Public health professionals' perceptions toward provision of health protection in England: a survey of expectations of Primary Care Trusts and Health Protection Units in the delivery of health protection.
BACKGROUND
Effective health protection requires systematised responses with clear accountabilities. In England, Primary Care Trusts and the Health Protection Agency both have statutory responsibilities for health protection. A Memorandum of Understanding identifies responsibilities of both parties, but there is a potential lack of clarity about responsibility for specific health protection functions. We aimed to investigate professionals' perceptions of responsibility for different health protection functions, to inform future guidance for, and organisation of, health protection in England.


METHODS
We sent a postal questionnaire to all health protection professionals in England from the following groups: (a) Directors of Public Health in Primary Care Trusts; (b) Directors of Health Protection Units within the Health Protection Agency; (c) Directors of Public Health in Strategic Health Authorities and; (d) Regional Directors of the Health Protection Agency


RESULTS
The response rate exceeded 70%. Variations in perceptions of who should be, and who is, delivering health protection functions were observed within, and between, the professional groups (a)-(d). Concordance in views of which organisation should, and which does deliver was high (> or =90%) for 6 of 18 health protection functions, but much lower (< or =80%) for 6 other functions, including managing the implications of a case of meningitis out of hours, of landfill environmental contamination, vaccination in response to mumps outbreaks, nursing home infection control, monitoring sexually transmitted infections and immunisation training for primary care staff. The proportion of respondents reporting that they felt confident most or all of the time in the safe delivery of a health protection function was strongly correlated with the concordance (r = 0.65, P = 0.0038).


CONCLUSIONS
Whilst we studied professionals' perceptions, rather than actual responses to incidents, our study suggests that there are important areas of health protection where consistent understanding of responsibility for delivery is lacking. There are opportunities to clarify the responsibility for health protection in England, perhaps learning from the approaches used for those health protection functions where we found consistent perceptions of accountability.
Cosford
Paul A
PA
Directorate of Public Health, East of England Strategic Health Authority, Cambridge, UK. paul.cosford@eoe.nhs.uk
O'Mahony
Mary
M
Angell
Emma
E
Bickler
Graham
G
Crawshaw
Shirley
S
Glencross
Janet
J
Horsley
Stephen S
SS
McCloskey
Brian
B
Puleston
Richard
R
Seare
Nichola
N
Tobin
Martin D
MD
D000288:Administrative Personnel / Q000523:psychology*; D000328:Adult; D001291:Attitude of Health Personnel; D003140:Communicable Disease Control / Q000458:organization & administration; D004739:England; D004782:Environmental Health / Q000458:organization & administration; D019538:Health Care Surveys; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration; D017053:Infection Control / Q000458:organization & administration; D007318:Inservice Training / Q000458:organization & administration; D007373:Interinstitutional Relations; D008875:Middle Aged; D011320:Primary Health Care / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D011634:Public Health / Q000331:legislation & jurisprudence*; D011635:Public Health Administration; D012040:Regional Health Planning; D012941:Social Responsibility; D011795:Surveys and Questionnaires