The Abrams report--communicable disease control; how do Health Districts measure up to the recommendations?

The aims of the study were to examine whether Health Districts in the North Western Region complied with the recommendations in the Abrams report regarding the control of communicable disease [incorporated into the Annex to Circular HSG(93)56], and to identify areas that need further attention.

The recommendations were extracted and arranged in questionnaire form. Further items were included dealing with the use of Epinet in communicating with the profession. A compliance score was derived from affirmative and qualified affirmative responses.

Many recommendations were met by all or most Districts. Compliance was 90 percent or over for 58 percent of the questions where an assessment was appropriate. Of the 16 Districts in consortia, 75 percent did not have a consortium plan. Day-to-day plans were informal in 21 percent of Districts. In 63 percent of Districts the Family Health Services Authority (FHSA) was not involved to the extent that it should be. The Consultant in Communicable Disease Control (CCDC) had insufficient District Health Authority support in 42 percent of Districts and insufficient Local Authority support in 16 percent of Districts. In 58 percent of Districts there was lack of inclusion of matters relating to the control of infectious disease in contractual statements between purchaser and provider. There was a lack of audit in 47 percent of Districts.

One plan or a compatible series of plans are required across each District. Informal day-to-day plans should be formalized. The FHSA should be fully involved in infectious disease control plans. Certain Districts require a Community Infection Control Nurse, accountable to the CCDC and/or administrative support to input and scan surveillance data. Contractual statements between purchaser and provider should include appropriate infection control requirements when this is not already the case. Communicable disease control audit should be a regular part of CCDC duties.