APPENDIX 58
Letter from the Assistant Chief Services
Officer (Health), Kerrier District Council to the Clerk of the
Committee (PH 95)
MANAGEMENT OF
INFECTIOUS DISEASES
& ROLE OF
NHS DIRECT IN
PUBLIC HEALTH
I have been passed a copy of your letter to
Ms Jane Naish of the RCN, dated 19 December 2000 by David Purchon
(President of Chartered Institute of Environmental Health).
If I may comment (unsolicited!) both on behalf
of the CIEH (as an elected Trustee sitting on the "Food &
General Health" Sub-Committee) and as an individual who has
undertaken formal research into E.coli O157 sources?
1. The management of infectious diseases
such as E.coli O157 is indeed complex and may involve many
people and agencies such as local authorities, GPs, Consultants
in Communicable Disease Control (CCDCs), Directors of Public Health,
MAFF, DWO, Water Companies, FSA, the Public Health Laboratory
Service (PHLS) and the Communicable Disease Surveillance Centre
(CDSC).
I know from experience whilst undertaking my
3-year research study how difficult it is initially to make the
necessary contacts—but generally everyone is keen to co-operate
and make the `system' work. However, I am also aware that unless
the local EHO (or other investigating Officer) has such commitment
and `staying power', many opportunities to properly ascertain
a cause for the infection are lost.
Countless people have tried to produce a comprehensive
but simple solution, but to my knowledge we have all failed! Perhaps
such investigations truly are "multi-agency" in nature
and in reasonably serious/extensive clusters of infection or outbreaks
the `Outbreak Control Team' (ICT), which will invariably be formed,
will have the task of pulling everyone together. The problem,
as I have already alluded to, is when one is investigating a `sporadic'
case of infection which doesn't warrant an ICT and yet, in potentially
serious infections such as E-coli O157 we then lose the
opportunity to advance our knowledge on the organism and its numerous
sources.
The CIEH has worked closely with CDSC and the
PHLS in work around infectious disease investigations and would
be keen to be involved in any further discussions/debate in this
area. David Purchon or I would be pleased to liaise with your
Committee as you see fit.
2. I feel that NHS Direct has an important
role to play in the area of public health. Again, I have first-hand
experience of where this has been the case with E.coli
O157.
I am a co-Patron of an organisation called the
"Heather Preen Trust" (together with Professor Hugh
Pennington) which was set up by Mrs Julie Preen after the tragic
death of her daughter, Heather, in August 1999 following a cluster
of case of E.coli O157 associated with Dawlish Warren beach
in Devon.
Julie and the Trust convened a high-level meeting
of relevant `experts' and professional bodies, including NHS Direct,
to discuss how best to deliver key messages concerning the infection
to both relevant health professionals and the public. As a result,
NHS Direct agreed to adapt its protocol for dealing with queries
which may potentially relate to E.coli O157 infection in
an attempt to avoid inappropriate advice and/or medication.
I hope you don't mind me making these unsolicited
comments, but I felt it was too good an opportunity to miss! I
would be very pleased to discuss any of these issues with you
if necessary.
26 January 2001
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