Examination of witnesses (Question 697-699)
THURSDAY 20 MARCH 2003
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
(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
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
(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
(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.