Joint Health Protection Plan

2012-2014



Foreword

This Joint Health Protection Plan (JHPP) provides an overview of health protection (communicable disease and environmental health) priorities, provision and preparedness for NHS Grampian, AberdeenCity, Aberdeenshire and The Moray Councils as required by the Public Health etc (Scotland) Act 2008.

This is the second Grampian Joint Health Protection Plan and covers the period from 1 April 2012 to 31 March 2014 and has been prepared by NHS Grampian in collaboration with AberdeenCity, Aberdeenshire and The Moray Councils. This plan supports the delivery of the Grampian Health Plan 2010-2013 and the AberdeenCity, Aberdeenshire and the Moray Community Plans.

The main section of the plan describes the national and local priorities for health protection and what actions we plan to take over the next two years. The appendices provide more detail on our planning infrastructure, resources and operational arrangements, capacity and resilience, and public involvement.

We hope that you will find this plan of interest and that the actions described will contribute to protecting the health of the people who live and work in AberdeenCity, Aberdeenshire and Moray.

Sir Lewis RitchieMr Ian Robertson

Director of Public HealthHead of Protective Services

NHS GrampianAberdeenshire Council

Mrs Carole JacksonMr Donnie Mackay

Trading Standards and Commercial Premises ManagerEnvironmental Health Manager

Aberdeen City CouncilThe Moray Council

This JHPP has been approved by following committees

  • NHS Grampian Senior Management Team

•AberdeenCity Council Housing and Environment Committee

•Aberdeenshire Council Infrastructure Services Committee

•The Moray Council Planning & Regulatory Services Committee

The plan is a public document and is available to members of the public on the NHS Grampian website at and on request from

Public Health Directorate

NHS Grampian

Summerfield House

2 Eday Road

Aberdeen AB15 6RE

E-mail:

This planis also available in large print and other formats and languages, upon request. Please callNHS Grampian Corporate Communications on (01224) 551116 or (01224) 552245.

Index of contents

Health protection: national and local priorities and local actions Page 5

Appendix 1Overview of NHS Board and Local AuthoritiesPage29

Appendix 2Health protection: planning infrastructurePage32

Appendix 3Health protection: resources and operational arrangementsPage38

Appendix 4Health protection services: capacity and resiliencePage 47

Appendix 5 Health protection: public involvement and feedback Page 49
Health protection: national and local priorities and local actions

NHS Grampian, AberdeenCity, Aberdeenshire and the Moray Councils work closely together with our partner agencies to deliver services to protect the health of the Grampian population. Health Protectionis the term used to describe the surveillance, investigation, control and prevention of communicable disease and environmental hazards to human health.

This plan outlines our current and future actions to address the priorities for Health Protection in Scotlandas described by the Chief Medical Officer ( We have also taken into consideration local priorities, local risks and challenges and lessons identified from recent outbreaks and incidents. The plan briefly describes actions undertaken in the previous planning period (2010-2012) and identifies new actions for 2012-2014. Where there are more detailed reports available these are referenced.

The Scottish Government are currently completing a review of Health Protection in Scotland and we await the final report which should be available in 2012. This report is likely to influence our priorities for 2012-2014.

Communication

Effective communication with all communities in Grampian is an essential component ofpublic health activity. Grampian is an attractive area for inward migration, especially from Eastern Europe and many migrant workers and their families are non-English speaking when they first arrive. Accordingly, to ensure effective communication with these communities, NHS Grampian has put in place the Language Line telephone interpretation service in over 600 locations and expanded the pool of face to face interpreters available to 120. There is also a great deal of relevant health care material readily available in the main local ethnic community languages. Specific material is produced, if required.

The communication needs of people with communication disabilities are also carefully considered. NHS Grampian provides a wide range of communication support, to help overcome any communication barriers.

1.Managing threats to the public’s health

Our overriding priority is to provide a response to incidents that may present a threat to the public’s health. This includes responding to both communicable disease and environmental incidents. This response must be available 24 hours a day. This operational response is dependant on having effective surveillance systems in place to detect changes in communicable disease and environmental exposures and the resources to respond in an effective and efficient way.

In 2010-12 NHS Grampian and Local Authority partners have reviewed the Outbreak Plan and developed an Environmental Incident Plan. We have managed a large number of single cases of communicable disease, outbreaks and incidents over the last 2 years and the details are provided in the supporting reports.

Action

NHS Grampian and the Local Authorities will consider the revised Scottish Government guidance on theManagement of Public Health Incidents: Guidance on the Roles and Responsibilities of NHS led Incident Management Team, October 2011,assess the implications for our organisations and our joint working arrangements, and update our plans.

2.Major Infectious Diseases including Pandemic influenza

NHS Grampian and partners respondedto the Influenza Pandemic from late April 2009 until March 2010. The response was led by Health throughout and it had a significant impact on most parts of the NHS despite the mild disease. There was limited wider impact on the wider society although there were significant opportunity costs as we all finalised our detailed planning.

A report is available on the Influenza A/H1N1v Pandemic in Grampian April2009-February 2010 at

Pandemic Influenzais still the highest risk on the Cabinet Office National Risk Register of Civil Emergencies (2010) and there are no grounds for complacency. Any presumption that the relatively mild H1N1(2009) pandemic is representative of future pandemics is not justified. Influenza pandemics are unpredictable with regard to timing, severity and impact.

The UK Influenza Pandemic Preparedness Strategy 2011 was publishedin late 2011. The strategy reflects the lessons learnt across the UK in our response to the 2009 pandemic and will enable a more flexible and proportionate response. It is likely that the Scottish Government will also develop detailed operational guidance for health and social care.

Pandemic preparedness is an integral part of our wider emergency response and preparedness and is underpinned by the Business Continuity Plans in place across the NHS and our partner organisations.

NHS Grampian is leading the development of a Major Infectious Disease Plan on behalf of the Strategic Co-ordinating Group (SCG). This plan will describe the Grampian Strategic and Tactical response to pandemic influenza and other major infectious disease e.g. SARS. The SCG plan will not include the detail of operational plans for the NHS or our partner organisations but will be underpinned by these detailed plans. NHS Grampian will develop a NHS Major Infectious Disease Plan to support the multiagency response.

All sectors of the NHS and partner organisations should have robust Business Continuity Plans (BCPs) in place plus detailed surge capacity where appropriate. These plans can be generic and support a response to both pandemic influenza and other major outbreaks of infectious disease.

Actions required to improve our preparedness in Grampian

  • Develop an SCG Major Infectious Diseases Plan that will describe our generic response to outbreaks of major infectious diseases including pandemic influenza ActionSCG Major Infectious Disease Liaison Group by June 2012
  • Develop an NHS Grampian Major Infectious disease Plan – Action Pandemic Influenza Coordinator and Civil Contingencies Leads by June 2012
  • All NHS sector and corporate service’s pandemic influenza operational plans and BCPs to be reviewedand updated in collaboration with Local Authority colleagues where appropriate – Action NHS Sector Civil Contingencies leads April 2012
  • Local Authorities to review and update theirpandemic influenza operational plans and BCPs in collaboration with the NHS where appropriate – Action Directors of Social Work by end April 2012

3.Immunisation and Vaccine preventable diseases

The Annual Report on delivery of the UK immunisation programme in Grampian 2010-2011 will be made available on the NHS Grampian website This report provides a brief overview of the delivery of NHS immunisation services in Grampian to provide assurance that appropriate clinical standards are being maintained in delivery of the programme. Immunisation uptakes within the childhood programme remain generally good as does influenza vaccination uptake amongst people aged 65 years and older. Substantial ongoing effort by vaccinators will be required to ensure these uptake levels continue to be sustained and to improve uptake in pregnant women and other at risk groups aged under 65 years.

Measles has re-emerged in Europe. More than 30,000 measles cases were reported by European countries in 2010, a five-fold increase compared to the annual average for the preceding five years. 85% of the cases were unvaccinated. The high incidence continued in 2011 with significant outbreaks ongoing in France, Spain and Belgium. It is estimated that, in a non-immune population, each case of measles can be expected to generate 12 – 18 secondary cases. Consequently there is a real risk of measles infection being imported into Grampian and a clear need to maintain uptake of MMR vaccine at the highest possible level. The most recently reported annual Grampian MMR uptakes of 95.1% for the first dose (by 24 months old), and 92.6% for the second dose (by 5 years old), exceed the Scottish average. Although these uptake levels are good, they need to be improved further to minimise risk of spread of this infection. Current uptakes still mean that 1 in every 20 five year-olds remains susceptible to measles infection in addition to all children under the age of 12 months being considered to be non-immune. Therefore, the most likely scenario following identification of a local measles case will be a cluster of secondary cases requiring urgent public health action to minimise secondary spread of infection, including the exclusion from work of exposed healthcare staff not known to be immune.

Seasonal influenza infection continues to be an important avoidable cause of illness. This can be very severe in people at higher clinical risk of complications due to other existing underlying conditions. Seasonal Influenza vaccination is offered each autumn to all those aged 65 years and older and to children and adults aged less than 65 years who are identified as being at higher risk of complications from the infection. The uptake of Influenza vaccination amongst older Grampian residents continues to be consistently good (75.9% amongst those aged 65 years and older in 2010-2011). However, uptake in people at higher clinical risk aged below 65 years has been very much poorer (64% in 2010-2011).

Action

NHS Grampian will:

  • Continue to implement and support the established routine vaccination programmes including childhood, Human Papilloma Virus (HPV) and seasonal influenza;
  • Implement a ‘catch-up’ MMR initiative aimed at improving immunity levels in older children during 2012;
  • Continue to encourage uptake of MMR among vulnerable frontline healthcare staff;
  • During future seasonal Influenza vaccination campaigns, make particular effort to increase uptake of vaccine amongst those at higher clinical risk in younger age groups;
  • Continue to promote and support the training of healthcare providers involved in the delivery of these immunisation programmes; and
  • Continue to review and update our existing policies for vaccine preventable diseases in light of new and emerging evidence.

4.Tuberculosis (TB)

The Scottish TB Action Plan was published in the early part of 2011. Following this, the Grampian policy for prevention and control of Tuberculosis infection was revised to ensure our public health actions to manage Tuberculosis infection remain firmly based on the most recent evidence of good practice. Although 2011 saw a lower number of TB cases in Grampian (41 cases) than in recent years, this level of infection continues to be of concern. TB can be a life threatening infection and requires several months of complex antibiotic treatment to effect a cure. The Annual Report of Tuberculosis Infection in Grampian provides detail of the local epidemiology and quality of local management and control of this infection. The report can be accessed at

Action

  • NHS Grampian will continue to lead on the management of TB cases, contact tracing and screening of contacts in liaison with Local Authority colleagues where appropriate
  • New entrant screening will continue to be targeted towards those individuals presenting the highest public health risk.

5. Gastrointestinal illness

The incidence of some gastrointestinal infections e.g. E coli O157 infection, are higher in Grampian than the Scottish average. This may be attributed to the increased exposure to animal faeces that may occur in a rural location combined with a large number of households on private water supplies, especially in Aberdeenshire. A Report on Gastrointestinal Infections in Grampian will be available on the NHS Grampian Website at

The NHS Grampian Health Protection Team has robust systems in place to undertake the ongoing surveillance of gastrointestinal infections. The team works closely with EnvironmentalHealth colleagues to investigate cases and/or outbreaks of gastrointestinal infections.

We have implemented the Health Protection Network Guidance for the public health management of infection with verotoxigenic Escherichia coli (VTEC)locally. All cases of E coli O157 infections are actively investigated and followed up, families supported and public health advice provided. Members of the Health Protection Team were involved in revising the current guidance and also are involved in the development of the Scottish Government’s VTEC Action Plan

The Moray Council has adopted the multiple barrier principle as described in The Private Water Supplies Technical Manual in order to minimise the risk of infection from private water supplies. In all planning applications for new houses served by a private water supply The Moray Council requests confirmation from the applicant/agent that ultra violet treatment will be fitted in each house.

The Moray Council has a localperformance indicatorto contact all cases of Infectious Diseases notified by NHS Grampian within 24 hours. In the last 3 years the Moray Council has achieved 100% of contacts within this timescale.

Food stuffs and private water supplies associated with suspected gastrointestinal infections are now analysed and examined by Aberdeen Scientific Services Laboratory (ASSL), the public analyst service serving Grampian.

NHS Grampian, Aberdeen City Council, Aberdeenshire Council and Moray Council have collaborated on projects to raise public awareness of the risk of acquiring E coli O157 associated with rural environmental exposure to animal faeces and inadequately treated private water supplies. This work has included posters in the local press, the production of a short film, joint working at exhibitions etc and a project in Moray to increase the uptake of grants to improve private water supplies.

Action

NHS Grampian in collaboration with the three Local Authorities will build on the success of the public awareness campaign already undertaken. The future campaign will incorporate public awareness messages on the risks associated with the acquisition of Campylobacter as well as E coli O157.

6.Sexual Health and Blood Borne Viruses (Hepatitis B, Hepatitis C and HIV)

In 2011 the Scottish Government published a Sexual Health and Blood Borne Virus Framework 2011-15. In February 2012 NHS Grampian released a Sexual Health and Blood Borne Virus Strategy (Full strategy and Executive summary) for consultation stating how we intend on taking forward the national framework based on local need.

NHS Grampian will continue to work with partners to implement “Respect and Responsibility: A Strategy and Action Plan for Improving Sexual Health”, launched January 2005 by the Scottish Government, which seeks to improve access to sexual health information and services whilst enabling flexibility for local services to respond to local needs.

Over recent decades NHS Grampian has become an area of in-migration. Since most countries in the world have a higher prevalence of viral hepatitis (B and C) and HIV infection than the UK, these infections have become of increasing importance to the health of our population.

Hepatitis Cis the most prevalent of the three BBVs locally, estimated to affect 1% of our population, mainly through current and past injecting drug use. There are approximately 2500 known hepatitis C cases in Grampian and the same number again may be infected but not yet diagnosed. Specialist management and treatment are increasingly effective and more easily available now. The emphasis now must be on identifying undiagnosed individuals so that long-term consequences of liver cirrhosis and cancer can be prevented through appropriate management.

Hepatitis B is vaccine-preventable infection, but most individuals affected in Grampian have acquired the infection abroad and through vertical transmission. Approximately 60 cases are diagnosed each year.

About 40 cases of HIV infection are new to Grampian each year, for some this diagnosis is already known and they have transferred into the area. The main route of transmission is through heterosexual unprotected sex, but sex between men who have sex with men remains a significant risk factor.

Actions

  • NHS Grampian will continue to improve the quality, range and consistency, accessibility and cohesion of sexual health services.
  • NHS Grampian, in collaboration with partners, will continue to support the population, regardless of faith, ethnicity, gender, age or disability, to acquire and maintain the knowledge, skills and values necessary for good sexual wellbeing and thus avoid sexually transmitted infections and unintended pregnancy.
  • NHS Grampian, in collaboration with partners, will continue to positively influence cultural and social factors that impact on sexual health.
  • NHS Grampian will continue to provide surveillance of hepatitis B, hepatitis C and HIV infections for the population.
  • This will then inform prevention treatment and support strategies to be implemented across multi-disciplinary and multi-agency settings for all 3 viral infections by targeting the public andspecific 'at risk' groups. This will be done usingpublic awareness campaigns, immunisation, promotion of safer sex, needle exchange provision for injecting drug users,early diagnosis, contact tracing, access to specialist care and staff training.
  • NHS Grampian will consult on and finalise its revised local strategy deriving from the recently published national Sexual Health and Blood Borne Virus Framework 2011-2015 which encompasses previous strategic work on hepatitis C and HIV.

7.Healthcare Associated Infection and antimicrobial resistance