Open Access Open Badges Research article

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

Paul A Cosford1*, Mary O'Mahony2, Emma Angell3, Graham Bickler2, Shirley Crawshaw4, Janet Glencross5, Stephen S Horsley6, Brian McCloskey2, Richard Puleston4, Nichola Seare7 and Martin D Tobin3

Author Affiliations

1 Directorate of Public Health, East of England Strategic Health Authority, Cambridge, UK

2 Local and Regional Services, Health Protection Agency, London, UK

3 Department of Health Sciences and Genetics, University of Leicester, Leicester, UK

4 Directorate of Public Health, East Midlands Strategic Health Authority, Nottingham, UK

5 Local and Regional Services, Health Protection Agency, Leicester, UK

6 Directorate of Public Health, Northamptonshire Primary Care Trust, Kettering, UK

7 Healthcare Workforce Deanery, East Midlands Strategic Health Authority, Nottingham, UK

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BMC Public Health 2006, 6:297  doi:10.1186/1471-2458-6-297

Published: 7 December 2006



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.


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


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 (≥90%) for 6 of 18 health protection functions, but much lower (≤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).


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.