Column Number: 003
Third Standing Committee
on Delegated Legislation
Thursday 26 June 2003
[Mr. Win Griffiths in the Chair]
Health Protection Agency
(Yr Asiantaeth Diogelu Iechyd)
(Establishment) Order 2003
Dr. Evan Harris (Oxford, West and Abingdon): I beg to move,
That the Committee has considered the Health Protection Agency (Yr Asiantaeth Diogelu Iechyd) (Establishment) Order 2003 (S.I., 2003, No. 505).
The Chairman: With this it will be convenient to consider the Health Protection Agency (Yr Asiantaeth Diogelu Iechyd) Regulations 2003 (S.I., 2003, No. 506).
Dr. Harris: I am grateful to you for chairing the Committee, Mr. Griffiths. It feels like old times seeing the hon. Member for Epsom and Ewell (Chris Grayling) here and you in the Chair in a Committee discussing the Public Health Laboratory Service. It is my pleasure to welcome the Under-Secretary of State for Health, the hon. Member for Welwyn Hatfield (Miss Johnson), to her new post, and wish her luck. We look forward to a useful debate on this topic. I hope that she sees the debate as an opportunity to get stuck into the important public health portfolio. I am also grateful to the Clerk for reading out the name of the lead order. I shall not repeat it, as I would not do as good a job as he did.
There are two general concerns about the orders that will be a recurring theme in my contribution—the speed with which the changes have been made and the fear, particularly on the part of the PHLS, that some of its important work in communicable disease control and everything that goes with it, including diagnosis, will be subordinated to the national health service's short-term needs, now that the NHS has taken over the running of many former PHLS laboratories. There is still time to tackle the concern that, under the changes, the National Radiological Protection Board is losing its ability to be seen to be independent and to maintain its expertise and worldwide reputation for quality of advice.
I will touch on a number of procedural issues: the first is the speed with which the change is being made; the second is the threat to use a regulatory reform order; the third is the fact that at the end of June, some months after the prayer was laid, we are debating a measure relating to a change that took place at the beginning of April 2003. Apparently, there is nothing to stop debates on a measure taking place so long after the prayer is laid or the measure is introduced. The prayer was not laid as soon as the order was laid before the House, but it is disappointing that it has taken us so long to reach this stage. At least one earlier Committee was scheduled to sit at the same time as a Second Reading or other significant piece business was being taken in the House, and I requested that the
Column Number: 004
Committee be postponed, but I did not envisage that a wait of many weeks would result.
I understand from the Liberal Democrat Whips Office that there was some difficulty about the usual channels notifying our office that the debate was scheduled to take place today. I found myself grateful to the hon. Member for Epsom and Ewell for pointing out in another Committee that he had received notification. I hope that the procedures can be examined to ensure that that does not happen again.
I recognise the persistent interest in this issue shown by the hon. Member for Epsom and Ewell and other Conservative Members, as well as hon. Members of all parties. My hon. Friend the Member for Somerton and Frome (Mr. Heath) initiated a debate in Westminster Hall on a related subject—viral pandemics—which bears reading; and the Cross-Bench peer Baroness Finlay of Llandaff had a useful debate on 9 January in the House of Lords. It can therefore been seen that concern is felt by all sides. Many hon. Members have received letters from worried constituents who are members of staff in the organisations involved, or direct representations from the organisations themselves. Ministers have been asked many questions about the issues.
Having made those points about procedure and the widespread interest, it is essential to recognise, to save the Minister time, that change always brings about objections. It is important that proposals are considered in as positive a way as possible. Like many Members, I have complained about the profusion of three-letter abbreviations and of organisations involved in inspecting the health service—that is not so much the subject today—and providing services in it. On the face of it, the mechanism set out in the orders is designed to reduce numbers and to streamline, at least at national and regional levels, the structure relating to health protection in its wider sense. It is only appropriate that, when proposals are first made, they are considered in a positive light and given fair wind. On the establishment of an overarching agency, despite the concerns, on balance my colleagues and I do not object to the principle of setting up the Health Protection Agency. It behoves those of us who are concerned about over-regulation and the profusion of agencies to recognise that changes that streamline agencies and reduce their number can be valuable.
Having said that the fact that there is a general problem with objections to change should not detract from serious concerns raised by those affected and outside organisations, I still hope that the Minister will give due regard to some of the concerns that have been raised on the subject. I will set out a series of questions for the Minister to ensure that she has time to address them. I know that the hon. Member for Epsom and Ewell has further detailed questions. I hope that I will not say everything that he wants to say and that he will not feel the need to repeat things that I have said.
I would like the Minister to update us on what consideration has been given and what decisions have been made in the devolved Administrations on the functions of the HPA. Although the Liberal Democrats rejoice in devolution, changes need to be
Column Number: 005
managed. The previous structure was considered to be a UK-wide system of support in many of the areas currently covered by the NRPB. Ministers should bear in mind that if they are not able to bring the devolved Administrations with them, that might partially defeat the objective of seeking to streamline advice.
It is likely that threats from biological, chemical and radiological hazards will not, to put it mildly, respect internal UK borders, so, where it is relevant to do so, it is rational to make the structures of advice and organised emergency planning as common as possible in all parts of the UK. Clearly, in the other countries of the UK—certainly in Wales and Scotland—that is a matter for the devolved assemblies. When dealing with the proposal, Ministers will be aware that if they choose to take a completely different approach, it will undermine some of the merits of going down their chosen path.
Chris Grayling (Epsom and Ewell): Does the hon. Gentleman not think that there is a strong case for the fields covered by the HPA not being for the devolved assemblies to determine? One of my disappointments in relation to the overall approach is that organisations are being fragmented across the UK, yet there will be no fragmentation if we are dealing with communicable diseases or—God forbid—biological attack.
Dr. Harris: I agree to a certain extent. One of the prices we pay for increased local power and devolved decision making is that some things that for administrative convenience might be organised on a UK-wide basis must be decided at a devolved level, particularly matters linked to the NHS—there is clearly a big overlap in relation to responsibility for the NHS. Administrative convenience would have worldwide systems of decision making and only one opinion when it came to giving advice. I recognise that there is an ideal that the hon. Gentleman seeks for the UK. In terms of devolution, however, we are where we are and it is important that the Minister gives us her judgment on her Department's consultations with the responsible people in the devolved Administrations on how closely the HPA could and should be mirrored in those countries. That applies particularly to the NRPB functions, because it would be peculiar if that body continued to exist in its current form beyond April 2004 only in respect of its relationship with the Scottish Administration and was merged into the HPA as far as England and Wales are concerned. Those problems would not hole the measures below the water-line, but it would be helpful to know whether the maximum simplification and clarification of responsibilities has been achieved.
Concern has been raised about the role of the PHLS and its laboratories. At the moment, they clearly have a role in feeding into the centre findings that are reported to them and, because of that central reporting mechanism, an enhanced role in distinguishing trends and potential outbreaks. The laboratories are run by the organisation that sets their work programme and there is no doubt that they perform that duty to the best of their abilities without too many competing priorities.
Column Number: 006
Significant concern was raised about the Government's proposals, under which most of those laboratories will be transferred to the national health service. The PHLS is concerned that the centralised collection of data will be affected, particularly during the transition phase, which is causing the most worry. It is also concerned that in responding to clinical pressures of NHS trusts, laboratories will place a lower priority on supporting national data collections. There may be long-term advantages in the design, but while there is huge pressure on trusts to perform to Government targets or milestones—we debated the correct word with the Minister's predecessor, the hon. Member for Salford (Ms Blears)—that might not be clinically based or even evidence based, there is concern that the priority given to work currently done under the auspices of the PHLS will take a back seat.
I would like the Minister not only to provide reassurance, but to explain what measures are in place to ensure that that does not happen and to collect data to demonstrate that it is not happening—or, equally valid, to collect data to show that it is happening and what action can be taken to ensure that the central reporting is carried out to the same extent as it is currently and at the same speed. I hope that the Minister recognises that that concern has been voiced by many people working within the system and that they are not yet satisfied.
There is concern about the role of consultants in communicable disease control being absorbed into the HPA. One can understand that at national and regional levels there needs to be an overarching organisation, but consultants in communicable disease control have excellent links not only with the local NHS and local commissioning organisations, despite the fragmentation of the public health function when health authorities were abolished in favour of primary care trusts, but with their colleagues in local authorities, particularly in environmental health departments. It is not clear whether those links will be enhanced or even retained if they are absorbed into an overarching structure at national level, such as the HPA.
That leads me to another concern arising from the many organisational and structural changes. To what extent have skilled and expert staff been retained? That may be a particular problem given the speed of the changes and the fact that two transfers are likely: first, to a special health authority and later, as legislative time allows, to a non-departmental public body. I shall be grateful if the Minister does not merely reassure me on that, but demonstrates that data have been collected showing the ability to retain staff at all levels under the transfer. That is not an unreasonable thing to request in relation to such a sensitive area.
I would also be grateful if the Minister would clarify what the links will be between the HPA and local environmental health departments. The trend in thinking is that there should be greater organisational unity between the public health functions of local authorities, especially district councils, and the local health bodies charged with protection of public health, particularly in the field of
Column Number: 007
communicable disease. It is unclear how those functions will work if there is a change of personnel.
How does the Minister envisage the HPA being more proactive in engaging the public about health scares as well as serious health concerns, and in engaging the public with the science involved? I know that hon. Members of all parties, especially those with a health responsibility, often receive letters expressing concern about clusters of cancer cases apparently related to mobile phone masts or overhead power lines. There is often very little or no evidence of the effects of those on public health—and in some cases positive evidence of no effect—but the strength of local anecdote is persuasive to many. The NRPB does its best in relation to those scares, but I believe that it would do even better if it had the resources to engage with the public and help them to understand the level of, and the evidence for, the risk. It should be even more keenly aware of the strength of public feeling and concern about some of those matters, over which people feel they have no control. The HPA would have an opportunity to take forward that work if it were given the funding and a suitable work programme.
Not only threats, whether chemical, biological or radiological, but undue concern about those threats can affect the quality of people's life. We have seen that recently in the context of the biological hazard presented by severe acute respiratory syndrome. Although, thankfully, it appears that globally and nationally we may be over the worst and the SARS threat is ebbing, other threats will arise. Everyone recognises that—indeed, the new chair of the HPA said that the major terrorist threat in relation to biological warfare comes from Mother Nature herself. It may not be long before SARS recurs or an equivalent or even more potent threat emerges. To reassure the public there has to be an ongoing programme of explanation about the basis of the scientific advice that the Government receive. If provoked, I shall explore that issue citing comments made by some politicians, but I shall leave the matter there for now.
How will the regional structure of the HPA work, given that the Government have referred to regional directors of public health? The areas covered by the regional directors are large and do not bear much relationship to other established regional boundaries. Given the long awaited advent of regionalism seen in the Government's offering local people the option of democratic regional assemblies in certain parts of the country, I wonder whether the Minister thinks that the current set-up of regional directors of public health is the right reporting structure for the regional advice functions of the HPA. Many other key organisations involved in emergency planning are based not on those regions, but on smaller areas more closely aligned with Government office areas.
The consultation document states that
''the Secretary of State will be empowered to delegate to the agency his function of appointing medical inspectors to examine prospective entrants to the UK under the Immigration Act. The agency will
Column Number: 008
appoint persons to act as medical inspectors, and will also be empowered to lend its own staff to act as medical inspectors.''
There has been a lot of interest in that issue, and I shall be grateful if the Minister updates us on the timetable for the publication of the Cabinet Office review. If, as seems likely from press reports, the Government overreact to calls from the tabloid press and tabloid politicians to conduct more inspections and to set up systems of pre-entry health inspection, there will be a significant drain on the HPA. There are other problems with that policy, which I shall not go into. I shall be grateful if the Minister clarifies current thinking and the timetable for the response to that issue.
The consultation document also proposes that
''the agency, under service level agreements with the regional directors''
''develop and monitor national standards for key health protection objectives or activities.''
Who will set those key health protection objectives or activities? I suspect that the Minister will say that Ministers will set them. That brings us back to the concern expressed by many independent bodies as well as by Opposition Members that such objectives will be aimed at meeting political targets and giving the Government the opportunity to announce success even if the standards do not necessarily relate to important outcomes or are not evidence-based. I will be grateful if the Minister at least promises that when the Department of Health or Ministers set the key health protection objectives for HPA activities—especially if they are associated with targets, which tend to distort rather than help activities—the Department will publish the evidence on which those standards, targets or milestones are based.
The Minister must retain the confidence of the staff working in the field, because their work is epidemiological rather than patient based. The evidence base weighs heavily on the advice given locally, regionally and nationally by those bodies and the professionals who work in them. It would be extremely depressing if the evidence on which the standards are based was not published and the Government used the opportunity afforded by the creation of the HPA to make health care professionals, senior management and all staff in the organisation start jumping through political hoops in order to meet politically inspired objectives.
Can the Minister provide an assurance that consultants in communicable disease control will not become civil servants and that they will retain their status as health care professionals without the usual restrictions on speaking out that apply to civil servants? Under the previous Government, when I worked in public health, health care professionals who were local directors of public health were extremely disappointed when they took on civil service-style contracts covering the half of their work that did not relate to communicable diseases. They suddenly became less able to speak their minds both to the local press and to the local population. I hope that the Minister recognises that public confidence in an
Column Number: 009
organisation such as the HPA depends critically on people's ability to feel that they can speak out as appropriate.
Will the Minister indicate whether the timetable has been satisfactory? Why was it necessary to move so quickly following the response to the consultation, the deadline for which was 1 April? Does she feel that it is appropriate to make the changes in two stages? Will she clarify whether, when the second change is implemented, staff will have been involved in two transfer arrangements subject to the Transfer of Undertakings (Protection of Employment) Regulations 1981? Why could she could not have used the opportunity of the existing legislation either to move in a single-step process, albeit not one ending on 1 April, or to set up a shadow body, so that people would be less worried about the impact of the change?
The timing has been especially unfortunate given the unstable world situation that persists despite the Government's hopes that the terrorist threat will not worsen and their intention that their recent actions would provide stability. Given the volatile situation in the aftermath of 11 September 2001, one might have thought that moving so quickly would pose a serious problem, particularly when concerns have been voiced by the boards of the bodies that will be affected. We discussed some of the issues in the course of debating the Health and Social Care (Community Health and Standards) Bill, particularly the possibility of the PHLS remaining in existence for the supply of media for microbiological laboratories. I shall be grateful if the Minister clarifies when that change will occur.
I am aware that the hon. Member for Epsom and Ewell wants to speak, so I shall curtail my remarks in the hope that the Minister will be generous in giving way during her winding-up speech. However, I wish to raise one more point. It relates to the NRPB, and reflects the most serious concerns about the Government's proposals. The Minister will know from previous questions that the board of the NRPB stated that:
''NRPB presents a coherent body of expertise that cannot be duplicated in universities or elsewhere, unlike the situation that exists for infectious disease control. This expertise can only be maintained by having a strong research base. The Board believes that the maintenance of this expertise and research function is dependent upon it managing its own finances. If the international and national scientific expertise of the NRPB were lost through the failure to maintain a critical mass, that expertise would not easily be recreated.''
That was in response to the consultation, which recommended that
''the NRPB should remain a discrete entity within the new HPA, as set out in Getting ahead of the curve, and that the independence of the NRPB and its international reputation for impartial advice must be retained.''
I am concerned that the other people who receive advice from the NRPB will not acknowledge the new HPA—a special health authority—as having the impartiality and independence that the NRPB enjoys. The same applies to the PHLS. There is time before the changes occur for the Minister to make it clear that there will be the necessary independence. It will soon become apparent if efforts are made to restrict that independence.
Column Number: 010
There is some merit in the Government's strategy. We recognise that they have consulted widely and that change is often not enormously popular. However, because concerns have been voiced by so many people about the end position and the timetable to reach it, I hope that the Government will consider the responses and make such changes as are still possible at this late stage.