APPENDIX 31
Memorandum by Dr T Moss, Doncaster Royal
Infirmary (SH 50)
The expansion in all common Sexually Transmitted
Infections (STI's) has been comprehensively documented by the
Communicable Disease Surveillance Centre/PHLS and has been subject
to extensive media broadcasting during the last four weeks.
The numbers of expert medical staff available
to Genito Urinary Medicine (GUM) clinics have decreased for a
variety of reasons.
In this Department we have a fully integrated,
forward looking service covering a wide range of aspects of genital
health in people of all ages from infants to old age. We enjoy
very high standards of referral both from primary care, and from
hospital colleagues.
There is a great depth of understanding and
support from our Chief Executive, Director of Clinical Services,
and fellow Clinical Directors. We have also benefited from comprehensive
visits from two of our MP's Ms Rosie Winterton and Ms Caroline
Flint.
We have regularly published a wide range of
research in peer review journals. In 2001 a text book on Chlamydia
was produced (edited) from this Department. (International Handbook
on Chlamydia)
We have trained future GPs as part of the V.T.S.
by full time attachments at SHO grade to GUM for some two decades.
Previously, these highly informed and extremely capable young
doctors had moved into primary care, shared their expertise with
colleagues and developed a far greater understanding and awareness
of the extensive morbidity resulting from STIs. They regularly
worked as our Clinical Assistants.
The longterm sequelae of Chlamydial disease
are well known. Regrettably, we are restricted to outdated diagnostic
technology which has a notorious false negative rate. Therefore
there is an urgent need to move to state of the art DNA diagnostic
facilities for identifying this disease which cripples the reproductive
health of so many thousands of women in the UK.
The further pressures and changes currently
affecting Primary Care have meant that many of our very experienced
Clinical Assistants and Medical Support Staff have resigned to
try to address increasing workload in their practices. This exodus
has been exacerbated by the extremely low rates of pay available
to Clinical Assistants and Hospital Practitioners. An urgent area
to address is remuneration for these vital staff. We have insufficient
Specialist Registrars to fulfil the required Consultant expansion
of this speciality.
There are two other compelling areas of concern:-
Doncaster/Bassetlaw has an extremely high number
of prisons and custodial institutions. It is well known that STIs
are particularly common in such institutions. The number of males
infected with Chlamydia in young offenders institutions may be
as great as 1 in 10, and in young women the figure may be an astonishing
one in five.
These institutions act as a reservoir for infection
to be returned and extended within our community. This adds to
the tragedy of avoidable infertility, ectopic pregnancy (with
occasional death) and chronic pelvic pain.
The resulting very high costs incurred to the
NHS are well documented. We have worked with our High Level Steering
Group for the Prison Healthcare Review Process for some two years.
It is clear that the aspiration to afford prisoners those high
quality services enjoyed by the rest of our population remain
unachievable without sufficient numbers of expert Genito Urinary/HIV
Clinicians to visit these institutions and provide appropriate
expertise and leadership. The expanding number of prisoners clearly
further exacerbates this problem.
We previously had identified the biggest point
source heterosexual outbreak of HIV in the United Kingdom, and
genetic sequencing confirmed that this was indeed a linked outbreak.
We established a model for Outbreak Control Procedure which has
been utilised in subsequent similar point source outbreaks. This
led to a considerably greater HIV workload in this Trust compared
with other District General Hospitals.
The situation has suddenly reached a point which
I believe cannot be sustained with current staffing levels following
the impact of a wide range of STIs presenting in migrant populations
and asylum seekers. The cost of providing anti retroviral drugs
and clinical services, as well as all of the other needs of a
sudden, unexpected, and unplanned influx of patients who often
have very advanced disease, is now a major concern within this
speciality.
The situation has reached a crisis which requires
central intervention as a matter of utmost urgency if we are to
provide the care and compassion that these people require. The
expansion of such high cost disease at such a pace could rapidly
absorb all of the extra investment which the current Government
has so helpfully committed to our National Health Service
All of the above factors are undermining the
motivation, morale, and indeed the health of people who have dedicated
their lives to providing a first class service controlling STI
in this country.
May I thank your Committee for considering these
observations.
June 2002
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