protocols and standards oliver blatchford darren ross martin donaghy january 2011 presentation to...
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PROTOCOLS AND STANDARDS
Oliver BlatchfordDarren Ross
Martin DonaghyJanuary 2011
Presentation to Health Protection Stocktake
Contents
• DefinitionsDefinitions
• Health Protection Strategy: role of Health Protection Strategy: role of HPSHPS
• Effectiveness & efficiency: informationEffectiveness & efficiency: information
• Effectiveness & efficiency: quality Effectiveness & efficiency: quality assuranceassurance
• Key challenges: information and Key challenges: information and quality assurancequality assurance
Definitions
Protocols– what should be done, when, where and by
whom at a local level. – a predetermined pathway for the provision of
a service – a set of standardized procedures for teams
Standards :– a standard statement explaining what is the
level of performance to be achieved;– a rationale providing the reasons why the
standard is considered to be important;– criteria, stating exactly what must be
achieved to demonstrate how the standard will be reached
Health Protection Consultation
2002
• improve the co-ordination and implementation of the required range of health protection measures;
• improve the effectiveness and efficiency of the key health protection functions of surveillance, investigation, risk assessment, management and communication and managing emergencies.
• enhance the accountability of health protection services in Scotland by more closely aligning policy, resource allocation and performance management functions.
• facilitate collaboration with UK, European and international counterparts in protecting health, especially in securing the best possible specialist advice and in recognising and responding promptly to emerging infections and the deliberate release of biological and chemical agents.
• provide incentives for people working in health protection to improve their individual and collective performance through a continuing process of personal, professional and organisational development.
Structural Options to:
to work, in partnership with others, to protect the Scottish public from being exposed to hazards which damage
their health and to limit any impact on health when such exposures
cannot be avoided
Health Protection Scotland Remit
2004/05
Strategic Priorities2005 to 2011
Influenza Pandemic, Seasonal and avian
Healthcare Associated Infection
Staphylococcus aureus, Clostridium difficile, norovirus, iatrogenic vCJD
Hepatitis C IVDU, liver disease
Vaccine Preventable Diseases
HPV infection (cervical cancer), Pneumococcal disease, Measles & mumps (MMR)
GI & Zoonoses E coli O157, Campylobacter, Salmonella
Environment and Health
Chronic and acute exposures, Good Places Better Health
Emerging Infections TB, HIV, Anthrax, Diphtheria, Listeria, Q Fever, iGAS, PVL, Vector borne infection
Scottish Government Health Directorate Policy, Performance ManagementPolicy, Performance Management
HPS
Local AuthoritiesLocal Authorities
Territorial NHS BoardsTerritorial NHS Boards
Co-ordination &Co-ordination &SupportSupportAccountabilityAccountability
ImplementationImplementation
HPAReference
Laboratories
AdviceAdvice
NSS
ECDC
Health Protection Advisory Group
Health Protection in Scotland
Other Scottish & UK Organisations*
* FSA, Animal Health, HSE, SEPA, SNH, Care Commission, Scottish Water, ACPO(S), PF, Media, SPS, GRO(S), Information Commissioner, Voluntary Sector, Universities, NHS (NHSQIS, NSD, ISD, Health Scotland, NES, NHS24, NISG, CLO)
Health ProtectionHealth Protection FunctionsFunctions
Investigation
SurveillanceSurveillance
AssessmentAssessment
Prevention & Response
CommunicationRisk Analysis
& Management
Workforce: Improve individual and collective
performance
Specialists
Practitioners
Wider Workforce
CPHM (CD/EH); Nurse Consultants;Consultant
Epidemiologists; General and Defined Specialists; EH Managers; Those in
formal specialist training;
Generic CPHMs (participating in on-call); Health Protection Nurses;
Epidemiologists; Infection Control Nurses; Environmental Health Officers; Infection Control Doctors & Managers
Microbiologists; Primary Health Care; Microbiologists; Primary Health Care; Secondary health care ; Veterinarians; Secondary health care ; Veterinarians;
“Blue light” services; Government Officials;“Blue light” services; Government Officials; Prison service; Occupational Health; Prison service; Occupational Health;
Environmental Protection; PharmacistsEnvironmental Protection; Pharmacists
COORDINATION, COORDINATION, COLLABORATION COLLABORATION
AND AND ACCOUNTABILITYACCOUNTABILITY
Health Protection in Scotland
• HPAG:HPAG: Secretariat, Reports
• Support to SG: Support to SG: Policy, circulars, Public Health Act, PQs, briefings
• Programmes & Projects: HAI (SA bacteraemias, C. difficile, hand hygiene, AMR); Immunisation (Flu, HPV, childhood); Hepatitis C
• Incidents and outbreaks: Civil Contingencies, organisational arrangements, input to local and co-ordination of national response
• UK/European Interfaces:UK/European Interfaces: UK Oversight, HPA, ECDC, UK scientific advice
• Support for Stakeholder groups: CPHMs, SMF, HP Nurses, TB Nurses, IC managers, ICNA, Travel, GI, NICG, Flu Co-ordinators, EHOs, HepC Coordinators
HPS Developments 2005-10
Surveillance New systems: Notifiable diseases and organisms, C. diff, SAB, Flu, HPV, Syndromes, STIs UK & Europe: NEPNEI, TESSy, EWRS , IHR New Reference laboratories (C. diff, HPV) & strategy
Investigation Burden of disease (HepC, IPD, MRSA) Prevalence of HAI; HPV in schoolchildren Outbreak investigations (Pandemic, C. diff, Q fever,
anthrax) Research Projects
Risk assessment
Modelling measles, pandemic, impact of HepC infection HTA: MRSA screening, HepC interventions
Prevention Immunisation: MMR, PCV/PPS, HPV, BCG, Flu Infection Control: Hand hygiene, decontamination, IC model policies, specific precautions, nurseries Risk reduction; Travel, IVDUs, STIs, at risk occupations, TB Prescribing; AMR strategy Public Policy: NHS, Food, Water, Environment, Care, Animals
Response Preparedness; pandemic, bioterrorism, poultry, environment, Hospitals, Offshore, Ports Incidents: pandemic, avian flu, anthrax, salmonellas, measles, vCJD, pollonium
Communication
Public: NHS24, Health Scotland, hand hygiene, media Service: alerts, guidance, newsletters, websites,
HPS Developments 2005-10
HPS Developments 2005-10
• Information: surveillance review, SHPIMS (support for NHS Board delivery), integrated Immunisation databases, governance & assurance
• Quality assurance (Quality assurance (Services) :: methodology, Pandemic Influenza preparedness, immunisation co-ordination, capacity and resilience
• Evidence based practice (Professionals):Evidence based practice (Professionals): support to Health Protection Network, Guidance, SHPIR, expert advice
• Research and Development: capacity, joint working, participation in national initiatives
• Commissioning laboratories: strategy, quality, developments, UK integration
• NHS Performance: input into SG HEAT Targets (MMR, HAI, C. diff), Project implementation & benefits (HPV), accountability reviews
EFFECTIVENESEFFECTIVENESS & S &
EFFICIENCYEFFICIENCYInformation: Scottish Health
Protection Information Management System
Background
• TB systems – Tayside– Argyll & Clyde
• SIDSS 2 – Notifications
• Outbreaks– Managing cases and data– Managing communications
• Resilience
Aims
• Management of infectious diseases– Cases– Contacts– Escalating for incidents & outbreaks
• Routine surveillance– Linking local and national surveillance– Consistent reporting– Standardised letters
• Knowledge management– From multiple sources– Supporting consistent practice
• Support audit of practice
Progress• Specification document (2007)
• Interim “solution” CDC
• SHPIMS funding sought– E-Health Board– Scottish Government
•Outline business case and initial agreement
• NHS Fife – HPZone (others?)
• Political / Economic climate
Background
• Unified system: common response to common problems
• Concern about incident management: Baseline Audit of NHS systems to manage public health incidents in Scotland, April/May 2003
• SG policy on limiting variation in NHS provision
• Development of QA in related areas : LA EH Function, civil contingencies, health improvement, HAI related standards by NHSQIS
AimsMonitoring the quality and effectiveness of health
protection services by:
– setting and auditing standards to ensure that NHS Boards and HPS have systems in place to deliver surveillance, risk management and communication, outbreak management;
– reporting to the Scottish Executive and the Scottish Health Protection Advisory Group;
– Liaising with NHS Quality Improvement Scotland on the above.
DCMO Letter: HEALTH PROTECTION SCOTLAND, November 2004
Approach
• Assure organisational systems not operational protocols or procedures;
• Agreement with NHSQIS: health protection system to “self” assure; QIS to ensure fit for purpose QA methods and practice
• Working Group on common remit and approach (SEHD/CMO(2007)2; feedback to Boards - key recommendations not formal audits
• Develop and pilot methodology: SG & HPAG request: Pandemic Flu (2006/07)
• Respond to requests for work on HP quality related issues
Progress• Pandemic Flu preparedness: report to Minister, HPAG and Boards June 2007
• HPAG recommendations 2008/09;
– NHS HP capacity & resilience - WG 2008; standards set; piloted Lothian and Grampian, no progress as Pandemic
– Immunisation Programme Co-ordination - Standards agreed NICG 2008; no pilot because of lack of common governance
• Response to requests:– Haemophilia Directors: Review of TSE IC Measures in Hospitals 2007– HPS Travel: WHO Accreditation of Yellow Fever Immunisation Centres 2008– HAI Task Force: Survey of Infection Prevention and Control Support 2009– MRSA Screening National Steering Group: QA Pilot Programme 2009– HPS CMT: Vale of Leven Outbreak and consequences- Debriefing 2009/10– DPHs: Lessons Learned from PF Containment Phase 2009/10– HPV National Steering Group: Lessons Learnt from introducing Programme 2010– SG GPBH Project: Survey of Development of Interventions 2010– SG Managing Incidents Guidance: Review of Lessons Learned 2010/11
Effectiveness and Efficiency
Information
– Investment required: If SHPIMS funded, then procurement exercise & Implementation exercise. If not funded, then diverging systems/practices and continuation of alternative ways of working in different parts of Scotland.
– Protocols & Procedures: return from investment dependent on move to common assured, working methods
– Attracting investment: competition for more limited resources; need for savings and impact; ? profile of Health Protection
Effectiveness and Efficiency
Quality assurance
• Definitions: Organisational systems vs Operational protocols
• Variation in provision: relationship to cost and outcomes; reflection of local needs or professionals’ views
• Governance: common goals, common reporting, need for unified system
• Approach: Formal audits vs incrementally ensuring lessons are learned and applied
Conclusions
• Challenges and strategic aims for health protection changing but still roughly the same as for 2002
• Still a need for a unified system
• Experience of HPS since 2005 has shown that common goals, systems, standards and information
are key to achieving strategic aims
• Experience has shown that a lack of a common governance system and significant investment and
variations in provision are major obstacles to a unified health protection system