Select Committee on Science and Technology Written Evidence

Visit to City Hospital, Birmingham on 6 and 7 March 2003

  The Committee visited City Hospital, Birmingham on the 6 and 7 March 2003. Members present were Lord Haskel, Lord Oxburgh and Lord Soulsby of Swaffham Prior (Chairman), Lord Turnberg and Baroness Walmsley and were supported by Specialist Advisers, Prof. Julius Weinberg and Prof. George Griffin, the Clerk, Rebecca Neal, and Specialist Assistant to the Select Committee, Jonathan Radcliffe.

  Over the two days the Committee met:
Mr John AdlerProfessor Del Ala'Aldeen
Mr Rishi BawaDr Ian Blair
Professor John BlighProfessor Steve Busby
Ms Deborah CrispProf Peter Davey
Dr Chris EllisDr Robin Ferner
Dr Douglas FlemingDr Adam Fraise
Professor Nigel FrenchProfessor Alasdair Geddes
Dr Martin GillProfessor Tony Hart
Prof P HawkeyProfessor Paul Hunter
Dr Peter IlesDr John Innes
Dr Mike McKendrickDr Cliodna McNulty
Dr Patricia O'NeillProfessor Laura Piddock
Dr Grace SmithMr Chris Teale
Dr Tim WellerMs Pauline Werhun
Professor Richard WiseMr Mark Woodhead
Dr Hugh Yarwood Smith

  The Committee also met staff from City Hospital when visiting wards. The Committee would like to thank all participants, City Hospital for hosting this event and, in particular, Professor Laura Piddock and Professor Richard Wise for their invaluable help in organising this visit.

  City Hospital forms part of Sandwell and West Birmingham Hospitals NHS Trust, which was created on 1 April 2002, has a turnover of £220 million and employs 7,000 staff.


Hospital Management and Infection

  1.  This session explored difficulties facing management of hospital in relation to infection.

  2.  Infection control had been pushed up the hospital manager's agenda as it was a factor in hospitals' star ratings.

  3.  It was difficult to ensure that hospitals had the capacity to deal with infection outbreaks as this relied on high levels of resources relating to numbers of beds, isolation rooms and staff.

  4.  Using alcohol hand wipes on wards as an alternative to hand washing could lead to substantial time savings and thus increased patient care.

  5.  There was routine health screening of staff, but not as much as desired. Agency staff posed a particular problem, as not all agencies screened their staff and hospitals could not wait to screen agency staff before employing them.

  6.  Facilities for isolating highly infectious patients were commonly inadequate.

Infections and modern medicine

  7.  It was important that the infectious disease service was co-ordinated. The HPA must attempt to integrate better the various infectious disease professions.

  8.  The disease notification system was slow and ineffective given that many doctors did not report.

  9.  Emerging diagnostic tests using chip technology might allow analysis within a day, but would still require follow-up tests by conventional methods.

  10.  Immunisation was the most cost-effective method of preventing infection but recent public anxiety about vaccination limited its use. There were also limits on the number of jabs people will accept. In addition, there are some infections for which it was unlikely that a vaccine would ever be available.

Hospital Care

  11.  Whilst infectious disease was managed reasonably well in District General Hospitals there could be problems in the future owing to unfamiliar diseases not being picked up.

  12.  Infection services could be improved by introducing national standards and increasing coordination between all those involved in infectious services. A recent discussion paper from the Joint Committee on Infectious Diseases and Tropical Medicine proposed that specialist infection centres within teaching hospitals should be developed.

  13.  Hospital acquired infections (HAIs), acquired after a minor operation, led up to 70 per cent fatality rates.

Primary Care

  14.  41 per cent of the population consulted their GP at least once a year because of an illness caused by an infection. This equated to a GP with an average list seeing 25-30 patients each week.

  15.  It was important to increase diagnostic accuracy at the first consultation. Whilst near-patient testing could provide a quick answer it was expensive and increase consultation time.

  16.  There should be an increase in sentinel practices providing surveillance data, which should ideally be linked to results from microbiological tests.

  17.  There could be many difficulties in identifying and treating patients who presented infectious disease, including:

    —  correctly diagnosing the disease when symptoms were ambiguous;

    —  following up treatment when the patient is disabled or does not adhere; and

    —  ensuring wider public safety when the patient was in the community.


Food and the risk to public health

  18.  Environmental health was funded by local authorities but was audited by, and accountable to, the Food Standards Agency (FSA). Environmental Health Officers worked closely with the Consultant for Communicable Disease Control.

  19.  Whilst all food premises were supposed to register with the EHO many did not. Licensing of high risk premises might ensure that workers were properly trained in food hygiene and that the premises would be obliged to provide documented hazard analyses.

  20.  There were ten EHOs covering the 2,500 food premises in Sandwell. They had recently had to drop their wider health promotion role (such as visiting schools) because of scarce resources.

  21.  Identifying the source of and further controlling food poisoning outbreaks was very time-consuming and often unpredictable.

  22.  There was a conflict between trying to find out the cause of the outbreak (the remit of the CCDC) and apportioning blame and prosecuting those responsible (the remit of the EHO).

  23.  It was very difficult to prosecute in food poisoning outbreaks as questionnaires used by CCDCs to obtain information on what was eaten etc were not witnessed; and samples taken for analysis were not taken in a way which would make them admissible as evidence in court. There were also difficulties with using epidemiological evidence in court.

  24.  The role of the CCDC, when part of the HPA, should continue as at present with more emphasis on communicating with other key players in public health.

  25.  Food production was increasingly a global operation: a significant proportion of poultry consumed in the UK was imported.

  26.  Illegal imports to the catering industry were a cause for concern.

  27.  Most outbreaks of water-borne infections were from private water supplies, which covered one to two per cent of the population.

  28.  The Health and Safety Executive should produce a guidance note about the regulation of standards of water in swimming pools as no body was clearly responsible for this nor was it viewed as a high priority.

  29.  Academic research had a key role in helping to control infection. There were some networks of researchers to investigate particular infections, such as CampyUK for campylobacter.

  30.  There was little funding available for developing near patient tests.

Respiratory Disease: an ever present problem

  31.  There was a need to develop better microbiological tests in order to differentiate quickly between different types of respiratory tract infections.

  32.  Tuberculosis notifications were steadily increasing in large urban areas, particularly in London. Possible reasons for this increase included:

    —  more clinicians notifying cases;

    —  changing age profile of the Asian population;

    —  co-infection in people with AIDS; and

    —  immigration from regions with different strains of TB.

  33.  Specialist nurses often ran services diagnosing and treating TB. However in areas with low incidence rates there was often very little expertise in this area.

  34.  TB networks, linking high with low incidence areas, had been established, and a TB Action Plan, would be launched by the Department of Health in April 2003. It was hoped that there would be national guidelines about TB screening. Resources were needed, particularly to purchase and develop software (for operation work rather than surveillance).

  35.  Teamworking was very helpful in relation to TB contact tracing. TB contact trace nurses should work closely with local CCDCs so as to share resources.

  36.  Directly observed therapy (DOT) was only used with patients who had previously failed to finish treatment as it was very expensive with more effective ways of using finite resources.

  37.  Multi-drug resistant TB was not yet a significant problem. There were only 35 cases a year in the UK (0.9 per cent of all cases): half of those in London.

  38.  Employing community workers to liaise between TB contact tracers and immigrant communities would make it easier to identify and to screen all new immigrant arrivals.

  39.  Whilst the health of asylum seekers is similar to local populations on arrival in an area it often quickly deteriorated owing to difficult social conditions, particularly poor housing.

  40.  Funding for emergency hostels for asylum seekers did not have a particular stream to pay for health checks. This should be rectified as it was placing significant demand on local health services.

  41.  High rates of infection were seen in prison particularly in Hep B and Hep C. Increasing availability of needles and condoms in prisons could help to counteract the spread of these infections.


  42.  It was necessary to re-examine how infection (both clinical infection and microbiology) was taught at medical schools as students often could not remember what they were taught about infection.

  43.  Infectious disease was an area that cut across the curriculum and therefore often was ignored as curricula were mostly very compartmentalised.

  44.  Medical schools did not measure outcomes of their teaching.

  45.  Nurses needed to understand key elements of science research (such as the concept of risk) in order to be able to correctly advise people on issues such as vaccination.

  46.  Ideally health professionals should have protected learning time in order to be able to provide updates on education about infectious disease. However, staff levels in Trusts must be increased to allow for this.

  47.  More clinicians needed training in research methods as many research papers were poor quality—particularly in the area of infection control (only 26 per cent of 296 papers since 1980 were judged to be "robust" by a Cochrane Review).

  48.  It was necessary to educate clinicians and nurses about the importance of infection control; in particular that they needed to take responsibility for it rather than seeing it as the job of the infection control nurse.

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