Recovery Guidance - Humanitarian Aspects
Needs of people – health
Background and Context
Those caught up in an emergency, as either part of a responders workforce or members of the public, can be affected in many ways. Physical and psychological injuries sustained as a direct result of an emergency will be as varied as the incident that caused them.
In many ways, a physical injury may be more apparent than psychological injury. Common to both, however, is the need for effective and timely diagnosis, treatment and continued support during recovery.
During recovery, an affected population and/or workforce is likely to need access to the healthcare system. Patients resident in the United Kingdom(1) Primary and Secondary healthcare services completely free of charge(2) through the various parts of National Health Services (NHS), for instance:
(i) Primary Care services encompassing:
- NHS Walk-in Centres – 24-hour confidential nurse-led health advice over the phone;
- NHS Direct – fast ‘no-appointment’ advice and treatments for minor conditions;
- GP (General Practitioner) Practices – diagnosing and treating a wide range of health problems in the local community;
- Dentists – routine and specialist care for teeth and gums;
- Opticians – carrying out eye and sight examinations, prescribing and fitting spectacles;
- Pharmacists – supplying prescription and ‘over-the-counter’ medicines and health care advice to patients and members of the public
(ii) Secondary Care services including:
- Emergency and urgent care;
- Ambulance trusts – responding to life-threatening and urgent conditions;
- NHS trusts – emergency and planned hospital treatment;
- Mental health trusts - specialist care for people with mental health problems; and
- Care trusts – combining NHS and social care.
See figure 1.0 below.
Figure 1.0 The National Health Service (England)(3)
[Source: www.nhs.uk]
Those requiring treatment will access healthcare services via one of several routes including:
- according to the need for emergency and urgent care;
- by self-presenting to the likes of their GP; or
- in benefiting from their own employer's occupational health support and services(4);
In providing the range of healthcare services, the NHS works alongside and in co-operation with a whole host of organisations and agencies operating in the private, public and voluntary sectors.
Policy and Guidance
England
There is a wealth of health information and guidance widely available offering routes to support and advice to both responders and members of the public. Cross-cutting advice and information is available from the likes of:
More specifically, responders may find it useful to refer to the following advice, guidance and support:
(i) Psychological Healthcare Needs:
The Department of Health is due to publish general guidance entitled Coping with a Major Incident which describes emotions and symptoms together with information on how to obtain treatment and support.
Other published guidance may be specific to the nature of the emergency, for instance, Defra's Rural Stress Action Plan (RSAP) published in the wake of the foot and mouth crisis.
Further information is available via:
and more generally via the likes of the Institute of Psychiatry
(ii) Physical Healthcare Needs
Guidance regarding physical healthcare needs is available at:
The National Institute for Health & Clinical Excellence provides national guidance on the promotion of good health and the prevention and treatment of ill health.
(iii) Longer Term Health Monitoring
The Health Protection Agency has a network of local and regional teams who work with GPs, hospital clinicians and other healthcare providers. HPA laboratories assist in the identification and analysis of disease or environmental samples and have experts who monitor disease trends, chemical specialists who advise on the health effects of environmental hazards, and radiological experts who advise on radiation. Research programmes aim to develop new ways of diagnosing, treating and controlling disease and establish how health is damaged by exposure to harmful substances.
Wales
There is a wealth of health information and guidance widely available offering routes to support and advice to both responders and members of the public. Cross-cutting advice and information is available from the likes of:
Responders may find it useful to refer to the following advice, guidance and support:
(i) Psychological Healthcare Needs: www.callhelpline.org.uk
The Welsh Assembly Government Health and Social Services Department is due to publish general guidance entitled Coping with a Major Incident which describes emotions and symptoms together with information on how to obtain treatment and support.
Further information is available via:
(ii) Physical Healthcare Needs
Guidance regarding physical healthcare needs is available at:
The National Institute for Health & Clinical Excellence provides national guidance on the promotion of good health and the prevention and treatment of ill health.
(iii) Longer Term Health Monitoring
The National Public Health Service (NPHS) works with GPs, hospital clinicians and other healthcare providers to monitor public health in Wales. NPHS also works closely with the Health Protection Agency to monitor disease trends and to access expert advice on the health effects of chemical or radiation release.
Scotland
Health in Scotland is a devolved matter. Health Protection Scotland works closely with emergency planning partners in Scotland including the Scottish Government, NHS Boards. Local authorities and emergency services as well as HPA in England and Wales to ensure preparedness for incidents which are likely to severely test the NHS and other public services. It also advises the Scottish Government in its overall strategic management of such incidents.
Northern Ireland
[TBC]
Roles and Responsibilities
General
During a major emergency, the NHS, supported by the Health Protection Agency, takes the lead on providing information to the public on any health aspects of the response and recovery from that incident.
For full details of organisational roles during a major incident, please refer to NHS Major Incident Guidance or DH emergency planning guidance.
Further information on how the NHS operates can be found on the NHS website.
Local
Primary Care & Secondary Care
Following any emergency, Acute NHS Trusts work closely with Primary Care Trusts (PCTs), Social Care and Mental Health NHS Trusts to provide advice and support to patients leaving hospital.
PCTs have a duty to protect and promote the health of the public and, therefore, have a central role in planning for and responding to any incident with major consequences for health or health services required in the short, medium or long-term. PCTs are responsible for the provision of primary care services, such as General Practitioner services and NHS Walk-in Centres.
Mental health trusts provide health and social care services for people with mental health problems. Mental health services can be provided through a GP, other primary care services or through more specialist care. This might include counselling and other psychological therapies, community and family support or general health screening. For example, people suffering bereavement, depression, stress or anxiety can get help from primary care or informal community support. If they need more involved support, they can be referred for specialist care. More specialist care is normally provided by mental health trusts or local council social services departments.
NHS Direct is at the forefront of 24-hour health care – delivering telephone and e-health information services, day and night, direct to the public. It provides information and advice about health (including psychological advice and support), illness and health services, to enable patients to make decisions about their healthcare and that of their families.
Independent Sector
The Independent Sector is an important partner for the NHS and crucial in delivering faster, more convenient care and choice to NHS patients. The NHS is harnessing the extra capacity and innovation available in the independent sector in several ways, including the Independent Sector Treatment Centre Programme.
Although the centres are run by independent companies, they must still offer the NHS value for money; meet the high clinical standards demanded by the NHS; and provide genuine extra capacity, rather than drawing doctors and nurses away from the NHS.
Voluntary Sector & Community Sector
The Voluntary Sector & Community Sector is also a valuable partner in expanding NHS and social care services and improving the overall care patients receive. These organisations play a vital role in helping the NHS meet national standards in some of the highest priority areas such as care for cancer patients and older people; as well as in shaping services round the individual needs of patients. A recent formal agreement between the Department of Health, the NHS and the VCS will help ensure voluntary organisations play an even bigger role in delivering and improving local services in the future.
Support groups and caring organisations that can provide information, guidance and support include:
- The Samaritans – Offers a 24-hour helpline for those in crisis.
- Cruse – Bereavement Care – Offers counselling, advice and support throughout the UK.
- Disaster Action – Provides support and guidance to those people who are affected by disasters.
- Assist Trauma Care – Offers telephone counselling and support to individuals and families in the aftermath of trauma.
For useful information on coping with trauma, see the following websites:
Employers & Occupational Health
An explanation of occupational health can be found on the Faculty of Occupational Medicine website.
The Institution of Occupational Safety and Health (IOSH) recognises the value to people's health and well being that well managed work can bring.
The government has increased its focus on occupational safety and health and its aim of improving access to competent occupational health advice and support, rehabilitation, return to work programmes and early interventions as outlined within its report Health, work and well being – caring for our future: A strategy for the health and well being of working age people.
Regional
Strategic Health Authorities & Regional Public Health Groups
Strategic Health Authorities (SHAs) are responsible for managing and setting the strategic direction of the NHS locally. They support PCTs and other NHS organisations and make sure they are performing well.
Specifically with regards to general recovery following an emergency, they:
- develop plans for improving health services in their area – including strategies for making better use of information technology.
- increase the capacity of local health services so they can provide better care to more people – for instance recruiting more NHS dentists or enabling more GPs and nurses to train in specialist areas such as coronary heart disease and asthma so they can treat more people in the community.
Strategic Health Authorities have responsibility for the co-ordination of health services when a major incident impacts on a more widespread level, affecting several hospitals or having a significant impact on primary care. This is carried out in partnership with Directors of Public Health and Regional Public Health Groups.
Regional public health groups are responsible for ensuring effective health protection arrangements are in place across each region. The Regional Director of Public Health has responsibility for emergency planning and works closely with the Health Protection Agency, NHS, Regional Resilience Teams in Government Offices and other agencies in the event of an emergency.
Lead Government Department
The Department of Health is accountable to the public and the government for the overall performance of the NHS. Its work includes setting national standards and shaping the direction of the NHS and social care services, and promoting healthier living. In the event of an emergency, the Department will provide strategic co-ordination of the NHS response. The Department of Health is contactable through Regional Public Health Groups, located within Government Offices, and Strategic Health Authority Emergency Planning Leads.
Other Government Involvement
Health Protection Agency
The Health Protection Agency (HPA) is an independent organisation dedicated to protecting people's health in the United Kingdom. The Agency does this by providing impartial advice and authoritative information on health protection issues to the public, communities, professionals, and to government.
The Agency combines public health and scientific expertise, research and emergency planning within one organisation.
The Agency's role includes:
- Providing impartial expert advice on health protection and providing specialist health protection services
- Identifying and responding to health hazards and emergencies caused by infectious disease, hazardous chemicals, poisons or radiation
- Anticipating and preparing for emerging or future threats
- Supporting and advising other organizations with a health protection role
- Improving knowledge about health protection through research and development, education and training
The Agency's expertise is provided by specialist medical, nursing, scientific and technical staff, backed by administrative and support functions. The Agency has a network of local and regional teams who work with GPs, hospital clinicians and other healthcare providers. The Agency's laboratories help in the identification and analysis of disease or environmental samples. The Agency has experts who monitor disease trends, chemical specialists who advise on the health effects of environmental hazards and radiological experts who advise on ionizing and non-ionising radiation. Emergency response teams support the country's readiness and response to unexpected threats, both natural and deliberate. The Agency's research programmes aim to develop new ways of diagnosing, treating and controlling disease and establish how health is damaged by exposure to harmful substances.
Devolved Administrations
Wales
In Wales, health is a function fully devolved to the Welsh Assembly Government. The NHS delivers services through Local Health Boards (LHBs) and NHS Trusts across Wales.
- Primary care services are provided by general practitioners (GPs) and other health care professionals in health centres and surgeries across Wales
- Secondary care is delivered through hospital and ambulance services
- Tertiary care is provided by hospitals which treat particular types of illness such as cancer.
- Community care services are usually provided in partnership with local social services, and delivered to patients in their own homes.
The National Public Health Service for Wales (NPHS) provides the resources, information and advice to enable the Welsh Assembly Government, Health Commission Wales, Local Health Boards, Local Authorities and NHS Trusts to discharge their statutory public health functions.
To do this, the NPHS delivers a full range of public health services, seeking to:
- Improve the health and wellbeing of the people of Wales and reduce inequalities in health;
- Protect against existing, new and emerging diseases and health threats; and
- Contribute to improvement in health and social care services.
The NPHS is a Category 1 Responder under the Civil Contingencies Act and is an integral member of the LRFs.
Scotland
Health in Scotland is a devolved matter. Health Protection Scotland works closely with emergency planning partners in Scotland including the Scottish Government, NHS Boards, local authorities and emergency services as well as HPA in England and Wales to ensure preparedness for incidents which are likely to severely test the NHS and other public services. It also advises the Scottish Government in its overall strategic management of such incidents.
Northern Ireland
[TBC]
Funding
Information on Private Medical Insurance can be found in the Dealing with insurance issues topic sheet.
Links to Other Topic Sheets
Case Studies (Incidents and Exercises)
Other Documents
(i) Psychological Healthcare Needs (including occupational health support):
Metropolitan Police Occupational Health policy – The Trauma Support Programme – Practitioners' Guide
Pre-Hospital Care – Interventions for PTSD and psychological distress in emergency ambulance personnel: a review of literature
( Emergency Medical Journal 2003;20;75 78 – A Smith and K Roberts)
NAO 2006 – Review of experiences of UK nationals affected by the Indian Ocean Tsunami
Association of Train Operating Companies (ATOC): Supporting Survivors – A guide outlining help for people in a crisis
London Trauma Centre – Report into 7/7 (C) [DN check status of organisation / inclusion within DH return]
Psycho-Social Support in Situations of Mass Emergency – A European policy paper concerning the different aspects of psycho-social support for people involved in major incidents and disasters ISBN D/2001/9387/1 (Ministry of Public Health, Belgium) (G)
North Tees & Hartlepool NHS Trust – Common reactions to traumatic events: Information for patients (B)
Allen Report – Publisher: HMSO
Pub Date: 1991
ISBN: 0113213700
Management of post-traumatic stress disorder in adults in primary, secondary and community care
Support for UK residents affected by recent disasters and terrorist attacks
Rubin et al 2005 – Psychological and behavioural reactions to the bombings in London on 7 July 2005: cross sectional survey of a representative sample of Londoners
BMJ 2005, doi:10.1136/bmj.38583.728484.3A
Rubin et al 2007 – Enduring consequences of terrorism: 7-month follow-up survey of reactions to the bombings in London on 7 July 2005
BJP 190, 350-356, doi 10.1192/bjp.bp.106.029785
The Rural Stress Action Plan (RSAP)
(ii) Physical Healthcare Needs
CCS 2006 – Hurricanes Katrina and Rita A Perspective
NAO 2006 – Review of experiences of UK nationals affected by the Indian Ocean Tsunami
DH 2007 – Provision of scientific and technical advice to Strategic Co-ordinating Groups during a major incident
(iii) Longer Term Health Monitoring
HPA 2005 – Continuing Public Health Response to the London Bombings of 7 July 2005
DH 2001 – Foot and Mouth Disease: Disposal of Carcasses – Programme of Monitoring for the Protection of Public Health
DH 2001 – Foot and Mouth Disease – Measures to minimise risk to public health from slaughter and disposal of animals – further guidance
List of Contacts
The Samaritans– Offers a 24-hour helpline for those in crisis.
Tel: 08457 909090
Cruse– Bereavement Care – Offers counselling, advice and support throughout the UK.
Tel: 0870 167 1677 (Monday – Friday 9.30am – 5pm)
Disaster Action– Provides support and guidance to those people who are affected by disasters.
Tel: 01483 799 066
Assist Trauma Care – Offers telephone counselling and support to individuals and families in the aftermath of trauma.
Tel: 01788 560800 (Helpline).
Footnotes
(1) The Department of Health will have a role in co-ordinating medical assistance for evacuees
(2) Refer to guidance under “Funding” for charging policies for non-UK nationals
(3) The information above shows how the NHS structure works in England. For information on the health service in other parts of the UK, please visit the NHS in Northern Ireland, the NHS in Scotland or the NHS in Wales. The Isle of Man and the Channel Islands have separate independent health service structures. For more information please visit Isle of Man Government, States of Guernsey Government and States of Jersey Government.
(4) Category 1 responders will usually access primary care through their employer's occupational health services.
