Operating Review

Overview 2005-06

The past year has been very productive against a challenging background. Within the Agency we carry out a huge volume of work that goes on day to day, responding to many thousands of enquiries and requests for information and advice, responding to incidents and supporting our many stakeholders with a range of services such as training, specialist diagnosis and production . This report illustrates many of these activities, showing the breadth of our work, in terms of the type of activity, the range of health protection issues, the number of stakeholders, and the nature of the problem, ranging from concern from individuals and local communities, to national and sometimes international problems. All are important, as directly or indirectly they each affect the public and individuals, who should always remain at the forefront of our purpose.

However, in this report, we also demonstrate how we are turning more to a 'programme approach.' The intention is that we focus on high priority health protection issues. Such priorities are informed by the burden of disease, the concern of the public, and government priorities. We aim to harness our resources across the Agency towards a common goal, focusing more on outputs and outcomes and so gain benefit from the organisation being greater than a 'sum of its parts'.

One of our important responsibilities is to respond to emergencies, supporting others when they are in the lead role and helping other organisations, particularly the NHS, in their preparedness. This year we delivered a significant programme of work on pandemic influenza preparedness and supported the response to major incidents such as the bombings in London on 7 July and the Buncefield fire, and we are breaking new ground in establishing a standard methodology for longer term follow up. This will remain a high priority for us.

Our profile has increased steadily through the year with around 200,000 visits and over a million hits per month on our website, 500 - 800 references to the Agency in the media each month, with an average of 100 - 150 broadcasts mainly in the Regions. We are frequently asked to present at major conferences and are contacted for advice by an increasing number of organisations and government departments, such as the recent request from a government department on the effects of arsenic and nickel in soil. As an organisation, our international profile continues to grow, for example through the two exercises we ran across the European Union.

Internally, our moves to develop an organisation more fit for purpose continue. In 2004/05, we moved to more integrated Centres. In 2005-06, we have concentrated more on how we work as an organisation. A Framework for Organisational Development is now incorporated into our Strategic Plan; ` Strengthening the Front Line' provided a new approach to the development of local services and we started on a process called 'The Intelligent Health Protection Agency ', which provides a way of working, and a tool for assessing that work. We have embarked on a series of reviews to create more efficient and effective working, including a new financial system.

Our external income has grown over recent years, which makes an important contribution to public health, as not all our work is funded by government. It also contributes to our overheads, and enables us to retain high quality staff for public health purposes. Some of this funding is for research. This is essential if we are to be at the forefront as a health protection organisation, basing our work on the latest evidence and being at the 'cutting edge' of technology. The establishment of Syntaxin Ltd is an important step for the Agency. It means that this cutting-edge research can be developed into products that will deliver direct health benefits to the public.

There is of course much more to do. Despite a major programme, for example in information technology and accommodation, we must continue to improve our infrastructure. We must complete Agenda for Change and the push forward with the Knowledge and Skills Framework and our workforce development programme. We will continue to improve internal communications and staff involvement, so that staff recognise the value of the work that they and others carry out and feel proud of the many achievements by so many people across the Agency.

Although the programme approach and more effective working across different parts are beginning to bear fruit, we must continue to drive towards outcomes, and we have an ambitious programme of work as set out in the Strategic Plan. Our day to day service must be delivered with constantly improving quality and efficiency, and we must be prepared to respond to any emergency no matter where in the country. We will need to ensure that our stakeholders are content with the services and support we provide, and reach out more to the public and involve them more in our work.

We have many highly professional and competent employees and I am confident that they will continue to rise to this challenge.


Individual Programmes

The Health Protection Agency delivers its strategic goals through 15 programmes. This ensures a co-ordinated way of working across the Agency, and provides a critical assessment of whether the Agency is using its resources to best effect to achieve its aims and objectives.

Each Programme is overseen by a director, who is a member of the Executive Group. The director is supported by a programme manager who co-ordinates the work. Members of each programme are drawn from across the organisation to provide expertise.

 

Programme 1 - Reducing the incidence and consequences of infection

Healthcare-associated Infections and Antimicrobial Resistance

Hepatitis

Sexual Health

Vaccines

Tuberculosis

Influenza

Gastrointestinal Diseases

Programme 2 - To protect against the adverse health effects of acute and chronic exposure to chemicals, poisons and other environmental hazards

Programme 3 - To improve protection against the adverse effects of exposure to ionising and non-ionising radiation

Programmes 4 and 6 - To prepare and respond to emerging health threats and emergencies including those posed by deliberate release

Programme 5 - To protect and improve the health of children

Programme 7 - To strengthen information and communications systems for identifying and tracking diseases and exposures to infectious chemical and radiological hazards

Programme 8 - To build and improve the evidence base through a comprehensive programme of research and development

Programme 9 - Develop a skilled and motivated workforce

Programme 10 - To manage knowledge and share expertise

Programme 11 - To build on and develop the intellectual assets of the organisation in partnership with industry and other customers, in order to better protect the public

Programme 12 - To raise the understanding of health protection and involvement of the public and ensure they have access to authoritative, impartial and timely information and advice

Programme 13 - To strengthen health protection at local and regional levels

Programme 14 - To contribute to UK international health objectives and to global health

Programme 15 - Making it happen - building the infrastructure to support effective operational functions

 

Programme 1

Healthcare-associated Infections and Antimicrobial Resistance

The Agency continued its active surveillance and feedback to the Department of Health, Strategic Health Authorities and the NHS on healthcare-associated infections (HCAI) such as MRSA, Clostridium difficile , and surgical site infections. It also published monthly bacteraemia reports from voluntary surveillance on the Agency's website.

The Agency strengthened MRSA monitoring by developing and introducing the MRSA enhanced surveillance system, implemented in October 2005. It also developed statistical process control charts to assist Trusts in monitoring their MRSA rates against targets.

Centre for Infections staff developed a template for "Drug-Bug" alert systems for identifying unusual or emerging antibiotic resistance patterns.

HCAI regional leads worked with the NHS to identify and spread good practice by establishing and co-ordinating HCAI networks. The Agency also coordinated, on behalf of the Department of Health, the HCAI Steering Group, which made recommendations to the Chief Medical Officer on areas for further action at the end of its first phase of work in summer 2005.

The Agency assisted with an investigation into the outbreaks of C. difficile at a number of NHS hospitals. It also produced an interim report with the Healthcare Commission on the results of a national survey of C. difficile in December 2005.

The Agency produced guidance on issues including the use of Health Protection Agency MRSA typing services, and the control of multi-resistant Acinetobacter baumannii . It also produced two reports on antimicrobial resistance and published the evaluation of IT systems for infection control. It contributed to the revised UK guidelines on MRSA.

Further developments to the MRSA surveillance system are underway, including enhancements to cover bacteraemias in renal units, an area for development this coming year. The first joint report with the Veterinary Medicines Department on antimicrobial resistance in both human and animal pathogens will be published.

 

Hepatitis

The first Health Protection Agency Annual Report on hepatitis C was published in December 2005. It showed that, based on Health Protection Agency modelling, the burden of severe liver disease due to hepatitis C infection is predicted to rise.

During the year the programme board supported the development of a set of standards for the routine surveillance and control of hepatitis B and C mainly from a local perspective.

The Agency was involved in the investigation of three incidents of hepatitis B in nursing homes (involving over 12 cases and three deaths), linked to the inappropriate use of diabetic blood testing devices. This led to the issuing of an alert by the Medicines and Healthcare Products Regulatory Agency.

Sixteen laboratories were recruited to establish enhanced surveillance of hepatitis C testing. They are monitoring the impact of the national awareness campaigns on the amount of testing conducted to inform healthcare planning for the treatment and diagnosis of infection.

The Agency published the results of vaccine coverage for several components of the selective vaccination programme (genito-urinary medicine clinics, prisons and in infants born to infected mothers). Improvements were seen in coverage in most programmes, most notably among injecting drug users. The Agency's modelling suggests that this has the potential to substantially reduce cases of hepatitis B in England .

Projects being undertaken for the coming year include implementing and auditing the hepatitis B and C standards in local Health Protection Units, taking action to improve the routine laboratory reporting of hepatitis A and B, and planning work to support the introduction and widening of indications for treatment of chronic hepatitis B and C.

 

Sexual Health

The sexual health programme board oversees a range of projects concerned with issues about the surveillance and epidemiology of sexually transmitted infections (STIs).

The Agency conducts quarterly audits of genito-urinary medicine (GUM) clinic waiting times on behalf of the Department of Health and in collaboration with the British Association for Sexual Health and HIV (BASHH). The audit aims to establish whether patients are offered an appointment within 48 hours of contacting the service as recommended in the Public Health White Paper 'Choosing Health' (2004).

In October 2005, Agency staff presented a report assessing HIV test uptake nationally. Uptake of HIV testing has exceeded the 60 per cent that the 'Sexual Health Strategy' specified should be achieved by the end of 2007.

The Agency took over the operational management of the National Chlamydia Screening Programme (NCSP) in November 2005. The roll out of the programme continues and national coverage will be complete by March 2007.

The lymphogranuloma venereum (LGV) outbreak has continued unabated, reaching 327 cases by the end of December 2005. A senior scientist was appointed at the Centre for Infections to help co-ordinate enhanced surveillance of LGV and syphilis.

The programme board continues to support emerging surveillance issues raised by BASHH and other professional bodies. These include developing methodologies for the surveillance of STIs in clinical settings outside GUM. Current projects include participating in the development of the Common Dataset for Sexual Health (Department of Health) and the calculation of STI rates by area of residence (BASHH/Health Protection Agency Information Group).

 

Vaccines

To maximise uptake within the national immunisation programmes the vaccine programme board established a nationwide network of Health Protection Unit immunisation leads to provide local leadership and communication for enhanced implementation of policy and the sharing of good practice.

The Agency began a study to evaluate the schedules for meningococcal C and pneumococcal vaccines in infants. The Agency is also monitoring the uptake and effectiveness of the adult pneumococcal immunisation programme.

Work continued on the Neisseria lactamica candidate vaccine against meningococcal disease, and a research proposal for options for use of the new Human Papillomavirus vaccine was submitted to the Department of Health.

The Pneumococcus and Haemophilus Forum was established to support surveillance of these infections and develop public health guidance. The Meningococcus Forum reviewed and revised extensive public health guidance on the management of meningococcal disease.

An Agency advisory and reference service for the Varicella Zoster (the virus causing chicken pox) immunisation programme was launched, including serological testing and polymerase chain reaction. 

The programme board assisted with the multi-agency outbreak team on the national mumps outbreak, issuing advice on priorities for MMR vaccine usage. The outbreak, which caused over 50,000 cases of mumps in 2005, with many universities and schools affected, declined significantly in 2006.

 

Tuberculosis

The aim of the tuberculosis programme is to contribute to the elimination of tuberculosis in England through support to the Department of Health and NHS in the key areas identified in the Chief Medical Officer's National Action Plan.

Achievements in the year included the assessment of the effectiveness of diagnosis of TB by molecular analysis of sputum and saliva, and a review of the role of gamma interferon tests in the diagnosis of latent infection.

Proposals were developed to strengthen local and national tuberculosis surveillance systems so as to provide the most relevant and timely information for those providing services.

The Agency also contributed to the World TB Day annual event to raise the profile of the public health problem posed by tuberculosis, and established a TB Newsletter.

Staff developed a molecular strain typing strategy which will contribute to improved local control of tuberculosis as well as better understanding of disease transmission at local and national level. In particular, this will help to identify early outbreaks.

An interim report on trends in the occurrence of tuberculosis in England, to be used as a baseline for future assessment of interventions, was prepared with a final report planned for the end of 2006.

Other future work includes overseeing the development of a revised national surveillance system, the finalisation of Revised Standard Operating Procedures for the laboratory diagnosis of TB, and the development and evaluation of molecular methods for rapid detection of resistance genes.

Future work of the Agency will be required to focus on ways to support measures to reduce transmission of infection in this country and reduce the risk that previously infected individuals develop disease.

 

Influenza

The priorities of the influenza programme board have been to deliver on the requirements of the Agency set out in the joint UK Health Department Pandemic Influenza Plan released in October 2005.

To ensure the establishment of robust nationwide arrangements for dealing with the human health aspects of avian influenza, the programme board worked closely with the Department for Environment Food and Rural Affairs (DEFRA), the Department of Health (DH) and other partners at a national, regional and local level. The output from this collaboration has been the development and cascade of Avian Influenza Specific Clinical and Laboratory Algorithms and Standard Operating Procedures for frontline health staff within the Agency and in the wider healthcare delivery setting.

The programme board oversaw the roll out of H5 laboratory testing capability to all Regional Health Protection Agency Laboratories with validated Proficiency Panel testing arrangements in place.

It developed evidence-based Pandemic Influenza related guidelines for infection control and clinical treatment, in conjunction with DH and appropriate professional bodies, including the British Thoracic Society.

It developed population-based modelling outputs to inform the strategic public health decision making required to mitigate the impact of an influenza pandemic.

There were ongoing collaborative research and development projects, including the development of candidate vaccines for influenza viruses with pandemic potential.

There was a review of existing influenza surveillance mechanisms in terms of their population coverage and potential development of daily reporting capability, in the event of a pandemic.

The planning and implementation of an ongoing Agency -led exercise programme continued to test various aspects of pandemic influenza-related preparedness and response arrangements at international, national, regional and local levels.

Ensuring that there is local, timely access to oseltamivir for deployment by frontline Health Protection Units in the event of an avian influenza incident was secured through liaison with DH and the NHS. 

The programme board's focus for the coming year is to secure robust, consistent frontline preparedness arrangements for pandemic and avian influenza.

 

Gastrointestinal Diseases

Staff conducted a follow -up of the Infectious Intestinal Diseases Study which took place about 10 years ago, and used new molecular methods developed by the Agency to test 4,500 stored faecal samples for infections such as rotavirus, norovirus, and cryptosporidium. The results of the research, which was funded by the Food Standards Agency (FSA), mean that a cause of illness has been identified in 80 per cent of cases.

The programme continued with its three-year enhanced sentinel surveillance of salmonella and campylobacter which began in November 2004 and which is investigating the risk factors for disease transmission. So far it has involved almost 30,000 samples and 20,000 patient questionnaires.

Following on from the Agency's work providing assistance and advice on the Salmonella Enteritidis outbreak associated with Spanish eggs, staff developed enhanced investigation protocols for the surveillance of future outbreaks. The protocols are used to monitor the effectiveness of measures taken by the FSA and European agencies to reduce the burden of disease associated with imported eggs. 

In addition, the Agency produced algorithms for diagnosis, investigation and management of vero toxigenic E. coli (VTEC) and salmonella. It has also worked to improve the timeliness and completeness of laboratory reporting of gastrointestinal infections by diagnostic and reference laboratories. It also continues collaborative work with partners such as the Drinking Water Inspectorate, and is producing a book on the management of food poisoning outbreaks with the FSA.

 

Programme 2

To protect against the adverse health effects of acute and chronic exposure to chemicals, poisons and other environmental hazards

The Agency, and in particular the Chemical Hazards and Poisons Division, provided significant strategic and scientific support during the Buncefield incident and the London bombings, and provided support in the management of other chemical incidents.

Three major reviews were completed. The first was on the effects of landfill sites on reproductive health. The other two were toxicology reviews covering current knowledge on reproductive toxicity and the neurotoxicity of environmental chemicals. 

The detailed review of the National Poisons Information Service (NPIS) in 2004 led to a number of improvements to the service, including the implementation of a new rota for consultants and NPIS information scientists.  These changes have increased joint working and have been evaluated successfully in the year by partners and clients.

Significant progress took place in the development of a matrix for risk prioritisation of chemicals and groups of chemicals and an associated user guide for health professionals. This matrix will lead to the development of integrated planning and preparedness for chemical incidents across the G7 countries as well as the European Union and the UK .

A mechanism for the routine surveillance of key health-related indicators and disease endpoints at a local level was developed and will be applied in one region as a pilot. It will investigate the utility of cancer registries, hospital admissions and registries of congenital anomalies in surveillance. The findings will be used to establish whether certain diseases are connected with environmental hazards.

In 2005/06, the Agency signed a Memorandum of Understanding with the Environment Agency and is in the process of signing agreements with other organisations. These will lead to improvements in the management of chemical incidents and research and development initiatives.

Work for 2006/07 will focus on four areas: to develop further the NPIS; to strengthen the links between the Agency and key stakeholders; to contribute to the EU-wide Action Plan for the improvement of children's health as part of the Children's Environmental Health Action Plan for Europe and to develop protocols for the Agency's actions in areas of significant public concern. 

The Agency is also launching The Newcastle Toxicology Research Unit, a joint initiative with the University of Newcastle upon Tyne . The Unit will develop novel biomarkers of exposure to environmental chemicals and focus on mechanistic toxicology. 

 

Programme 3

To improve protection against the adverse effects of exposure to ionising and non-ionising radiation

The Radiation Protection Division (RPD) provided formal scientific advice throughout the UK on the health effects of ionising and non-ionising radiations, underpinned and supported by its laboratory research and development, epidemiological studies, exposure assessments and computer modelling.

It also provided advice to the public, across the Agency and to local organisations with responsibilities for public health. Work in this area was enhanced in 2005/06 by the formation of a medical exposures department.

The Division recently took on responsibility for advising government departments on the health effects of ultrasound and infrasound; it set up an expert advisory group to review the existing knowledge.

In the work on non-ionising radiation, emphasis is placed on the health effects of public exposures to power frequency electromagnetic fields and radiofrequency radiations where there is significant public concern and scientific uncertainties.

Over the year, RPD ran a broad range of training courses on radiological protection. Many of these updated the staff of external bodies on technical and scientific developments.

RPD continued to have a significant role in emergency planning for radiological emergencies, and planned and took part in many radiological emergency exercises.

Commercial services provided in radiation protection included the personal monitoring of occupational exposures, commercial radiological protection advice, environmental monitoring, radiochemistry, instrument testing and a specialised service that covers dental radiology. Financial surpluses from these services were used to support core scientific work in radiation protection.

RPD will respond to the forthcoming draft Recommendations of the International Commission on Radiological Protection (ICRP) and initiate consultation with stakeholders in order to provide advice on implementation in the UK .

In 2005/06 there was a corporate target concerned with development of work across the two divisions of the Centre for Radiation, Chemical and Environmental Hazards (CRCE). This was achieved and has led to another two targets for 2006/07, including secondment of staff between Chemical Hazards and Poisons Division and RPD departments.

 

Programmes 4 and 6

To prepare and respond to emerging health threats and emergencies including those posed by deliberate release

Programme 4 (To protect against new and emerging diseases and health threats) and Programme 6 (To improve preparedness of responses to health protection emergencies including those caused by deliberate release) were merged in April 2005.

At this time, the National Radiological Protection Board joined the Agency. The integration of emergency plans and arrangements continued through the period culminating in the integrated participation of the Agency in a major civil nuclear emergency exercise. Participation included local radiation specialists, communications and the strategic Agency response.

Over the year, the Agency was busy establishing a limited emergency response vaccine capability within existing facilities and developing a strategy for the rapid manufacture of vaccines in collaboration with other organisations.

It provided ongoing support to the Chief Medical Officer's National Expert Panel on New and Emerging Infections, which brings together experts from different fields to assess the risks of new diseases.

It continued with its short and medium/long-term horizon scanning to identify potential threats to public health from emerging infections.

The Agency continued to work with key organisations and partners in industry to identify risks and implement responses to minimise the incidence and impact of variant Creutzfeldt - Jakob disease (vCJD). A capacity for screening the tonsils in the national anonymous tonsil archive for the presence of abnormal prion protein is being prepared at the Centre for Infections. Testing will begin as soon as a suitable high throughput test system becomes available. The Agency and its industrial partner continue to develop the novel prion decontamination technology, 'Prionzyme', which has now received essential CE mark approval.

The Agency ran two exercises for the European Commission, and ran eight multi-agency exercises in the UK covering a range of public health threats. It also provided training for frontline staff. Over 1,300 NHS staff completed the A&E radiation monitoring training and ambulance personnel dosimeter training.

The development of the Agency's National Emergency Response Plan is ongoing and was tested during the London bombings and the Buncefield fire. Lessons and appropriate action following incidents and from the exercise programme were identified and will be used to develop further emergency preparedness and response arrangements.

The Agency continues to develop its Emergency Operations Centres with one major project completed and others planned to ensure an integrated Agency response to emerging health threats and emergencies. It will also develop emergency preparedness standards for internal use. This will promote consistent and integrated arrangements as well as providing a common basis for monitoring and measuring performance in this area.

 

Programme 5

To protect and improve the health of children.

The Health Protection Agency, together with the Environment Agency, is leading on the development of a UK Children's Environment and Health Action Plan (CEHAP). In order to develop this plan a scoping study was commissioned to identify and review current activities relating to the WHO (Euro) Children's Environment and Health Action Plan for Europe (CEHAPE) and EU environment and health initiatives. This study is continuing into 2006/07 and a workshop to discuss these findings is to be held during 2006.

An integral part of developing the CEHAP is to involve young people and ensure their views are taken into consideration, activities so far have included:

Continued involvement of young people is planned.

The Agency is developing a national hand hygiene initiative that will be integrated into the schools curriculum. The first pilot scheme to improve hygiene and hand washing practice in primary schools was taken forward in the North West in consultation with a number of local partners. This pilot evaluated current material on the market and worked with 12 schools to identify which types of resources both teachers and pupils preferred. The findings from this work will form the basis of a larger pilot in another region during 2006/07. In order to gain the maximum impact this work is linking up with other key initiatives and agencies such as the National Patient Safety Agency's 'cleanyourhands' campaign and the Healthy Schools Programme.

The Agency recognises that an important element of becoming a 'young people friendly' organisation is ensuring that there are good communication routes. As part of this a public facing children's health section on the Agency website is under development and is expected to be launched in 2006/07.

The burden of disease report Health Protection in the 21st Century, published in October 2006 included children's health as a cross cutting theme within each chapter, and included a chapter on children's health. The report identified gaps and priority areas for future work to improve children's health. The Agency will work with partners and stakeholders to identify how these priority areas will be taken forward.

 

Programme 7

To strengthen information and communications systems for identifying and tracking diseases and exposures to infectious chemical and radiological hazards

The surveillance strategy programme board developed a vision for surveillance over the next five years with an accompanying set of tasks, and work was completed on documentation setting out a high level framework for the principles and standards for surveillance systems operated by the Agency.

In the second half of the year the programme started work on delivering the strategic vision. The first steps included an analysis of the current situation and of unmet requirements in priority areas. A catalogue of surveillance systems used by the Agency was completed and analysed. This allows for systems to be evaluated, and will be undertaken jointly with Health Protection Scotland (HPS) using a shared evaluation model.

The programme also identified surveillance success stories since the inception of the Agency so that lessons could be learnt and exemplar systems identified. Projects to review the use of HPZone (which is a tool for local Health Protection Units to use that allows case and incident recording, risk assessment and management of response) as a system for national use in HPUs and an evaluation of Field Information Management Systems have begun.

Surveillance needs from Health Protection Agency programmes were requested in order to conduct a gap analysis between where the Agency is now and what is required. The programme aims to complete the gap analysis, identify candidate systems and recommend systems to be further developed and duplicate systems to be decommissioned.

Factors affecting the programme include the identification and implementation of an appropriate accountability framework for surveillance system operation and development. The completion and strengthening of the corporate IT infrastructure programme will also be critical to the programme's future development and performance. The main external factor affecting the programme is the NHS National Programme for Information Technology, which presents significant potential benefits through its development of an electronic health record linking clinical, pathology and prescribing data at primary and secondary care levels.

Future projects include defining standards for surveillance systems and their outputs, with respect to information, technology, operations and performance; the development of a plan for implementing technical and operational framework for surveillance within the Agency, based on wider deployment of existing systems that represent best practice, integration and/or decommissioning of other systems to

reduce redundancy; and procurement or development of new systems to meet unmet needs (as identified through gap analysis).

 

Programme 8

To build and improve the evidence base through a comprehensive programme of research and development

The Agency's research and development (R&D) informs and supports both its work and that of others. The estimated spend from external contracts during the year was in excess of £10.9 million. This represents a 26 per cent increase over the three-year period 2003-06.

A five-year R&D strategy has been developed and published. In-year R&D priorities will be agreed as part of the R&D Business Planning Cycle.

This year, the Agency bid successfully for funding from a variety of research projects including a share of an £8.5 million project from the European Commission investigating environmental stressors in Europe. The Agency was also awarded a grant of £1.82 million from the UK Home Office to look at the detection of biomarkers for deliberate-release pathogens.

A significant award of £3.39 million was received from the Department of Health (DH) to investigate variant Creutzfeldt-Jakob disease (vCJD). Also in the public health area, DH asked the Agency to take over the National Chlamydia Screening Programme with a value of £1.13 million.

The Agency continues to play a major role in European surveillance of infectious diseases and health education. These aspects were reflected by two major grants from the EU for diphtheria surveillance and the development and dissemination of a school antibiotic and hygiene information pack.

 

Programme 9

Develop a skilled and motivated workforce

At the end of 2005, approximately 1000 staff had been fully assimilated to Agenda for Change (AFC) terms and conditions, and approximately 1400 posts had been through the initial phase of the job evaluation process. The process of implementing AFC for former National Radiological Protection Board staff also commenced.

The implementation of the Knowledge and Skills Framework (KSF), as part of AFC, was the workforce development priority during 2005/06. To support this, more than 60 KSF training events, local briefings and follow-up sessions were held. The Agency now has an extensive internal library of KSF Outlines covering in excess of 100 posts. The focus is on ensuring that all posts covered by the AFC agreement have KSF Outlines by the end of 2006.

A corporate training programme was introduced, primarily informed by data from staff Personal Development Plans. Delivered in a partnership arrangement with external suppliers, utilisation rates are currently 91 per cent (places occupied v places available), with a satisfaction rating of 98 per cent .The programme is supported by a user-friendly Learning and Development site on the staff intranet.

An employee development policy was agreed and published, together with corporate guidelines for induction. Project proposals were submitted for the development of standard health protection competencies for staff working in Health Protection Units.

The full implementation of appraisal (with KSF) across the Agency remains a priority. In the 2005 Employee Opinion Survey, 77 per cent of respondents reported having had an appraisal in the previous 12 months (although formal returns to the HR Division were lower than this figure). Improvements are expected in this area in 2006/07.

Other priorities for the programme for 2006/07 include completion of the assimilation of all Agency staff to AFC terms and conditions, and implementing the improvements recommended as a result of the 2005/06 Employee Opinion Survey.  A further priority will be addressing senior management succession planning, for which a project plan is already in place.

 

Programme 10

To manage knowledge and share expertise

Over the course of the year, 5,000 pages and 2,000 embedded documents were added or updated on the Agency's website, which was named as one of the five most useful UK health websites by The Guardian newspaper. Over 4,500 pages and documents were added or updated on the staff Intranet, and improved information location and retrieval facilities were added.

The programme coordinated the National Knowledge Service tuberculosis pilot. This was undertaken in collaboration with partners in the NHS, Department of Health, and charitable organisations. They produced a range of information resources for health professionals, carers and patients, and revised and updated an on-line decision support system for clinical staff. These resources were highlighted in the recently published National Institute of Clinical Excellence Guidelines on Tuberculosis.

Beyond the Agency, the Goal 10 Programme provided the lead for the NHS Connecting for Health 'Do Once and Share' project on tuberculosis. This mapped out care pathways and information flows for the detection and management of tuberculosis, and will inform the NHS National Programme for Information Technology systems development.

Other information management system developments included the implementation of an online catalogue of books and reports (about 12,000 items), journal holdings, 250,000 selected journal articles from 1988 onwards, and details of all the Agency / Public Health Laboratory Service staff publications since 1987.

The next year will see the implementation of a content management system that will improve resilience and editorial process control for the website and intranet. The completion of this project will enable the programme to start work on the development of the National electronic Library for Health Protection, as a specialist branch of the NHS National Library for Health. The programme board will also respond to the new Public Health Information and Intelligence Strategy that is being implemented in response to the government's White Paper Choosing Health . A major initiative in this respect in the coming year will be the development of community health protection profiles.

 

Programme 11

To build on and develop the intellectual assets of the organisation in partnership with industry and other customers, in order to better protect the public

To enhance and realise the value of the Agency's intellectual assets, rigorous systems were put in place to identify opportunities at an early stage.

Workshops and technology-scouting exercises around the Agency were organised on a range of topics in order to identify opportunities and assess their value. The Agency's Innovations Competition, for example, elicited some promising ideas which the Agency is looking to develop.

The Agency, as a member of the Interact Partnership, was successful in winning a third round of funding from the Department of Trade and Industry for Intellectual Property development and exploitation.

The Agency appointed business development managers to cover all its Centres and Divisions in order to focus on winning international contracts. Opportunity Assessment Groups met on a regular basis, and significant contracts were awarded by UK and overseas government agencies, commercial companies based in Europe, North America and Asia , multi-national organisations, and charities. These contracts strengthened and complemented the Agency's core functions.

Particular successes were the formation of Agency's first spinout company, Syntaxin Ltd, the launch by Genencor of Prionzyme (TM), a product based on Health Protection Agency technology for removal of prions associated with variant Creutzfeldt - Jakob disease ( vCJD), and the licensing to OPi of the life-saving leukaemia drug Erwinase. These successes, of course, have built on technology built by the Agency over many years of research and development. The focus will now shift to development of some of the emerging opportunities across the Agency which have been identified in the course of the past year.

 

Programme 12

To raise the understanding of health protection and involvement of the public and ensure they have access to authoritative, impartial and timely information and advice

The communications division continued to improve the quality and timeliness of the Agency's public-facing communications including reports, press releases, guidance and new material going on to the website, ensuring all information was accessible, useful and people-friendly.

The division provided a 24/7 service to the media and to Agency staff at national, regional and local levels. The demand placed upon the Division increased exponentially as awareness of the Agency and its brief grew among the media, stakeholders and the public. 

In an average month, both nationally and locally, the Agency received between 500 and 800 mentions in the print media, and staff participated in an average of 100 to 150 broadcast and print interviews.  This was alongside providing expert scientific press briefings for the publication of Agency reports, and supplying factual background material to ensure journalists were well informed and had the most recent facts and figures.

The division continued to develop and assist with the roll out of a series of public engagement projects across the country, the majority focussing on children or groups disproportionately affected by health issues. Initiatives included a hand-hygiene project in the North West to improve children's awareness of hand washing and a play called 'Emma' to teach children about sexual health. Pupils also visited the Agency to understand more about its work, and lectures on pandemic flu were given at colleges and the Science Museum in London .

The division worked productively with stakeholders including the NHS, local and central government, the Environment Agency, the Food Standards Agency, the Health and Safety Executive, and academic and scientific partners.

A range of communications projects are in the pipeline. These include extending the mobile phone texting service to issue public health messages which was piloted among students in the East Midlands; a conference for children in the West Midlands to increase their knowledge of health protection; and the introduction of a publications feedback form to obtain the views of people who are in receipt of the Agency's reports and advice.

 

Programme 13

To strengthen health protection at local and regional levels

2005/06 was a year of major change for Local and Regional Services. Implementation of the Board policy of 'Strengthening the Front Line' has resulted in the creation of two divisions, the Regional Microbiology Network and Local and Regional Services with new managerial arrangements at national and regional levels.

Considerable progress was made in designing the Health Protection Unit for the sustainable communities of the future. The 'Intelligent HPA' project has focussed on the needs of Health Protection units to be local enough to be responsible to communities, but large enough to sustain expertise and to deal with the full range of health threats. Considerable attention has been given to clarifying the roles, responsibility, functions and outputs of units within a range of scenarios leading to clarification of the key inter-agency relationships that need to be managed. The national expert support and the technical tools, such as surveillance systems and risk algorithms needed to meet justifiably high expectations that communities have for health protection, are also being defined.

 

Programme 14

To contribute to UK international health objectives and to global health

The Agency's international profile and contribution to UK international health objectives continued to develop during 2005/06.

Events of note included the designation of the Agency's 2005 Annual Conference as a UK European Union (EU) Presidency Event and the secondment of a senior staff to the European Centre for Disease Control to support the establishment and operation of this new EU organisation.

The World Health Organisation (WHO) continued to request the expertise of the Agency's staff for international health protection issues via short-term secondments, advice from the WHO-collaborating centres within the Agency, and Agency participation in WHO meetings and seminars.

The Agency also participated in a health protection seminar in South Africa at the request of the South African Ministry of Health under the aegis of the Department of Health/South Africa Memorandum of Agreement on health co-operation.

International collaboration and the exchange of good practices on global health protection priorities, including pandemic influenza preparedness, were undertaken with many countries. These included China (frequently as part of the Department of Health's memoranda of understanding on health issues), Hong Kong (the Agency has a memorandum of understanding with the Centre for Health Protection in Hong Kong ), and with organisations in over 40 other countries.

Future projects for the international programme include the d evelopment of other key international partnerships with health protection organisations worldwide; support for the International Association of National Public Health Institutes (of which the Agency is a founder member); and supporting the health protection work of the European Centre for Communicable Diseases (ECDC) and the WHO.

 

Programme 15

Making it happen - building the infrastructure to support effective operational functions

It is the aim of the Agency's support functions to provide efficient, economic and effective services to the rest of the organisation, thus ensuring operational and frontline staff have the infrastructure and the tools they need to achieve their strategic goals.

During 2005/06, we have continued our programme of harmonisation and modernisation of systems and processes whilst maintaining a stable and reliable service and minimising disruption to the rest of the organisation. Particular highlights include:

The harmonisation and modernisation programme has already generated substantial savings which are being redirected towards the Agency's priority frontline services.

 

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