Health CommitteeWritten evidence from the Health Protection Agency (ETWP 100)

Summary

Health Protection is an integral part of the public health workforce in the UK and thus closely aligned with the NHS and wider healthcare community.

The health protection workforce is highly specialised and covers various disciplines and professions each with unique training and education needs, that must be recognised within any new education and training system.

Public Health England (PHE) will be the only specific organisation responsible for specialist health protection; unique skills and expertise will be required that will not be provided through other NHS routes.

Currently the Health Protection Agency (HPA) trains and develops its own staff and trains the wider workforce in health protection, a responsibility which should continue as part of PHE, making it a significant stakeholder in the future education and training landscape.

HPA’s health protection training is delivered via its Health Protection Academy, an example of good practice that is easily transferable into PHE.

Existing links with professional bodies involved in training and education for health protection need to be maintained and developed.

Authority and responsibility for future commissioning and provision of health protection training needs to be clarified, in particular the relationships between PHE, Health Education England (HEE) and the NHS Commissioning Board.

Future education and training solutions must recognise the cross-boundary nature of public health, and provide planned, transparent and flexible career pathways delivering the health protection leaders of the future.

Arrangements as we move to the new education and training system must ensure a “safe and robust” transition with an emphasis on the maintenance of quality.

Health Protection in England

1. Specialist Health protection in England is currently delivered by the HPA, which employs some 3,800 specialist staff including doctors, nurses and approximately 2,200 scientists. The function will transfer to PHE in April 2013. It is important to note that PHE will be the only specific organisation with responsibility for specialist health protection and this function will not be provided through other NHS routes.

2. HPA’s role is to provide an integrated approach to protecting public health through the provision of services support and advice to the NHS, local authorities, emergency services, other arms length bodies, the Department of Health and the devolved administrations and as such, is an integral part of public health, closely aligned to the NHS and wider health economy. The HPA operates through local Health Protection Units, a network of laboratories and four specialised microbiological, epidemiological chemical and radiological centres with a local, national and international remit.

3. Integrated HPA/PHE and NHS working is demonstrated in the support (epidemiological, reference microbiological, and specialist advice) HPA provides to NHS trust-based infection control teams in the prevention and control of healthcare associated infections. Furthermore, health protection staff work in close partnership with environmental health officers in local authorities, providing microbiological and epidemiological support in managing outbreaks of food-borne diseases.

The Health Protection Workforce

4. The health protection function incorporates a variety of professional disciplines:

Public Health/Epidemiology.

Public Health Microbiology/Virology/Infectious Diseases.

Chemical and Clinical Toxicology.

Radiation Protection.

Emergency Planning and Preparedness.

Research and development.

5. The workforce associated with these specialist areas includes:

Consultants in Public Health or Specialist in Public Health.

Epidemiologists.

Modellers/health economists and bioinformatics staff.

Consultant Public Health Microbiologist.

Consultant Infectious Diseases.

Nurses in HPUs.

Biomedical scientists.

Clinical Scientists and other laboratory scientists.

Medical Consultant Toxicologists and environmental scientists.

Radiation protection specialists eg radiation dosimetry scientists, radiochemistry and other scientists.

Emergency planning officers.

6. In some areas, for example toxicology and radiation protection, the HPA is the sole repository of highly specialised experts. Often small in number, they have an internationally recognised reputation that places the UK in a unique position to contribute significantly to the global response for such events as the Fukushima nuclear incident.

Unique Skills required for Health Protection

7. The health protection workforce protects the public from a broad range of threats, each with their own unique considerations. However, key common functions underpin the delivery of tangible health outcomes, notably: surveillance and monitoring; developing standards and best practice; research; providing expert advice; and responding to incidents and emergencies. In practice, this means developing public health intelligence and translating it into action at international, national, regional and local levels.

8. The remit of the health protection workforce is to provide a coherent, flexible, resilient and rapid response to public health emergencies such as disease outbreaks, chemical and nuclear accidents, and natural disasters such as floods.

9. In order to do this, the workforce operates and maintains the UK’s high-containment laboratories and facilities for essential research on the world’s most dangerous bacteria and viruses, protecting the nation’s biosecurity and translating this research into action. The horizon is scanned for new and emerging threats to the health of the people of the UK, and staff work closely with international organisations such as the World Health Organization.

10. Furthermore, staff provide the highest-quality, research-driven and evidence-based information possible. This includes data and advice to government and professionals working in healthcare and advice to the public on how to stay healthy and avoid health hazards.

11. Examples of how this translates into practice include:

At the local level, Consultants in Communicable Disease Control (CCDC)/Consultants in Health Protection together with health protection nurses, epidemiologists and emergency planning officers, deal on a daily basis with communicable disease, environmental hazards and other health protection incidents. Their activities include prevention, preparedness and control and management of outbreaks/incidents.

Public Health Microbiologists/Virologists and Infectious Diseases consultants use their skills in the diagnosis and management of outbreaks and incidents at local, regional, national and international levels. They provide the risk assessment on which the public health response is predicated—based on their specialist scientific expertise and experience. Examples of joint working across national and international borders include the swine flu pandemic in 2009 and the German E.coli O104 outbreak in 2011.

12. The unique skills required in order to continue to deliver this function must be recognised and met through a robust, integrated education and training system underpinned by effective workforce planning. Importantly, the educational needs of small and therefore vulnerable specialties and disciplines must not be overlooked, and forms a significant aspect of managing this major educational change.

HPA/PHE Contribution to Health Protection Training

13. HPA’s specialist training and education activities represent a unique and valued resource for the health protection workforce in the United Kingdom and internationally. Currently the HPA is either the sole or the significant provider of training in all of the above mentioned specialist areas, holding the National Treasure status for the health protection and epidemiology element of the Public Health Specialist Training Scheme and for Toxicology specialist training. The HPA is also an accredited training provider by the Institute of Biomedical Science (IBMS) and holds the Affiliated Research Centre (ARC) status with the Open University. In addition, many senior staff are contracted with universities as Visiting Professors or Senior Lecturers, and toxicology course material is published as textbooks.

14. Our ability as an organisation to incorporate and develop important evolving disciplines such as bioinformatics and whole gene sequencing into the education of health protection and public health staff, provides an opportunity for the HPA to lead future workforce development in these disciplines.

15. Specifically, HPA provides the training for tomorrow’s specialist health protection staff through its contribution to Specialist Training Schemes (Public Health, Microbiology/Virology and Toxicology), on-the-job training for biomedical and clinical scientists, the UK Field Epidemiology Training Programme, PhD Studentships and through development and delivery associations with professional bodies and universities (including the Faculty of Public Health, and, the Royal College of Pathologists). The HPA also provides training places for international trainees on the European Programme for Intervention Epidemiology Training (EPIET).

16. HPA is also commissioned by the Department of Health to provide emergency and resilience training (through courses and large-scale multi-agency exercises) for the NHS and for European colleagues funded by European grants.

17. HPA has recently drawn all their specialist education and training elements under the Health Protection Academy in order to assure quality, identify training needs and facilitate future workforce development. The academy model consists of topical themes (for example: Epidemiology, Microbiology and Emergency Planning) providing training and development across professional groups (doctors, nurses, scientists) rather than within the usual unidisciplinary professional silos. The proposed education and training system, could consider applying a similar model.

18. It is anticipated that health protection workforce training, development and delivery will transfer to PHE on formation. This means that PHE will be a significant stakeholder in the development of the new education and training system and needs to be fully involved particularly in the development of HEE.

The New System

19. Within the new system, authority and responsibility for commissioning and provision of health protection training needs to be clarified, in particular the relationships between PHE, HEE and the NHS Commissioning Board.

20. In order to ensure appropriate succession planning, we see PHE adopting a leadership role in defining health protection training needs and delivering appropriate specialist education for the future workforce.

21. Current delivery of training and contribution to curriculum development by HPA is inextricably linked to other bodies, including professional associations such as: deaneries, Faculty of Public Health, Royal College of Pathologists, Royal College of Emergency Medicine, Institute of Biomedical Science and the UK Public Health Register. These existing links and the collaborative working that ensues must be retained in the new system.

22. Future education and training solutions must be comprehensive and integrated and build on these existing relationships and structures. Moreover, it must recognise the cross-boundary nature of public health and health protection work, resulting in transparent and flexible career pathways, attracting and retaining the top scientific and medical talent. This will ensure that public health, and health protection in particular, remains a career of choice. A key consideration for the new system will be in creating the health protection leaders of the future, essential in order to prevent and, if required, respond to increasingly-frequent national and international health protection incidents (for example: extreme events such as flooding, heatwaves and emerging infections and potential bioterrorism).

23. Finally, as we move to the new education and training system it is essential that a “safe and robust” transition is implemented, with an emphasis on the maintenance of quality.

December 2011

Prepared 22nd May 2012