Health, Social Care and Sport Committee
Meeting date: Tuesday, December 21, 2021
Agenda: Decision on Taking Business in Private, Common Framework on Public Health Protection and Health Security, Budget Scrutiny 2022-23
- Decision on Taking Business in Private
- Common Framework on Public Health Protection and Health Security
- Budget Scrutiny 2022-23
Common Framework on Public Health Protection and Health Security
Our second item is an evidence session with Nick Phin, who is the director of public health science and medical director at Public Health Scotland, as part of our scrutiny of the provisional common framework on public health protection and health security. Good morning, and thank you for coming along.
What changes will be brought about by the framework, and how will that affect public health in Scotland?
[Inaudible.]—and develop. One is to improve the exchange of information with England and the other two devolved Administrations.
We will also try to pool data as we look at research issues such as omicron and its potential impact on people’s health, to get the answer more quickly and in a more robust way.
The third area to look at is cross-border arrangements. Microbes do not respect borders. We have seen how rapidly severe acute respiratory syndrome coronavirus has spread globally, in common with many other diseases. Making sure that we have good cross-border co-operation, both within the United Kingdom and with the European Union, is going to be critical.
The fourth area to look at is our research priorities, and we should agree a common focus for research.
Those are four potential benefits to the new ways of working. I do not think that anyone would disagree in principle with the objectives. As ever, it is on the application of those that we probably need to do some further work.
Yes. My colleagues have some quite detailed questions—in particular, about our role as a committee in the scrutiny of decisions.
An issue that arises from members having looked at frameworks in other portfolios over the past couple of years is the role of the Parliaments of all four nations and their influence on, or knowledge of, the decision-making process. Are you able to elaborate on any potential in that? Where do the Scottish Parliament and the Scottish Government fit into the decision-making process?
There are four tiers, if you like. The first is what we call the health protection oversight group, which has representatives from the Scottish Government and Public Health Scotland along with those from other agencies and Governments. It will meet to discuss and agree issues.
The next level above that is attended by me and by Michael Kellet, for the Scottish Government. The health protection agencies and Government officials of the other three nations also attend. That meeting is at a very strategic level, and we will meet maybe two or three times a year to agree the oversight of the plan.
The third level is the English, Scottish, Welsh and Northern Ireland chief medical officers’ group. Feeding into that is a ministerial group, the composition of which is still to be agreed and is an important point for resolution.
Everything that you have said about alignment in responses to any public health threat makes perfect sense. We have seen that in action during Covid. However, should one of the nations want to have a different response—for reasons that we do not yet know, because we have to take everything as it comes—would the framework allow for that?
Yes. Clearly, there is still a degree of autonomy for each country. Wherever possible, consensus is the desired way forward, from the point of view of communications, policy and operations. However, as we have seen with omicron, there can be divergence in how each of the four nations across the UK interprets a situation and responds to it.
A key issue is that the health systems of the four nations have diverged and are now quite different from one another. I cannot see how we could have a very rigid approach. It needs to be flexible in order to take account of the various systems.
I presume that the response to the Covid pandemic has informed quite a lot of how the framework has been put together.
Yes. Discussions had started prior to Covid. Brexit had been on the agenda for some time, so work had started on what the framework might look like. My understanding is that the Scottish Government and the agencies that existed before Public Health Scotland had appropriate input into that. I started just under 12 months ago, so I am getting up to speed as quickly as I can with issues and events in Scotland.
Thank you. We move to the deputy convener, Paul O’Kane.
Good morning to all who are joining us. Following on from the initial question and conversation, my questions will focus on international relations more broadly. To set the scene a bit on the topic, will the approach to international relations that has been set out in the memorandum of understanding be required often? Is that something that we will—[Inaudible.]
Before I moved to Scotland, I worked with what was Public Health England—it was the Health Protection Agency before that—and one of my roles was providing a national focal point both for the international health regulations and for the European Centre for Disease Prevention and Control, which is the scientific advisory body for the EU. I am therefore quite familiar with the processes that are involved.
My understanding is that negotiations are currently on-going for a memorandum of understanding with the ECDC that would allow us access to various scientific committees and networks, to share data both at country level and across the EU. Those things are all currently under negotiation and discussion.
One of the consequences, if you like, of Brexit has been a greater reliance on the International Health Regulations 2005, which were established by the World Health Organization to allow the exchange of information on issues of public health that are considered to be serious. Those issues are not restricted to infectious diseases; in fact, they include environmental issues. That stable platform has been used pending further agreement on access to the early warning and response system—EWRS—of which the UK was a member and to which Scotland fed in by submitting our data directly into Europe.
Thank you for that. I will follow that up, if I may. Is your sense of that perhaps similar to what you said in your first answer—that the aim would be very much to have a more collaborative approach whereby we would come to a consensus instead of having to look to the letter of the memorandums of understanding when they come forward?
Yes. As the national focal point when I was in Colindale, which is the centre for infectious disease surveillance and control, I saw a tendency for the scientific expertise to rest within PHE. At an early stage, I asked the devolved Administrations to take the lead in various areas, which is something that I would want to see developing in the discussion with the EU around the memorandum of understanding. We are not quite there yet, because the current technical committee has 15 representatives from the UK Health Security Agency but only one from Wales, two from Northern Ireland and three from Scotland. Some work is therefore needed to make sure that we are adequately represented in those technical discussions. However, it is early days yet. As I say, I believe that collaboration is the way forward.
Thank you. That consensus approach and the desire to get it right from the start are really helpful.
In the hypothetical situation that we could not get agreement between the four nations on an international treaty or international concerted action, is it your view that we would need to invoke conflict resolution procedures, or would the UK Government seek to act unilaterally? From the conversation that we have just had, we know that consensus is certainly what we would be aiming for, but we cannot always achieve that. I am keen to get your sense of that.
I cannot really answer that question. It would be a policy issue determined by the seriousness of the issue, and the Scottish Government would want to take a view on that. I think that it would be invoked at that level. It would clearly try, whenever possible, to get resolution at some other tier in the administrative structure.
Good morning, Dr Phin. I am interested in information sharing. Given that we now have different scientific advisory groups in each Administration, many of the members of which will, I am sure, know each other, we probably want to pursue a collaborative process using non-legislative measures rather than legislative approaches, which is part of the memorandum of understanding. I am interested in how good information sharing is between the four nations. You have said that there are three representatives from Scotland but 15 from England in the group, and only one from Wales and two from Northern Ireland. How is information currently shared if there is a top-heavy input from England compared with Scotland, Wales and Northern Ireland?
That particular example was the ECDC memorandum of understanding technical group. I mentioned it to illustrate where we have been and the work that we have to do. I would want to ensure that the mix included some of the expertise that we have in Scotland. It is, as I say, early days; the first meeting of the Health Protection Committee took place only a couple of months ago. Although it is not a case of relying on who you know, I do know many of the people involved well and there is a recognition that they genuinely want to collaborate. Therefore, it is about having those discussions. If, in the course of those discussions, we get no further, we will have to escalate matters appropriately.10:00
As a former healthcare nurse who worked in operating theatres, I am very keen that clinicians, scientists and experts work together, because it is through knowledge sharing that we will tackle this pandemic and any future concerns with regard to suppressing future pandemics. I know that a pandemic committee has been established in Scotland, too, so there are lots of experts around the table. However, are we good at information sharing at the moment? How can we avoid duplication and different people doing the same kind of work?
When I look around, I can identify some areas where duplication is occurring, but I think that that reflects where we are with the development of the common framework. One key element is having a common understanding on research and trying to identify areas where one country might take a lead and other countries would come together to support it. We are not there yet, but we need to look at and address the issue. There is sometimes a tendency to forget about things if they are not addressed at the outset, and it is important to ensure that we are involved at an appropriate level and that we can contribute in a meaningful way across the United Kingdom.
Finally, with regard to surveillance and other data, I think that it is necessary that we look at the number of Covid cases and the behaviour that has, say, led to an outbreak. We hear about people who are, for example, against wearing face coverings. If we are looking at surveillance in different parts of the four UK nations, are we able to make good comparative decisions that show that one way might be better than another? Would that inform our search for the best way of dealing with the pandemic?
Yes. I can give you a couple of examples. There is the SARS-CoV-2 immunity and reinfection evaluation—or SIREN—project, in which Scotland is punching above its weight. Indeed, I think that we are contributing 4,500 or 5,000 individuals to support the study, which looks at infections in healthcare workers, the impact of personal protective equipment and reinfections and the waning of vaccine effectiveness over time. It is a good example of our working collaboratively. In another example that relates to the new omicron variant, the four countries have fairly rapidly agreed a common case definition, to ensure that we are comparing apples with apples rather than apples with oranges.
There are slight challenges to deal with. The divergence in the development of health services, the collection of data, the timeliness of the data that is collected and the date on which it is reported present a slight problem with regard to getting a truly accurate representation. Wherever possible, though, we definitely share common case definitions in order to make possible the sort of comparison that you have described.
Emma, are you happy for me to pass over to our colleagues for some supplementary questions?
There are many research, cancer and other databases that Scotland does not have but that England does. If we were to combine and work together, we would have a much larger and much improved pool of data. For example, there is the fracture liaison service database, which we do not have in Scotland. It makes sense to me to join these things together and have a big database. Will that approach encourage more shared databases and more shared work between our nations?
The focus of the MOU is health protection, so fractures would be slightly outside its scope, although I see no reason why that could not be developed over time. That said, obviously, the more information we can share, the quicker we can potentially identify issues and problems as well as beneficial treatments. I think that data sharing is something that we should be pushing.
An organisation called Health Data Research UK has been giving Public Health Scotland funding to examine how we can improve our information technology infrastructure so that we can share data with valid researchers across the UK and even internationally. The data sharing initiative is at an embryonic stage but, certainly, the IT capability is within our grasp. The key issues are in ensuring that we comply with the general data protection regulation and that any data is handled appropriately.
I fully support the suggestion, but the area that you are talking about would currently be outwith the remit of the MOU.
It is nice to see you today, Dr Phin. I have certainly had a lot of correspondence in my inbox about the secondary breast cancer audit, which Scottish patients are not contributing to, so I found that last question from my colleague pertinent.
I would like to ask about the key lessons that the four nations have learned from the pandemic. What policy divergence has there been, what has changed from what was done in the past and are the key lessons reflected in the framework? I am thinking in the context of the research that the Scottish Election Study published last week, which said that there was a poor understanding of the Scottish Government’s FACTS messaging compared with the “Hands, face, space” messaging that came from Public Health England. Given what we have heard about collaboration and consensus, do you think that we might be a bit more aligned in the future?
It is still early days. The first meeting of the Health Protection Committee was, I think, in October. It agreed a work programme that identifies 11 areas, one of which is a review of disease notifications across the four nations. Scotland and Wales have been allocated the lead on that. The work also includes health protection, development of the workforce, education and so on. Communication is not on the list, but I think that one of the key messages from the Covid pandemic is that we need to pay more attention to the behavioural aspects of getting messages out. I was one of the incident directors in Public Health England’s Covid response. We recognised at an early stage that assumptions that were being made about communications were not being borne out by research that was undertaken by many behavioural scientists.
One of the key messages is that we should use behavioural scientists and the information that they have developed in a way that helps to communicate messages. I was not in Scotland at the time that you are talking about, so I cannot comment on the approach that was taken. However, the insights from behavioural scientists are certainly key; I note that there are one or two important behavioural scientists on the standing committee on pandemics that has been established in Scotland. We are aware that it is something that needs to be addressed.
Thank you. That is all from me, convener.
Thank you, Sue. I will move on. I trailed the fact that Gillian Mackay would be asking questions about consultation and scrutiny, so I will bring her in.
Thank you, convener. The consultation on the framework has taken place. What issues did parties raise during the consultation, and have they been addressed?
Unfortunately, I am unable to answer that fully. Many of the consultations took place prior to my appointment. If the committee wishes it, I can try to identify answers by speaking to colleagues and will provide that information separately. I am unable to comment on what happened prior to my appointment.
Thank you. It would be good to follow that up at some point, if we can, convener.
The convener touched on this earlier. Will implementation of the framework impact on parliamentary scrutiny and decision making in the policy area? If so, what impact will it have?
I cannot really comment on that—I am sorry. As I said, I am still familiarising myself with the current system. One of the proposals in the MOU is that we look at how ministers and Parliament are involved in scrutiny. That has been highlighted as one of the issues that need to be addressed, but the detail is not yet available and discussions are on-going.
That seems to be an issue that I can take to our Conveners Group. Obviously, the committee has had common frameworks before it in the past year or so. We can learn a lot of lessons from that, which might inform how we think scrutiny should happen. We will take that issue away for consideration.
Evelyn Tweed has questions on cross-border co-operation.
Thank you, convener. Good morning, Dr Phin. Does Public Health Scotland believe that the arrangements in the European Union and United Kingdom trade and co-operation agreement will facilitate adequate participation of the UK in controlling cross-border threats to or from its closest neighbours?
That is an area in which, prior to Brexit, we had extremely good relations. Many of us knew individual focal points within each of the countries, and the early warning and response system allowed member states to communicate confidentially with other member states to highlight potential issues and even to share information on cases of concern—a case of tuberculosis, for example, when someone left the UK untreated and therefore presented a potential hazard to the country that they were travelling to, or vice versa. The EWRS was a means of country-to-country communication. It was also a means of informing the World Health Organization and the European Centre for Disease Prevention and Control of bigger issues through wider information sharing.
That gap is not fully addressed through the International Health Regulations 2005, but it is one of the areas that is being pursued in the memorandum of understanding with the ECDC. It is hoped that, very shortly, we will have access to a new version of something called EPIS—the epidemic intelligence information system—which will be called EpiPulse. That would allow for timely sharing of information. At the moment, we have access to the EWRS for coronavirus and flu. The mutual benefit for Europe and the UK of sharing that information is recognised.
However, if you look at certain maps of Europe and look for UK data or even Swiss data, there will just be a grey mark. Therefore, there is still work to do to get some of our data integrated in a way that will allow for comparison, which can be fairly crucial in understanding our progress towards controlling and responding to infections.10:15
Are there any other gaps that we need to consider or places where we need to strengthen things?
One of the areas in which we will, I hope, strengthen things through the MOU is scientific collaboration. We had been part of something like 16 special interest groups, which would meet and come up with common approaches to the big infectious disease issues. That process allowed data to be standardised and common approaches to be taken to issues. At the moment, we are not part of those groups unless we have particular expertise that the EU wishes to access, but developing and being part of those networks will be important to knowledge sharing and reaching common understanding. Participation in those expert networks is certainly a gap that needs to be filled.
Were those networks in place because of collaboration across the EU?
Yes—they were supported and sponsored by the ECDC, which provided the secretariat, hosted the meetings and facilitated gathering of the experts in order to reach consensus and to make recommendations on specific issues with regard to the 17 disease areas that were identified.
Thank you—that was really helpful.
I will call Stephanie Callaghan, but Emma Harper has a supplementary. I apologise, Stephanie.
My supplementary is similar to Sue Webber’s question about the “Hands, face, space” guidance. We have test and protect in Scotland, while England has had track and trace or test, trace and isolate. What collaborative work will be done on finding out whether TTI, test and protect or whatever worked, and on people’s understanding of and adherence to the guidance? It is important that what is contained in messaging is achievable in order to contain pandemics, so I am interested to hear whether there will be any collaboration on behavioural aspects with regard to such important messages.
With any major incident or pandemic event, what we call a lessons learned exercise will be undertaken. In Scotland, we have already had an internal focus on some of that, but it would be important to do the same thing on a UK basis. I am not aware of any work that is being planned, but it is certainly something that could be picked up by the health protection oversight group or the Health Protection Committee itself if, as I suspect it will be, that is felt to be important in learning lessons for any future pandemics.
An inquiry has just been launched in Scotland, with a lead identified, and there is also the imminent UK, or England, inquiry. That will partly be about understanding what was done and how well it worked. I imagine that fairly detailed questions will be asked along the lines that you have suggested. However, it would be better to start that work earlier, instead of waiting for an inquiry. As I have said, we do not know when the next pandemic will be, so it is important that we learn the lessons for future events.
Stephanie Callaghan will ask our final set of questions, on resources.
Good morning, Dr Phin, and thank you for joining us this morning.
Under the memorandum of understanding, the shared work programme must be delivered within existing resources. Do you feel that that is realistic? Are existing resources adequate? Are there circumstances in which that could become challenging?
That is an interesting question. If we were to baseline the health protection resource in Scotland, we would be talking about 90 to 100 people, whereas in England there are probably several thousand. There is quite a disparity in that respect.
In the programme that has been set by the Health Protection Committee, Scotland has been identified as the lead in three areas—review of disease notifications, analysis of the four-nations working groups and a look at the evolving science of genomics with regard to collaborations, co-operation and sharing of data sets and information. Those are big pieces of work.
I can speak only for Public Health Scotland, but I have to say that we would be extremely hard-pressed to contribute meaningfully to those pieces of work and reviews. Clearly, we would prioritise that activity, because there has been no review of disease notifications for more than 10 years. We might identify through a review changes that would help to improve things, but I worry that if the current Covid response carries on, our capacity to respond adequately might not be optimal. That said, it is a collaboration between Public Health Scotland and the Scottish Government, so how the work will be divided will clearly need to be discussed.
That was very helpful.
As there are no more questions, I thank Nick Phin for his time this morning. I suspend the meeting ahead of our session with the cabinet secretary at 11 o’clock.10:22 Meeting suspended.
11:00 On resuming—