HC 1048-III Health CommitteeWritten evidence from BD Ltd (PH 63)

BD is a leading global medical technology company that develops, manufactures and sells medical devices, instrument systems and reagents. The Company is dedicated to improving people’s health throughout the world. BD is focused on improving drug delivery, enhancing the quality and speed of diagnosing infectious diseases and cancers, and advancing research, discovery and production of new drugs and vaccines. BD’s capabilities are instrumental in combating many of the world’s most pressing diseases.

Founded in 1897 and headquartered in Franklin Lakes, New Jersey, BD employs approximately 29,000 associates in more than 50 countries throughout the world. The Company serves healthcare institutions, life science researchers, clinical laboratories, the pharmaceutical industry and the general public.

In the UK, BD employs some 1,200 people, with a main administrative headquarters in Oxford and manufacturing facilities in Plymouth and Swindon. We welcome the opportunity to participate in this inquiry.

Summary

As set out by the Committee, Public health is a vital, but often neglected, aspect of the National Health Service.

Effective Public Health service provision and early intervention can reduce long term costs and limit the demand and strain on the NHS.

The overarching goals of public health provision; to prevent disease, prolong life and promote health living can help to manage long term budgets through early intervention.

Public Health goals should be supported by national standards to ensure progress made and momentum built over recent years is not lost.

It will be important to ensure that a joined up system is put in place to ensure devolved functions for Public Health are monitored and local decisions are made on the basis of need - reaching the over arching goals of public health provision - rather than based purely on budgetary requirements during this period of financial constraint on public services.

It is imperative that that the plans for complex structural change be effectively scrutinised to ensure the importance of public health is recognised and to ensure that health services are commissioned effectively at a local level.

Response

1. As the government pursues its localism agenda, it will be important to recognise the contribution national standards have made to improving public health, whilst acknowledging where such imperatives have had unintended consequences.

2. We are delighted that implementation of screening programmes features in the Public Health Outcomes Framework and would suggest that there is a conscious read across to the NHS Outcomes Framework where joint measures can improve public health.

3. National Screening programmes have undoubtedly had a positive impact on public health – although there are improvements that can be made to ensure greater value for money and to target high risk hard to reach groups.

4. Part of this success is, we believe, due to the role of the Health Protection Agency (HPA) and we are pleased that many of the functions of the HPA will transfer to the newly created Public Health England. However the confusion over precise responsibilities for individual programmes is already creating inertia at an operational level and it is vital that momentum in such programmes is not lost during this period of structural and organisational change.

5. Clarity needs to be given over where responsibility will ultimately fall for commissioning public health services locally and how the devolved power to Directors of Public Health will be monitored and assessed.

6. The responsibility of Public Health England to target areas of inequality and to improve public health through ring fenced funding is to be welcomed, however long term cost implications of any reduction in preventative measures. such as those in national screening programmes, should be recognised.

7. The transition to Public Health England was set out to be developed in alignment with changes to PCTs and SHAs, and the creation of the NHS Commissioning Board (NHSCB). It was expected that the detailed arrangements would be set out in a series of planning letters throughout the course of 2011. Clarification needs to be given as to interim measures if the phased transition of responsibilities from the HPA to Public Health England will be delayed due to the extended consultation process of the Health and Social Care Bill.

8. There has been good progress in the reduction of healthcare associated infections (HCAIs), notably MRSA. However attempts to improve the diagnosis of C difficile have been thwarted by a number of factors. Existing guidelines have failed to take account of emerging evidence that recommended tests are inaccurate and result in under diagnosis. This is confounded by the reluctance of Trusts to move to more sensitive tests which would suggest that their performance in infection control was worsening. Associated penalties have resulted in Trusts being reluctant to embrace systems offering improved sensitivity which would demonstrate the true prevalence of C difficile.

9. Initiatives need also to be more nimble to incorporate emerging evidence. For example more infections are caused by MSSA than MRSA, but are more easily treated. Despite a recent mandate to report incidences of MSSA, this has not been accompanied by an imperative to screen surgical patients for colonisation and realise the subsequent benefits from reduced infections as seen in work carried out by Blackpool, Fylde and Wear NHS Trust.(http://www.bfwh.nhs.uk/departments/comms/docs%5CBlackpool%20Hospitals%20first%20in%20the%20UK%20to%20screen%20for%20superbug%20MSSA.pdf)

10. The need for the NHS to maximise its productivity is well rehearsed. At an operational level, however, efficiencies become confused with savings, as individuals are put under pressure to reduce in year budgets. With regard to, for example, HCAIs and the protection of healthcare workers, we have noticed that there is an attempt to screen fewer groups of patients or limit the use of safety engineered needles in an attempt to reduce the absolute cost of such initiatives. We believe there should be zero tolerance to HCAIs or exposing healthcare workers to avoidable risk, such as from sharp’s injuries. The risk posed by or to an individual in any given clinical situation can not be known and safety must be the absolute priority. Given that, for example, patients with MRSA infection have a six fold increases in mortality rates and require significantly longer hospital stays, the balance of short term value for money and longer term cost effectiveness must be found.

11. Similarly, many Trusts are reluctant to use rapid, molecular screening techniques for MRSA in the belief that such tests add cost. However work from Achyut Guleri and colleagues from Blackpool, Fylde and Wyre (British Journal of healthcare Management, February 2011: http://www.bjhcm.co.uk/cgi-bin/go.pl/library/article.cgi?uid=81983;article=BJHCM_17_2_64_71) and Katherine Hardy and colleagues for the Heart of England Trust (Clinical Microbiology and Infection, April 2009) have demonstrated that this approach both significantly reduces MRSA infection and is a cost effective use of NHS resources.

12. There is also evidence (Bagger et al, Lancet February 2004) that there is a link between deprivation and post operative susceptibility to MRSA infection. In the study of heart patients in London there was a seven fold higher infection rate for patients from the most deprived areas to the least.

June 2011

Prepared 28th November 2011