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CHAPTER 5: PUBLIC HEALTH INVESTIGATION
INTRODUCTION
5.1 Public health investigations are of three types:
- epidemiological (the pattern of disease and likely causes);
- microbiological or toxicological (the nature of the hazard);
- environmental ( e.g. tracing the supply and distribution of food or the dispersion of contaminated air).
5.2 In the 19th century, a key concern was preventing TB and other infections spreading from person to person and therefore the 1897 Act placed a penalty on persons letting houses for making false statements about the occurrence of infectious diseases in their premises. The Food Safety Act 1990 sets a framework for investigation, enabling procurement and analysis of samples and powers of entry and inspection of records, including computer systems. The Health and Safety Executive ( HSE) also investigates health concerns on any health matters on behalf of employees, within the framework of the Health and Safety at Work Act 1974 ( HSAWA) and the accompanying regulations and it is not proposed to change this system.
5.3 An investigation is usually carried out over a period of time, although in certain acute situations such as the outbreak of an infection, accurate information is required more urgently. This usually entails interviewing a range of individuals, carrying out specific tests and collating and analysing data from these in computerised databases. Occasionally, this involves access to documentation kept by private or public sector organisations.
ISSUES FOR CONSIDERATION
Legislative options for ensuring compliance with public health investigation
5.4 The collection of information during such an investigation has, at times, been compromised by either individuals or organisations. Individuals may not wish to divulge details which may incriminate or embarrass them or potentially lead to claims of malpractice or indeed criminal proceedings. Organisations might not disclose certain information for reasons of commercial confidentiality or liability or impact on trade e.g. the extent to which contaminated food products from a producer had been distributed to retail premises. This can impede the proper and timely investigation of a serious public health incident.
5.5 It would be useful if information which could vitally assist in determining the risk to others of exposure to infection or a chemical or radiation hazard is not wilfully withheld from those investigating an incident. An approach is needed which balances the rights of the individual who holds the information with the wider public interest. Thus the trigger point, where the duty to divulge information over-rides commercial or individual interests, should be clear. Penalties for not divulging information should be defined and there should be a facility to appeal against a request to divulge information.
5.6 The trigger for the duty to divulge and co-operate in the investigation of a public health incident should be specific enough to ensure that normal commercial practices are not infringed. The trigger(s) could range from:
- a significant public health incident or outbreak;
- involvement of a notifiable disease, organism or health risk state;
- the seriousness of the outbreak or incident in terms of morbidity, mortality or potential health risk.
Proposals for confirming whether information is necessary
5.7 Procedures requiring the release of information need to be quick and simple if the investigation is not to be delayed. It is proposed that, where the requisite information is refused, the incident management team leader should ask the Chief Executive of the NHS Board principally concerned to sign a certificate confirming that the information is necessary to assist the investigation. If, notwithstanding the certificate, the information is refused, the Team Leader could seek a warrant from the Sheriff for the information to be provided. Failure to comply with the warrant issued by the Sheriff would be a criminal offence, incurring a penalty.
5.8 An appeal procedure will be needed. This too will require to be swift. The appeal could be made to:
- the Chair of the NHS Board;
- if not resolved, the internal appeal could be followed by an external appeal to a Sheriff;
or
- an emergency appeal straight to an external (independent) body such as the Sheriff or Sheriff principal, if the sheriff has agreed that the information should be made available.
Question 3
Investigation Options
Views are invited on whether:
3.1 legislation should make it a statutory duty to divulge information during public health outbreaks or incidents.
3.2 the triggers necessary for such action might be:
a) a significant public health incident or outbreak
b) involvement of a notifiable disease, or organism or health risk state
c) the seriousness of outbreak or incident in terms of morbidity, mortality or potential health risk
3.3 the need for such information should be certified by the Chief Executive of the NHS Board, or a case made by the competent person, or whether this should be the Sheriff
3.4 an appeal system or structure should be available against the duty to divulge, involving either reference to the chair of the NHS Board, and thereafter to the Sheriff, if necessary, or in emergency situations, direct to the Sheriff.
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