Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 420-428)



  420. You are saying that most GP practices are now connected to the net.
  (Professor Little) Whether the connections between the GP practices and the net is slightly fraught from my little understanding of the difficulties that GPs have, but in principle—so long as that connection could be sorted out a bit more rapidly—GPs generally have computers there. There are some pockets where they do not. We have just set up a study in Brighton where even the most interested practices—about thirty or forty per cent of them—did not have computerised consultation information so I am sure they do not have lab links. I suspect it is patchy, but I would think that most GPs have some kind of computerised system and there is really no reason why there should not be a better link between the GP and the lab.

  421. Are there any incentives for GP's to make sure that their practices are web literate?
  (Professor Little) I am not aware of any incentives, I must say. Do you mean financial incentives?

  422. Yes.
  (Professor Little) I do not think there are.
  (Mrs Howard) There are incentives for nurses within those development plans through the local information technology and implementation systems.
  (Professor Little) I do not think so, but that may just be ignorance.
  (Mrs Williams) In London over the last couple of years we have had a target to meet which has been that every chest clinic should be connected to the NHS net in order to run a TB register across London. All the enhanced surveillance and notification information is put on to the TB register. The idea also is that we have some mechanism for tracing patients that get lost. This is in the early stages, but there have been a couple of patients that have been found by this system. They turn up to another clinic and there are certain patient identifiers which will highlight that they have been seen elsewhere. There are still a few things that we need to improve on, but it is actually working out quite well in making the information much more readily available. The only point I would make is that the money for this work has so far been through the London Regional Office for Public Health which then became the DHSE which, in the last week, has been disbanded and as yet they do not know how they are going to continue to support this particular project. It is very vulnerable.

  423. Do you feel the systems that you use and that are given to you to use or you are exposed to are sufficiently user friendly?
  (Mrs Howard) It is variable. Training in how to electronically handle the data is lacking in all the professions probably. Also I think there are insufficient health intelligent people within the public health departments to actually support out into primary care and for that type of training to be offered in any depth. That is a big gap. There is probably also a need for software packages that are more user friendly and will allow some local interrogation of data as well as allowing us to send it upwards. The other thing is to get the systems to talk to one another. For example, the system within prison health care does not talk to anyone. There are issues there in terms of, for example, commencing immunisation against hepatitis B in prisons. In the prisons that I have responsibility for the prisoners are moved so rapidly that we can only offer that immunisation to very few inmates because they are moved within a three week period. If we had a system whereby they could actually talk within the system we could follow through and ensure that the immunisation programme was completed. But we do not have that sort of facility at the moment.

  424. Are you saying that the prison systems cannot talk to the systems in other prisons?
  (Mrs Howard) Again, I am not an expert. From my understanding talking to the health care managers of the two prisons I am involved with there are difficulties. Certainly when they discharge a prisoner they certainly cannot talk to the National Health Service.
  (Mrs Perry) Could I just urge caution on concentrating specifically on computer systems to be able to provide this surveillance. Our experience in the acute sector is that we have tried to use computerised surveillance systems. For ease of completion a lot of areas have gone back to a paper-based system that uses an optical scan reading to be able to feed in, so we do need to consider those kind of systems, especially bearing in mind advances that are happening in primary care with diagnostic and treatment centres. We may need to be looking at post procedure surveillance where the patients actually play quite a key role in providing surveillance data to inform action.

Baroness Warwick of Undercliffe

  425. This is really about broader communication and co-ordination. So many of the very graphic examples that you have given us to illustrate the points you are making have depended on communication. How close and effective are the links between the primary care team and the CCDCs and the EHOs?
  (Mrs Howard) The links between the CCDC and the EHO are very close. They have very good working relationships. The links between the CCDC and the primary care teams are, generally speaking, very good. However, the link between the three is probably not so good. Where the planning takes place within primary care trusts, there is joint planning between local authorities and PCT's—local authorities and health—and I think there is a need also to bring people in from the primary care teams and to involve them in that planning as well as the health protection agency staff so that there is a planning in terms of local development around prevention and control. There is also scope in the future—and I am aware of certainly one post like this—where senior nurses have joint posts with the local authority; they are partly HPA and NHS employed and partly local authority employed. I am aware of one place where that is actually happening and it works very well. It bonds the two organisations together so there is good communication, good working together. We already have DPH's that are joint appointments between PCT's and local authorities. I think there are a lot of other agencies that perhaps should be included in this in terms of health protection being linked to the inequalities agenda. This includes the voluntary sector and drug abuse teams, all these types of agencies. The National Commission for Standards and Care is another agency. We need to have much more formal communication. It is quite good on a local level but there needs to be a communication. For example, in Scotland they are actually working with public health nurses to develop standards for infection control within care. That is not happening here in England at the moment to my knowledge. There are further education colleges. There are training companies that actually manage the NVQ training programmes for the carers. We need this cross-community communication. It needs a leadership and a steer to have it there. Universities as well. We touched on the content of training courses et cetera, but also more broadly within the university courses as well. There needs to be a steer to help us at ground level develop those links and to work with people.
  (Mrs Perry) Could I add in there that the links of acute care need to be considered as well. For example, the trust that I am employed by also employs the school nurses. Traditionally you would consider the school nurses to be primary care workers but they do in fact come under the umbrella, in some areas, of secondary care. Other examples would be nurses specialising in cystic fibrosis, blood borne viruses, nurse practitioners in new-natal care, respiratory care nurses. The links between the acute and the primary care in terms of sharing information and agreeing consultative action are variable throughout the country. Many years ago we did have infection control committees that were district-wide where we would have linked all these people together. Currently we have infection control committees that will be based in acute care, infection control committees that are now being developed by the primary care teams. I believe the key is in having some kind of link-up between all these different committees so we are all having consistent action across the two levels of care because patients move between the acute and the primary care constantly.

Lord Turnberg

  426. Are there too many committees?
  (Mrs Perry) In some areas I do believe you do have to have the committees around the table with the key people. You need to have your committees that focus on the action that you are going to take in your specific area that can concentrate particularly on that. You also need to have that joined up linking of working so you are agreeing consistent action across all areas of health care. I would argue for both.
  (Professor Little) I am not sure I would be able to comment on how close the links are generally. My contact with the CCDC is that they do give us periodic information. If local feedback from surveillance information is going to be rapid I suspect it would come through the CCDC. I anticipate that we will get better and more frequent communication from the CCDC. I have never personally contacted the environmental health officer and I suspect that most GP's do not, but presumably if they suspected food poising in one of the local restaurants they might give them a ring. Probably they would give the CCDC a ring and tell them that it might be something they have to look at. I would say there are links. They are not very close. They are probably reasonably effective given the level of surveillance and feedback we have at the moment, but it would be nice if they were a little bit closer. They have been good, for example, when there has been an outbreak of meningitis in students in Southampton. We have had fairly rapid feedback from them about what we should be doing and advice about treatment contacts et cetera. I have no complaints, but I suspect we need slightly closer links.

Lord Patel

  427. Following on to what Mrs Perry said, are there infection control standards in the acute sector?
  (Mrs Perry) There are guidelines for infection control in acute care. There are also Controls Assurance Standards as to how we should be operating our services.

  428. Are these monitored?
  (Mrs Perry) They should be monitored by strategic health authorities, yes. I am afraid I am referring to a document that I do not have in front of me, but a recent survey of strategic health authorities demonstrated that they are not monitoring compliance to these standards.
  (Mrs Howard) May I go back to the point about too many committees? I think there is a need to separate out the infection control committees which essentially will deal with issues within acute trusts and primary care trusts around clinical infection control, that type of prevention and control. The concept of having an umbrella committee would draw in all the various factions like the environmental health officers, DEFRA, all the people that we work with on a regular basis. There is a need to differentiate out what the purpose of the committee is and what the reporting structures are. There probably are too many committees in some respects, but on the other hand would what you are discussing at an infection control committee be relevant to the chief veterinary officer for the county who is attending the environmental committee, the over-arching committee, the health protection committee. It is horses for courses in many ways.

Chairman: I think we are now at an end of our session, but I wonder if I can ask Mrs Williams to reply to the last question in writing. There are two reasons why I ask that. One is that we have run out of time. Secondly, it is a big issue that we are particularly interested in because when we were in the United States we saw what the US was doing both in Atlanta and also in New York. We were most impressed by that so we would very much value your extended commentary on this, if you would not mind.

Baroness Walmsley: As I was going to ask the question, could I add a rider that I was going to ask. Could we have your opinion on the adequacy of supply of negative pressure isolation rooms in this country?

Chairman: I am sorry to give you this chore, but I am sure you will give us a good reply. All I have to say now is to thank you all very much for coming along. I hope you felt the questions were reasonable. Your answers were very good indeed. If there is any point that you feel has not been explored enough, please feel free to submit a commentary in writing to us. You will of course get a transcript of what was said today and you will have the opportunity of correcting it factually. Thank you.

previous page contents next page

House of Lords home page Parliament home page House of Commons home page search page enquiries index

© Parliamentary copyright 2003