1. Protocols and Standards NHS Board perspective Dr Helen Howie 19 January 2011

2. Professional principles GMC – Good Medical Practice plus supporting guidance NMC – The code: Standards of conduct, performance and ethics for nurses and midwives FPH - Good Public Health Practice

3. Life of a Board HPT Bit like general practice No idea what that next query will be Workload unpredictable Wide in scope Interpret good practice and apply appropriately Rigid protocols/SOPs rarely appropriate

4. Local HPT action must be Responsive Timely Flexible Resilient Appropriate Proportionate

5. To do this we need Skilled team able to interpret & apply expert knowledge appropriately Access to expert information & advice Local operational know-how Well established routes of communication

6. And………. Critical mass of staff Local knowledge of the ‘patient’ i.e. population health status and local settings Corporate accountability for public health Strong local organisational partnerships Leadership, strong team ethos and supportive culture i.e. no blame

7. Multiple sources of expert advice HPS HPN SGHD HAI Task force SIGN FSA Expert groups HPA DoH e.g. Green Book NICE ECDC CDC WHO Hawker et al Chin - APHA

8. Guidelines Systematically developed statements which help in deciding how to treat particular conditions Guidelines are not intended to be construed or to serve as a standard of care SIGN methodology –Based on systematic review of evidence –Assessment of quality of evidence –Strength of recommendations

9. Health Protection Network ‘ Professionals are expected to take this guideline into account when exercising their professional judgement.’ ‘The guidance does not overrule individual responsibility of professional to make decisions appropriate to the circumstances of individual incidents and cases in consultation with partner agencies and stakeholders.’.

10. But……… Often no evidence base Grey areas Rely on expert opinion Need to apply to situation Strive for consistency But will be legitimate variation

11. We monitor our performance Daily, weekly and monthly peer review of practice Limited formal audit e.g. E coli O157 and meningococcal disease On call standards –Response and attendance time –Handover –Scottish criteria

12. To improve our performance Local guidance – what to do when Challenge evidence base when necessary Provide training –Health Protection Team –On call staff –Wider partners Local PH governance arrangements Annual review against HP plan and local governance standards

13. What would help improve our local practice More evidence based guidance SHPIR – kept up to date but revisit Reduce duplication of effort – adopt UK guidance where appropriate Information management system that supports surveillance and incident management Access to expert advice –Not just signposting to guidance –Ability to debate interpretation & application in specific situations

14. Clinical Standards CSBS Principles (2001) Evidence based Explicit, measurable and realistic Mandatory Outcome orientated + structure & process Few – focus on what matters Credible and widely disseminated Balanced – still holistic care Achievable but stretching

15. Standards in Health Protection HAI standards Civil Contingencies - NHS QIS CG&RM and NHS resilience audit against NHS Responding to Emergencies Plus –Scottish criteria for on call –Quality assurance - capacity & resilience

16. Standards in Health Protection Revisit ‘Assuring the quality of NHS Boards health protection services in Scotland’ Widen scope to include HPS Use NHS QIS methodology Use HPN guidelines Develop standards and measurable criteria All HPT assess against standards Continuous quality improvement But remember the CSBS principles