---

Earl Howe: I am grateful to the Minister. His answer clarifies a number of dark corners in my mind. I shall obviously read his reply when it is printed, but what he had to say about the allocation of resources was especially helpful. Also, the memoranda of understanding ought, as he said, to put in place uniform protocols and standards across the country, if the system works as intended. I am a little sceptical about the ability of strategic health authorities to manage performance in the same tight way that they do for acute services, but we shall have to see how that works. It is important that the performance management role is conducted in as an informed and expert a way as possible.

I do not intend to delay the Committee further on this amendment. It has been useful to flag up the issues to which the Minister has helpfully responded. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

3.45 p.m.

Lord Clement-Jones moved Amendment No. 2:

Page 1, line 10, at end insert "including zoonosis"

The noble Lord said: One of the most important parts of the Bill is the clause that deals with the health function of the HPA. This amendment goes to the heart of the Bill as currently constructed. It is designed to ensure that the HPA's remit includes diseases which can be transmitted from animals to humans, such as SARS and avian flu.

I did a quick printout of some of the headlines from the past few months. SARS and avian flu have been right at the centre of not only domestic public health concerns, but also international health concerns. In parenthesis, I should like to say that I attempted to make the amendment refer to "zoonoses". Unfortunately, there appear to be too few Greek speakers in the Public Bill Office; the amendment should read "zoonoses" as opposed to "zoonosis". That is what I am reliably told, not having had a very strong classical education.

Because zoonoses can pose such serious public health threats, many of which are newly emerging diseases, the HPA certainly should have a responsibility for preventing their spread. That point was made strongly in the report entitled Getting Ahead of the Curve, in 2002. I

3 Mar 2004 : Column GC253

shall not weary the Minister by repeating the words in that report, but it was a very interesting tour d'horizon on some aspects of public health. I think that the Minister might find paragraph 2.48 of the report quite helpful.

By including zoonoses in the Bill, we would ensure that the HPA can draw resources not only from agencies dealing solely with human health, but also from those with animal health and food safety concerns, such as Defra and the FSA. With the HPA, we have an excellent opportunity to bring together surveillance information and prevention approaches to infections that cross the borders of human, animal and food-borne disease.

I hesitate to quote at great length from the House of Lords Select Committee report, Fighting Infection, in the presence of the noble Lord, Lord Soulsby, who I know will be making a contribution later. Page 27 of the report authoritatively states that,

"many emerging human infections are zoonotic and in order to predict possible outbreaks more accurately it is essential to have good collaboration between specialists in human and animal infection".

The report recommended,

"that the HPA be provided with resources to take on specific and primary responsibility for integrating surveillance related to human, animal and food-borne infection at national, regional and local levels in order to bridge the gaps that currently exist between these areas of specialties".

Including zoonoses clearly within the remit of the HPA would help to bridge those gaps and strengthen surveillance networks. In response to Fighting Infection the Government produced another document that I shall also pray in aid. It agreed that close collaboration is needed between human health and animal health in the investigation of zoonotic diseases, referred to on page 15.

More generally, we understand that the New and Emerging Infections Panel has been set up to assess infectious disease threats. I believe that the panel met in November 2003. It will be an advising body to the Department of Health and the HPA. It will also co-ordinate activities with the UK Zoonoses Group. Therefore, including zoonoses in the remit of the HPA would help to formalise the existing ties between the HPA and zoonosis surveillance. I understand that the HPA already is working with veterinary laboratories to set up formal communication networks to bring together the UK Zoonoses Group and local specialists in infectious disease and veterinary health.

Finally, co-operation between agencies is extremely important in handling the animal/human interface of disease transmission. I hope that I am not anticipating the Minister too much; I am sure that he will say that co-operation is working marvellously and will continue to do so, and so forth. But it is vital that no gaps exist for surveillance or emergency planning. The importance of shared information and collaboration in the area of zoonosis is noted internationally. In the United States, which lacks a national public health surveillance system comparable to that of the UK, animal and human infection experts are required to share surveillance information for animal-borne infections such as West Nile fever.

3 Mar 2004 : Column GC254

Of course there is a strong case to be made for co-operation, but we need an agency charged with taking the lead role in respect of that co-operation. That is the crux of the matter and noble Lords who have put their names to this amendment believe that it should be HPA-led. I beg to move.

Baroness Finlay of Llandaff: I start by expressing my thanks to officials in the Public Bill Office for their patience. I was slow to spot the drafting error in the amendment sent to them. They have been extremely helpful in seeking to make the correction to "zoonoses".

I strongly commend the amendment. There is a need for joint working, in particular to develop adequate surveillance, sharing of intelligence, joint field investigations, joint risk assessment and the development of common control policies and advice over infections occurring in man that derive from animal sources.

Over the years, attempts have been made to develop forums for medico-veterinary collaboration. The Zoonoses Order 1975 was passed to bring together the then Department of Health and Social Services, the State Veterinary Service and the Public Health Laboratory Service. At the local level, liaison groups were established, but the momentum was not sustained. Following the publication of the Phillips report, the Chief Medical Officer for England established the new UK Zoonoses Group. Within the former PHLS, the Zoonoses Advisory Committee, known as AC Zoo, was established in 2000. At the local level, a new initiative to revitalise local liaison groups was introduced by Defra and the Chief Veterinary Officer. However, it has been difficult to sustain a cross-disciplinary focus on the unique status of zoonoses infections at the national level. Indeed, at times the profile of such infections slips in terms of political importance.

The Chief Medical Officer has set up a new high-level committee, the National Expert Panel on New and Emerging Infections. Much of its time will be devoted to zoonotic diseases, but the word "zoonoses" is not included in the title. What is lacking is a cross-disciplinary scientific core unit embracing the full spectrum of activity in order to provide leadership across disciplines as well as serving the UK Zoonoses Group and other relevant committees.

It is important that this major group of diseases should fall under the remit of the agency to be charged with health protection. A zoonoses unit within the HPA should be given designated responsibility for co-ordination of zoonoses activities, including surveillance and contributing to the annual UK zoonoses report, field investigations and so forth. It should also establish the necessary cross-disciplinary expertise with Defra and the Veterinary Licensing Authority.

I suggest that there should also be a standing conference on zoonoses. In 2001, the first international conference was held in Cardiff, headed "The Prevention and Control of Zoonoses: from Science to Policy". It was sponsored by Defra, the Department of Health, the National Assembly for Wales and the

3 Mar 2004 : Column GC255

European Society for Emerging Infections, and was an outstanding success. It set the tone and established the feel for the kind of collaboration required.

I should declare an interest in that I am employed by the NHS trust which has incorporated the National Public Health Service for Wales. It has provided the Zoonoses Surveillance Centre for England and Wales and houses an extremely important reference unit in this area, in particular in relation to anaerobes, toxoplasma, cryptosporidia, hydatid and toxocara. Between 24,000 and 25,000 specimens per annum are sent from England to Wales for the Zoonoses Surveillance Centre, in particular the toxoplasma reference unit.

I hope that, given the size of the problem of the zoonoses, not only those that have hit the headlines recently, the Committee will agree that it will be important for the Health Protection Agency formally to include this spectrum of diseases within its remit.

Lord Soulsby of Swaffham Prior: I have great pleasure in supporting the amendment for all of the reasons that have been mentioned by the noble Lord, Lord Clement-Jones, and the noble Baroness, Lady Finlay of Llandaff. The noble Baroness mentioned the Cardiff conference in 2001 on zoonosis. It was an outstanding event and demonstrated clearly that the medical and veterinary people concerned with infectious disease thought that diseases transmissible between animals and man could exist. The amendment is to make sure that collaboration between veterinary and medical authorities will provide a unity of surveillance of infectious diseases in animals.

As the noble Lord, Lord Clement-Jones, said, so many of the new infections that we have—avian flu is the latest, SARS is another—are zoonoses. However, there are others that we forget, such as human flu that occurs world-wide and was originally a zoonosis that came from animals in mainland China. Many of our food-borne infections are zoonoses. It is important that we have that insertion at the end of line 10 to include "zoonoses"—it is right that it should be "e" rather than "i"—so that we do not forget the importance of the relation between animal infections and human infections. I am sure that that will not be the case, but we must make sure that the word "infectious" of "infectious disease" is not forgotten and that so many of them devolve from animals, either through food-borne infections or other sources. I support the insertion of the two words "including zoonoses" into the clause.

---