

9.4In addition to the above, there may be opportunities for other future developments. For example, following the recent NHS restructure, each of the seven newly-formed Local Health Boards will have an executive member Local Public Health Director. It is anticipated that each of these seven Local Public Health Directors (when appointed) will have a very broad range of public health responsibilities spanning the domains of health protection, health improvement, health service quality and health intelligence. As a result, the work pressures and demands placed on Local Public Health Directors are expected to be extremely high. It may therefore be possible for each Local Public Health Director to be supportedby a specialist that could take on lead responsibilities for chemicals, radiation and environmental hazards in each of the Local Health Board areas. This would not only ease the pressures and demands on each of the Local Health Board Local Public Health Directors, but also create additional capacity within the specialist environmental public health protection resource through the development of a network of public health specialists with environmental public health protection skills and expertise.