Policy responses and statements

Name of organisation:

Scottish Executive Health Department

Name of policy document:

Public Health Legislation in Scotland - A Consultation

Deadline for response:

12 January 2007

Background: The Scottish Executive requested views on proposals to update public health arrangements in Scotland. The responses to the consultation will help to inform future public health policy and the drafting of new legislation to ensure that we are able to respond effectively to current and foreseeable public health threats.

Public health legislation in Scotland dates from the late 19th century. Scotland in the 21st century faces fresh challenges. Diseases, such as SARS and Ebola have emerged, while recent years have seen the resurgence of old threats, once thought to be in decline, like tuberculosis. Other diseases such as HIV, Hepatitis C and pandemic influenza continue to threaten. Environmental factors also contribute significantly to health and well-being. To this is added the threat of bio terrorism; and the need to be prepared to tackle its many potential manifestations.

Against this background, it is timely to review the statutory powers in the public health field to ensure they are fit for purpose to respond to current and foreseeable challenges and to meet our international obligations. We need modern, fair, clear and streamlined laws that combine respect for the rights of the individual with powers which enable the relevant authorities to respond quickly, decisively and comprehensively to protect the health of the community from harm. This consultation therefore, invites views on how we might shape public health legislation in the 21st century and provides an opportunity to display the vision and perception shown all these years ago by the architects of the legislation we now seek to update.

Public health legislation in Scotland is contained in a number of statutes and dates back to the late 19 th century. It has contributed significantly to the huge strides we have made in controlling infectious diseases, nuisances and other threats to health. However, there is increasing evidence that the legislation is not wholly consistent with current practice or modern life. The document sets out a number of proposals to strengthen the public health response in Scotland and to clarify the roles and responsibilities of those working in the public health field. It has been developed through the work of a Public Health Review Group, which comprised representatives of a number of relevant public health organisations and disciplines.

The World Health Assembly of the World Health Organisation has adopted new International Health Regulations, which aim to enhance the global public health response to new diseases and naturally occurring, accidental release or deliberate use of chemical and biological agents or radionuclear materials that affect health. The new Regulations require to come into effect by June 2007, although member states have a further 12 months from the entry into force date to adjust their domestic legislation. The Scottish Executive is working with the UK government to establish the legislative changes required to comply by that date and further information will be made available in due course

COMMENTS ON
SCOTTISH EXECUTIVE HEALTH DEPARTMENT
PUBLIC HEALTH LEGISLATION IN SCOTLAND - A CONSULTATION

The Royal College of Physicians of Edinburgh is pleased to respond to provide a response to the Scottish Executive on this important review of legislation.

It is a comprehensive and well prepared document. It is timely, bearing in mind our commitment to human rights, and proportionate action within the law; the recent lessons of threatened SARS; the introduction of International Health Regulations; and the need for national legislation to comply and complement. The document sets out context well, and this response proceeds straight to answer the questions set out at the end of each chapter.

QUESTION 1: ORGANISATIONAL AUTHORITY

1.1 The proposal to assign legislative powers in relation to people to NHS Boards and for property and premises to local authorities, as set out in Tables 1 and 2

The proposal to assign powers in relation to people to NHS Boards is new, has implications that are discussed later in the text and offers clarity which is welcome. The Act should enable such a framework, and regulation should set out the substance, including boundaries and shared responsibilities where these are necessary. We anticipate further discussion over separation of responsibilities, given concerns expressed amongst practitioners from several disciplines, and current relationships between authorities and styles of work. There will be resource consequences for the NHS Boards that shoulder new responsibilities. We support this proposal in principle.

1.2 Whether the provisions in Tables 1 and 2 in Annex D could usefully be updated and retained in new legislation

In outline, we agree. Annex 1.4m (page 43) sets out the powers under the National Assistance Act. There should be clarity between this legislative proposal and that of the Adult Support and Protection Bill as to which piece of legislation takes the lead. Item 8, on compensation, is addressed later.

Annexes B and C live within the wider environment of the interplay between NHS and Local Authority-sourced advice and is workable. The duty to co-operate, as mentioned in this area, is welcome and appropriate.

In Annex D, the powers marked “useful to keep” need further review by people with experience in these areas. It would be useful to cut out powers that are unlikely to be used, covered in other legislation, or extinct at this point.

The matter of NHS budget for eventualities such as this is discussed later.

1.3 Whether there should be a requirement for the production of local Health Protection Plans and Statements, to be incorporated within Community Plans or Health Improvement Plans/Local Delivery Plans

The health protection plans are a practical and appropriate proposal, backed by duties to co-operate. The outstanding risk, however, is a major theme that influences the need for new legislation - that is, clarifying “who is in charge?”. There are risks:

1. that jointly conceived plans fail to address and resolve definitively differences of view about lead and support roles, risk and resource sharing. There should be clear guidance on expectations in this regard.

2. that the plan will adopt a low profile in the business and content of local plans with wider and often more strategic scope. There is a body of opinion that Health Protection Plans should be free-standing, distinct from others, and clear about their status. Only the Community Plan, a local authority-led document, has statutory status. There must be clarity about the relationship and priority of a Health Protection Plan between Health Delivery Plans, Community Plans and other strategic and operational documents with multi-agency ownership and differing boundaries. The Director of Public Health report should have a section devoted to the planning of health protection, and may be the document in which the plan is set.

3. that the plans are sufficiently quality assured - creation of a plan should be strengthened by an assurance mechanism, such as the need for Health Protection Scotland (HPS) to act on behalf of the Scottish Executive in checking that such plans are competent and clear. Such plans need to have clarity yet flexibility, and the balance is sometimes fine. They also need to have clear triggers for scaling up and changing leadership, as set out in these paragraphs. These issues need to be identified and resolved, and seen to be resolved, in the text of every plan.

In conclusion, then, there should be “back” stop powers of direction to produce, improve and agree plans or, in the event of incompetent plans under execution, a direction to change arrangements.

1.4 Whether the issues to be covered in Plans/Statements should include the matters covered in paragraph 3.17

We agree, together with protocols for dispute resolution and transfer of leadership.

1.5 Whether the AIDS (Control) 1987 Act should be considered for repeal in Scotland

We agree - the AIDS (Control) 1987 Act should be incorporated into the current legislative proposals.

1.6(a) Whether the provision and statutory role for a DMO should be retained in new legislation

There are differing opinions. On organisations, there should be a general duty of competence or capability, without a designated qualification per se. There is a risk, however, that such a power invested in an organisation which sees few public health incidents and therefore, lowers their perception of risk, will be reductionist and prepared to take a risk of being exposed. However, considering small NHS Boards such as the Islands, they should be allowed flexibility of organisational integration in the future that either places capabilities in merged or atypical organisations, or allows key competencies to be called on from outside its boundaries in order to respond to even routine threats and hazards.

Therefore, we believe a designated officer function should be vested in an organisational role, rather than specifying a designated medical officer function as an individual.

1.6(b) If the role is retained should this role be a joint appointment between LA and NHS

It would be ideal if a joint appointment could be reached between LAs and NHS. Where there are differences of view, the NHS Board would take the lead role.

1.6(c) If the role is retained, should we define qualifications/professions eligible to fulfil this role

The consensus is that, as an incident escalates unpredictably, and where the end-point is a hearing before a Sheriff, a suitably competent person should take the lead role. That person should have a clinical training, should be able to make a diagnosis and differential diagnosis in order to fulfil the first condition of public health incident management in the most frequent scenario - a possible outbreak of communicable disease - that is, to establish whether an outbreak exists.

While we suggest defining “a public health specialist with experience of assessment, investigation and management of public health incidents” - a medically qualified person with specialist training is the most likely person to fulfil such a role with sufficient assurance. However, we recognise the changing role of health professionals. Competence and capability of a person and a team charged with health protection responsibilities requires many skills. The key competence is the ability to diagnose, discriminate, make key judgements based on specialist knowledge, and command trust and confidence.

1.7 Whether legislation should require that certain outcomes, including those which restrict liberty, need input from a competent person and, in particular, a professional with defined qualifications

We agree that a competent person should be specified for proper consideration of potentially drastic measures such as those which restrict liberty. They should possess a professional qualification which encompasses diagnostic capability, the ability to discriminate a given case definition relevant to a public health incident from other possibilities, and assess the risk to the individual and to populations as a result. This description strongly suggests that the person should be medically qualified, but it would be unnecessary for such a person to be required persistently if the incident or outbreak involved large numbers of people, where the clinical syndrome was unequivocal, and responsibility for diagnosis could be devolved. Therefore, decisions taken before a Sheriff and in the initial stages should centrally involve a medically qualified professional with diagnostic and discriminatory capability.

1.8 If so, whether these qualifications should be defined in regulations or guidance

Regulations being less flexible than guidance - guidance may suffice, although diagnostic capability is an enduring quality of medical practice and unlikely to shift to other professions in the medium term. Therefore, regulations should state a medically qualified professional, but guidance could state devolved responsibility following the confirmation of early cases and a clear clinical syndrome.

1.9 Whether powers for Scottish Ministers to intervene in public health matters should follow the principles already established in legislation

We agree, and such powers for Scottish Ministers would take care of failures to resolve disputes, say, between Local Authorities and NHS Boards; or incidents that quickly overwhelm the capability of Local Authority/NHS systems such as those on the Islands.

QUESTION 2: NOTIFICATION OPTIONS

2.1 A new system of statutory notification to public health agencies, which:

We welcome the proposals for a new system of statutory notification. This system needs to be modernised. However, the number of conditions should be kept to the minimum number consistent with effective health protection, in order to maximise the quality of data and intelligence derived from the information collected.

1. has two lists: one on notifiable conditions and the second on reportable hazards

   We agree.

2. identifies three types of notifiable conditions:
   • diseases eg tuberculosis
   • organisms eg Clostridium botulinum
   • “health risk states” eg close contacts of SARS cases

   This is reasonable. The definition of “health risk states” needs further work, but is as likely to be an international endeavour, as circumstances dictate.

3. Does not require consent for notification since it will be a legal requirement to notify and report to NHS Boards or other appropriate authority

   We accept there is an overriding public interest need for presumed consent to the sharing of information resulting from notification. Nevertheless, such a system should be transparent to the public, justified and subject to a commitment for full public information about the use of such data in order to maintain confidence in its use.

4. Includes the option to place a statutory duty on doctors to inform the patients of the notifiable condition as soon as possible

   We agree, but question the need to specify “doctors” to inform the patients - perhaps “health services” or “competent clinicians” would suffice - for instance, many flu spotters may not be doctors in current voluntary surveillance programmes.

5. Defines a “reportable hazard” as any micro-organism or environmental hazard

   We agree, although the likely hazard categories would be too broadly defined. We would suggest the term “a defined micro-organism” rather than “any micro-organism ...” and the organism should present a serious public health hazard.

6. Places a statutory duty on public and private sector organisations involved in testing for the presence of micro-organisms and environmental hazards in human, water, food and environmental samples to report on a defined regular basis to a named public health agency, the numbers and details of samples in which a reportable hazard is detected

   We agree, but suggest placing “numbers and details” with a phrase to reflect discretion in the use of data, such as “necessary purposes” - this would allow investigators to return to take more details from sample documentation if the need arose. Again, such a power must be confined to hazards that present a serious public health risk.

7. Specifies the reportable hazards and the details required, including to comply with EC and WHO requirements

   We agree.

8. Specifies a time limit for notification and reporting in regulations

   We agree. Some notifications, depending on the clinical and public health urgency, should be by instantaneous electronic transmission.

9. Specifies a penalty for not notifying in regulations

   We agree.

10. Discontinues current arrangements for payment of a fee per notification to general practitioners

    This change is justifiable, in that electronic systems create no added effort for a clinical team to create an appropriate information flow, once an initial decision and change is made. However, the Bill and subsequent regulations should consider the matter of incentives to report fully and accurately – carrots rather than just a stick – see i.

2.2 Proposals for developing an additional notification system for non-communicable diseases that:

1. defines the “statutory reportable conditions&rdquo
2. places a statutory duty on public and private sector organisations involved in caring for individuals suffering from the disease or investigating its extent in a population to report on a regular basis the numbers and details about those suffering from the disease and specified factors involved in its causation
3. specifies the diseases and the details required or the specific measurable factors leading to their occurrence to be reported
4. does not require consent for notification since it will be a legal requirement to notify and report
5. specifies a time limit for notification and reporting in regulations
6. specifies a penalty for not notifying in regulations

This is a welcome but controversial proposal. First, it is important to distinguish between notification and reporting. Notification implies an urgency in this context, whereas reporting implies more rigour to case finding and definition, formal systems of communication and less frequent transfer of data. Annual data updates may suffice in some cases (statutory HIV/AIDS reporting as at present). This proposal is therefore in the realm of a reporting system.

Arguments in favour are that the use and application of data on non-communicable disease is not as effective as it could be. The control of epidemics of disease could be more effective with statutory backing to data collection and sharing. One example might be the firm commitment of alternative health care providers, including private and voluntary sectors, to bear a duty of reporting for specified conditions, or in a specified way that is compatible with national databases in order to generate a comprehensive picture of health in the country.

There may be examples of such diseases already - a duodenal ulcer disease which, we now know, has an infectious agent at its root in many cases; certain arthritic conditions which may, in the future, be regarded as being infectious or immunological disorders; obesity or certain genetic conditions.

There have been diseases recently where, in the initial stages of the epidemic, the cause or agent was unknown. AIDS is the clearest example, where the initial agent under scrutiny was a chemical compound - amyl nitrate. It is not possible to rule out future epidemics with non-communicable agent causation, particularly those in C(B)RN categories where syndrome surveillance will be vital.

There may be disorders that could pre-dispose to high disruption to services or basic commodities; or high resource implications such as a cohort of people exposed to radiation at one time; to a transfusion type at one time; a diffuse and poorly characterised condition with world-wide distribution that requires enhanced surveillance.

In other words, there are scenarios that are possible in future, and shortcomings in information management currently, that merit the assurance and protection of the law in surveillance and data collection, and the legal capacity to do so would be welcome.

On the other hand, existing data streams function adequately on a voluntary and incentivised basis, such as cancer and diabetes registers, that may be undermined by the force of law, in terms of ownership of the principle and professional self-regulation of the information collection process and use.

There is the potential for single issue campaigns, or strong research interest, or occupational health issues, to unbalance the priorities and operation of such a system, which will have to take a firm view of the public health case for a statutory system.

There is the potential for public concern that professional and special interests might use the law to achieve goals that may then impose restrictions on rights. The potential for genetic registers (and their relationship to research, commercial or police/judicial databases) to undermine public confidence is an example. Separate legislation for this area of interest would be more appropriate.

Any system of communication for non-communicable disease would need to pass stringent tests of necessity, proportionate action and defined purpose, as well as the potential or actual threat to public health. We find such arguments challenging to justify in current circumstances, but accept that future medical knowledge and bio-security circumstances may warrant such measures. The College would be keen to engage in further debate on the matter.

2.3 The proposal that the key issues to be considered prior to making a new condition or hazard reportable should be:

1. cultural and moral sensitivities

   These sensitivities work both ways. The responsible sharing of data between statutory means can result in effective management of a public health threat where the absence of data perpetuates an injustice or inequality.

2. public health significance

3. current ethical and legal guidance

4. commercial considerations

   We question the relevance.

5. resource and quality issues.

   We would suggest further criteria that include, for example:

6. how definable and reliable is likely to be the condition or syndrome;

7. for which there is a justifiable and effective avenue for public health action.

2.4 Whether to continue to exclude sexually transmitted infections from any new notification system and whether any other disease or condition be excluded

We believe that STIs should be included in the scope of reporting systems. A single system would simplify a process that has the potential for over-complexity. Under secure electronic systems, it should now be possible to create innovative ways of reporting (not notifying) sexually transmitted infections whilst preserving the confidentiality of the personal health information. STIs are serious threats to public health, and reliable knowledge of their existence and trend is vital to protect public health. Notification systems are dependent on their purpose. STIs are laboratory diagnoses, and it may be justifiable to encourage reporting for the primary purpose of surveillance. Secondary purposes in the clinical realm such as contact tracing may not be allowable uses. It would depend very much on clarity of purpose for the information flow, and the conditions under which these flows were to be reviewed and secured.

2.5 Whether there are there any other legislative options for surveillance which should be considered

For public health surveillance, there may not be any other options, but we must make a clear distinction between legislative arrangements for public health arrangements, and data bases for other purposes – such as medical research, commercial monitoring, of the investigation of crime.

QUESTION 3: INVESTIGATION OPTIONS

3.1 Legislation should make it a statutory duty to divulge information during public health outbreaks or incidents

We agree - this is a contentious but necessary matter. Legal capacity will rest with the NHS Board, and should involve the judgement of the Director of Public Health, as distinct from the incident control team, given the importance of the matter and the need to take into account the wider legal position and interests.

3.2 The triggers necessary for such action might be:

1. a significant public health incident or outbreak
2. involvement of a notifiable disease, or organism or health risk state
3. the seriousness of outbreak or incident in terms of morbidity, mortality or potential health risk

   We believe that criterion c) would be sufficient to cover all purposes.

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

The proposal is a reasonable process - we agree. The power should clarify the scope of information required, to encompass contacts with persons, as well as premises and property.

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

This is also a reasonable process. Justification for the Sheriff should include data protection arguments such as necessary purpose, justifiable purpose and proportionality of response. We believe the Sheriff Principal should be involved.

QUESTION 4: STATUTORY POWERS FOR HEALTH PROTECTION

4.1 Whether legislation should provide for the introduction of quarantine orders for a period of up to 21 days, with provision for renewal or extension

We agree. Such legislation is needed in the light of new and emerging diseases.

4.2 Whether quarantine orders should only be applied where the criteria in paragraphs 6.9 and 6.12 are met

We agree.

4.3 Whether exclusion orders should apply more widely to include, eg work, social and religious events, neighbours, travelling and other activities

Is it necessary to define all eventualities amongst gatherings? The key risks are the nature of the disease and its likely means of spread, and the proposal for exclusion should be proportionate to that risk. Travel will need to be defined according to public or private transport. As the question stands, the listing is sufficient.

4.4 Whether exclusion orders should:

1. apply to specified states and/or organisms and or activities
2. have penalties for non-compliance

We agree, in consequence, but the criterion in i) should relate to the risk to public health.

4.5 Whether there should be penalties for non-compliance

We agree.

4.6 Whether compensation payments should extend to all groups liable to be excluded under exclusion orders or affected by other orders

While use of compensation is infrequent, it acts as important assurance for all groups. NHS Boards will wish to limit their liability, if there is a mass pandemic for instance. Also, such an eventuality may result in individuals taking themselves out of work or school, uncertified. A Regulatory Impact Assessment (RIA) will be necessary here for financial purposes.

4.7 Whether the payment of compensation should become the duty of the NHS, rather than the LA as currently, given the proposed transfer of powers in relation to people to the former; if recommended, this change would require NHS Boards to be insured against compensation claims

This proposal follows the sense of the earlier proposal for NHS Boards to address “people” issues. However, the NHS does not habitually take insurance. This should, perhaps, be spread in pooled arrangements for all of NHS Scotland.

4.8 Whether legislation should provide for the introduction of detention orders, covering:

1. the removal to a suitable place of those who risk spreading disease by virtue of being a contact or those with an infectious disease who refuse to comply with a quarantine order or medical advice
2. an appeal system

   We agree. The ‘suitable place’ is something of a challenge to locate/define.

4.9 The proposal not to seek powers to require a person to have medical treatment

We agree. Involuntary detention is a drastic measure, and linked to refusal of medical treatment. The extent of medical examination, though, will need to be defined, including the taking of blood, fluid, solid and tissue samples.

QUESTION 5: ENVIRONMENTAL HEALTH CONCERNS AND NUISANCE

This chapter is more generally drawn and will require the practical experience of Environmental Health Specialists to comment more fully.

5.1 Whether it is perceived that there is a gap in legislation to deal with threats from the environment

We support the general principle for a need for legislation to address gaps here.

5.2 If so, what are your views on introducing provisions on “environmental health concern” in new public health legislation: these provisions would be totally separate from the Environmental Protection Act 1990

We accept the need to move on from the principle of “nuisance” and believe that “environmental health concern” is the correct term.

5.3 Should any of the components of the Public Health (Scotland) Act 1897 outlined in Annex H be retained or amended

There needs to be review of the use of portions of these provisions. We would question continued use of powers relating to outdated processes, for instance.

5.4 Whether the definition of an “environmental health concern” could be:

“any exposure pertaining to the physical environment of any premises, which is

1. discernable to the unaided senses
2. of such a nature, so located; and
3. having such temporal characteristics as to engender material discomfort or be prejudicial to the psychological or physical health and wellbeing of a person without unusual sensitivity to that particular exposure”

If you consider that there is a better term than public health ‘concern’ which covers the issues described, then please let us know

We accept the wording, pending the view of Specialists.

5.5 Whether the new system of environmental health concern management could include:

1. public (individual or group) report to the local authority
2. joint assessment by local authority and NHS public health staff of the risk, based on the precautionary principle and agree actions with the community
3. proportionate action by local authority, based on adequate legal sanctions, including abatement or prohibition orders similar to those used currently, or in food standards legislation

   We agree.

5.6 Whether the time is also right to expand the statutory nuisance regime in the Environmental Protection Act 1990 to include light and insect pollution; and are there any other areas of nuisance that should be added now

We agree.

In general terms, we believe that a RIA would be appropriate here. Such powers may be double-edged for the public - restrictive for potential perpetrators, and liberating for potential victims. The issues may need further explanation, but we offer general support for the issue and proportionate measures.

QUESTION 6: MORTUARIES OPTIONS

6.1 The routine responsibility for resourcing and provision of mortuaries in Scotland should become the responsibility of NHS Boards

6.2 The NHS should be allowed to charge the police for the use of mortuaries

6.3 The provisions identified in Annex I should be updated and retained in new legislation with provision, in particular, made for cremation to take place as appropriate

We agree that such provisions need to exist. NHS Boards will need to consider whether they have effective measures to meet CBRN eventualities and other incidents with the potential for mass fatalities. Again, this needs a RIA with contingency for significant incidents, with safe storage, handling and investigation facilities and collaboration with Local Authorities.

QUESTION 7: PORT HEALTH

7.1 How well you consider the current port health arrangements work in Scotland; and

7.2 how they might be strengthened

These are open issues. One specific matter in paragraph 9.4 - trade as well as travel is extensive and should receive the attention of this legislation.

From experience, particularly with aircraft, there should be a duty on captains to give the longest possible notice, and adequate detail, of a potential public health hazard on their craft. There should be an obligation on them to give full information in order to facilitate investigation. This, if possible, should include the location of people affected or potentially affected, and sharing information on passenger lists and whereabouts, both on the craft at the time and subsequently. Strengthening arrangements would entail clarity of responsibilities, of scope, of relationship to immigration and customs services, of competency and capability. There is an argument in favour of placing co-ordinating responsibility with Health Protection Scotland, given the dynamic nature of this matter, frequent involvement with UK agencies and laws, relatively specialist demands, competencies and training needs.

QUESTION 8: SAFEGUARDS

8.1 Legislation should contain provisions similar to Regulation 12 in England and Wales, allowing the passing on of information beyond the health protection team by a competent person in specific circumstances

We agree. These proposals are reasonable and proportionate, and inclusion in the Act would give authority to the activity.

Sharing information is a double-edged issue. The public are disbelieving sometimes when health professionals fail to disclose information to others, rather than disclose too much. Recent history is littered with failures in child protection, as illustrations of this point.

8.2 Issues of enforcement against one’s own organisation should be handled by:

1. a separate health board or local authority
2. a newly-created public health forum or board
3. another arbitrator
4. robust internal procedures that protect and separate conflicts of interest

This scenario does happen, and there are recent examples. Incident management arrangements should be local as possible. Where there is potential conflict, there should be a duty of organisations and individuals to declare interests, and penalties if they do not. If there is any doubt, there should be an outside arbiter who is there, not to take over the responsibility for an incident, but to ensure clear governance and probity. Such an arbiter should be introduced by either the LA or NHS, but at the suggestion of any party.

8.3 Outbreak and incident reports should be circulated to a defined audience

Key outbreak and incident reports should be public documents. Any more detailed reports with individually identifiable information might have these parts removed, or could be written separately. They would be submitted to the appropriate NHS Board Governance Committee, and their FOI schemes would determine further public disclosure.

QUESTION 9: TASKS AND OFFENCES OPTIONS

9.1 Whether the proposed statutory split between governance and penalties is satisfactory, or whether an alternative approach might be preferable

We agree.

9.2 Whether penalties should only be applied to the non-completion of tasks in List B

In common with our answer to question 8, people with a potential conflict of interest should provide all necessary information, and there should be penalties for failure to disclose.

9.3 Whether legislation should include penalties for non-compliance with tasks

We agree.

9.4 If so, whether List A infringements might be addressed through the health governance framework, with List B breaches liable to attract either a monetary penalty or, in serious cases, a term of imprisonment

Infringement under List A may be addressed through the health governance framework, but could also be addressed through corporate governance or, even corporate killing legislation. We believe that List B infringements should attract legal sanctions.

9.5 Whether legislation should include provision for any other enforcement measure, such as:

1. electronic tagging
2. video monitoring
3. public health monitoring

   Need the document be this specific? Electronic tagging, for instance, is an effective means of monitoring but surveillance technologies will change over time. Satellite tracking, for instance, could be, and it is not in there. We need to underline that such a measure would only be appropriate where the potential risk is great, and with prior legal scrutiny.

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939

[10 January 2007]