Select Committee on Science and Technology Written Evidence

Memorandum by Bradford Metropolitan District Council (MDC)

1.   What are the main problems facing the surveillance, treatment and prevention of human infectious disease in the UK?

    —  Under resourcing of Public Health particularly for investigative and surveillance work at local level. Much investigative and surveillance work is carried out by Environmental Health Officers employed within Local Authority Departments. There is an ever increasing workload of ever increasing complexity placed upon these departments. The work does not enjoy the high profile of, for example, Education and therefore funding is difficult to attract or keep. Staffing levels are often inadequate to ensure proper surveillance leading to the possibility of clusters of disease not being properly identified with the consequence that preventive measures are not put in place.

    —  Marginalisation of Local Authorities in the proposal for Public Health reform. The work done by Local Authorities through their Environmental Health Officers is not reflected in this document. They seem to be included almost as an after thought. To remove Local Authorities from Public Health involvement is to remove the local dimension from surveillance, cut out important links with the food industry and to remove local accountability.

    —  Attention not proportionate to clinical/public health. The main thrust of the document seems to be on fixing it when it is broken, Public Health is about not letting it break in the first place. Public Health needs to be in partnership with Primary Care, not subservient to it.

    —  Surveillance is often ponderous, timescales need to be shortened for passing information between various partners. Information Technology is not used to full potential, various parts of the service cannot transfer information to other parts quickly and securely. Results of analysis are often slow to reach the surveillance agencies, often leaving a cold trail to follow when investigating possible sources and vehicles of infection. Limited staffing resources exacerbate such problems as often the urgent takes precedent over the important, that is we attend to today's crisis without having the time to fully evaluate yesterday's crisis, possibly missing important links between the two. Simply changing the personnel who undertake these tasks will not solve these problems, it is the system which needs changing and adequately resourcing.

    —  Issues around medical confidentiality can cause difficulties. There are occasions when the clinical arm is reluctant to share information with the Local Authority side of the surveillance arm on the grounds of medical confidentiality. There needs to be better definition of medical confidentiality so that Environmental Health Officers can have access to the information they need. These are professional officers who deal in confidential information as a matter of course in their working lives and can be trusted with the limited amount of information that would be required to ensure thorough investigation and surveillance.

    —  An urgent review is needed of the outdated legislation that is being used. Present legislation dates beck to the 1980's but has its roots much further back in time. Legislation is needed that reflects the global nature of 21st Century lifestyles and that balances the rights of the individual with the right and duty of the state to protect the health of all its citizens.

2.   Are these problems adequately addressed by Getting Ahead of the Curve?

    —  Resourcing issues are not addressed. The development of the regional aspect of public health working is welcome and important but unless adequately resourced will not achieve its full or desired potential. The greater the number of channels of communication that need to be maintained the greater is the need for adequate staff numbers with satisfactory means of communication. To provide compatible information technology is a huge, resource intensive issue which does not seem to have been addressed by this document

    —  Existing systems are either fragmented or subsumed into clinical areas. There is potential for diminution of service from PHLS with diminishing expertise in and importance given to, food and environmental sampling and analysis. This expertise is fundamental to Local Authority investigative and surveillance work, it provides the link between the food we eat or the environmental conditions in which we work with the diseases that affect the public, often in large numbers. The logistics involved in transporting specimens to an appropriate laboratory could prevent some Local Authorities from taking samples as they would not be able to comply with time limits from sampling to laboratory. There will no doubt be advantages to the detection of hospital acquired infection but this seems to be at the cost of diminution of service to the Local Authorities. If the existing expertise in Public Health is fully utilised then there are major benefits to be had, if not valuable time will be lost as new staff find the pitfalls by falling into them.

3.   Is the UK benefiting from advances in surveillance and diagnostic technologies: if not what are the obstacles to its doing so?

    —  Information is transferred slowly, better and more importantly compatible IT is needed. Surveillance and diagnostic technologies are developing and there is little doubt that the UK is benefiting from them. The caveat is that we do not move the information about in a suitable manner. The issues surrounding this have been discussed above.

    —  Better understanding of what each part of the service needs to know and why they need to know it. There is a need for each part of the Public Health Alliance to know what its partners do and why they do it. It is a fairly straightforward communication or public relations issue. It may well be that the "clear line of sight" resolves this issue. Obviously the "clear line of sight" needs to be established and this should provide the impetus to clear up this issue.

    —  Trust that each part of the service will deal with the information professionally and sensitively. As stated above there are occasions when free transfer of information is blocked or made more difficult than is perhaps necessary. If we all know what the other parts of the partnership do and why they do it this bond of trust is more likely to be developed. Without it we shall not be as effective as we could otherwise be.

    —  The acceptance that each part has a role to play and that the whole is greater than the sum of the parts. There is a tendency for each part to operate within its own sphere of influence and/or competence. There are vast stores of knowledge and expertise that can be brought together for the benefit of the service. These proposals should assist that process.

4.   Should the UK make greater use of vaccines?

    —  This is a medical issue outside the scope of the Local Authority.

5.   Which infectious diseases pose the biggest threats in the foreseeable future?

    —  Some of the old ones—measles because it is not deemed by the public to be serious, Tuberculosis because it is endemic still in parts of the world visited by many of our residents. Conditions for its spread still exist in this country and the people who live in those conditions are disenfranchised through lack of knowledge. Development of antibiotic resistance in existing pathogens either through veterinary use or in human medicine is likely to pose an increasing threat.

    —  New ones—E.coli O157 suddenly appeared as a human pathogen with devastating results. It adds a new dimension to investigation and surveillance because of its ubiquitous nature and low infective dose. Salmonella species have been known to change their usual pattern of infectivity and this may happen at any time. Surveillance is essential to ensure these developments are picked up.

6.   What policy interventions would have the greatest impact on preventing outbreaks of and damage caused by infectious disease in the UK?

    —  Put adequate resources into combating family outbreaks with an emphasis on a proactive approach. This is a largely neglected area of work. There is no agency with outright responsibility for it, though doubtless the Health Protection Agency will be in a position to change that. Much of the communicable disease investigation work is based in the home but resources in terms of both staff and time are too limited to be able to spend the amount time needed to gain the required results.

    —  Increased food and personal hygiene education in schools. If we are to cut the cycle of infection we need to ensure that people are given the type of information they need to keep themselves safe from infection. Though the school curriculum is a crowded vehicle it does give access to a captive audience, one that is hopefully receptive and not set in bad habits and one that can be reached at various stages of development.

  Introduce licensing for all food businesses (with appropriate lead in times). It seems strange that a licence is needed to look after someone's pet cat whilst they take a holiday but anyone (apart from a butcher who sells both raw and cooked meat) can set up in business selling food to other people. It would be prudent to start with those whose business constitutes the highest risk and work forward on a rolling programme. Exemptions for those who sell only wrapped sweets would be acceptable. Fees charged should be ring fenced to ensure that the licensing process is largely self- financing. Equally we should ensure that anyone who wishes to run a food business is trained to at least intermediate food hygiene standard prior to opening and that all food workers are trained to at least basic standard within three months of starting employment. A great deal of misery is caused through ignorance of basic hygiene techniques.

October 2002

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