Select Committee on Science and Technology Written Evidence

Memorandum by the Society of Directors of Public Protection in Wales

  The following is given as evidence to be considered by the above inquiry and represents the views of local authority environmental health departments in Wales. These views are limited to the communicable disease function performed by local authorities in relation to the investigation of food poisoning and other notifiable communicable disease.

  The Society of Directors of Public Protection in Wales represents the views of all 22 local authorities in Wales through a series of technical panels dealing with various aspects of public protection. The Communicable Disease Technical Panel exists to advise the Society, develop skills and expertise, provide training, and promote common standards in relation to the communicable disease function in local authorities. The Panel also represents local authorities on a series of working groups and joint committees with partner organisations such as health authorities, phls/cdsc, and the National Assembly for Wales.

  These comments reflect therefore the current practice and experience of local authorities in Wales and their involvement in the communicable disease function.

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

  An effective surveillance is a fundamental part of any communicable disease strategy and other parts of a strategy will fail unless effective surveillance is in place. The principal component of the present surveillance system is co-ordinated by PHLS receiving laboratory confirmed isolates and other reports from a variety of sources. The local authority role in surveillance is the receipt of notifications from the medical practitioner attending the patient. Its effectiveness is easily compromised for a variety of reasons and modern methods such as laboratory reporting are now being used more widely. Local authorities also receive notifications from patients, employers, event organisers or discover CD incidents during the course of other investigations. There is a wide variation in the use of reporting mechanisms between laboratories and local authorities, and variations in methods of handling such notifications between individual local authorities. Disease incidence rates in districts/regions show a wide variation which in part is caused by poor surveillance, ineffectual notification and a disparity in resulting actions.

  The law relating to the investigation of communicable diseases, including surveillance and notification, is very much out of date and in need of a major review. Previously anticipated reviews have not materialised and new threats are being controlled and managed by old working practices. The advent of a proposed health protection agency and the recent global threats of biological terrorism seem to provide a just impetus to a review of the current legislation.

    —  The notification aspect of surveillance needs to be updated to include notification by electronic or telephonic means.

    —  The notification by medical practitioners needs to be strengthened by means of guidance and/or coercion.

    —  Provide suitable and sufficient resources in terms of equipment and training to ensure that future notification methods meet the essential requirements of the surveillance system.

    —  The receiving, handling, storage and reporting of data relating to disease notification needs to be standardised.

  The epidemiology and environmental components of causative organisms can be better understood by timely and accurate surveillance. This leads to effective treatment and the development of strategies for control and prevention.

2.   Will these problems be adequately addressed by the Government's recent infectious disease strategy, Getting Ahead of the Curve?

  The present surveillance system covers England and Wales with Scotland and Northern Ireland covered by a separate system. A combined surveillance would surely serve the United Kingdom more effectively. However, the recent devolution of government has resulted in the division of the health protection agencies of the four countries. A common surveillance system must be the aim of any review.

3.   Which infectious diseases pose the biggest threats in the forseeable future?

  Generally speaking, the communicable diseases which are increasingly requiring an environmental health intervention include E coli 0157, Legionnaires' Disease, Q Fever. However, of major concern to local authorities is their ability to deal with cases of disease which are nominally unknown in the UK but which for a variety of reasons become introduced into the UK. The effect of climate change, long food chains, global travel and people migration will contribute to new and emerging threats.

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

  The best policy intervention is preparedness backed up by adequate surveillance, effective prevention and control strategies, timely and accurate treatment regimes and public education. To this end effective and uniform standards of performance should be required of local authorities to enable them to discharge their legal and enforcement duties.

October 2002

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