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Powers to reduce the risk of serious threats to public health should be strengthened, the English government has indicated, in a consultation paper designed to update legislation to take account of recent developments such as severe acute respiratory syndrome (SARS) as well as chemical and radiation hazards.
The government's proposals are designed to update the current law—the Public Health (Control of Disease) Act, 1984—which gives local authorities powers to prevent and control the spread of infectious disease. The government proposes that these powers be updated, with more modern and flexible provisions that can apply to contamination by chemicals and radiation as well as infectious diseases.
“Infectious diseases were once seen as a problem that would disappear in the foreseeable future. The emergence of new diseases, such as HIV/AIDS and SARS, and the re-emergence of old diseases, such as tuberculosis, have shown that that is not the case,” the consultation paper warns.
To cope with these challenges, the paper recommends supplementing current powers that allow an infected person to be medically examined and detained in hospital with powers that may be more effective at controlling the spread of disease, such as keeping a person in quarantine.
Currently people who pose a threat to public health are not compelled to accept NHS services, although use of the services on offer is generally high. The current law allows a person thought to be infected with a specified infectious disease to be medically examined. Someone known to have a specified infectious disease may be removed to and detained in hospital. These powers are used only in exceptional circumstances and as a last resort.
There is also a requirement for the provision of information, such as the requirement on doctors to notify the local authority if they see a patient who has a specified infectious disease.
The consultation paper argues that the current law should be changed because it is outdated, is piecemeal, and cannot deal with new challenges to public health. Many of the provisions of the act are directly derived from Victorian antecedents “largely based on nineteenth century social conditions, and a nineteenth century understanding of the science behind the spread of diseases.”
The provisions of the act originated at different periods often to tackle very specific problems. “As a result, the Act does not provide a complete toolkit for tackling infectious disease, but only some tools, useful in some circumstances but not in others,” the consultation paper notes.
Recent challenges to public health have strengthened the case for review, the consultation paper argues. It recommends taking an “all hazards” approach, extending measures from infectious diseases to contamination by chemicals and radiation, such as the polonium poisoning reported in London in 2006. New legislation should also reflect current views on human rights, data protection, and medical confidentiality.
The consultation paper says that the new legislation should be based on a set of general principles. It recommends that decisions on actions must be informed by an assessment of the level and nature of the risk to public health that is based on scientific principles and available evidence.
The views or wishes of the person directly and individually affected by the decision must be taken into account, and any action taken must be the least restrictive of a person's rights and freedom of action that would achieve the appropriate level of health protection. Someone posing a public health threat could be put in quarantine or required to stay away from work or school, however, if this was considered appropriate.
Caroline Flint, minister for public health, welcomed the consultation paper: “What we need is modern, up to date legislation that takes account of the latest scientific knowledge and allows us to respond in an effective and proportionate way to the threats posed by the spread of infectious disease or contamination by chemicals or radiation.”
The changes proposed in the consultation paper relate to England, although similar proposals are made for Wales in a consultation paper published by the National Assembly for Wales. Comments on the proposals should be sent to the Department of Health by 25 June.
Rod Griffiths, president of the Faculty of Public Health, strongly supported the recommendations. He said, “Current law is out of date and has not been reviewed since major changes such as the Human Rights Act have come in. There is a real risk that confusion or hesitation about legal niceties could inhibit action in the early stages of an incident. Clarity about powers and who is expected to use them is essential.”
Professor Griffiths was concerned that changes had not been introduced previously and noted that the consultation has “been in the pipeline” since 1988, when the Acheson committee proposed a review because, even then, the law was outdated.
“Since then, the case for change has strengthened with each new incident, polonium 210 providing the most recent example. The opportunity was missed at the time of the civil contingencies bill [which gives the government wide ranging powers in an emergency] because, astonishingly, the Department of Health was not ready. The current proposals must be followed through with a new act.”
Review of Parts 2, 5 and 6 of the Public Health (Control Of Disease) Act 1984: a Consultation is available at www.dh.gov.uk/en/Consultations/Liveconsultations/DH_073452.