121.The system for health protection is now more complicated than it was before 2013. One local authority public health team told us that in their area, when an Outbreak Control Team was convened to respond to a local outbreak of an infectious disease, some nine different organisations needed to be represented on it. It was felt that this complexity and scale increased the chances of errors in communication and co-ordination occurring, and could also cause delays in the response to such outbreaks.
122.Wolverhampton public health teams raised concerns about the fragmentation of health protection, arguing that the separation of public health from the NHS “has led to numerous difficulties including the sharing of and access to data on health protection incidents, engaging with other NHS services, and understanding each organisations role and responsibility for the wide array of health protection issues within their boundary.”
123.Establishing arrangements that work effectively across the complex web of different organisations now involved in delivering health protection requires good relationships. While witnesses were generally positive about the quality of these relationships in their local areas, there was a strong feeling that arrangements for health protection should not be dependent on them:
124.There was also evidence of variation between local areas. While some areas were clear about the challenges posed for health protection by the new system, others, including London and Manchester, reported no difficulty at all.
125.PHE regional centres were universally seen to be providing good support to local areas on health protection.
126.Reassuringly, the response to Ebola at both a national and a local level was seen to have worked well. However, when asked how the new system would cope under the strain of a pandemic, witnesses felt that it would be more difficult than during the last pandemic in 2009.
127.In particular, lack of clarity around CCGs’ role was an issue raised by several witnesses.
128.As well as the difficulty associated with forging relationships across more complex systems, specific problems with capacity and funding were also highlighted.
129.Clarity over funding responsibilities was also raised as an issue by witnesses:
130.Responding to these concerns, PHE told us that some of the problems raised by witnesses around health protection responsibilities pre-dated the 2013 transfer to local authorities. They also described their ongoing efforts since then to clarify the situation:
131.Concluding, Professor Cosford, PHE’s Director for Health Protection, said “I do not see a reduction in the quality of the response to outbreaks as a result of the 2013 changes. I do see that there is still a need for us to work on clarifying some of the roles and responsibilities so that it can be made smoother in certain circumstances.” Professor Cosford argued that the response to health protection will always be prioritised by Public Health England, but it may be at the expense of other areas of work particularly if the incident is large or prolonged. We also heard that for the first time, health protection is now going to be included in NHS England’s national ‘Who Pays’ guidance, in an attempt to clarify the funding situation.
132.Dr Ian Cameron, Director of Public Health for Leeds City Council, articulated the need for clearer, more coherent national guidance and support as follows
133.However, differences remained amongst our witnesses from different areas about which were the most appropriate local forums for health protection to be led from. Local health resilience partnerships were mentioned as one option, and another recommended structure was for health and wellbeing boards to assume responsibility through establishing a Health Protection Committee reporting directly to the main board. One witness pointed out that in his locality, that would not be a good use of resource, as it could lead to PHE local health protection consultants having to attend some 48 meetings per year.
134.The system within which the health protection function is now delivered is complex. Despite PHE’s efforts to provide guidance, in some areas there is still uncertainty over roles and responsibilities, and lack of clarity over funding arrangements. A further concern raised by several witnesses is the shrinking capacity in provider trusts to provide additional, timely support during outbreaks.
135.Health protection is a critical public health function, and more work needs to be done at a national level to support local areas to deliver a seamless and effective response to outbreaks and other health protection incidents. This work should begin with an audit of local arrangements, including a review of capacity in provider trusts, and the development of a national system to collate and disseminate lessons learned from incidents. We will review PHE’s progress on this work in six months’ time.
66 Local Authority written evidence, para 3
67 Local Authority written evidence, Executive Summary
68 Public Health Wolverhampton para 3.2
70 Q185, Q190
30 August 2016