Select Committee on Science and Technology Minutes of Evidence

Examination of witnesses (Question 697-699)




697. Good morning, gentlemen. Thank you very much for coming along. For the record, could you identify yourselves and state the institution you belong to?

  (Dr Donaghy) I am Dr Martin Donaghy. I am the Clinical Director of the Scottish Centre for Infection and Environmental Health, based in Glasgow, which is the national surveillance centre for co-ordinating clinical disease and environmental health control within the NHS in Scotland.
  (Dr Salmon) I am Roland Salmon, Director of the Communicable Disease Surveillance Centre in Wales. For the record, you have promoted me to be head of the whole Public Health Laboratory Service in Wales!
  (Dr Smyth) My name is Brian Smyth. I am Consultant Regional Epidemiologist and Director of the Communicable Disease Surveillance Centre in Northern Ireland.

  698. Are there any statements you care to make?
  (Dr Donaghy) We would just like to thank you for the invitation.

  699. The first question is a broad question: can you describe how communicable disease surveillance operates in Wales, Scotland and Northern Ireland; and, in particular, what are the major differences from the system envisaged for England after April 2003, when the HPA takes effect?
  (Dr Salmon) As you have started with Wales, perhaps I will take the opportunity to respond first. At a technical level at least, the similarities in disease surveillance far outweigh the differences, in that they are substantially based on voluntary laboratory reporting and statutory notification. In Wales, we participate to various degrees to the enhanced surveillance systems that have been set up by our colleagues in Colindale. We do have one or two surveillance systems that have been developed within Wales which are particular to us. There is a GP surveillance scheme. We were able to start earlier, and perhaps make more progress with the hospital-acquired infection agenda than was possible in England. At a technical level, the similarities outweigh the differences. Organisationally, the intention is that the Public Health Laboratory Service in Wales will become part of what will be called the National Public Health Service Wales from 1 April. That will incorporate my unit, the communicable disease surveillance centre; the current public health laboratories, which are six in total; and we will be then partnered with an organisation that will include the public health departments from the disappearing health authorities. In practice, that means that within the same organisation we will have the consultants in communicable disease control.
  (Dr Donaghy) Technically, the situation is similar in Scotland. On the communicable disease surveillance side, our systems are alike to those that operate in England. We run through local NHS wards and NHS trusts communicable disease surveillance, and we integrate that through a national centre, SCIEH. We run four basic types of surveillance: the ongoing reporting of laboratory isolates; we then run disease or organism-specific surveillance systems on things like meningococcal infection and healthcare associated infection; we also run outbreak surveillance and incidents surveillance, where we monitor public health incidents; and, lastly, SCIEH operates, on behalf of the Food Standards Agency in Scotland, a food surveillance system; and because SCIEH also covers environmental health, we run certain environmental exposure surveillance systems as well. Technically, we are very alike to our colleagues in the other three countries in the UK. Organisationally we are different. Firstly, we operate in a different legislative context; the law is different up there, and that has some impact on how we are organised. SCIEH was set up in 1993 and integrated two units: the communicable disease Scotland unit and our environmental unit; so that is that difference, in that we are more integrated set-up. In terms of how we would link with the new arrangements in England from 2003, the Scottish Executive Health Department has put out a consultation document called Health Protection in Scotland. The consultation period has finished. The responses have now been analysed by the Executive, and we expect that they will be announced in June. There is an election in Scotland in May, so there will be no announcement before the election in Scotland. We understand from colleagues in the Scottish Executive that the most likely organisational arrangements will be a further strengthening of the Scottish centre, particularly to look at the overlap in the environment side with non-communicable disease surveillance. The basic local tier for communicable disease surveillance will remain in NHS boards. Recently in Scotland the White Paper on Health has been published, and NHS trusts are being scrapped in Scotland, so everything will be co-ordinated through NHS boards. It is likely that the national remits will remain in place, but they will be underpinned by more structure and more formalised service-level agreement type arrangements between the centre and the local operators. The last area that is likely to change is the network of reference laboratories in Scotland. It is likely that the responsibility for the commissioning of these reference laboratories will come into the new national organisation. These are all likelihoods because they are subject to ministerial decision-making in the Scottish Executive.
  (Dr Smyth) In 1998 the Chief Medical Officer in Northern Ireland led a major review of communicable disease control arrangements. One of the many recommendations was that there needed to be a regional communicable disease epidemiology unit outside the Department of Health. That led to the Department of Health in Belfast entering into a contractual arrangement with the PHLS, which led to the establishment of the Communicable Disease Surveillance Centre in Northern Ireland. My reporting arrangement is through CDSC Colindale. We have steadily grown in size since our creation in 1999. Our remit is confined to communicable disease control, even though from 1 April my unit will become part of the new Health Protection Agency. In Northern Ireland, there are four health and social services boards, led by a Medical Director of public health, in whose team there is a consultant in communicable disease control. The Northern Ireland Assembly, prior to its suspension, instigated a review of public administration, and there is a forthcoming review of the public health function, which will address health protection arrangements. The current organisational arrangements for communicable disease control and health protection are therefore likely to change in the future. In regard to the technical matters of surveillance, there are many similarities to the arrangements in Wales and Scotland that my colleagues have already described. Because my unit is now part of the PHLS, we have been able to use surveillance methodologies, approaches and definitions that are currently in use in England and Wales, and I think this has greatly facilitated obtaining comparable data for Northern Ireland to compare with other parts of Great Britain. Lastly, we are very conscious in Northern Ireland that we do share a land border with another Member State, and I understand that your Lordships will want to explore that in further detail in due course.

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