Select Committee on Defence Minutes of Evidence

Examination of Witnesses (Questions 1006 - 1019)




  1006. Thank you very much for coming. You know the background to our Inquiry. I always have to apologise to witnesses, saying I do not suppose in your current job you thought you would be appearing before the Defence Committee, but we are the Committee showing real interest in what we should, as a nation, be doing post-September 11 and, obviously, Dr Troop, your area of responsibility is pivotal to the whole process. Would you like to introduce your team and their backgrounds to us?

  (Dr Troop) First of all, I am the Deputy Chief Medical Officer and as well as being the DCMO I have responsibility for all the health protection aspects of public health—that is chemical, radiological, infectious diseases emergency planning. That was a new arrangement when I came and I was asked to take on that as an integrated function. Dr O'Mahony is on secondment from the Public Health Laboratory Service, Communicable Disease Survellience Centre (CDSC) . Mary came to head up the infectious diseases of our health protection division, and Mr Harper, who is also our chief scientist, heads up the environmental hazards of health protection but also has emergency planning in his section.

  1007. Thank you so much for coming. The first question really relates to the document The Future of Emergency Planning in England and Wales which was published in August 2001, and which provoked a fairly wide consultative process. The Ministry of Defence did not appear in that document and we could not tease out of them whether they knew about it or whether they kept out of it deliberately. What I would like to ask is: what involvement did you and the Department of Health more generally have in that process? Did you respond to the consultation process? Where were you in that document, in the response document and in any evaluation of that document?
  (Dr Troop) We have had links across into emergency planning centrally—formerly at the Home Office and now at the Cabinet Office. Our Head of Emergency Planning has always been linked into that process. The former head of our Emergency Planning Unit was very much linked into the Home Office and now the Cabinet Office. Our new head of unit took up post on September 11, although we had appointed him the week before. He is sitting behind us.

  1008. A great sense of planning for which the Government is not known!
  (Dr Troop) Our previous head of the unit retired and we had just appointed a new one. He had good links, had a lot of informal discussion and was obviously involved in relevant committees as well, but we did also send in a response to the consultation.

Jim Knight

  1009. Dr Troop, you kindly sent us some slides for the presentation you did at a public policy seminar in March.
  (Dr Troop) Somebody sent them in.

  1010. One of the UK's strength is our integrated public health system, locally, regionally and nationally. When the Ambulance Service Association came last week they said they had not been aware of the existence of the consultation document until after the closing date for responses. How does this happen within the strength of our integrated local and regional system?
  (Dr Troop) I cannot answer that, I am sorry. I am not sure why it did not go to them. It may have gone to other people within the Ambulance Service, because we do not always necessarily go to the associations. We go to senior people within either the department or to senior people within the service, and that does not necessarily go through then to the professional associations. That may be why it did not go to them.

  1011. They suggested that this was evidence that the public health function of the Department of Health is not particularly well connected on a day-to-day basis with the more operational points and units of the NHS. Do you agree with that?
  (Dr Troop) No, I think there is probably a misunderstanding over what people think of public health. I am a public health person by background, and I have been at district, regional and national level. I head up, as I explained, all the health protection functions. I am on the operational board of the Department of Health, and I work closely with the Director of Operations. When we had our operations room, which we set up on September 12 in the department, we worked very closely with all our colleagues in the department on the operational side to make sure that the NHS was well-linked into all the work that we were doing. At the regional level, the Regional Directors of Public Health (and I was one before I came here) have overview not just of public health as people think of it but, also, the clinical and service aspects—working very closely with all their colleagues. It is the same at the district level. I think that people are thinking, perhaps, of certain aspects of public health but public health in the round is very integrated into our NHS and very integrated in the Department of Health—in a way that it is not in many other countries, where it is often a very separate strand. But we are a very integrated service, and that is one of our strengths.

  1012. The Ambulance Service is part of that integration.
  (Dr Troop) At the local level for emergency planning we have health emergency planning advisers and they work closely with Ambulance Services, with NHS trusts, with people in health authorities, and there has been a lot of work going on at the local and regional level. Within the department Gron Roberts came to the select committee, he is a half-time adviser in the department and he works very closely with us and, particularly, with the Head of our Emergency Planning Unit. There has been a lot of joint work, for example, on things like decontamination, and that has been a joint piece of work between them and ourselves. So it may be there have been instances—it is a huge service—where integration has never been as active as it might have been and there may be times when one can always find, in a huge very busy situation, where communication is sometimes not perfect. However, I would not think that was the generality.

  1013. So you would expect and hope that parts of the service, such as the Ambulance Service, would have responded to the consultation document. If they had, would you see that consultation to help your planning or would that just go straight to the civil contingency secretariat dealing with consultation, and that would be that?
  (Dr Troop) The Association, of course, has the right to say what it likes to whom it likes; it is a professional association. Within the department we do try and co-ordinate our response, because it is important that we have a collective understanding of the issues. So I would hope that that is the way it would work at a national level. At the local level, people often respond also from the NHS, though, directly in consultation. Also, with the review, much of it was around local authorities as well. Our main drive has been around the NHS response and, of course, there is an interface with the local authority about which we are very concerned, but our main drive has been our own capability and our own co-ordination. I think our links across the UK are extremely strong.

  Chairman: Could you let us know if we could have a copy of your response to the document. It would be quite helpful. Thank you.[1]

Mr Howarth

  1014. Dr Troop, the Chairman mentioned at the outset the emergency planning review, which came before September 11. I understand that the review has identified four areas for further work. Can I ask some questions on each of those areas, taking each one in turn? The first area is policy, where it was proposed to produce a partnership duty for local authorities and other agencies within the context of a national framework for emergency planning. To which health bodies do you expect this partnership duty to apply? Will it apply to hospital trusts, ambulance trusts, prime care groups?
  (Dr Troop) As you know, the Health Service is changing in its structure at the moment.

  1015. Is there anything new about that?
  (Dr Troop) For those of us in it, no. I have lost count of how many reorganisations I have been in. The situation until 1 April and, indeed, until 1 October when the changes formally come into place, is that health authorities have responsibility for emergency planning but, obviously, every trust has a responsibility to respond and contribute to the planning but, also, to have that operational response. It is changing so that in future it will be the Primary Care Trusts who will have the planning responsibility. They will be required to do so in partnership with other Primary Care Trusts, because they are quite small, and identify a lead for that work, but the Trusts, of course, will continue to provide the major operational response. The Regional Directors of Public Health have been asked to ensure that that is all in place. So the duty will be to work with the Primary Care Trusts to ensure that the plans are co-ordinated, but then to work with the Ambulance Service and other NHS trusts on an operational basis to make sure that the delivery is in a co-ordinated way.

  1016. What we are talking about here is a partnership duty which implies (and we will come on to legislation in a moment) some sort of contractual duty. I can see that the local authorities will have the lead role in this but I would be surprised if it was the Primary Care Trusts who were the principal health sector in all this because, surely, we are talking about the capacity to deal with an emergency, and hospitals need to be involved in that as well.
  (Dr Troop) Yes. As I say, the actual operational response to an emergency is the Ambulance Service and the NHS trusts—the hospital trusts. They are the two prime groups who respond to an emergency. However, in ensuring that we have a plan across the health system, the Prime Care Trusts will have the responsibility to make sure that there is a co-ordinated plan, that they have the contracts with all these organisations and to make sure that they have appropriate capacity to respond. So I think there is a difference between, if you like, looking at the co-ordinated plan and developing their own plans as a trust to fit in with a co-ordinated plan which is, as you say, emergency planning being led by local authorities. I think there are different responsibilities on different NHS organisations.


  1017. It is now six months since September 11 and we are proceeding almost at a gentle pace, as though no one is allowed to attack us until our Committee has produced its report, the consultative process has been concluded, the NHS reorganisation is completed and then we will be in a position to respond. With the emergence of Primary Care Trusts, have you given them any direction that this is not to be a two-year process, to come up with plans, and that the moment they are up and running, their planning has to be sufficiently capable and robust to be activated swiftly? Has there been any instruction?
  (Dr Troop) Yes, absolutely. We have written to all the Primary Care Trusts, advising them that they are taking over the responsibility for emergency planning, but we have required strategic health authorities to ensure that as the Primary Care Trusts are in a state of development—most of them have got their chief executives but not all of them have appointed their Directors of Public Health—in the next few months the strategic health authorities and the Regional Directors of Public Health must ensure that there are plans in place in each health economy, if you like, and will be handing it over but will hand it over in an orderly way to those Primary Care Trusts. So that there is somebody holding the ring to make sure the plans are still there and are not lost. We are also working with people in Primary Care Trusts who are taking over this responsibility to be clear about their needs to be able to respond. If we think of the CBRN response, if you talk about an explosion, yes, the Ambulance Service is the front-line service, but if we are talking about an infectious disease it is not the Ambulance Service, it may be the Primary Care sector, it may be the Accident and Emergency Department, it may be the infectious disease consultant. Similarly with chemical and radiological incidents, there are a number of different players who might be the front-line response. That is why we have to have this co-ordinated mechanism from one organisation. Our role over the next six months is to ensure that they all feel confident that they can carry out this co-ordinated role.

  1018. Are key staff available in each Primary Care Trust?
  (Dr Troop) They are being appointed at the moment. Not all the Directors of Public Health appointments have been completed; that process is going through at the moment. A large number of them already have, but the Regional Directors of Public Health and the Chief Executives are working through that programme. We have asked each Regional Director of Public Health to make sure that the emergency planning and the consultants in communicable disease are all working in an effective or integrated way in the interim until they move into the agency next year. From 1 April, of course, we will have our new agency for health protection which will work very closely with the NHS and provide specialist support in this field.

  1019. Would you mind sending us a copy of the directions that you have sent?[2]
  (Dr Troop) Yes, of course.

1   Ev 201. Back

2   Ev 201. Back

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