Examination of Witnesses (Questions 1006
WEDNESDAY 24 APRIL 2002
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 healththat
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 centrallyformerly 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
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
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
(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 aspectsworking
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 Healthin 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
(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 instancesit is a huge servicewhere
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
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.
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 truststhe
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 developmentmost of them have got
their chief executives but not all of them have appointed their
Directors of Public Healthin 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
(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?
(Dr Troop) Yes, of course.
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