Select Committee on Defence Minutes of Evidence

Examination of Witnesses (Questions 1040 - 1059)



  1040. I am not a subscriber to BUPA or any of the private health services, but are they part of this loop if you are communicating to hospital trusts? Is there any role for the private health sector? Please do not construe this as a total endorsement of the private sector but it is a necessary question to ask.
  (Dr Troop) They are linked in with some of the surveillance work, because obviously they sometimes pick things up, although most of their work is elective and not emergency. When people were asked to look at the capacity within their locality they obviously looked at the capacity they have in total, including the private hospitals. If we have an emergency message to get out, I will ask the local DPH when they get their message to alert the local private facilities as well. Most of the doctors in those facilities are also in the NHS, and it is mainly through the medical staff that the message spreads.

Rachel Squire

  1041. Picking up your point about challenges, Dr Troop, although chemical, biological and radiological attacks or threats are frequently lumped together, they are in fact very different in how they would manifest themselves and how they would be dealt with. So whilst certainly looking at the advantages of bringing different agencies together into one agency, can you outline what the current responsibilities are for each of those areas, and what the proposed responsibilities of the new agency will be, given the very distinctive nature of each of those areas?
  (Dr Troop) I think it would be best if I asked Dr Harper to respond on radiological and chemical aspects because they are in his area.
  (Dr Harper) The current situation with the radiological area is that the National Radiological Protection Board plays this independent role as a statutory basis and provides advice to various government departments on actions that might be necessary in the case of an incident that is moving as one of the agencies into the Health Protection Agency and its functions will be protected within the new agency. So there is not a substantial change in terms of the minimum level of functions but what we would be looking to the new agency to provide is some read-across particularly in terms of emergency response where there is a horizontal issue that the radiation area is working very closely with chemical and with micro-biological. On the chemical side, it is a more disparate range of activities and currently we have a system in which the National Focus for Chemical Incidents plays the overarching national role if there were to be an incident. We have, at a regional level, provider units in Newcastle, the West Midlands and in London, also in Cardiff and in Scotland, but as far as England is concerned, which is the remit of the new agency, in the first place, the functions of those provider units and the National Focus will be brought together within the Health Protection Agency. There is also something called the National Poisons Information Service, and this provides information primarily to clinicians. It is very closely linked in terms of the expertise and the information that is used, but is actually a separate entity. In some parts of the country it works more closely with the provider unit function, in other parts it is more distinct. Those are the areas that will be brought together within the new agency.

  1042. The second question is that one of the proposed functions of the new agency will be to deliver a local health protection service working with the NHS and local authorities, involving specific functions relating to the prevention, investigation and control of infectious diseases, as well as chemical and radiological hazards. Can you explain how that will operate?
  (Dr Troop) At the moment we have people working locally on these areas. We have consultants in communicable disease control. We have health emergency planners. Increasingly, those staff have taken on managing chemical incidents and other emergency aspects of planning. It was very clear that we needed to develop that service so that we have people who are trained to cover the whole range of these kinds of emergencies. They have taken it on, they have taken on training but we need to make it much more recognised that we need people with this range of expertise. Also, we found that some of them were working in a fairly isolated way and without, we thought, sufficient development. The intention is to draw those people in and develop their skills but also hopefully to draw others in to cover that range of emergency from the whole of CBRN and emergency planning. They will be employed by the Agency but they will be assigned to work at the local level with the PCTs so they will still be working side by side with them just as they do now, with the PCTs, with the trusts, with the Ambulance Service and so on. There will be, also, a core at the regional level to support the Regional Director of Public Health to have an overview of all this planning within each of the regions. They will have a two way relationship. One, vertically within the Agency so they are part of a larger body so they will have continuing professional development and training and expertise to draw on, an opportunity for careers to move around, and at the same time they will have a close relationship still with all their colleagues in the NHS in public health and wider and will have a service level agreement between the kind of expertise they will provide to support the response of local bodies. That is how we are working towards it at the moment. There is a huge amount of discussion with all those relevant organisations to make sure that what we put in place meets everybody needs.

  1043. No small task.
  (Dr Troop) No, but it is very exciting. The overall response to this has been very exciting. People will see that we are going to have probably one of the best international infrastructures for health protection. People from the WHO, for example, have been very excited and they see this as a model that they hope a lot of other countries might pick up.

Patrick Mercer

  1044. In the interests of time, I had a lengthy question here about the eight areas in Getting Ahead of the Curve where further action against bio terrorism threats is concerned. Could we have a written answer from you on that perhaps?[4]
  (Dr Troop) Yes, certainly.

  1045. Asking about what steps have been taken in respect of each of these since the publication of the Report?
  (Dr Troop) Yes, of course.

  1046. Thank you so much. May I ask a couple of more specific questions. Under the high clinical awareness category of one of these eight steps, how are you ensuring that your message is getting out to doctors and nurses in the National Health Service? Can I encourage you to be as brief as possible.
  (Dr Troop) Yes, I am sorry. The first thing is the PHLS, as I say we have got detailed guidance on their website which is pretty comprehensive and they have now put on their training slides and notes for people to use at the local level to back that up. Virtually all the Royal Colleges involved have had major conferences and so on and we have been speaking and other people have been speaking at all those conferences to make sure there is an awareness across the country. We have now set up a standing training committee chaired by our Deputy Director of HRD who will involve all the relevant professional bodies to try and ensure that it gets built in to all their normal training programmes so we have got quite a comprehensive approach to it.

  1047. What sort of timetable is there on that? How much urgency is there?
  (Dr Troop) As I say, some of that is in place already. We first had the group set up in December and now this work is being taken forward. It will partly depend on how quickly people get into their various curricula and their training programmes. There are so many different bodies, we will have to rely on them to take it through and obviously with encouraging support from us but to make sure they get it into their training programmes.

  1048. That is the bit that worries me, the phrase "we will have to rely on them". I understand that but is there any urgency that you can dictate to them?
  (Dr Troop) I think there is a sense of urgency amongst all these people. I think the feedback we get is people want this in their training, they want this on a routine basis. Therefore, I do not think there is any lack of willingness for people to build it into their training programmes. Clearly how they do this, how they build it into general medical training, they will have to do it, our role is to encourage and support and make sure they do it.

  1049. I understand.
  (Dr Troop) That is why we have set up the mechanism for that to happen. Meantime, as I say, training materials are out there for them and the other thing that we can do is produce a lot of training materials that people can use. There has been training material produced for clinicians and that is available on the website now.

  1050. Under the elements of both research and/or surveillance and the improvement of both these aspects, do you expect to be able to detect the relevant micro bio-organisms before systems appear?
  (Dr Troop) That is where it is very difficult. Perhaps Mary can answer that because she has done many years in surveillance and picking up outbreaks.
  (Dr O'Mahony) What we are trying to do always in surveillance is to detect a problem early on. There are different ways that we can detect it. We can detect it because people have symptoms and they may or may not go to a health care system. The earliest warning system that we have put in place, that Dr Troop has already mentioned, is getting information from NHS Direct where the public are ringing in, potentially saying "I have a problem, I would like advice". That information is now being collated to see if we can pick up any shift in patterns of particular symptoms being reported. This is a new system and its use was one of the very early things we did in response to bio-terrorism early alert systems. The next step when people become unwell is they will present to primary care, and many GP practices have got established surveillance systems that we are linking in with. On a practical level this system is used every winter for early warning for flu and so alerts the NHS to potential problems be around bed usage. If people are seen by primary care, they may have a sample taken and that sample will go to a micro biology laboratory. Surveillance will pick up that result through the NHS laboratories as well as the Public Health Laboratory Service. In addition, scans are taken from newspapers and other reports about softer information which may be around both in this country and abroad. All of that information is collected constantly and monitored against background levels. So what we can say every week is "What is the current levels of infection" and we compare it with the pattern of previous years and months to detect anything that is unusual. That is from routine reporting. What is actually very important in the health service are phone calls. As Dr Troop mentioned, people ring up saying CDSC "I have got a patient here I am concerned about," that is often our best indicator. We have lots of information that comes constantly from within the health service; colleagues may also give us information from other Government bodies, e.g. contaminated water supplies or concerns about illness in animals that we will take note of. That is constantly underway and we pick up a number of outbreaks every year from such different sources which we respond to collectively within the NHS, with other organisations and other Government agencies.


  1051. Whole academic careers have been made on analysis and intelligence failures and when I was listening to you I could think of all the occasions in history, or many of them, where all the indicators were there that there would be an attack and it is at the centre, the receiving analysis, the will to transmit information to a higher level, where the failures truly occur. Are you satisfied when all this stuff is coming up that you have a sophisticated centre that is able to respond very smoothly because, I do not want you to have to read in The Times tomorrow to give you an indication of what might be happening? Is there any technology available—in fact we know that there is—which might help that process of collating, analysing and deciding what kind of disease or problem there might be either locally, regionally or nationally?
  (Dr O'Mahony) There is a national system in place as I mentioned already but it can always be improved. We are constantly looking within the health service, using the new electronic patient records that will be introduced in the years to come as encompassing information from many activities in the health service providing a key indicator for alerting us. Pulling information together from many sources, not just the health service alone but other Government bodies, is going to be very important from the point of view of chemical, nuclear and biological problems. That is an area that we want to develop further with other Government bodies. The new Health Protection Agency is one way because there we will have one main agency within health that other Government departments can relate to. For example, if there were to be problems in Zoonoses, infections in animals which may have the capacity to transmit to man, and we know that many future problems are likely to come in this route: we will work in terms of intelligence gathering with other Government departments is a new area that we will have to develop further.
  (Dr Troop) Can I just say our assessment is that we have a good surveillance system which is better than many other countries but in Getting Ahead of the Curve we have identified, also, that the basis of anything is good surveillance. Therefore, one of the priorities in Getting Ahead of the Curve is to get to the frontline technology of this to make sure that we are the best in this. We are good but, like everybody else, we could be better.

Patrick Mercer

  1052. The foot and mouth outbreak obviously had lessons to teach everybody, I am thinking particularly about viruses borne by air rather than an epidemiological approach, which we have heard about. From the purely military point of view we seem to be a long way off in detecting airborne viruses. Has foot and mouth helped? Have you made any particular progress on that aspect?
  (Dr Troop) It was not so much on that aspect. We learnt a huge amount from the foot and mouth outbreak. Our concern from a public health point of view was burial of animals and the burning of animals. Transmission of viruses by air which whilst from the veterinary point of view was important, from a public health point of view it was not our big issue. But it is an area where we have a lot of evidence and experience because many of our pandemics are because of airborne viruses, not least influenza. I think a pandemic flu would be as devastating as anything else that we could have and therefore, not surprisingly, that is where a lot of research in work has been. We have done quite a lot of modelling of the transmission of some of these diseases, some of these highly infectious diseases. We have worked with the Home Office, we have worked with the MoD to draw on their experience of their work, their modelling experience, and we have put into that in the civilian situation some of these diseases and how they might transmit and how they might transmit through a population. So some of our response plans are based on that kind of modelling work which has been done. We are continuing to do that modelling and that will be a feature again when we move to the new Agency. We are well ahead compared with many other countries in the sophistication of our modelling. We are leading a piece of work internationally on that. There is going to be an international conference on that which we are leading from the UK.

  Patrick Mercer: Your answers are more reassuring than many we have had. I applaud that. The Royal Society in a report in July 2000 identified 25 micro-organisms or bacterial toxins which potentially could be used in a deliberate release. Against how many of these do you hold effective drugs or vaccines?


  1053. That might be better responded to in private.
  (Dr Troop) We will send you that.

  1054. Please.
  (Dr Troop) We have got a range of counter-measures but we will send you some detail.

  Chairman: We do not want you to provide too much information.

Patrick Mercer

  1055. What assessment have you made of the risks from genetically mutated micro-organisms?
  (Dr Troop) I think we have done that more in terms of meningitis and flu than we have anything else. In terms of the others, I think it might be some information we would send you. The kind of assessment we have done against different potential agents is information we will probably send you separately if you are happy with that?

  Patrick Mercer: Thank you very much indeed.

Mr Jones

  1056. I have three questions to ask you about the decision of the Government to acquire a smallpox vaccine stock for the UK. What I want to do is ask each question, get an answer and then move on. I know time is getting on. Can you tell me what was the reason for taking the decision to establish a national stockpile of smallpox vaccine? In doing that, can I give you some background as to what this Committee's involvement has been in this so far. We did a report before Christmas on the threat from terrorism which was published on 12 December 2001. We took evidence from the Director of Policy at the MoD, Simon Webb, and also the Secretary of State. I have just re-read the evidence to see whether there was any indication there that there was a need for this, I cannot see that. The Committee did in its report actually draw attention to possible threats and I will just read it very briefly. "Although we have seen no evidence that either al Qaida or other terrorist groups are actively planning to use chemical, biological and radiological weapons, we can see no reason to believe that people, who are prepared to fly passenger planes into tower blocks, would balk at using such weapons. The risk that they will do so cannot be ignored". Now that is actually in the main report and with all reports we get a response back from the Government which we published on 7 March. That is highlighted in paragraphs 20 and 21 of the Government's response. There is no mention in this at all about acquiring a national stockpile of any biological agent, let alone smallpox. What has changed since 7 March when the Government responded to our report?
  (Dr Troop) The basis of our planning is based on cross Government working, being advised that we should be prepared for the range of threats and the choice of agents against which we have made an assessment. CDC in Atlanta, the Americans have set out categories of agents against certain criteria about their ability to create harm within a population and again also looked at by the WHO and therefore the counter-measures that we have developed are against those categories of agents that have identified in those organisations. The overall general planning that we have for the different kinds of issues we should plan is based on advice we receive across Government. We are not the MoD, we are not the Foreign Office, we are not the Home Office, we do not do the assessment, our role is to develop the plans in response to an agreed set of problems.

  1057. This is the Government's response, I accept you are not part of the MoD. Therefore, since 7 March when we got their response something has obviously changed. When were you asked to have this as a priority, was it before 7 March?
  (Dr Troop) We have had some planning for this, as you gather, for a number of years, it is not a new issue but at a pretty low level because of the other emergencies we have talked about like explosions which were always considered to be a higher risk. After the sarin attack in Tokyo, people also wanted to be prepared for a chemical attack. As you know there is a sub-committee of the CCC which is a CBRN sub-committee and we are part of that. Therefore, our plans that we have been submitting are through that process.

Mr Howarth

  1058. What is CCC?
  (Dr Troop) Sorry, the Civil Contingency Committee, the Cabinet sub-committee. John Denham from the Home Office has been chairing the CBRN sub-committee and all Government departments have been represented on that and all Government departments have submitted plans to that committee and have been agreed and discussed within that committee. We are working on this cross Government basis and as part of that our response as professionals is to provide the details of the response that might be needed.

Mr Jones

  1059. I want to move on. Do you not think it is strange that if there was a threat in, say, December, Mr Webb or the Secretary of State did not feel a need to tell us? As the Chairman quite rightly knows, and we all know, we do take things in private session so we can be told things on a classified basis and they do not get into the report. You were involved in this decision, obviously, when was it actually taken?
  (Dr Troop) I am not involved in the decision as to what the various risks are. As I said, we have been planning for a range of attacks for a number of years.

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