Examination of Witnesses (Question number
TUESDAY 1 APRIL 2003
782. Sir William, Dr Troop, welcome and thank
you very much for coming along. Firstly, may I say that we have
a document from you which in fact only arrived yesterday, so we
have not had an opportunity to read it and it may well be that
some of our questions and some of your answers are contained herein,
so if we seem to be doubling up with certain statements, you will
forgive us; it is really due to the fact that we have not had
an opportunity to read it, but it has been photocopied and it
will go around the Committee. To begin with, could you state who
you are and where you are from for the purposes of the record
and then after that, if there is any opening statement you would
wish to make either collectively or individually, now is the time
to do it.
(Sir William Stewart) My Lord Chairman,
members of the Committee, thank you for the opportunity to give
evidence. My name is Bill Stewart, I am Chairman of the HPA from
midnight last night.
(Dr Troop) I am Dr Pat Troop and I am the Chief Executive
designate of the Health Protection Agency until we have our board
meeting, I hope, this afternoon.
783. Any opening comments or statements?
(Sir William Stewart) Maybe I could make a few comments,
my Lord Chairman. The HPA, as we have said, has now been in existence
for ten hours, so if we cannot fully answer all of your questions
of what we will do, we hope that you will understand. I believe
that the Health Protection Agency is the right way ahead because
the world is rapidly changing. If you go through infectious diseases,
the biggest bio-terrorist is Mother Nature. As global travel becomes
the norm, it brings global diseases to an unsuspecting population
and the cost to nations is huge. There are current concerns about
SARS, but in addition to that, you have got antibiotic-resistant
bacteria, viruses resistant to antivirals and agents that are
resistant to both. A key, crucial issue is that it is this combination
of global bugs and global numbers, with a propensity to jump species
barriers and to mutate across the globe, without eradication which
is an increasing concern. So if I summarise it, global bugs multiplied
by global numbers times global transportation. If you check that
with flights into the UK last year, there were 750,000 flights
which came into the UK from abroad last year carrying 72 million
passengers from abroad. So the 55 million people of the UK now
risk exposure from the bugs of 6.3 billion people and their animals.
Increasingly, we are not a self-contained island. Now, that is
on top of all the existing bugs that we have got: influenza, TB,
you name it, it is already here. Then on top of that, we have
now got the prospect of man-made bioterrorism. You can think about
how easy it is, maybe, to smuggle an illicit substance into the
UK. For example, in 2000, drugs worth a street value of £789
million were seized. The point I am making is that it is very
difficult to keep things like bioterrorism agents out. With Mother
Nature times what is already here, times the bioterrorist thing,
I believe that the status quo is simply not an option. We have
to feed into the burgeoning system: speed, systems to address
infectious diseases and protocols. We have to capitalise on the
vast range of intellectual expertise that there is in our higher
education system. Perhaps I can leave it there.
784. Dr Troop, any comments?
(Dr Troop) No, I will not add anything, thank you,
at this stage.
785. Perhaps we can go on to the questions.
This Committee has been labelled "Fighting Infection"
when obviously we are particularly concerned about infection,
so can I just ask a very simple question to start with, which
is what were the main reasons for the creation of the HPA? You
will no doubt be aware in the document Getting Ahead of the
Curve that the HPA was originally referred to as the "National
Infection Control and Health Protection Agency". Now, the
abbreviation to the "Health Protection Agency", is that
merely a convenience or does it indicate that national infection
control somehow or other is receiving a smaller amount of attention
than originally intended?
(Sir William Stewart) I think that is a question which
is really for the Department of Health because it was they who
set up the Health Protection Agency.
(Dr Troop) As I was the one in the Department of Health
at the time, perhaps I should answer that one. No, it was no diminution
of function. It was, as you say, shorthand. As we were going around
the country, quickly people were calling it the Health Protection
Agency because it was a shorter name and people found it hard
always to keep saying the long name and we got a lot of feedback
from everybody that they would just prefer it to be that way,
but it is certainly in no way a reduction of the work on infectious
786. Again, in Getting Ahead of the Curve
on page 134, there are 14 reasons for the HPA and yet we have
heard from the National Health Service Federation briefing on
the HPA, that they have stated that the threat of chemical, biological,
radiological and nuclear terrorism has been one of the main reasons
for setting up the HPA. How do you respond to that comment?
(Dr Troop) That was a push, but that was all. Discussions
about pulling together different aspects of health protection
have been going on for some time and when the CMO was developing
a strategy, we were getting feedback from people that if we were
going to look at the infrastructure for infectious diseases, they
wanted us to do it across health protection and not just for infectious
diseases because there are all sorts of links that can be made.
The first big push after that came when we had the Foot and Mouth
disease problem, when there was a potential public health problem
with the disposing of 4 million carcases and I was asked as Deputy
CMO to chair a health group. I pulled together people from chemicals,
radiation, from infectious diseases, the different aspects of
infectious diseases. Many of the problems we were looking at were
the same, but the outcomes are different depending on if airborne
or soilborne. Much of the risk analysis work we did was common,
but we were looking at the different potential risks and that
worked extremely well and we were finding that people modelling
from one group was helpful across another group and so on, so
the synergy started to show very well. Then it is true that when
we had September 11, that set us up very well for doing the work
for that and again I pulled together a wide health group from
all these disciplines and around the table basically I had the
people who would be in the Agency. The mutual learning and their
methodologies and so on were very strong and, therefore, if you
like, it became more obvious that we needed to do this integration
at the national level and at the local level and I can talk more
about that if you wish.
787. Of course you will bring together effectively
CAMR, the PHLS and the Department of Health. Was the relationship
between these organisations effective in the past and were there
areas that you now can identify need attention?
(Dr Troop) There was already some joint working and
individual groups were working together on specific issues. This
is at the national level, but also at the local level. What we
found at the national level even just in the time that we have
been working over the last two or three months as we have started
to put our strategy together is that the number of areas for collaboration
just go up all the time and the learning from each other. If we
look at our corporate plan, nearly all the goals we are setting
ourselves are integrated and go across the whole field. For example,
looking for long-term effects, there are long-term effects with
infections, there are long-term effects of, say, vaccines, there
are long-term effects of chemicals and radiation and yet we found
people working separately on these areas and they are coming together
now to share some of the methodology. What we have found is that
the more we have looked into our areas of work, the more we are
gaining from being together. The other thing is at the local level
which is that the same people were being asked to cover different
aspects of work, CCDCs, consultants in communicable disease, were
picking on issues around chemicals and so on and many of the issues
in working with local authorities overlapped and our capacity
there really needs developing and again people were keen to do
that in an integrated way. So it is not that people were unwilling
to work together, but I think it is just that all the possibilities
did not come out until we started to work together closely.
(Sir William Stewart) Can I say, my Lord Chairman,
that Sir Kenneth Calman back in 1998, Sir Liam Donaldson's predecessor,
was right about the need to bring PHLS and NRPB closer together.
He wrote, "It is not enough to assume that if each element
of the system is doing its best; that the whole system is doing
its best". Let me add to that, that Lord Turnberg, when he
was Chairman of PHLS, and I was Chairman of CAMR, we tried hard
to bring the two organisations closer together perhaps with limited
788. In Sir William's opening comments, he said
that they want to capitalise on intellectual capacity in higher
education, which sounds like an excellent proposal. I just wondered
how he thought he might do that.
(Sir William Stewart) Basically it is
a generic issue of the skills and expertise out there that we
ought to be tapping into. You then say, "How do you do that?"
First of all, you bring together a very good board, you then have
a sub-committee, say, a science advisory committee which is clearly
interested and which we will have. In addition to that,
we have to link with the MRC. Today, in fact at this very moment,
Charles Penn, who is our interim Director of Research, is presenting
at an MRC strategy on health protection issues. There must be
links with BBSRC, which you asked about and I used to be the Chief
Executive of the predecessor of the BBSRC. Then there could be
the involvement of the Wellcome Trust on how they might shape
things together with us on R&D and, as I said, we are setting
up a science advisory committee. Next Monday, the 7th, for example,
I will attend as a member of the Wellcome Trust Working Party
on Public Health Protection, so there is a lot of commonality
between the organisations. I would like to build on that. The
other point I would make is that it has been suggested, and I
think it has been taken aboard, is that there is a need for the
co-ordination of research activity in generalI think you
mentioned it, my Lord Chairmanthe question of bringing
co-ordination across the different sectors. I believe that co-ordination
should be treated lightly. I do not think you need over-co-ordination,
but you certainly need to have some generic ways forward and we
should seek to do that just by involving the university sector
at every possible opportunity. I do not believe that all HPA's
facilities ought to be located at Colindale PHLS, CAMR or at NRPB,
789. One area, as you might imagine, I am very
interested to know your opinion about is the VLA, the Veterinary
Laboratories Agency, and the relationship within co-ordination,
if one should use that word, to HPA and all the other agencies
that you have got to bring together. I believe that there is a
lot of important work being done there which pertains to human
(Dr Troop) And we would strongly agree
with that and that is something that we have picked up in our
forward-planning, that the HPA must work in partnership across
the board. What we are looking for is an organisation which is
outward-looking, which does identify all the potential links and
one of the strategies we have got is really mapping out on a much
more systematic basis all the partners with whom we should be
working and then over the course of the year systematically building
up the right kind of relationships which will be different for
different kinds of organisations, but if we are going to tackle
the whole issue of zoonosis, for example, we really do need to
work in that kind of partnership and out of the ones we have drawn
up, it is a very strong one. There are already links of course,
but we want to build on those and make them stronger.
Baroness Warwick of Undercliffe
790. This question is about research and I think
Sir William was almost beginning to expand on the question, but
we have heard concerns that there is not any one body which is
taking responsibility for evaluating new diagnostics and media.
You quoted Ken Calman as saying if they are each doing their best,
it is not good enough because the whole may not be. Do you envisage
that the role of the HPA will need to become that one body in
order to develop relationships, to co-ordinate research activity
with all the various other bodies, which you were asked about,
to build links with?
(Sir William Stewart) Well, the HPA is
a young organisation
791. Yes, very.
(Sir William Stewart)and there are other organisations
which have been involved for some time. I would not like to say
that the HPA will take over all the responsibilities of these
distinguished bodies, but what we have got to do is to work with
them and if in fact health protection is on the agenda, the HPA
has to play an important role. I would have thought that working
with partners like the Wellcome Trust, the MRC, the Department
of Health, the Food Standards Agency and the Health & Safety
Executive, really there is an opportunity for the HPA to play
an important role, but not alone.
792. I just wondered also where you thought
the funding for applied public health research was likely to come
(Sir William Stewart) Well, let's see where we are.
The research money that the HPA already has will remain with the
HPA, but the new thing that we will do, and you will be interested
in this because of your university experience. We will bring in
a peer-review system, we have to allocate grants for three-to-five-year
periods, we have to have visiting groups come in. This has not
been regularly done before. In relation to the money, just like
the university sector, we have got to go out and try and raise
funds externally. We actually do that rather well. CAMR gets about
70 per cent of its funds from external income, the National Radiological
Protection Board gets, I think it is, about 60 per cent of its
funds from external income and the PHLS had a substantial income
from outside funds as well. We have to go to the European Union.
We are not proud. If the science is worth doing and it is relevant
to public health protection we will take the money from anybody.
793. Do you see that research as actually involving
multi-health professionals or would it be restricted?
(Sir William Stewart) The days are over
when you think that one scientist can do everything on his own.
Basically the disciplines are interacting, the people are interacting
and we have really got to work together, not only within the UK,
but you have got to get the best expertise that you can get anywhere
in the world. Some people are a bit introverted in thinking we
can do it all in the UK. We cannot because we carry out only about
5 per cent of the world's research.
794. Would you see research being initiated
possibly by mental health officers and nurses?
(Dr Troop) We are looking very much at developing
a multi-disciplinary or multi-range of backgrounds of people in
health protection. We have been working with people like the Faculty
of Mental Health Medicine and other bodies about future development
needs and training. Certainly just as the Director of Public Health
now can come from any background, so it would be the same for
health protection and the work we have done thus far is that we
would like to encourage a whole range of people from all sorts
of different backgrounds still to do the same kind of training.
There is now with several bodies a voluntary register for public
health and people can register to be specialists equivalent to
medical consultants, providing at the moment they hand in a portfolio,
but in the future they will be able to do it through the same
kind of training programme. I think if we can do that across health
protection, we would want to encourage some of those to move into
research as well and I have had a lot of very welcome feedback
from, for example, environmental health officers to come up that
795. I wonder if I could pursue the research
theme a little further. It is conceivable that Sir William and
Dr Troop know that I was a past Chairman of the Public Health
Laboratory Service, but I say it for the record! The Academy of
Medical Sciences produced a report last year on trying to get
around some of the problems of microbiology which are problematic
and the PHLS were quite keen to assist in helping this. One of
the things which was concerning us was how we develop better relationships
with the university sector, to engage very closely with places
such as Cambridge where we had good relationships and where we
wished to build our interest in academic activities with joint
posts and so on. Is this something that you wish to pursue in
your HPA or will all that be lost?
(Sir William Stewart) I am not sure whether
you are lobbying, Lord Turnberg, or not, but by and large it is
the sort of thing we have to think of. As I said earlier on, the
days of us doing everything in-house are away.
(Dr Troop) We are very keen to support the development
of microbiology as a whole and I have been talking with the CMO
and I have been asking Brian Duerden, CEO of PHLS, to take a lead
on helping us with that within the Agency and working with others.
We have talked to the royal colleges and we have talked to others
in microbiology about how we drive the whole specialty and there
are a number of exciting issues looking at joint training in public
health and joint training in infectious disease and part of that
must be to build up the academic base. I think that if we are
going to attract young people in, if we are going to attract new
people in, we need to build up that academic base both for research
and for development, so we see that one of our roles over the
next year, two years, three years is supporting and helping to
drive some of that development because we need it across the whole
NHS and for that you need a strong academic base, so I think that
it is going to be one of our key roles in helping to push that
(Sir William Stewart) Lord Turnberg is right in saying
that there has been a run-down in microbiology. There has been
a very substantial run-down in microbiology. Many of the people
who would have been good microbiologists in the past, are all
molecular biologists now and nobody wants to know about whole
organisms or what organisms actually do. In my presidential address
to the British Association in September 2001, I deplored the run-down
of microbiology in the UK and asked what rogue nations might do
without recourse to nuclear weapons or laser technology. I made
that comment on the 5 September and a week later it was pretty
obvious what some of them would do. It means also that because
we do not have a strong base, large pharmas are actually moving
their resource out of the UK, and a good example of that was SmithKline
Beecham before it became a part of Glaxo SmithKline. It just took
its microbiology, more or less en bloc, took it out of the UK
and put it in the United States. We have to make sure that things
like that do not happen again. We have got to build up the base
along the lines that you were talking about.
796. Can I pursue with Sir William the matter
of the possibility of the HPA earning funds outside. I am not
quite sure what you are referring to here, but I find it hard
to see how something having the core function of the HPA, which
is effectively a public service function, will be able to earn
substantial funds outside to help its prime purpose. I can well
see how funds could be earned using possibly under-used, but essential,
HPA facilities to perform work for others, but I do not really
see how the central research purpose of the HPA can be funded
in that way. The other question is whether indeed the HPA will
have the opportunity to bid for a share of the central NHS research
(Sir William Stewart) Two good points.
I believe that nothing should get in the way of HPA focusing on
health protection, but as any academic, as any scientist knows,
as you do that intellectual property turns up. What you have got
to do, in my belief, is you have got to capitalise on that. As
I say, you cannot let it get in the way of the main aim of the
organisationpublic health protection but I think there
is great opportunity to exploit intellectual property as it arises.
Now, that does not mean to say that we take anything that shows
some intellectual property forward ourselves but what we can do
is share the way forward with industry. By generating funds in
this way, we also generate funds for the totality of the system,
but I do not think that should be a substitute for proper public
797. I think this last question covered most
of the point that I was going to make. The question is that as
you get into your stride, how is the research commissioning work,
which is going to be required by the HPA, going to develop, however
it is funded? The research function of the HPA, how is it going
to develop? Are you going to be having your own funding arrangements,
as suggested perhaps by Lord Oxburgh, or are you going to be having
to depend on other sources of support?
(Sir William Stewart) Basically we will
seek to have responsibility for commissioning the funds that we
have already got, but we will do that, I think as I said earlier,
via a peer-review system which will involve external experts.
We must do research which is as good as what can be done in the
universities or anywhere else so long as it is public health protection-related,
so we will do it with lots of expertise from professions brought
in to help us.
798. Is it possible to give us some idea of
how large those funds will be? Are they going to be small to start
with and then grow?
(Sir William Stewart) They are not large, so I will
let Dr Troop answer that.
(Dr Troop) As part of our core grant we do have some
funding for R&D and that is not going to change. In Getting
Ahead of the Curve it was suggested that we might have to
rebid for that. What has been agreed is that on behalf of the
Department we have been asked to lead the development of the strategy
for health protection and we will then hope to attract some of
the funding beyond our grant for that, but obviously if it is
a broad strategy, the Department of Health funding could go in
a number of different ways, but as we develop that strategy, if
it is an overview, I think that would also give us the opportunity
to secure funds elsewhere. It already is quite a strong research
base and it is something we would want to continue and develop,
but how far that will go at the moment is difficult to predict.
799. When you say it is already a strong research
base, you mean among the institutions which are going to come
under the aegis of the HPA?
(Dr Troop) Yes. About 30 per cent of our current grant
is for R&D in the organisation.