Joint HealthProtection Plan 2016-2018
Foreword
This Joint HealthProtection Plan (JHPP) provides an overviewof health protection (communicabledisease andenvironmental health) priorities, provision and preparednessfor NHS Grampian, Aberdeen City, AberdeenshireandThe MorayCouncils as required bythe PublicHealthetc (Scotland)Act 2008.
This is the fourthGrampianJoint Health Protection Plan, whichcovers the periodfrom1April 2016to31March2018andhasbeen prepared byNHS Grampian in collaborationwithAberdeen City, AberdeenshireandThe MorayCouncils.
Themain sectionof the plan describes the national and localprioritiesfor health protectionandwhat actions we plantotakeover thenext two years.The appendicesprovide moredetailonourplanninginfrastructure, resourcesandoperationalarrangements, capacityandresilience, and public involvement.
Wehope that you will find thisplanofinterestandthattheactions describedwill contributeto protecting thehealth of thepeople wholive andwork in Aberdeen City, Aberdeenshire and Moray.
Susan Webb
Interim Director of Public Health Belinda Miller, Head of Service, Economic Development andPublic Health Protective Services NHS Grampian Aberdeenshire Council
Jim GrantCarol Jackson
Head of Development ServicesProtective Services Manager
The Moray CouncilAberdeen City Council
This JHPPhas beenapproved by
•NHSGrampianBoard
•Aberdeen CityCouncil
•Aberdeenshire Council
•TheMorayCouncil
The planis apublic documentandis available tomembers of the public ontheNHS Grampianwebsiteat
andon request from
Public Health Directorate NHS Grampian Summerfield House
2EdayRoad AberdeenAB15 6RE
Email:
This plan is also availablein large printand other formats andlanguages, upon request. Please callNHS Grampian CorporateCommunicationson (01224) 551116 or (01224) 552245.
Index of contents
Healthprotection:nationaland local prioritiesandlocal actionsPage5
Appendix1 / OverviewofNHSBoard and Local Authorities / Page / 27Appendix2 / Healthprotection:planninginfrastructure / Page / 29
Appendix3 33 33 / Healthprotection: resources and operationalarrangements / Page / 35
Appendix4 / Healthprotection services: capacityand resilience / Page / 42
Appendix5 / Healthprotection:public involvement andfeedback / Page / 43
Health Protection:National and Local PrioritiesandLocalActions
NHS Grampian,Aberdeen City, Aberdeenshire and the The MorayCouncils work closelytogether with our partneragencies todeliver services to protect thehealth of the Grampianpopulation. ‘HealthProtection’is the termused to describethe surveillance, investigation, control and prevention ofcommunicablediseaseandenvironmental hazards to human health.
Thisplanoutlinesourcurrent andfuture actions toaddress the national and local priorities for healthprotectionin Scotland and Grampian,taking account of local risks and challenges andlessons identified fromrecentoutbreaksandincidents.
Since 2014, the ScottishGovernmenthas completed areviewofHealth Protectionin Scotland andthe NHS Grampian Health ProtectionTeamhas becomepartof thenationalobligateScottish Health Protection Network.Currently, two further national reviews are underway: a review of the NHS Public Health function and a Shared Services review. We await their final reports which are likely to influence our priorities for 2016-2018.
Effective communication with allcommunities in Grampianis anessential componentofpublic healthactivity.Grampian isan attractive areafor inward migration,especially fromEastern Europeandmanymigrant workers andtheirfamiliesare
non-English- speakingwhen theyfirst arrive. Accordingly, to ensure effective communicationwith thesecommunities, NHS Grampian has putin placetheLanguage Line telephone interpretation service in over 600 locationsand expanded the pool ofavailableface-to-face interpreters.Thereis also a greatdealofrelevant healthcarematerial readilyavailable in themain local ethnic community languages. Specificmaterial can be produced, ifrequired.
The needs of peoplewith communicationdisabilities are also carefullyconsidered.NHS Grampianprovides awide range ofsupporttohelpovercomeanycommunication barriers.
1.Managing Threats to the Public’s Health
Our overridingpriorityis to providea responsetoincidentsthatmaypresentathreatto thepublic’s health. This includes respondingtoboth communicable diseaseand environmentalincidents.This responsemust be available24hours of eachday.
The operational response is dependentonhaving effective surveillance systems in place to detect changes in communicabledisease andenvironmentalexposures andtheresources to respond inaneffective and efficient way.
In2014-16NHSGrampianand Local Authoritypartners havereviewedand revisedtheInfectious Disease Incident Planinaccordance withthe revisedScottish Government guidanceon theManagement ofPublicHealth Incidents: Guidance on the RolesandResponsibilities of NHS led Incident Management Team, Updated July 2013.Wehave managed alarge numberofsingle cases ofcommunicable disease, outbreaks and incidentsover the lasttwo years.
From April 2016 the NHS Grampian Health Protection function has supported Shetland Health Board in meeting its statutory Public Health (Health Protection) responsibilities within and out of hours. This support will continue for a period of 12 months in the first instance and, following review in March 2017, may be continued on a longer term basis.
Action
NHS Grampianwill respond tothe conclusions oftheScottishGovernment reviewsof the NHS Public Health function and Shared Services. Together withour threeLocalAuthorities and Shetland Health Board we will consider theimplicationsfor our organisations andour joint workingarrangements with the aim of maintaining a sustainable response to threats to public health.
2.Major Infectious DiseasesincludingPandemicInfluenza
Pandemicinfluenza continues to represent the most significant civil emergency risk in the CabinetOfficeNational Risk Register of Civil Emergencies (NRR) (2015).Influenza pandemicsare intrinsicallyunpredictablewithregard totiming,severityandimpact.Incomparisonwithprevious influenza pandemics, the H1N1(2009) influenza pandemic was verymild, but there areno groundsforcomplacency.
Majorinfectiousdiseasepreparednessisanessentialpartofintegratedcivilprotectionandemergencymanagement.Althougha pandemicismostlikelytobecausedbyanewsubtypeoftheInfluenzaAvirus,therequiredresponseshould be precautionary, but proportional and flexible enough tomeet the specific demandsof anylocal major infectious disease incident.NHS Grampian planning is undertaken through the Major Infectious Disease Group, inclusive now of Health and Social Care Partnership representation.
The nature or magnitude of the wider consequences associated with a Major Infectious Disease Incident may require a multi-agency coordinated response, in addition to the Health Protection response and an integrated Health and Social care delivery response. Timely and sufficient escalation to tactical and strategic multi-agency coordination is required to manage an effective and efficient joint response. NHSGrampianretainstheresponsibilityforthelocalinvestigationandmanagementofthepublichealthaspectsofanincident, irrespectiveofaResiliencePartnershipcoordinatedresponse.
Theexisting Grampian Local Resilience Partnership (GLRP) plan(2012) has been reviewed, and the revised Major Infectious Disease Response Framework will be approved before the end of 2016. The existing NHS Grampian Major Infectious Disease Plan (2013) will be replaced by an integrated Major Infectious Disease Response Framework for Health and Social Care.
Actions
- NHS GrampianandLocal Authorities are required tomaintain up-to-dateoperational plans, basedon the UKInfluenza Pandemic Preparedness Strategy2011.
•Regular exercises should be conductedtotest and validateassumptions andensure that plans arefitforpurpose andworkable, and that staff areappropriatelytrained andprepared to activatethem.
- Allsectors of the NHSandpartner organisations shouldhave robust Business ContinuityPlans (BCPs)inplaceplus detailed surge capacity where appropriate. These plans can be genericand supporta response to bothpandemic influenza andother majoroutbreaks ofinfectious disease.
3.Immunisation andVaccine-preventable Diseases
Immunisationuptakeswithin the childhood programme remain generally good asdoesinfluenzavaccinationuptake among people aged 65 years and older.During2014-2016,several changes to thechild and adult immunisationprogrammeshave been successfullyimplemented in Grampian, inaccordance with national policy. Thesehave included introduction of MenB vaccination for infants and Men ACWY vaccination for teenagers, as well as roll-out of seasonal flu vaccination to include all children attending primary school. Impending change in the roles of health visitors and school nurses have implications for the future delivery of childhood immunization services. The current national renegotiation of the GP contract may also impact on the delivery of infant and pre-school child immunization.
Actions
NHS Grampian will:
- Implementtheanticipatedfurther changes tothenational childandadult vaccinationprogrammesduring2016-2018.
- Continue toreviewand updateourexistingpolicies for vaccine-preventablediseasesinlight ofnewandemergingevidence.
- Explore and determine the future local model of service provision for child immunization, taking account of the change in health visitor and school nurse roles and any agreed GP contract changes.
4.Tuberculosis
The ScottishTuberculosis (TB) ActionPlanwas publishedintheearlypart of 2011.Followingthis, the Grampian policyfor preventionandcontrol of TB was revisedto ensure ourpublichealth actions tomanageTB infectionremainfirmlybased on themostrecent evidence ofgoodpractice. In 2014, 38 Grampian residents were diagnosed with TB, giving a rate of 6.9 cases per 100,000 population, which was slightly higher than the rate for Scotland as a whole (6.5 per 100,000). TB continuestobe apotentiallylife-threateninginfection requiringseveral months of complexantibiotic treatment toachieve acure, sothis levelofinfection inthe communityremainsa cause ofconcern. Considerableongoingpublic healtheffort isneeded toreduce the risk oftransmission of this infection within Grampian.
Actions
•NHS Grampian will continue toleadonthemanagement ofTB cases, contacttracingandscreening ofcontactsin liaisonwith Local Authoritycolleagues where appropriate
•Newentrant screeningwillcontinuetobetargetedtowards those individuals presentingthehighest public health risk.
5.GastrointestinalIllness
Gastrointestinal (GI) and zoonotic infectionscontinue to posea clear andpresentdangerin Grampian.Theincidence ofsomeGI infections, particularly Verotoxigenic E coli (VTEC)O157 and non-O157 infections, is higher inGrampianthan the Scottishaverage. The incidence of some other infections is increasing e.g. Giardia, Hepatitis E infections. Thismaybe attributedtothelarge rural population and large number of households onprivatewater supplyin Grampian,which increases the risk of exposure to animalfaeces. Newer, more sensitive tests may also be a contributory factor. However, concerted effort byNHS Grampian HealthProtectionTeamand Local AuthorityEnvironmental Health colleagues in surveillance andmonitoringof GI illnesses, raisingpublic awareness aboutthe risk ofinfection and providing information on preventionandcontrol has led toareduction in the overall number of cases ofGIinfections in recent years. A Memorandum of Understanding supports the joint working between the NHS Grampian Health Protection Team and the environmental teams in each of the Councils.
Actions
•NHSGrampianwill continuetobuild on partnershipworkingandcollaborationwithourlocalauthority partnerstoensurethe general public is protectedagainst themenace of GI illnesses
•NHSGrampian,incollaborationwiththethreeLocalAuthorities,willcontinuetobuildonthesuccess ofthe public awareness campaign alreadyundertaken
•NHS Grampian, in collaboration with the three Local Authorities, will continue to collect information and data on GI infections and zoonoses for the purposes of prevention, control and surveillance of these diseases
•NHS Grampian, in collaboration with the three Local Authorities will continue to support the work of the Scottish Health Protection Network (SHPN) Gastrointestinal and Zoonoses (GIZ) Group.
6.Sexual Health and Blood Borne Viruses
Bloodborneviruses(BBVs) (HIV,hepatitis B, hepatitisC) are amajorpublic health problemin Grampian.Inthe UK, itis estimatedthat asignificantnumberofindividuals infectedwith these viruses are unaware oftheirinfection. A significant proportion of these infections are associated with travel to and fromcountries where the prevalenceofBBVsisveryhigh. In 2011,theScottish Government publishedaSexualHealthandBlood Borne Virus Framework 2011-15, which has been followed by a 2015 – 2020 update. This framework outlinesthe vision to improve sexual health(SH)andreduceBBVs in Scotland.Theframework reiterates the needfor partnership and joined-up workingwith local authority, third sector and otherpartners toachieve better outcomesforpeople with sexual health problemsand BBVinfections.
InGrampian, Sexual HealthandBBV work is coordinatedbytheSHandBBV ManagedCare Network (MCN) andthe MCN sets priorities based on theSH/BBVframework.
In2016/17, theSH/BBV MCN priorities are to:
•reduce inequalities in sexual health
•increase uptake of long acting reversible contraception (LARC) across Grampian
•reduce recently acquired HCV infection and reduce risk of HCV infection amongst IVDU
•reduce undiagnosed BBV infections in Grampian by increasingtestingfor BBVsinatrisk groups,and care and support for those with hepatitis B, hepatitis C and HIV infections.
SincetheScottishGovernmentpublishedtheSH/BBVframework, NHS Grampian,throughthe MCN and in collaboration with its partnershas:
•completedanHIVneeds assessment and subsequentlyimplemented animprovement planin 2013/14
•rolledout dried bloodspot(DBS) testingin non NHS sitesincludingin drugservices and voluntaryorganisationsproviding needle exchangefor peoplewho inject drugs
•completedaHepatitisBneedsassessment
•completed a review of abortion and repeat abortion in Grampian
•continued work to promote increased BBV testing in primary care, workplace and university settings
•promoted increased support and care for people living with viral hepatitis and HIV.
Actions
NHS Grampianwill:
•continue todevelop novelways to increase BBV testinginthe‘hard toreach’ atrisk population
•continue towork in partnership with localauthority, 3rdsector andother partners to improve the qualityofservices for people with sexual health and BBV disease in Grampian through the Managed Care Network.
7.HealthcareAssociatedInfection
NHSGrampian continues toimplementtheAnnual HealthcareAssociatedInfection(HAI)Work plan,andthefindings fromregular HealthcareEnvironment Inspectorateinspections.
Clostridiumdifficileinfection, Staphylococcusaureusbacteraemiaand surgical siteinfectionsurveillance is carriedout inallhealth carefacilities inNHSGrampian.Surveillance information can be accessedfromthe Health ProtectionScotlandweb site
Actions
NHS Grampian is committed to:
•reducinghealthcareassociated infectionsandhasdeveloped systemsforsurveillance,andmulti-disciplinarycollaborationand communication
•ensuringcompliancewith infection prevention and control policies,protocolsand guidelines
•providingeducationand trainingin infection prevention and controlfor all staff,includingthose in the community
•implementingqualityimprovementmethodologyin the prevention of healthcareassociated infection.
8.Water
The NHS Grampian Health Protection Team works with the Environmental Health Departments of the three Local Authorities and Scottish Water to monitor and address any issues of water quality for the population of Aberdeen City, Aberdeenshire and Moray. Most water is distributed through the mains system managed by Scottish Water and is routinely monitored for pathogens and chemicals of concern. A significant proportion of domestic and commercial supplies are on Private Water Supplies (PWS), with quality assurance monitored mostly through Environmental Health teams. The relatively high proportion of PWS in Aberdeenshire and Moray Council areas place our populations at some degree of increased risk, which is managed collaboratively. Apart from monitoring the water and encouraging safe use of such systems, an assessment is being made of how conversion from PWS to mains supply can be promoted and facilitated.
Actions
NHS Grampian is committed to
- ensuring the continued good quality of water to the population of Grampian by
- managing any risks in relation to water quality through education, monitoring and incident management (when needed).
9.Health Protection Priorities within Local Authorities: LocalHealth Protection PrioritiesCarriedoutbyEnvironmentalHealthProfessionalswithin LocalAuthorities
9.1Environmental Protection
9.1.1 Monitoring andimproving airquality
The Scottish Government’s Clean Air for Scotland – The Road to a Healthier Future, November 2015 (CAFS) includes, for delivery by Health Boards, the action: ‘NHS Boards and their local authority partners will include reference to air quality and health in thenext revision of their Joint Health Protection Plans, which should identify and address specific local priority issues’.
AberdeenshireCouncilcompletes annualreports in accordancewith ScottishGovernmentguidance.No Detailed Assessmentshave been requiredand no Air QualityManagement Areas have been declared.The Council monitorsnitrogen dioxide levelsin anumberof urban locations.Appropriateassessmentsaremade of planningapplicationsthatmaygive risetoairquality concerns,including biomass boilers.
Aberdeen CityCouncil, in liaison with NHS Grampian, will support the implementation of the CAFS actions and specifically promote the provision of local information about air quality, support behaviour change to improve health and air quality, and encourage active travel and alternatives to car travel. Annual reports are completed in accordance with Scottish Government guidance. Three Air Quality Management Areas have been declared: City Centre; Wellington Road (Queen Elizabeth II Bridge – Balnagask Road); and the Haudigan roundabout/Auchmill Road corridor. An Air Quality Action Plan was approved in March 2011 and an updated report detailing current and proposed future measures to improve air quality was published in 2015.
The MorayCouncilcompletes annualreportsin accordance with theScottishGovernmentguidance. No detailed assessments foranypollutantswerehighlightedasbeing required inthe 2015 update report and noAirQuality ManagementAreashave been declared.Nitrogen dioxide levelsaremonitored at17 locations.Followingthe openingin 2012ofthe A96 Fochabers–Mosstodloch Bypass,significantreductionshave beenfound inthe levelsatthemonitoring pointin FochabersHigh Streetdue tothereducedtrafficflow.
9.1.2Controllingenvironmental noise/antisocialbehaviournoise
AberdeenshireCouncilEnvironmentalHealthServicehas responsibilityforinvestigatingnoisecomplaints. A mediation service is also available. Visitsare made outwith normal office hourson aplanned basis. Arrangementsare in place with Police Scotland to work togetheroncertaindomesticnoisecomplaints.The Service also liaises with the Council’sAnti-socialBehaviour Officersand a mediationservice toresolve complaints.
Aberdeen City’sAntisocial BehaviourInvestigationTeam (ASBIT), whichprovidesan outofhoursservice todealwith domesticnoise complaints,transferredtothe Community SafetyteaminJune 2010.The EnvironmentalHealth Service investigatesall othernoise complaints.
Aberdeen came underthe scope oftheEnvironmental Noise Directive (END)in2013 when the City’s transportation networkwasmappedfor noise.The strategicmapswereused to identify Candidate Noise ManagementAreas(CNMAs)and CandidateQuietAreas (CQAs). In 2015, 15 Noise Management Areas and two Quiet Areas went forward. The Aberdeen Noise Action Plan was submitted to the Scottish Government in March 2014 and is available to view at
The MorayCouncilEnvironmentalHealthhasresponsibility forinvestigatingnoisecomplaints.TheAntisocial Behaviour Teamispart ofEnvironmentalHealthand its communitywardens deal with domesticnoise complaints. Visitsaremade outwithnormalworking hours on a pre-arrangedbasis. Where enforcement is not an option, mediation is offered where both parties are willing to participate.
9.1.3Investigationandremediationof contaminated land
Aberdeenshire Council’sContaminated Land team has responsibility for undertaking site investigations under Part IIA of the Environmental Protection Act 1990, and for assessing any potential contamination issues identified from planning applications. There are four formally identified Contaminated Land sites in Aberdeenshire. Site investigation reports and remediation schemes are agreed as part of the planning application process.
Aberdeen City Council’sContaminated Land team investigates its area for sites where historic contamination presents a risk to human health or the wider environment. They also assess planning applications to ensure that sites with the potential for contamination are appropriately investigated and where necessary remediated to make them suitable for their new use.
The Moray Council continues to inspect sites potentially affected by historical land contamination in accordance with the statutory duty under Part IIA of the Environmental Protection Act 1990. Recent investigations have included: unexploded ordinance surveys of former army sites in Elgin; an area of public gardens in Keith that was formerly the town’s gas works; various residential developments built on former sawmills, railway yards and other industrial uses. However, many more potentially contaminated sites are dealt with through the planning process, with applications being screened to ensure the suitability of the sites for the proposed developments.
9.1.4 Investigation and abatementof statutorynuisance
Aberdeenshire CouncilEnvironmental Health Serviceinvestigates reports of potential statutory nuisance and works with authors of the nuisance, owners and other relevant parties to identify improvements to protect the health of residents, neighbours etc.
Aberdeen City Council’sEnvironmental Protection Team investigates reports of potential statutory nuisances which may affect the health of residents within the city. The officers will take the appropriate action to abate the nuisance,giving advice or taking enforcement action against owners or authors of the nuisance.
The Moray CouncilEnvironmental Health investigates complaints of potential statutory nuisances and takes the appropriate enforcement action to abate any nuisances to protect the health of persons who may be affected.
9.1.5 Monitorunauthorised encampments setupbythe travelling community.
AberdeenshireCouncil Housing Service is responsibleformanaging unauthorised encampments in accordancewith approved policy.The Council’s Officer/MemberSub Committeemeetsregularlytoconsider issues relating to the travelling community. TheHousing Service employs a Gypsy/Traveller Liaison Officer (GTLO) to address the needs of the travelling community and management of unauthorised encampments. EnvironmentalHealth dealwith any statutorynuisanceassociated with theseencampments.