Communities and Local Government CommitteeSupplementary written submission from the UK Faculty of Public Health

Protecting the population from infectious disease outbreaks, natural disasters or environmental hazards is a critical public health function.

An effective response to any outbreak or hazardous event is dependent upon: accurate and timely information; a robust and effective response plan appropriate to the context and the available resources; and a timely coordinated response, guided by the plan, from all relevant agencies.

Strong and effective leadership is vital to a successful outcome. Under the present arrangements in England, local leadership under such circumstances is normally provided by the local Director of Public Health.

It is now unclear, however, where this leadership will lie in the new system. Guidance from the Department of Health issued on 31 August 2012 states clearly that:

“the DH does not expect local authorities to produce a single all-encompassing ‘health protection’ plan for an area, but rather to ensure that partners have effective plans in place. This includes commissioning plans aimed at prevention of infectious diseases, as well as joint approaches for responding to incidents and outbreaks agreed locally with partners.”

However, the draft statutory instrument recently laid before parliament—The Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2012—appears to translate this into a purely advisory role, with no requirement for organisations to accept or act on the advice provided:

“8.—(1) Each local authority shall provide information and advice to every responsible person and relevant body within, or which exercises functions in relation to, the authority’s area, with a view to promoting the preparation of appropriate local health protection arrangements (“health protection arrangements”), or the participation in such arrangements, by that person or body.”

This lack of clarity presents a significant risk to the health of the population.

The Communities and Local Government Committee is conducting an important inquiry into local public health arrangements. Would the Committee consider exploring with witnesses whether the Government intends the local Director of Public Health to have a leadership role in local outbreaks and similar health related emergencies? If so whether this is to be supported by regulation and expressed clearly in guidance? If not, where will the leadership role lie and what will be its basis in law?

The Department of Health may argue that that there exists no legal authority for the Local Authority, through the Director of Public Health, to ensure that health protection plans are in place, and rather that the Director of Public Health may escalate concerns where they arise to Public Health England (exercising the Secretary of State’s duty to health protection).

However, we feel it vital that as a minimum the Director of Public Health should have responsibility for ensuring plans are in place, and that the existing guidance stands and is reflected within the forthcoming Regulations. Our strong advice would be that the guidance should also be strengthened to give the Director of Public Health a coordinating role for the implementation of local health protection plans. In emergency situations, the ability to act immediately is of critical importance to increasing the opportunity for a successful outcome. Escalation to Public Health England risks unnecessary delays in responding to emergencies and puts the public at risk.

January 2013