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Back to Legal Responses to Health Emergencies

Summary

The public health crisis system in England is based on broadly drafted modernized legislation and regulations.  It operates on a local level with primary health care providers using national guidelines to draft emergency plans.  Designated agencies or departments are responsible for coordinating local efforts if the crisis becomes national or spills over into more than one local area.  Multiagency groups help to coordinate the response.  Cooperation and coordination is emphasized as essential to manage public health crises.  The legislation regarding infectious diseases has recently been amended to take into account modern-day challenges and scientific knowledge. 

I.  Structure of Public Health Crisis Management System

A.  Government Responsibilities

The Secretary of State has a legal duty to protect public health in England from disease and other dangers.[1]  The Secretary has established a number of bodies and programs to meet this duty.  The National Resilience Capabilities Programme (NRCP) is the core framework through which the government is preparing for emergencies across all parts of the United Kingdom.[2]  This program aims to ensure that the UK has a well-prepared infrastructure that is able to address rapidly and effectively a wide range of emergencies.  The program is divided into a number of different groups, one of which includes infectious diseases in humans.[3]  The Department of Health is the lead organization in planning for this type of emergency.  

The Department of Health, the National Health Service (NHS), Public Health England, and local government authorities[4] are the main organizations responsible for addressing public health crises and, under the NRCP, infectious diseases.  These organizations are responsible for different aspects of planning for public health crises.[5]  Public Health England, an Executive Agency of the Department of Health, is the national public health agency and responsible for fulfilling “the Secretary of State’s duty to protect the public’s health from infectious diseases and other public health hazards.”[6]

B.  Department of Health

The Department of Health is involved on an organizational level in the prevention and control of infectious diseases by developing policies and setting standards.  It is the lead government department involved in planning for a human influenza pandemic.[7]  Responsibility for the functions of the Department of Health rests with the Chief Medical Officer, the government’s principal medical advisor.[8]

There are a number of bodies that advise the Department of Health and the NHS on the control and prevention of infectious disease.  One of these is Public Health England, an executive agency of the Department of Health.[9]  Public Health England’s role is to “protect and improve the nation’s health and wellbeing, and reduce health inequalities”[10] and its general duty is to fulfil the Secretary of State’s statutory duty to protect public health.11[]  It works in a number of areas to discharge these functions, such as providing the government, the NHS, public health professionals, and the public with scientific advice; supporting local government with advice on how to protect health; and ensuring that effective local and national arrangements are in place to respond to health protection concerns and emergencies.[12]  Public Health England is responsible for the Secretary of State’s duties under the Health and Social Care Act 2012.  It replaced the Health Protection Agency as a “category 1” responder[13] under the Civil Contingencies Act 2004 in respect of health hazards and emergencies caused by infectious diseases, chemicals, poisons, and radiation.[14]  Public Health England operates in a number of ways to both respond to and help prevent health emergencies, such as by providing advice to the public on how to remain healthy and avoid hazards, conducting surveillance to detect any threats, and preparing plans to ready the nation for any future threats to its health.[15]Its functions are described as combining “public health and scientific knowledge, research and emergency planning within one organization.”[16]

C.  National Health Service

The National Health Service (NHS) is responsible for the diagnosis and treatment of individuals with infectious diseases, as well as for improving and protecting the health of the population.[17]  Regarding the latter two functions, the NHS has a broad array of responsibilities to prevent and control infectious diseases that include implementing health programs, preventing the spread of the disease, surveying the local community, and monitoring any emergence or transmission of infectious disease.

Under the Civil Contingences Act the NHS must demonstrate the ability to effectively respond to an emergency, including infectious disease outbreaks.[18]  This type of preparation in England is known as emergency preparedness, resilience, and response (EPRR).[19]  To manage its EPRR responsibilities, the NHS has established commissioning boards and clinical commissioning groups.[20]  It has also established local health resilience partnerships to coordinate the work and planning for EPRR across all health bodies.[21]

D.  Local Authorities

Local authorities have a number of statutory obligations and powers to control the spread of infectious diseases under the Public Health (Control of Disease) Act 1984.[22]  The types of infectious diseases that trigger the local authorities’ powers under the Public Health (Control of Disease) Act are known as notifiable diseases and are specified in the Act and the regulations made under the Act.[23]  Additional infectious diseases have been added to the list through regulations, and the Secretary of State has discretion to add more, although the inclusion of any further disease is dependent upon the impact of the disease.[24]  Diseases subject to the WHO’s International Health Regulations are contained in the list.  Doctors and health care providers also have the duty to report other diseases that pose a significant risk to human health.[25] 

All incidents of notifiable diseases must be reported to an officer appointed by the local authority.[26]  There are no requirements in the legislation as to whom should be appointed, but typically the post goes to the local Consultant in Communicable Disease Control.  Doctors and health care providers are under a legal duty to complete the notification form immediately on suspecting or diagnosing a notifiable disease.  Lab confirmation of the suspected disease is not needed in order for notification to occur.[27]  Once notified, the proper officer must report the case to Public Health England within three days, or twenty four hours for urgent cases.[28]

To ensure that health needs are met on a local level, local authorities can order that a disease not provided for in the Public Health (Control of Disease) Act or in regulations issued by the Secretary of State be labeled a notifiable disease within its designated area.[29]  The order must specify the provisions in the Public Health (Control of Disease) Act that apply to the disease and, unless the situation is an emergency, be approved by the Secretary of State.[30]

E.  Civil Contingencies Secretariat

The Civil Contingencies Secretariat (CCS) assists the government in preparing for public health crises.  The CCS was established in 2001 as part of the Cabinet Office to improve the UK central government’s ability to prepare for and handle emergencies.[31]  The CCS assists relevant organizations, both within the government and outside of it, in planning and preparing responses to emergency situations.  The work of the CCS concentrates on four main areas: risk assessment, preparation and planning, response and recovery, and building a resilient society. [32]

F.  Department for Environment and Rural Affairs

The Department of Environment, Food and Rural Affairs (DEFRA) plays an important role in any health crisis related to a disease that can be transmitted from animals to humans.[33]  The Minister of Agriculture has wide-ranging powers, which are discussed in Part II(E), below.

G.  Port Health Authorities

Port health authorities also exist throughout England.[34]  During an emergency, their primary function is to control infectious diseases at ports of entry into the country.[35]  The port health authorities may be part of a local authority, or in some cases they may be a single authority that conducts the functions across a number of local authorities.  The port health authorities work closely with a number of other government bodies.[36]

H.  Collection of Public Health Information

Diseases surveillance in the UK is based on statutory reporting required of doctors and other health workers who diagnose or suspect notifiable diseases.[37]  Statutory reporting requirements are contained in the Public Health (Control of Disease) Act and the Health Protection (Notification) Regulations 2010.  The Act requires registered medical practitioners who become aware or suspect that a patient is suffering from a notifiable disease to submit a certificate containing the patient’s details to the local authority.[38]  Laboratories that confirm the diagnosis of a notifiable disease are under a legal duty to inform Public Health England with the details of each case of a notifiable disease.[39]  Public Health England then collates this information and publishes reports with an analysis of any trends.[40]

I.  Decisions and Decision Makers

In the United Kingdom, the decision makers are determined according to the structure provided by the Civil Contingencies Act 2004.[41]  All responder organizations designated as category 1 under this statute follow a nationally recognized structure of three different levels of command—operational, tactical, and strategic.[42]  Operational (also known as bronze) command refers to people managing the working elements of the response in such settings as hospital wards or the scenes of major incidents.[43]  Tactical (also known as silver) command is responsible for managing an organization’s response to an incident.  Tactical command must ensure that plans are in place to achieve objectives set by strategic command and that operational command provides an efficient, coordinated response.[44]  Strategic (also known as gold) command has overall command of the organization’s resources.  This level of command liaises with partners to develop strategy and policies and allocates funding to help address incidents.[45] 

For incidents and emergencies involving several organizations and agencies, a Strategic Coordinating Group may be convened to coordinate.[46]  The NHS’s emergency response teams take the form of area Commissioning Boards.  In cases of wide-reaching emergencies, the Commissioning Board national team can assume command of all of the resources of the NHS across England, and the regional Commissioning Boards take action based on the commands of that team.[47]

J.  Crisis Triggers

In addition to regional procedures for outbreaks of infectious diseases, a general health crisis in England is referred to under the broader term “major incident.”  The NHS defines the term as

[a]ny occurrence that presents serious threat to the health of the community, disruption to the service or causes (or is likely to cause) such numbers or types of casualties as to require special arrangements to be implemented by hospitals, ambulance trusts or other acute or community provider organisations.[48]

In addition to health crises, major incidents include chemical, biological, radiological, or nuclear incidents; train crashes; and incidents involving terrorism.

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II.  Powers To Prevent the Spread of Disease

A.  Legal Overview

The government was criticized at the turn of the century for not having a clear, coherent legislative and regulatory framework for an effective public health crisis system that could deal with major health risks, particularly the risk of human pandemic diseases.[49]  A 2003 report from the House of Lords recommended that the roles and responsibilities of the groups involved in the fight against infectious disease be more clearly defined.[50]  The result of this report was the development of the NHS’s Emergency Planning Guidance, first published in 2005.[51]  This guidance provides general principles on how NHS organizations should handle major incidents, which are defined to encompass “big bang” incidents, such as casualties arising from a terrorist attack, and “rising tide” incidents, such as an infectious disease epidemic.[52]   

The primary piece of legislation that addresses public health emergencies is the Public Health (Control of Disease) Act 1984.[53]  This Act served to consolidate a number of pieces of legislation from the nineteenth century, much of which was “directly derived from Victorian antecedents.”[54]  The laws were based on the scientific knowledge and social circumstances of those times and, therefore, did not address modern risks, such as contamination from chemicals or radiation.  This Act was reformed in 2009 after the Law Reform Commission recommended that public health legislation was overdue for review,[55] noting that the scientific understanding of disease contagion at the time the laws were drafted were not congruent with today’s scientific knowledge.  Additional powers to detain individuals suffering from diseases caused concern that the Law would not stand up to a challenge brought under the Human Rights Act 1998, as it would be “difficult [for the government] to argue that exercise of these powers is ‘necessary’ or even effective in disease control.”[56]  The Law Reform Commission expressed “fear . . . that the effectiveness of the British response to a major outbreak of contagious disease could be significantly impaired by the defects in the law.”[57]

As a result of these concerns, the government enacted the Health and Social Care Act 2008, which repealed a large number of provisions in the Public Health (Control of Disease) Act 1984.[58]  The amendments aimed to bring the provisions concerning infections up to date and take into account other concerns, such as radiation and chemical contamination.  The updated provisions of the 1984 Act provide two areas under which regulations may be made in relation to diseases. The first relates to in-country provisions and the second to England’s international borders.[59]

B.  Current Laws and Regulations

Under the Health and Social Care Act 2008, the Secretary of State may make regulations (referred to as “health protection regulations”) to prevent, protect against, control, and provide a public health response to an incident or to the spread of infection or contamination in England, even if the threat originated from outside the country.[60]  The Law provides examples of powers that the Secretary of State may exercise by regulation, including

  • imposing or enabling restrictions or requirements on individuals in the event of, or in response to, a threat to public health; or
  • providing local authorities with functions to monitor public health risks.[61] 

The restrictions may include keeping a child away from school, prohibitions or restrictions on events or gatherings, a “special restriction or requirement” or “Part 2A order,” [62] or requirements with regard to the handling and treatment of dead bodies.[63]  Any restriction imposed under the provisions of this Act must be proportionate with the aim that it is trying to achieve,[64] in order to comply with human rights principles adopted in the UK.

The Secretary of State may not make regulations requiring that a person receive medical treatment, including vaccinations, as was the case under previous legislation.  However, special requirements and restrictions may, if there is a serious and imminent threat to public health, require “medical examinations, removal to or detention in a hospital or other establishment, or isolation or quarantine.”[65]

The statute limits the powers and penalties the regulations may confer.  The regulations can

  • confer functions on local authorities and other persons;
  • create offenses, although these cannot be punishable with imprisonment or a fine of more than £20,000 (approximately US$35,000);
  • enable courts to order that anyone convicted of an offense under the regulations take or pay for remedial action;
  • make regulations that apply to different areas of the country;[66]
  • provide for the execution and enforcement of restrictions or requirements imposed;
  • provide for a system of appeals from and reviews of decisions made under the regulations;
  • allow or prohibit charges to be levied;
  • permit or require the payment of incentive payments, compensation, and expenses; and/or
  • provide for the resolution of disputes.[67]

To prevent the spread of infection or contamination, the Public Health (Control of Disease) Act provides that Justices of the Peace may impose restrictions and requirements on individuals, premises, groups, and objects through orders, known as “Part 2A Orders.”  Only local authorities may apply to a Justice of the Peace for a Part 2A Order, and these orders may, in certain circumstances, be made without notifying the individual affected by the Order.[68]  Once made, an individual affected by the order, the local authorities, or any other body that is responsible for enforcing or executing the order may apply to have it revoked or varied.[69] 

Such an order may require that an individual

  • submit to medical examination;
  • be removed to a hospital or other suitable establishment;
  • be detained in a hospital or other suitable establishment (unless otherwise stated, for a maximum period of twenty-eight days);[70]
  • be kept in isolation or quarantine (unless otherwise stated, for a maximum period of twenty-eight days);[71]
  • be disinfected or decontaminated;
  • wear protective clothing;
  • provide information or answer questions about their health or other circumstances;
  • have their health monitored and the results reported;
  • attend training or advice sessions on how to reduce the risk of infecting or contaminating others;
  • be subject to restrictions on where they go or with whom they have contact; and
  • abstain from working or trading.

The Justice of the Peace may issue the order only if he/she is satisfied that a person may be infected or contaminated, could present significant harm to human health, and there is a risk the person may infect or contaminate others.[72]  The Justice of the Peace may also order that the suspected infected or contaminated person provide information about the identity and location of other individuals that may be infected or contaminated who pose a risk to others, to enable “contact tracing” of these individuals.[73]

Justices of the Peace have similar powers to make orders in relation to premises or things that may be infected or contaminated when they could present significant harm to human health and there is a risk that they may infect or contaminate humans.[74]

For items (things), the order may impose a number of restrictions or requirements, including that the thing be seized; retained; isolated; quarantined; disinfected; decontaminated; destroyed; disposed of; or, in the case of dead bodies, cremated or buried.[75]  For premises, the order may impose restrictions or requirements, including that the premises be closed, disinfected, decontaminated, or destroyed.  For conveyances or other moveable structures, the order may require that they be detained.[76] 

To enable contact tracing to help prevent the spread of infection or contamination, the order may require the owner or person in control of the thing or premises to provide information or answer questions about the thing or premises.[77]

The Justice of the Peace may also issue additional orders to include “such other restrictions or requirements as the justice considers necessary for the purpose of reducing or removing the risk in question.”[78]  The order may be conditional; for example, if a person refuses to be decontaminated, he/she must remain in isolation until the risk of contamination or infection has passed.

C.  Aircraft and Ships

The Secretary of State has the authority to make regulations to prevent the spread of infection or other contamination through vessels, aircraft, trains, or other conveyances leaving or arriving at any place, or to give effect to any international arrangement regarding the spread of infection or contamination.[79]  The regulations may cover issues such as

  • detaining conveyances; 
  • requiring the medical examination, detention, isolation, or quarantine of individuals;
  • inspecting, analyzing, retaining, isolating, quarantining, or destroying “things” (objects);
  • disinfecting, decontaminating, or using other sanitary measures for conveyances, persons, or things;
  • prohibiting or regulating the arrival or departure of conveyances and the entry and exit of persons or things;
  • imposing duties on masters, pilots, train managers, and other persons on board conveyances and on owners and managers of ports, airports, and other points of entry; or
  • requiring persons to provide information or answer questions (including information or questions relating to their health).[80]

D.  Sanctions and Fines for Failing to Comply with Requirements

Failing to comply with the requirements of an order without a reasonable excuse can result in a fine of up to £20,000 (approximately US$35,000).  Where the court is satisfied that the “failure or willful obstruction constituting the offence has caused premises or things to become infected or contaminated or otherwise damaged them in a material way” by an individual convicted of an offense under the Act, the court may require the individual to take or pay for remedial action.[81]  The police may take individuals that contravene an order of detention, isolation, or quarantine into custody and return them to the place specified in the order.[82]

E.  Animals and Disease

England’s experience with Bovine Spongiform Encephalopathy (BSE) and foot and mouth disease has caused it to introduce numerous pieces of legislation to prevent the spread of such diseases and halt any impact they might have on public health.  The Animal Health Act 1981[83] (the 1981 Act) contains broad provisions ranging from requiring the disinfection and cleansing of places where animals reside or visit, to prohibiting animal movement and imports, to requiring vaccinations and the slaughter of animals.

The Minister of Agriculture has wide-ranging powers under the 1981 Act and can issue orders setting standards for the declaration of infected areas that state who can declare an area as infected, as well as the effect, consequence, and duration of such a declaration.[84]  The Minister can make orders prescribing the seizure, detention, or disposal of diseased animals, or those suspected of being diseased.  To prevent and reduce the risk of spreading any animal disease to humans, the Minister can make an order providing that any provision of the 1981 Act will apply to a specified disease.[85]

Enforcement of the 1981 Act falls to the police, who can arrest and detain any person suspected of, or found committing, an offense under the Act.  Punishment is either imprisonment and/or a fine.  If a person infects an animal with a disease specified in the 1981 Act, he/she is guilty of an offense and can be fined and/or imprisoned for up to two years, as well as disqualified from keeping or dealing with any animals.[86]

F.  Vaccines

The UK currently does not have the capability to produce large numbers of vaccines; most are purchased from France and Belgium.[87]  Certain strategic vaccines and drugs are being stockpiled; however, owing to concerns that information on these items may prove useful to terrorists, the government has not publicly disclosed any further details.  During the outbreak of the swine flu in 2009, the government stated it had enough antivirals on hand to treat thirty-three million people in the UK—half of the population.[88]

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III.  Transparency of Public Health Crisis Management System

A.  Disclosing Information to the Public

There is a duty under the Civil Contingencies Act 2004[89] for those connected with the public health crisis system to disclose information to the public, and the NHS has noted that this is based upon the “belief that a well-informed public is better able to respond to an emergency, and to minimise the impact of the emergency on the community and on NHS services.”[90]  The NHS follows the Civil Contingencies Act Ten Step Cycle[91] of communications, which helps to provide for effective communication.[92]  The Civil Contingencies Act 2004 places two duties on responders to public health crises.  The first duty is to warn and inform the public of any likely risks and threats that NHS organizations may address, and of any planned responses to these risks and threats.  The second duty is the organization’s response to a crisis.  The NHS notes that when making information available to the public in crises, the communications must be “simple and easily digestible.”[93]

B.  Methods of Dissemination

There is no formal emergency broadcast system in England for public health crises, but there are long-standing protocols as to how information should be disseminated.  The NHS has implemented a web-based cascade system known as the Central Alerting System that issues “patient safety alerts, important public health messages and other safety critical information and guidance to the NHS and others.”[94]  The NHS notes that the media will play a key role in disseminating information to the public and that there must be clear guidelines for providing clear and accurate information through these means.[95]  

C.  Effectiveness of the Communications System

The BSE crisis, followed by the foot and mouth epidemic, led to a massive loss of public confidence in “official pronouncements about infectious disease issues” from government institutions.[96]  This loss of confidence was exacerbated by the government repeatedly stating that certain events pose no risk to the public’s health.[97]  National Audit Office examinations of debriefs to the media also found that there was a lack of coordination and consultation in disseminating this information, resulting in inappropriate health advice being given to the public.[98] 

The communication system during the swine flu outbreak in 2009 appeared to operate effectively, with statistics on individuals who were tested for the flu, as well as those who tested positive, available on the Internet from reliable government pages and distributed via the media.[99]

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IV.  Cooperation with the WHO

England complies with the WHO’s International Health Regulations.  The provisions from these regulations were implemented in the Public Health (Control of Disease) Act,[100] as supplemented by regulations. 

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V.  Recent Developments

Public Health England has helped to provide enhanced screening for Ebola at England’s main ports of entry (Heathrow, Gatwick, and St. Pancras).  “Targeted Passengers” are those identified by the Border Force officers as those who have travelled from Sierra Leone, Guinea and Liberia.  These passengers must have their temperature taken and complete a questionnaire that includes information about their current health, travel history, and any contact with Ebola patients.  The results of these tests and questions will determine whether the person will be permitted to continue their journey with advice or receive additional checks and possibly be transferred to a hospital.[101]

Prepared by Clare Feikert-Ahalt
Senior Foreign Law Specialist
February 2015


[1] Health and Social Care Act 2012, c. 7, § 11, http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted, inserting § 2A into the National Health Service Act 2006, c. 41, http://www.legislation.gov.uk/ukpga/2006/ 41/contents.

[2] HM Government, Emergency Response and Recovery: Non Statutory Guidance Accompanying the Civil Contingencies Act 2004, Oct. 2013, ¶ 3.4.2, https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/253488/Emergency_Response_and_Recovery_5th_edition_October_2013.pdf.

[3] Id.

[4] “Local Authority” is defined in section 1 of the Public Health (Control of Disease) Act 1984, c. 22, as district councils, county councils, county borough councils in Wales, the Common Council of the City of London, the Sub-Treasurer of the Inner Temple and the Under-Treasurer of the Middle Temple, and the Council of the Isles of Scilly; see also UK Resilience, Pandemic Flu, Cabinet Office (Apr. 2008), http://www.cabinetoffice.gov.uk/ukresilience/ pandemicflu.aspx.

[5] Public Health England, Pandemic Influenza Response Plan 2014, ¶¶ 1, 2, 2.3, 3.1, https://www.gov.uk/ government/ uploads/system/uploads/attachment_data/file/344695/PI_Response_Plan_13_Aug.pdf.  Health is one area that has been devolved to the administrations in Northern Ireland, Scotland and Wales.  However, in public health crises, the Department of Health takes responsibility for the response of the entire United Kingdom.

[6] Id. at 6.

[7] Id.; Cabinet Office, Departments Responsibilities for Planning, Response, and Recovery from Emergencies, 2011, at 6, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/61354/ lead-government-department-march-2010.pdf.  For more information on the role and responsibilities of lead government departments, see Cabinet Office: Civil Contingencies Secretariat, The Lead Government Department and its role – Guidance and Best Practice,2004,https://www.gov.uk/government/uploads/ system/uploads/attachment_data/file/61355/lead-government-departments-role.pdf.

[8] Chief Medical Officer, Professor Dame Sally Davies, Dep’t of Health, https://www.gov.uk/government/people/ sally-davies (last visited October 21, 2014). 

[9] About Us, Public Health England, https://www.gov.uk/government/organisations/public-health-england/about (last visited October 21, 2014). 

[10] Dep’t of Health and Public Health England, Framework Agreement Between the Department of Health and Public Health England, Nov. 2013, at 1, https://www.gov.uk/government/uploads/system/ uploads/attachment_data/file/259756/DH-PHE_FRAMEWORK_AGREEMENT_FINAL_VERSION_FOR_ PUBLICATION_accessible.pdf.

[11] Id. ¶ 2.1.

[12] Id. ¶ 2.2.

[13] Category 1 responders are designated by the Civil Contingencies Act; they are “likely to be at the core of the response to most emergencies [and] are subject to the full range of civil protection duties in the Act.”  They currently include the police, fire and rescue, health bodies, the Maritime and Coastguard Agency, local authorities and the Environment Agency.  HM Government, Emergency Response and Recovery: Non Statutory Guidance Accompanying the Civil Contingencies Act 2004, 2013, ¶ 3.2 & Glossary at 217, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/253488/Emergency_
Response_and_Recovery_5th_edition_October_2013.pdf
See also Part I(I), infra.

[14] Id. ¶ 3.2.22. 

[15] Dep’t of Health and Public Health England ¶ 6.5.

[16] Id. ¶ 6.7.

[17] National Health Services Act 2006, c. 41, §§ 1 and 7, http://www.legislation.gov.uk/ukpga/2006/41/contents.

[18] Civil Contingencies Act 2004, c. 36, § 2 and sched. 1, http://www.legislation.gov.uk/ukpga/2004/36/contents.

[19] NHS England, NHS England Core Standards for Emergency Preparedness, Resilience and Response (EPRR) (July 2014), http://www.england.nhs.uk/wp-content/uploads/2014/07/eprr-core-standards-0714.pdf.

[20] NHS Commissioning Board, NHS Commissioning Board Emergency Preparedness Framework 2013, ¶ 1.4, http://www.england.nhs.uk/wp-content/uploads/2013/03/eprr-framework.pdf.  As of April 1, 2013, this guidance superseded both The NHS Emergency Planning Guidance 2005 and the Arrangements for Health Emergency Preparedness, Resilience and Response from April 2013.

[21] NHS England, supra note 19.

[22] Public Health (Control of Disease) Act 1984, c. 22, §§ 1–2, http://www.legislation.gov.uk/ukpga/1984/ 22/contents.

[23] Id. § 10.  Current notifiable disease are acute encephalitis, acute infectious hepatitis, acute meningitis, acute poliomyelitis, anthrax, botulism, brucellosis, cholera, diphtheria, enteric fever (typhoid or paratyphoid fever), food poisoning, hemolytic uremic syndrome (HUS), infectious bloody diarrhea, invasive group A streptococcal disease, legionnaires’ disease, leprosy, malaria, measles, meningococcal septicemia, mumps, plague, rabies, rubella, severe acute respiratory syndrome (SARS), scarlet fever, smallpox, tetanus, tuberculosis, typhus, viral hemorrhagic fever (VHF), whooping cough, and yellow fever.

[24] Health Protection (Notification) Regulations 2010, SI 2010/695, http://www.legislation.gov.uk/uksi/2010/ 659/made.

[25] Guidance: Notifiable Diseases and Causative Organisms: How to Report, Public Health England (May 1, 2010), https://www.gov.uk/notifiable-diseases-and-causative-organisms-how-to-report

[26] Health Protection (Notification) Regulations 2010, ¶¶ 2–3, http://www.legislation.gov.uk/uksi/2010/659/made

[27] Id.; see also Public Health England, supra note 5.

[28] Public Health England, supra note 5.

[29] Public Health (Control of Disease) Act 1984, c. 22, § 16(1).

[30] Id. § 16(2).

[31] Cabinet Office and National Steering Committee on Warning & Informing the Public, Improving the UK’s Ability to Absorb, Respond to and Recover from Emergencies, http://www.cabinetoffice.gov.uk/ukresilience/ ccs.aspx (last updated Sept. 18, 2014).

[32] Id.

[33] About Us, Dep’t for Env’t, Food & Rural Affairs, https://www.gov.uk/government/organisations/department-for-environment-food-rural-affairs/about (last visited Nov. 5, 2014).

[34] Public Health (Control of Disease) Act 1984, §§ 1–2.

[35] HM Government, supra note 2, ¶ 3.2.26.

[36] Id. ¶ 3.2.26.

[37] Health Protection (Notification) Regulations 2010, ¶¶ 2–3. 

[38] Public Health (Control of Disease) Act 1984, § 11.  An example of a reporting form is available online at Notifiable Diseases: Form for Registered Medical Practitioners, Public Health England (Feb. 17, 2010), https://www.gov.uk/government/publications/notifiable-diseases-form-for-registered-medical-practitioners.

[39] Health Protection (Notification) Regulations 2010, ¶ 5.

[40] Notifiable Diseases: Current Weekly Report, Public Health England, https://www.gov.uk/government/ publications/notifiable-diseases-current-weekly-report (last updated Nov. 5, 2014).

[41] Civil Contingencies Act 2004, c. 36, sched. 1, http://www.legislation.gov.uk/ukpga/2004/36/contents.

[42] NHS Commissioning Board, NHS Commissioning Board Command and Control Framework for the NHS During Significant Incidents and Emergencies, Jan. 7, 2013, ¶ 5.1, http://www.england.nhs.uk/wp-content/uploads/2013/01/comm-control-frame.pdf.

[43] Id. ¶ 5.2.

[44] Id. ¶ 5.2.

[45] Id. ¶ 5.2.

[46] Id. ¶ 5.3.

[47] Id. ¶ 6.1.18.

[48] Id. ¶ 1.4. 

[49] A Strong Britain in an Age of Uncertainty: The National Security Strategy, Cm. 7953, 2010–11, ¶ 3.38, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/61936/national-security-strategy.pdf

[50] House of Lords, Select Committee on Science and Technology, Fighting Infection, Fourth Report, H.L. 138, 2002–03, http://www.publications.parliament.uk/pa/ld200203/ldselect/ldsctech/138/138.pdf.

[51] National Health Service: Department of Health, Emergency Preparedness Division, NHS Emergency Planning Guidance 2005: Underpinning Materials, ¶ 2.2.4, http://webarchive.nationalarchives.gov.uk/20130107105354/ http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_081303.pdf.  

[52] Id.

[53] Public Health (Control of Disease) Act 1984, c. 22, http://www.legislation.gov.uk/ukpga/1984/22/contents.

[54] The Law Commission: Ninth Programme of Law Reform, March 2005, H.C. 535, http://lawcommission. justice.gov.uk/docs/lc293_9th_Programme.pdf.

[55] Id. ¶ 4.4.

[56] Robyn Martin, The Exercise of Public Health Powers in Cases of Infectious Disease: Human Rights Implications, 14(1) Med. Law Rev. 132, 136 (2006), http://medlaw.oxfordjournals.org/content/14/1/132.full. pdf+htmlSee also The Law Commission, supra note 54, ¶ 4.6.

[57] The Law Commission, supra note 54, ¶ 4.10.

[58]Health and Social Care Act 2008, c. 14, http://www.legislation.gov.uk/ukpga/2008/14/contents.  See also Dep’t of Health, Review of Parts II, V and VI of the Public Health (Control of Disease) Act 1984: Report on Consultation (Nov. 2007),http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Consultations/ Responsestoconsultations/DH_080384.

[59] Public Health (Control of Disease) Act 1984, c. 22, Part 2A, as inserted by the Health and Social Care Act 2008, c. 14, § 129, http://www.legislation.gov.uk/ukpga/2008/14/section/129.  The Health Protection (Notification) Regulations 2010, 2010/659, form part of the in-country regulations.

[60] Id. § 45C, as inserted by Health and Social Care Act 2008, c. 14, § 129.

[61] Id.

[62] “Special restriction or requirement” is defined in the Act as meaning: “a restriction or requirement which can be imposed by a justice of the peace by virtue of section 45G(2), 45H(2) or 45I(2) of the PHA.”  Id. § 45C(6)(a).  Special restrictions may only be imposed in response to a “serious and imminent threat to public health, or . . . contingent on there being such a threat at the time when it is imposed.”  Id. § 45D(4).  Part 2A orders are described below.

[63] Id. § 45C.

[64] Id. § 45D.

[65] Id. §§ 45D–E.  Health and Social Care Act 2008, Explanatory Notes, ¶ 408, http://www.legislation.gov.uk/ukpga/ 2008/14/notes/contents.

[66] Public Health (Control of Disease) Act 1984, c. 22, § 45P, as inserted by the Health and Social Care Act 2008, c. 14, § 129.

[67] Id. § 45F.

[68] Id. § 45M.

[69] Id.

[70] Id. § 45L.

[71] Id.

[72] Id. § 45G.

[73] Id.

[74] Id. §§ 45H–I. 

[75] Id. § 45H. 

[76] Id. § 45I.

[77] Id. §§ 45H–I.

[78] Id. § 45K; Health and Social Care Act 2008, c. 14, Explanatory Notes, ¶ 419, http://www.legislation.gov.uk/ ukpga/2008/14/contents.

[79] Id. § 45B.

[80] Id.

[81] Id. § 45O.

[82] Id. § 45N. 

[83] Animal Health Act 1981, c. 22, as amended, http://www.legislation.gov.uk/ukpga/1981/22/contents

[84] Id. § 17, as amended

[85] Id. § 29, as amended

[86] Id. § 28A–B.  

[87] House of Lords, supra note 50, ¶ 4.8.

[89] Civil Contingencies Act 2004, c. 36, http://www.legislation.gov.uk/ukpga/2004/36/contents.

[90] NHS Commissioning Board, supra note 20, ¶ 12.12.

[91] Gov.UK, Civil Contingencies Act (2004): Duty to Communicate with the Public, 2007, https://www.gov. uk/government/uploads/system/uploads/attachment_data/file/60906/10_step_cycle.pdf.

[92] NHS Commissioning Board, supra note 20, ¶ 12.27(h).

[93] Id.

[94] Central Alerting System, NHS, https://www.cas.dh.gov.uk/Home.aspx (last visited October 29, 2014). 

[95] NHS Commissioning Board, supra note 20, ¶ 12.25.

[96] House of Lords, supra note 50, ¶ 7.20.

[97] Most notably, during government announcements in the midst of the BSE crisis, the government reassured the public that British beef was safe to eat, with the Agriculture Minister feeding his daughter a beef burger to demonstrate the point.  In the BSE case, the government later asserted that its statement about British beef being safe to eat did not mean that there was no risk involved.

[98] Comptroller & Auditor General, National Audit Office, Facing the Challenge: NHS Emergency Planning in England, H.C. 36, 2002–03, at 37, http://www.nao.org.uk/wp-content/uploads/2002/11/020336.pdf.

[100] Public Health (Control of Disease) Act 1984, c. 22, http://www.legislation.gov.uk/ukpga/1984/ 22/contents.

[101] Press Release, Public Health England, Department of Health and NHS England, Enhanced Ebola Screening Process Begins (Oct. 14, 2014), https://www.gov.uk/government/news/public-health-england-enhanced-ebola-screening-process.

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Last Updated: 06/09/2015