Visit to City Hospital, Birmingham on
6 and 7 March 2003
The Committee visited City Hospital, Birmingham
on the 6 and 7 March 2003. Members present were Lord Haskel, Lord
Oxburgh and Lord Soulsby of Swaffham Prior (Chairman), Lord Turnberg
and Baroness Walmsley and were supported by Specialist Advisers,
Prof. Julius Weinberg and Prof. George Griffin, the Clerk, Rebecca
Neal, and Specialist Assistant to the Select Committee, Jonathan
Over the two days the Committee met:
|Mr John Adler||Professor Del Ala'Aldeen
|Mr Rishi Bawa||Dr Ian Blair
|Professor John Bligh||Professor Steve Busby
|Ms Deborah Crisp||Prof Peter Davey
|Dr Chris Ellis||Dr Robin Ferner
|Dr Douglas Fleming||Dr Adam Fraise
|Professor Nigel French||Professor Alasdair Geddes
|Dr Martin Gill||Professor Tony Hart
|Prof P Hawkey||Professor Paul Hunter
|Dr Peter Iles||Dr John Innes
|Dr Mike McKendrick||Dr Cliodna McNulty
|Dr Patricia O'Neill||Professor Laura Piddock
|Dr Grace Smith||Mr Chris Teale
|Dr Tim Weller||Ms Pauline Werhun
|Professor Richard Wise||Mr Mark Woodhead
|Dr Hugh Yarwood Smith||
The Committee also met staff from City Hospital when visiting
wards. The Committee would like to thank all participants, City
Hospital for hosting this event and, in particular, Professor
Laura Piddock and Professor Richard Wise for their invaluable
help in organising this visit.
City Hospital forms part of Sandwell and West Birmingham
Hospitals NHS Trust, which was created on 1 April 2002, has a
turnover of £220 million and employs 7,000 staff.
THURSDAY 6 MARCH
Hospital Management and Infection
1. This session explored difficulties facing management
of hospital in relation to infection.
2. Infection control had been pushed up the hospital
manager's agenda as it was a factor in hospitals' star ratings.
3. It was difficult to ensure that hospitals had the
capacity to deal with infection outbreaks as this relied on high
levels of resources relating to numbers of beds, isolation rooms
4. Using alcohol hand wipes on wards as an alternative
to hand washing could lead to substantial time savings and thus
increased patient care.
5. There was routine health screening of staff, but not
as much as desired. Agency staff posed a particular problem, as
not all agencies screened their staff and hospitals could not
wait to screen agency staff before employing them.
6. Facilities for isolating highly infectious patients
were commonly inadequate.
Infections and modern medicine
7. It was important that the infectious disease service
was co-ordinated. The HPA must attempt to integrate better the
various infectious disease professions.
8. The disease notification system was slow and ineffective
given that many doctors did not report.
9. Emerging diagnostic tests using chip technology might
allow analysis within a day, but would still require follow-up
tests by conventional methods.
10. Immunisation was the most cost-effective method of
preventing infection but recent public anxiety about vaccination
limited its use. There were also limits on the number of jabs
people will accept. In addition, there are some infections for
which it was unlikely that a vaccine would ever be available.
11. Whilst infectious disease was managed reasonably
well in District General Hospitals there could be problems in
the future owing to unfamiliar diseases not being picked up.
12. Infection services could be improved by introducing
national standards and increasing coordination between all those
involved in infectious services. A recent discussion paper from
the Joint Committee on Infectious Diseases and Tropical Medicine
proposed that specialist infection centres within teaching hospitals
should be developed.
13. Hospital acquired infections (HAIs), acquired after
a minor operation, led up to 70 per cent fatality rates.
14. 41 per cent of the population consulted their GP
at least once a year because of an illness caused by an infection.
This equated to a GP with an average list seeing 25-30 patients
15. It was important to increase diagnostic accuracy
at the first consultation. Whilst near-patient testing could provide
a quick answer it was expensive and increase consultation time.
16. There should be an increase in sentinel practices
providing surveillance data, which should ideally be linked to
results from microbiological tests.
17. There could be many difficulties in identifying and
treating patients who presented infectious disease, including:
correctly diagnosing the disease when symptoms
following up treatment when the patient is disabled
or does not adhere; and
ensuring wider public safety when the patient
was in the community.
FRIDAY 7 MARCH
Food and the risk to public health
18. Environmental health was funded by local authorities
but was audited by, and accountable to, the Food Standards Agency
(FSA). Environmental Health Officers worked closely with the Consultant
for Communicable Disease Control.
19. Whilst all food premises were supposed to register
with the EHO many did not. Licensing of high risk premises might
ensure that workers were properly trained in food hygiene and
that the premises would be obliged to provide documented hazard
20. There were ten EHOs covering the 2,500 food premises
in Sandwell. They had recently had to drop their wider health
promotion role (such as visiting schools) because of scarce resources.
21. Identifying the source of and further controlling
food poisoning outbreaks was very time-consuming and often unpredictable.
22. There was a conflict between trying to find out the
cause of the outbreak (the remit of the CCDC) and apportioning
blame and prosecuting those responsible (the remit of the EHO).
23. It was very difficult to prosecute in food poisoning
outbreaks as questionnaires used by CCDCs to obtain information
on what was eaten etc were not witnessed; and samples taken for
analysis were not taken in a way which would make them admissible
as evidence in court. There were also difficulties with using
epidemiological evidence in court.
24. The role of the CCDC, when part of the HPA, should
continue as at present with more emphasis on communicating with
other key players in public health.
25. Food production was increasingly a global operation:
a significant proportion of poultry consumed in the UK was imported.
26. Illegal imports to the catering industry were a cause
27. Most outbreaks of water-borne infections were from
private water supplies, which covered one to two per cent of the
28. The Health and Safety Executive should produce a
guidance note about the regulation of standards of water in swimming
pools as no body was clearly responsible for this nor was it viewed
as a high priority.
29. Academic research had a key role in helping to control
infection. There were some networks of researchers to investigate
particular infections, such as CampyUK for campylobacter.
30. There was little funding available for developing
near patient tests.
Respiratory Disease: an ever present problem
31. There was a need to develop better microbiological
tests in order to differentiate quickly between different types
of respiratory tract infections.
32. Tuberculosis notifications were steadily increasing
in large urban areas, particularly in London. Possible reasons
for this increase included:
more clinicians notifying cases;
changing age profile of the Asian population;
co-infection in people with AIDS; and
immigration from regions with different strains
33. Specialist nurses often ran services diagnosing and
treating TB. However in areas with low incidence rates there was
often very little expertise in this area.
34. TB networks, linking high with low incidence areas,
had been established, and a TB Action Plan, would be launched
by the Department of Health in April 2003. It was hoped that there
would be national guidelines about TB screening. Resources were
needed, particularly to purchase and develop software (for operation
work rather than surveillance).
35. Teamworking was very helpful in relation to TB contact
tracing. TB contact trace nurses should work closely with local
CCDCs so as to share resources.
36. Directly observed therapy (DOT) was only used with
patients who had previously failed to finish treatment as it was
very expensive with more effective ways of using finite resources.
37. Multi-drug resistant TB was not yet a significant
problem. There were only 35 cases a year in the UK (0.9 per cent
of all cases): half of those in London.
38. Employing community workers to liaise between TB
contact tracers and immigrant communities would make it easier
to identify and to screen all new immigrant arrivals.
39. Whilst the health of asylum seekers is similar to
local populations on arrival in an area it often quickly deteriorated
owing to difficult social conditions, particularly poor housing.
40. Funding for emergency hostels for asylum seekers
did not have a particular stream to pay for health checks. This
should be rectified as it was placing significant demand on local
41. High rates of infection were seen in prison particularly
in Hep B and Hep C. Increasing availability of needles and condoms
in prisons could help to counteract the spread of these infections.
42. It was necessary to re-examine how infection (both
clinical infection and microbiology) was taught at medical schools
as students often could not remember what they were taught about
43. Infectious disease was an area that cut across the
curriculum and therefore often was ignored as curricula were mostly
44. Medical schools did not measure outcomes of their
45. Nurses needed to understand key elements of science
research (such as the concept of risk) in order to be able to
correctly advise people on issues such as vaccination.
46. Ideally health professionals should have protected
learning time in order to be able to provide updates on education
about infectious disease. However, staff levels in Trusts must
be increased to allow for this.
47. More clinicians needed training in research methods
as many research papers were poor qualityparticularly in
the area of infection control (only 26 per cent of 296 papers
since 1980 were judged to be "robust" by a Cochrane
48. It was necessary to educate clinicians and nurses
about the importance of infection control; in particular that
they needed to take responsibility for it rather than seeing it
as the job of the infection control nurse.