Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by The Public Health Laboratory Service (PH 41)

  1.  The Public Health Laboratory Service is concerned with the effect of infection on public health, its corporate purpose being to protect the population from infection by maintaining a national capability of the highest quality for the detection, diagnosis, surveillance, prevention and control of infections and communicable diseases. The PHLS makes its unique contribution to improving the health of the population through the co-ordinated activities of its network of microbiology laboratories, surveillance, epidemiology and field investigation services, research development, education and training programmes, in collaboration with other agencies at local, regional, national and international levels. In this way, the PHLS provides essential support for those authorities with formal and statutory responsibilities for communicable disease control. Proper and timely co-ordination with clear objectives and clarity over roles and responsibility are essential to this purpose. Equally, speed of action and timeliness are also critical because communicable diseases can spread and outbreaks occur with frightening rapidity.

  2.  In preparing this evidence for the Committee, we have selected 11 of the many infections or incidents of public health importance whose control particularly involves co-ordination issues. Short individual summaries of these are provided in the attachments to this paper. Each of the 11 infections or incidents has its own particular aspects. Collectively, however, they illustrate four key areas to draw to the Committee's attention.

  These are:

  2.1  The vital need for increased investment in training in general and in developing co-ordinated "surge capacity" for dealing with infection incidents. Surge (or response) capacity cannot be maintained where staffing is reduced to the bare minimum through imposition of excessive efficiency savings. We cannot wait for incidents to occur before deciding there is a need for preparedness.

  2.2  The resource requirements that will emerge with the new Communicable Disease and Sexual Health/HIV & AIDS Strategies which are expected to be launched by Government in 2001.

  2.3  The concern that overly strict interpretations of new legislation relevant to patient confidentiality could potentially place patient health and even lives at risk from infection if they make proper surveillance and infection control impossible. To resolve these issues it may be necessary to re-visit the legislative framework for control of infection—a task which in any case is long overdue.

  2.4  The difficulty in persuading health authorities at every level to see communicable disease as important, compared with the "super-charged priorities" of cancer and heart disease. For some infections and areas it is unclear who will be dealing with infection, especially at a population level through Primary Care Groups and Trusts.

  3.  In addition concerning the specific infections whose details are attached, a number of other themes emerge, some of which extend beyond more than one infection:

  3.1  Heavy health burden and considerable opportunity for health gain. This is the case for most of the examples. HIV transmission in the UK is costing England alone more than £250 million annually in medical and social care. Tuberculosis in London, infertility in women due to genital chlamydia and hospital acquired infection are other examples. It is estimated by the National Audit Office that some 15 per cent of hospital acquired infections may be preventable, with the saving of some 750 lives and £150 million annually.

  3.2  An expectation of health protection by the public who may presume their food and water to be free from the dangers of infection. Contamination of baby milk, waterborne disease and E. coli O157 (VTEC) infection show why this is not always the case.

  3.3  A requirement for international co-ordination. The incident of contamination of baby milk and the recent deaths from infection in injecting drug users required international detective work and control measures operating across the four UK countries and beyond.

  3.4  The need to maintain public confidence in health promotion as well as health protection measures, specifically those of vaccination (preventing meningococcal disease with a new vaccine), screening (protecting babies against infections carried by their mothers) and retaining a safe water supply (waterborne disease).

  3.5  A requirement for rapid, effective, co-ordinated action. This is especially the case for very infectious or very serious conditions such as for the Lassa Fever incident and the outbreaks of VTEC infection and meningococcal disease when they occur.

  3.6  Gross Health Inequalities which are to be found for HIV, tuberculosis, hepatitis B and genital chlamydia infection.

  4.  The PHLS would welcome an opportunity to give oral evidence to the Committee in order to expand on the points made in this submission; to explain why the arrangements for communicable disease prevention and control are deserving of the Committee's attention and how, in terms of the multi-agency working involved, they may well be an exemplar for other aspects of the Committee's inquiry.


    1.  Prevention of HIV Transmission in the United Kingdom.

    2.  Tuberculosis in London.

    3.  Infertility and other reproductive ill-health in women due to Genital Chlamydia Infection.

    4.  Hospital acquired infection.

    5.  Contamination of baby milk.

    6.  Waterborne disease.

    7.  The most important gastrointestinal infection: VTEC O157.

    8.  Unexplained deaths and severe illness in injecting drug users.

    9.  Preventing Meningococcal Disease with a new vaccine.

  10.  Protecting babies against infections carried by their mothers.

  11.  A serious infection incident: Lassa Fever in London.

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