Select Committee on Science and Technology Fourth Report


FOURTH REPORT

2 JULY 2003

By the Select Committee appointed to consider Science and Technology.

ORDERED TO REPORT

FIGHTING INFECTION

PREFACE AND SUMMARY OF RECOMMENDATIONS

1.1 The Science and Technology Select Committee established a Sub-Committee in May 2002 to carry out an inquiry into diagnosis, treatment, prevention and control of infectious disease. The membership of the Sub-Committee together with declarations of interest is given in Appendix 1.

1.2 The Sub-Committee issued a call for evidence in July 2002, which is given in Appendix 2. This attracted 117 written submissions from individuals and organisations. Forty-nine individuals from thirty-eight organisations were invited to give evidence in person [1]. In July 2002 the Sub-Committee organised a seminar, hosted by the Academy of Medical Sciences, to gain an overview of some of the main issues of infectious disease control [II]. Over the duration of this inquiry the Sub-Committee visited health care institutions, research and surveillance centres and public health departments in England, Switzerland and the United States of America [see evidence vol II].

1.3 The organisation of some of the services involved in infectious disease control has changed over the duration of this inquiry following the establishment of the Health Protection Agency (HPA) in April of this year. The broad concept behind the HPA was widely welcomed by our witnesses, although they raised a number of concerns about the detail. The HPA is in an early stage of its development and, throughout this report, we draw attention to some of the areas that we believe it must address as a matter of urgency.

1.4 There is a large number of infectious diseases and many methods and particular services are needed to tackle them. In this report we discuss the processes of diagnosis, treatment, control and prevention; we focus on infection in general as it affects humans. However, we discuss the importance of animal-borne infection and we also draw on specific infections as examples. We point readers to some recent and pending inquiries which investigate in more detail particular groups of infection. The House of Commons Health Committee has published a report on sexual health[2] and the National Audit Office will, in winter 2003-04, publish a follow-up to its earlier study of Hospital Acquired Infection[3]. The House of Commons Science and Technology Select Committee will discuss deliberate release of infection in its report on Bioterrorism, expected to be published in July 2003. We reported on antibiotic resistance in 1998 with a follow-up report in 2001[4].

1.5 This report focuses on infectious disease as it affects England (devolved administrations have separate arrangements[5]) but we recognise the importance of international dimensions to infectious disease control and discuss this accordingly (see chapter nine).

Acknowledgements

1.6 We received much help from a large number of organisations and individuals throughout this inquiry. We thank all of our witnesses. Without people giving up significant time to submit evidence in writing or attend formal evidence sessions our inquiry and report would not have been possible.

1.7 We are most grateful to the following which hosted visits or seminars:

·  Academy of Medical Sciences

·  Central Public Health Laboratory - Public Health Laboratory Service (CPHL, PHLS),

·  Centre for Applied Microbial Resistance (CAMR)

·  Institute of Food Research

·  Birmingham City Hospital

·  Emory University, Atlanta, USA

·  Grady Hospital, Atlanta, USA

·  Centers for Disease Control, Atlanta, USA

·  Department of Public Health, Washington DC, USA

·  National Institute of Allergy and Infectious Disease, Washington DC, USA

·  Institute of Medicine, Washington DC, USA

·  New York City Department of Mental Hygiene and Public Health, USA

·  Felton TB Centre at Harlem Hospital

·  World Health Organization Headquarters, Geneva, Switzerland

·  Institute of Migration, Geneva, Switzerland

·  UNAIDS, Geneva, Switzerland.

1.8 Throughout this inquiry we have been fortunate to have the aid of two committed Specialist Advisers—Professor Julius Weinberg of City University and Professor George Griffin of St George's Hospital Medical School. We thank them for their careful advice and hard work..

Summary of recommendations

1.9 This report outlines a number of problems facing an effective response to the threat of infection in England. We acknowledge that infection cannot be conquered, but we believe that the Government could significantly improve services in order to counter the effects of infection.

    1.  We recommend that the Government recognises and addresses the fact that, although England has not experienced major epidemics of infection in recent years, this owes as much to good fortune as to good management. Without improvements we fear that this country will suffer from major epidemics and will continue to see infectious disease take its toll in economic terms, in suffering and in lives [9.16].

1.10 In view of this, we have made recommendations on the following themes:

Developing collaboration

    2.  We recommend that the Department of Health encourages and facilitates the development of infection centres which integrate scientists (virologists, microbiologists), clinicians and epidemiologists. These should be associated with academic and tertiary referral centres and the regional HPA laboratories. Each Strategic Health Authority should have access to services of one of these [9.24].

    3.  We recommend that the Minister for Public Health should publish as a matter of urgency a document outlining roles and responsibilities of all organisations involved in infectious disease services and should disseminate this to those concerned in order to facilitate effective communication and collaboration [9.7].

    4.  We recommend that the Minister for Public Health should publish an annual account of all progress in cross-departmental working in relation to infectious disease [9.5].

    5.  We recommend 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 speciality [5.38].

    6.  We recommend that the HPA publishes by April 2004 a proposal for developing collaborative relationships with organisations concerned with tackling infection, including the devolved administrations, environmental health departments and the Food Standards Agency [9.12].

    7.  We recommend that the Government enable the HPA to second health professionals to international bodies such as WHO and provide the resources to make this possible [9.33].

Providing well-trained staff

    8.  We recommend that the Government, in conjunction with relevant Royal Colleges and the Joint Committee on Infection and Tropical Medicine, address the shortage of expertise in clinical infectious disease, clinical microbiology and communicable disease epidemiology by increasing numbers of fully funded consultant posts and ensuring that there are available training posts [7.5].

    9.  We recommend that the General Medical Council, the Nursing and Midwifery Council, the General Dental Council and the Health Professions Council ensure that universities strengthen existing content relating to clinical and public health aspects of infection undergraduate education [7.15].

    10.  We recommend that, with respect to postgraduate education, the medical Royal Colleges and the Nursing and Midwifery Council should ensure that infection prevention and control is a key component [7.16].

    11.  We recommend that the Government investigate the decline in numbers of trained Environmental Health Officers in local authorities and take steps to reverse this trend [7.9].

Improving information exchange

    12.  We recommend that the Department of Health should ensure that procedures for collecting and reporting information electronically are integrated where possible into everyday working practices and are less burdensome than at present [6.8].

    13.  We recommend that the Government should develop a fully compatible electronic system of infectious disease surveillance information across all relevant departments and agencies [6.15].

    14.  We recommend that the HPA should standardise information entry across all surveillance systems. This should be undertaken in consultation with representatives of all those involved in the collation and transfer of information for infectious disease control [6.11].

    15.  We recommend that the HPA takes the lead in further developing electronic methods for providing feedback about surveillance and for targeting delivery of information about infectious disease to healthcare professionals [6.19].

Maintaining public health laboratories

    16.  We recommend that the Department of Health should ensure that Primary Care Trusts provide NHS laboratories with at least the same level of extra resources for public health work (including food, water and environmental activity) that was previously received through the Public Health Laboratory Service [5.14].

    17.  We recommend that the Department of Health ensures that microbiology laboratories managed by the HPA and NHS Trusts act in a coordinated manner to deliver effective surveillance and to provide surge capacity [5.15].

Vaccines

    18.  We believe that vaccine development should be facilitated and recommend that the Government should develop and maintain clear evidence based guidelines about vaccine requirements and should create financial incentives to enable early research, development and commercialisation of vaccines [8.4].

    19.  We recommend that, given that there is little vaccine production capability in the United Kingdom, the Government should, by April 2004, develop and publish a strategy to ensure that there is secure access to supplies of vaccines in the face of national outbreaks of infectious disease [P 4.13].

    20.  We recommend that the Government should fund enhanced surveillance of the impact of vaccine programmes on the incidence of disease particularly when new vaccines are introduced [5.20].

Initiating research and development

    21.  We recommend that the Department of Health, in conjunction with the HPA, establishes and publishes by end of 2003 clear evidence-based priorities for the development of vaccines and diagnostics [8.10].

    22.  We recommend that the Department of Health ensures that funding is made available to increase research into organisation and delivery of infectious disease services and, in particular, into how human behaviour impacts on outcomes of diagnostic procedures, treatments and prevention programmes [8.15].

Communicating with the public

    23.  We recommend that the HPA, like the Food Standards Agency, should act, and should be seen to be acting independently of Government [7.24].

    24.  We recommend that the HPA creates a post for a well-resourced infectious disease specialist to act as spokesperson and to lead on all aspects of communicating with the public including developing innovative methods of increasing awareness of infectious disease [7.30].


1  
Evidence is found in :

House of Lords Select Committee on Science and Technology Fighting Infection: Written evidence volume I (evidence received up to 18th February 2003), , Session 2002-3; HL 23, ISBN 010 400218 2

House of Lords Select Committee on Science and Technology Fighting Infection: Evidence volume II (oral evidence and written evidence received after 18th February 2003), Session 2002-3; HL 138-I

In addition this is available on the CDRom provided in the back of this report volume or on the website: www.parliament.uk/hlscience  Back

2   House of Commons Health Select Committee Sexual Health, Fourth Report Session 2002-03, HC 69. Back

3   The Management and Control of Hospital Acquired Infection in Acute NHS Trusts in England Session 1999-2000, HC 306 Back

4   House of Lords Select Committee on Science and Technology Resistance to Antibiotics, Third Report Session 2000-01, HL 56, ISBN 0 10 405601 0 Back

5   Northern Ireland, Scotland and Wales organise services differently. The HPA has some presence in Wales and a Service Level Agreement with Northern Ireland. Back


 
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