Select Committee on Science and Technology Written Evidence

Memorandum by the Royal College of Pathologists


  The College oversees the education and training of specialists in all pathology disciplines, which includes medical microbiologists and virologists. It sets standards and organises assessment, monitors appointments to consultant posts and publishes reports and guidelines. It also has an important role in promoting public understanding of laboratory medicine and advising Government bodies. With regard to "Fighting Infection" all consultant medical microbiologists and virologists and heads of NHS microbiology and PHLS laboratories are members or fellows of the Royal College of Pathologists. There are also several CsCDC and REs and academic staff who are members of the College. The Vice President, Professor D Jeffries, is the current chair of the joint RC Physicians/Pathologists Committee on Infection and Tropical Medicine. This group has established joint training posts in infectious diseases/microbiology and with the Speciality Advisory Committee of the RC Pathologists is involved in discussions covering manpower and training with the Workforce Confederation. Both these initiatives should help to strengthen infection services in the future. The current shortage of specialists and laboratory staff in general is a constraint to improving the surveillance, prevention and control of human infectious diseases.

  The College has been pivotal to discussions with the Department of Health on "Modernisation of Pathology" and is committed to working in networks of laboratories where expertise, staff and equipment may be shared to improve the service to patients. This process has progressed in some areas and the College favours the proposals in the DH paper on Microbiological Services ( that there should be regional microbiology networks. However there are problems about the speed of the process and the ability of networks to deliver the surveillance requirements of the Health Protection Agency by April 2003.


  The first step in counting the number and causes of deaths in the UK was taken with the publication of Risks of Mortality in 1532 as a response to the threat of a plague epidemic in London. This lead in 1662 to John Graunt publishing the first scientific work on disease surveillance. These modest beginnings produced the Registrar General's returns, the Office of National Statistics and the legislation most recently revised as the Public Health Act 1984 and the Infectious Diseases Regulations 1988. All these efforts depend on doctors seeing ill patients and making a clinical diagnosis which is then notified to the Proper Officer of the local government authority. The legislation and practice associated with the notification of infectious diseases is far behind the science of laboratory medicine. We believe the time is well overdue for a re-examination of public health law, in particular the Infectious Diseases Regulations which are the basis for statutory notification. We consider this should be augmented by laboratory reporting of significant microbial diagnoses. There should be a duty on all medical microbiology and virology departments to completely report in a timely fashion to public health officials. This will require appropriate information technology and resourcing. The flow of data from laboratories in England and Wales to the Communicable Disease Surveillance Centre (CDSC) and in Scotland to the Scottish Centre for Infection and Environmental Health (SCIEH) has been voluntary and in some regions and countries nearly complete. The Public Health Laboratory Service (PHLS) staff have generally performed better than NHS Trusts, but not always (the College published an audit of this in 1994 by Dr Mark Farrington and others). Returns from smaller and private laboratories have been poorer. Complete reporting is essential for the surveillance of infectious diseases.


  Studies comparing clinical notifications and laboratory reporting often show wide variation. For example, statutory notifications of the childhood diseases—measles, mumps and rubella—compared with salivary antibody confirmation have shown hundredfold differences in incidence. The notification of "suspected food poisoning" may yield dozens of different causes without microbiological and chemical examination of specimens. Surveillance of infectious diseases without laboratories is like pathology without a microscope, chemistry without a balance or surgery without an anaesthetic.

  Similarly, physicians have little hope in making an accurate diagnosis, prescribing correct treatment and preventing the spread of an infection without laboratory backup. Lack of a confirmed diagnosis may lead to wrong decisions in choice of antibiotic, advice to the patient and control of infection. Needless to say the laboratory methods used must be standardised with good quality assurance. We believe this requires nationally agreed procedures in accredited laboratories. In the UK this is best achieved by the CPA, which is strongly supported by the RC Path. There is a concern that some new diagnostic kits are designed for near-patient testing without adequate control.

  For surveillance purposes, the denominator population and sampling methods need to be addressed. There is some concern that Primary Care Trusts may not wish to sample, for public health reasons, where the result of a faecal sample, for example, may be of value for epidemiological purposes but not of benefit to the management of the individual patient.


  Many Members and Fellows of the College are engaged in the research for new diagnostic methods and vaccine development. The task of validating and bringing new discoveries into clinical practice is an important part of the work of microbiologists and virologists and we would be interested in providing further evidence if the Committee were interested. Star gazing about future threats may be less productive but the College has always been interested in addressing the risks of newly emerging infections and informing our members and the public in a balanced way.


  The new strategy contains much valuable information and highlights the need for action plans in some specific topics. However, the proposal to join chemical and radiation agencies with the PHLS/CDSC and the significance put on dealing with emergencies might take the Government's "eye off the ball" of the burden of infection. The College welcomes the stress on good laboratory methods working to common standards and would wish to take this forward with the other professional bodies.

October 2002

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