Memorandum by The Public Health Laboratory
Service (PH 41)
1. The Public Health Laboratory Service
is concerned with the effect of infection on public health, its
corporate purpose being to protect the population from infection
by maintaining a national capability of the highest quality for
the detection, diagnosis, surveillance, prevention and control
of infections and communicable diseases. The PHLS makes its unique
contribution to improving the health of the population through
the co-ordinated activities of its network of microbiology laboratories,
surveillance, epidemiology and field investigation services, research
development, education and training programmes, in collaboration
with other agencies at local, regional, national and international
levels. In this way, the PHLS provides essential support for those
authorities with formal and statutory responsibilities for communicable
disease control. Proper and timely co-ordination with clear objectives
and clarity over roles and responsibility are essential to this
purpose. Equally, speed of action and timeliness are also critical
because communicable diseases can spread and outbreaks occur with
2. In preparing this evidence for the Committee,
we have selected 11 of the many infections or incidents of public
health importance whose control particularly involves co-ordination
issues. Short individual summaries of these are provided in the
attachments to this paper. Each of the 11 infections or incidents
has its own particular aspects. Collectively, however, they illustrate
four key areas to draw to the Committee's attention.
2.1 The vital need for increased investment
in training in general and in developing co-ordinated "surge
capacity" for dealing with infection incidents. Surge (or
response) capacity cannot be maintained where staffing is reduced
to the bare minimum through imposition of excessive efficiency
savings. We cannot wait for incidents to occur before deciding
there is a need for preparedness.
2.2 The resource requirements that will
emerge with the new Communicable Disease and Sexual Health/HIV
& AIDS Strategies which are expected to be launched by Government
2.3 The concern that overly strict interpretations
of new legislation relevant to patient confidentiality could potentially
place patient health and even lives at risk from infection if
they make proper surveillance and infection control impossible.
To resolve these issues it may be necessary to re-visit the legislative
framework for control of infectiona task which in any case
is long overdue.
2.4 The difficulty in persuading health
authorities at every level to see communicable disease as important,
compared with the "super-charged priorities" of cancer
and heart disease. For some infections and areas it is unclear
who will be dealing with infection, especially at a population
level through Primary Care Groups and Trusts.
3. In addition concerning the specific infections
whose details are attached, a number of other themes emerge, some
of which extend beyond more than one infection:
3.1 Heavy health burden and considerable
opportunity for health gain. This is the case for most of the
examples. HIV transmission in the UK is costing England alone
more than £250 million annually in medical and social care.
Tuberculosis in London, infertility in women due to genital chlamydia
and hospital acquired infection are other examples. It is estimated
by the National Audit Office that some 15 per cent of hospital
acquired infections may be preventable, with the saving of some
750 lives and £150 million annually.
3.2 An expectation of health protection
by the public who may presume their food and water to be free
from the dangers of infection. Contamination of baby milk, waterborne
disease and E. coli O157 (VTEC) infection show why this
is not always the case.
3.3 A requirement for international co-ordination.
The incident of contamination of baby milk and the recent deaths
from infection in injecting drug users required international
detective work and control measures operating across the four
UK countries and beyond.
3.4 The need to maintain public confidence
in health promotion as well as health protection measures, specifically
those of vaccination (preventing meningococcal disease with a
new vaccine), screening (protecting babies against infections
carried by their mothers) and retaining a safe water supply (waterborne
3.5 A requirement for rapid, effective,
co-ordinated action. This is especially the case for very infectious
or very serious conditions such as for the Lassa Fever incident
and the outbreaks of VTEC infection and meningococcal disease
when they occur.
3.6 Gross Health Inequalities which are
to be found for HIV, tuberculosis, hepatitis B and genital chlamydia
4. The PHLS would welcome an opportunity
to give oral evidence to the Committee in order to expand on the
points made in this submission; to explain why the arrangements
for communicable disease prevention and control are deserving
of the Committee's attention and how, in terms of the multi-agency
working involved, they may well be an exemplar for other aspects
of the Committee's inquiry.
1. Prevention of HIV Transmission in
the United Kingdom.
2. Tuberculosis in London.
3. Infertility and other reproductive
ill-health in women due to Genital Chlamydia Infection.
4. Hospital acquired infection.
5. Contamination of baby milk.
6. Waterborne disease.
7. The most important gastrointestinal
infection: VTEC O157.
8. Unexplained deaths and severe illness
in injecting drug users.
9. Preventing Meningococcal Disease
with a new vaccine.
10. Protecting babies against infections
carried by their mothers.
11. A serious infection incident: Lassa
Fever in London.