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CHAPTER 9: PORT HEALTH
INTRODUCTION
9.1 Port health, which includes both seaports and airports, is a specialised field with specific legislation. Globalisation has facilitated the rapid passage of infectious disease and contamination across, and between, continents. The resurgence of serious infectious diseases that can neither be controlled by vaccination nor treated with available antibiotics ( e.g.SARS or avian flu), have made it important to review current port health infection control measures.
CURRENT POSITION
9.2 Most port health legislation dates from the 1897 Act which created the Port Authorities. The Port Health system was developed further by The Public Health (Scotland) Act 1945 and the Health Services and Public Health Act 1968 and a number of Statutory Instruments (The Public Health (Aircraft) (Scotland) Regulations 1971, amended in 1974 & 1978 and the Public Health (Ships) (Scotland) Regulations 1971, amended in 1974 & 1978 ) refined procedures for public health action in relation to aircraft and ships. There is, in the main, consistency of approach throughout the UK ( Annex J).
9.3 Most local authorities which have ports or airports have a number of Environmental Health Officers who specialise in port health and there is a Designated Medical Officer or other medical officer of an NHS Board to discharge the duties under the 1971 Regulations. However, these regulations concentrate on compliance with the 1969 International Health Regulations which aim to provide maximum security against the international spread of a small number of diseases (smallpox, plague, yellow fever, cholera) with a minimum interference with world traffic. These limitations are believed to be out of step with the needs of modern public health and the 1969 Regulations have recently been revised to reflect public health protection rather than specific disease control. Any new legislation will require to meet IHR 2005 obligations.
9.4 The powers in the current legislation for health authorities are not expected to be applied to any vessel from an excepted area (currently Belgium, Channel Islands, France, Greece, Isle of Man, Italy, Luxembourg, Republic of Ireland, Spain, the Netherlands and the UK) unless there is grave danger to health. Co-operation between port health interests and airport authorities is generally good but, with the increase in international travel and the consequent higher risk of communicable disease, the need for heightened vigilance is clear. For all port health needs, there is a reliance on early recognition and notification by ship or aircraft crew. In some instances, there may be a need for a retrospective port health assessment for a traveller who has been on board during the infectious phase of their illness ( e.g. tuberculosis); and passenger follow-up and treatment or screening may be advised.
9.5 The port health legislation covering ships is limited to coastal waters up to three nautical miles from the coast of Scotland. Offshore installations outwith this limit are therefore not covered by public health legislation. The Health and Safety Executive ( HSE), the Maritime and Coastguard Agency ( MCA) and the Marine Accident Investigation Branch ( MAIB) have statutory duties in relationship to offshore health
and safety. Their responsibilities are complementary and cover offshore installations ( HSE),
general operations of ships worldwide ( MCA) and investigation of marine accidents ( MAIB) ( HSE leaflet: http://www.hse.gov.uk/pubns/indg361.pdf ). Any disease that is notifiable onshore is "reportable" offshore to the HSE.
ISSUES FOR CONSIDERATION
Strengthening the current regulations covering port health
9.6 The need to update and further develop the provisions contained in our existing legislation with regard to public health measures at points of entry and relating to international traffic is further re-inforced by the IHR 2005.
9.7 It is too early to be specific about the measures which will be required at a UK level to ensure compliance. Scottish Ministers are working closely with the UK Government, the National Assembly for Wales and the Northern Ireland Office on how to reflect IHR requirements in new port health regulations. Details of the proposals will be published in due course. There will, of course, be consultation with key stakeholders on the detail of any new regulations.
9.8 Related to port health, although not for inclusion in new public health legislation, are the arrangements for medical examinations carried out in Scotland under the Immigration Act 1971. Currently, by arrangement with the UK Government, Scottish Ministers have the function of appointing medical inspectors direct and instructing them. From a practical perspective, however, it is thought to be more desirable that doctors with the necessary skills be identified by NHS Boards, with arrangements put in place to ensure that medical examinations for the purposes of the Immigration Act 1971 are managed at local level.
9.9 The policy intention is to better integrate the clinical aspects of medical examinations for immigration purposes at ports of entry within the general arrangements for health services in Scotland. Further information on this issue will also be available shortly.
Question 7
Port Health
As stated above, specific measures which need to be brought into place to better reflect IHR are currently being considered.
However, it would be useful to hear your views on:
7.1 how well you consider the current port health arrangements work in Scotland; and
7.2 how they might be strengthened.
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