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HPA local and regional capacity and resilience

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Presentation to Scottish Health Protection Stocktake Working Group 15 November 2010 - Edinburgh Dr Sue Ibbotson Regional Director, HPA West Midlands – PowerPoint PPT presentation

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Title: HPA local and regional capacity and resilience


1
  • HPA local and regional capacity and resilience
  • Presentation to Scottish Health Protection
    Stocktake Working Group
  • 15 November 2010 - Edinburgh

Dr Sue Ibbotson Regional Director, HPA West
Midlands
2
HPA local and regional capacity and resilience
  • Structures
  • Responsibilities and roles
  • Governance arrangements
  • Operating arrangements
  • Testing the system pandemic flu
  • Issues for the future

3
Current structure
HPA Board
Chief Executive
Local and regional services
Centre for Infections
Regional Microbiology Network
Centre for Emergency Preparedness and Response
Centre for Radiation, Chemical Environmental
Hazards (CRCE)
National Institute for Biological Standards and
Control
4
LaRS - structure
  • Nine coterminous regions covering 2.5m to 7.6m
    population, with 26 coterminous Health Protection
    Units
  • National Emergency Response Department
  • LaRS Divisional director
  • As well as HPUs each region also has
  • Regional Epidemiology Unit
  • Regional Health Emergency Planning team
  • Regional Director and business/governance support
  • LaRS operations are supported by
  • CRCE field teams (Birmingham, Chilton, London,
    Nottingham)
  • Regional Communications Manager/press officer
  • Regional Microbiologist and HPA regional
    laboratory
  • HR business partner and case worker (shared)
  • Finance manager (shared)
  • and, national specialists as requested.

5
Regional Director/HPU Director roles
  • RD
  • - manage LaRS resources in the region
  • - overall responsible for HPA delivery in the
    region
  • - regional HP strategy with and on behalf of RDPH
  • - LaRS lead for specified national programme(s)
  • HPU D (c0.5 wte CCDC work)
  • - manage HPU resources
  • - responsible for HPU operational delivery
  • - direct regional programmes

6
Workforce
  • HPUs multidisciplinary CCDCs, HP nurses,
    practitioners, information support and admin
  • An average HPU
  • - covers 2m population
  • - has gt1 CCDC per 500,000 population
  • - total 18.5 wte staff
  • REUs c2 Consultant Epidemiologists, scientists
    and admin

7
LaRS FunctionsPrepare, Respond, Prevent
Preparing for incidents, outbreaks and
emergencies
Operational and strategic management
Enabling individuals and teams (clinical
governance)
8
HPA Local and Regional Services - roles
  1. Surveillance of infectious diseases, and tracking
    of health protection incidents, exposures and
    health impacts, to inform local and regional
    action
  2. Alerting of partners to emerging infectious and
    environmental threats to health
  3. 24/7 specialist provision to investigate and
    manage incidents, outbreaks, emergencies and
    clusters of disease
  4. Provision of evidence-based risk assessment and
    health protection advice for action by partners
    across the full range of hazards
  5. Provision of plans, tools, training and
    exercising for partners to prepare for incidents
    and emergencies
  6. Designing and providing training for partners to
    ensure high quality health protection delivery
    and train the next generation of specialists
  7. Strengthening the science base for health
    protection.
  8. Leadership and specialist support to local and
    regional strategic partnerships on health
    protection prevention and control programmes
  9. Provision of health protection information, tools
    and advice to NHS commissioners, performance
    managers and providers in support of NHS
    priorities
  10. Provision of named medical consultants to provide
    expert advice to and agreed proper officers for
    the relevant sections of the Public Health
    Regulations for each Local Authority.

9
Governance arrangements - internal
  • Line management LaRS team via Regional Director
    to LaRS Division/CEO. Local and regional business
    plans. Corporate financial and HR frameworks and
    scrutiny.
  • Health protection programmes
    cross-divisional, LaRS nationwide and regionwide
    networked leads (developing HPA strategy and
    supporting policy into practice)
  • Development of guidance, structured nationwide
    briefings, operating procedures and associated
    standards
  • Emphasis on competence through PDPs networked
    learning and training opportunities
  • HPZone case management tool plus
  • LaRS-wide clinical governance strategy and
    standards plus development support governance
    and quality structures at local, regional and
    corporate level
  • Integrated governance arrangements, through
    Regional Executive Groups and LaRS Senior
    Management Team to corporate group
  • Assurance processes linked to HCC/CQC and CCA
    requirements coordinated corporately

10
Governance arrangements with DsPH and LAs
  • Framework Agreement 2008 with the NHS
  • Front line PH delivery eg mass immunisation/prophy
    laxis TB contact tracing is responsibility of
    PCT (provision and commissioning)
  • Local Health Protection Partnership Boards
    proposed variably embedded and formalised
  • RD HPA works closely with Regional Director of
    Public Health

11
How we work
  • Maintaining good working arrangements with DsPH
  • Annual local and regional business plans cover
    developments
  • HPUs are the front door to the agency and
    manage all local routine business plus level 1
    incidents, outbreaks and emergencies
  • HPUs support a wide range of local NHS and
    partnership groups
  • Implementing strategy through the commissioning
    process is a PCT responsibility
  • HPU senior staff have geographical and portfolio
    responsibilities
  • Regional oversight of incidents and outbreaks,
    support and escalation as required
  • Shared learning from incidents development of
    tools, implementation of new systems, procedures
    etc through national programmes and projects
  • Business continuity plans. Mutual aid within
    regions and then LaRS-wide if necessary through
    line management arrangements.

12
LaRS West Midlands
  • 5.4m population mixed urban and rural
  • 3 HPUs and 3 specialist on-call rotas
  • 17 PCTs 35 LAs 24 NHS Trusts
  • REU plus national Real Time Syndromic
    Surveillance
  • c70 wte staff
  • c700 significant incidents/outbreaks per annum

13
LaRS West Midlands case studyHCAI in a hospital
What happened?
What did we do?
  1. outbreak of C difficile
  2. HPU advice not being implemented.
  3. recommendations not taken forward a second
    outbreak monthly regional surveillance
    demonstrates outlier status
  • HPU engaged proactive advice
  • peer review of hospital IPC and surveillance
    arrangements by Regional Microbiologist, Regional
    Epidemiologist and CCDC. SHA and PCT engaged.
  • RD engaged, additional REU input, support from
    national specialists

14
LaRS West Midlands case studyTyre fire
What happened?
What did we do?
  1. Fire service alerts regional CRCE team
  2. CRCE alerts HPU
  3. Large fire, potential health effects likely to
    burn for days. HPU alerts RD
  1. Initial risk assessment potential extent of
    toxicological hazard to health immediate advice
  2. HPU engaged, lead CCDC undertakes public health
    risk assessment with CRCE and assesses need for a
    structured public health response. Discusses
    with multiagency police lead and RD.
  3. RD asks for a Science and Technical Advice
    Committee to multiagency silver response
    established by Health Emergency Planning Adviser
    working with lead CCDC and CRCE. CRCE engages
    Environment Agency air quality monitoring team.
    Air Quality Cell established. Daily syndromic
    surveillance switched on.

15
Testing the system pandemic fluWest Midlands
16
Confirmed cases of pandemic (H1N1) 2009 in the
West Midlands during the containment phase by
date of illness onset and route of transmission
(n1967)
17
Early distribution of flu A/H1N1 (2009) cases in
the West Midlands (to 8 June 2009)
18
Pandemic flu HPA containment response May-July
2009 - West Midlands
  • gt3000 laboratory confirmed cases 60 hospitalised
  • 344 schools risk assessed and advice given
  • Contact tracing for 2000 cases
  • gt10,000 tests Regional Microbiology Network
    laboratories and other staff from HPA centres
    supported the HPA Birmingham laboratory
  • Briefings and epi reports up the line
    descriptive epi studies
  • National syndromic surveillance outputs
  • Advice to the NHS commands
  • Engagement with Birmingham City Council Overview
    and Scrutiny
  • c300 media bids 70 interviews
  • HPA established a Flu Response Centre - 8
    increasing to 60 desks
  • and deployed c150 wte staff daily from all over
    the country
  • BADGER Ltd undertook all operations in respect of
    symptomatic patients in Birmingham
  • PCTs undertook prophylaxis in schools

19
H1N1v West Midlands HPA Integrated Response
Coordination Diagram
Key
DH
CCC
National Emergency Coordination Centre (HPA)
RRT
West Midlands REOC (HPA)
LA(s)
SHA
ERMA 2
West Midlands FRC
BADGER PCT Ops
School cell
HPU
FRC-HPU Cells
FRC-HPU Cells
Comms
FRC-HPU Cell
HPU
HPU
Community Engagement
HPA Laboratory
Media Handling
Epidemiology
Real Time Surveillance
National Primary Care Surveillance
Control
Advice
Coordination
SHA, PCT and/or LA resource
20
Capacity and resilienceIssues for the future
  • Roles and relationship between the national
    Public Health Service and DsPH in LAs
  • Independence
  • The intermediate tier
  • Strengthening the nationwide and national
    epidemiological approach whilst delivering
    locally responsive services
  • Increasing expectations reducing resources
  • Being local enough whilst preserving critical
    mass
  • Workforce development
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