Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 120-126)


Baroness Warwick of Undercliffe

  120. Quite a lot of evidence that we have received has commented on the lack of infectious disease specialists and the difficulty of recruiting to microbiology posts. Several people have referred to that. Equally, Professor Finch talked about the range of expertise that ought to function in a more integrated manner. We have just touched on the more general practitioner having some elements of specialist knowledge and so on. I wonder if you could say something about how you see the skill mix required for infectious disease treatment and control evolving and how you think the training should evolve.
  (Dr Wright) I think that we could be on the verge of a considerable improvement in relation to the possibility of getting an infectious disease specialist into district general hospitals. A consequence of Calmanisation was that each infectious disease unit would usually have a registrar post and a senior registrar post, and both of those were often converted to Calman specialist registrars. Therefore, in training now we probably have more infectious disease specialists than ever before. What is less clear cut is where they will go to work. There is now a strong academic stream in British infectious diseases, because infectious diseases is such a fertile area for studying immune response—this is why we developed an immune response, to respond to infectious agents. So I am optimistic that both the academic provision and the clinical service provision in district general hospitals should improve. This will require a will among the persons describing the configuration of specialist interests in departments of medicine in general hospitals to accept the notion that they need somebody who is a general physician with an interest in infection. It would be sad if the infectious disease provision were to be left with the new breed of microbiologists with an interest in infection. This joint training in microbiology and infectious diseases has just started and so numbers of individuals training are low as yet but they will certainly increase in number. I think we have the potential, in terms of numbers of people training, to increase

considerably the representation of infection along with the other accepted specialties in district general hospitals.


  121. Dr Wright, I am aware that you have to leave and, if you wish to leave, please do so, but if you feel that there is anything that you feel you would still wish to say you could let us have it in writing.
  (Dr Wright) Thank you. My clinic starts at half-past one.
  (Dr Beeching) Just to reply with some numbers, if I may. This is from the Royal College of Physicians' publication looking at workforce requirements across the board. In our own submission we recommended that the target should be a clinical adult infectious disease specialist for every 250,000 people. This is in comparison with Sweden, where there is one per 27,000; Norway, one per 61,000; but, perhaps more comparable, in the Netherlands, which has a similar kind of practice of both microbiology and infectious diseases, just over one in a quarter of a million. Our projected requirement for the UK would be about 200 adult ID physicians and perhaps some extra specialists, which roughly correlates to putting one into each district general hospital unit—there are about 250. So two different estimates came up with a similar answer. We currently have 85 roughly in England. We have had a five per cent expansion historically for the last 15 years. The current workforce targets we have estimated at 200 by 2010. The current workforce target that has been set is actually just under 130. So I think it is fair to say that the profession would feel that there is room for considerable expansion which will require an increasing number of specialist registrars in training.

Baroness Warwick of Undercliffe

  122. Could you say something about infectious disease nurses. We have talked about clinical practitioners, but what is the role of nurses?
  (Dr Beeching) There is the infection control nurse, who has a very specific and very important role, both in the hospital and in the community; there are clinical infectious disease nurses who manage inpatients in a unit; and then of course there is a district nurse, a component of health visiting and infection control. So there are three different groups. I think the clinical practitioners actually do not have a cohesive group in the country but they are a very important component of health care and for educators as well, should there be outbreaks, for other nurses.
  (Professor Finch) I support what has been said by my two colleagues but I think it is also not just about simply increasing the number of infection specialists but it is about how they integrate and deliver their expertise in partnership with other professionals within the total body infection expertise. I think this is very important. In other areas of medicine, we have cancer centres, for example. Those of us working in larger centres have tried to develop the concept of an integrated department of infection that captures the diagnostic, the public health, the sexually transmitted, the clinical infectious diseases services. It is important. It is important not only because different types of expertise are required but you do need critical mass which can be used effectively to inform research and educational needs. I think it is through the establishment of centres of excellence built around integrated departments of infection that will bring about real change at local and national level. It goes back to the original question concerning surveillance. If we know more reliably and more accurately what is the time burden of disease, we can plan those units and staff them in a manner appropriate to the population needs.


  123. One final question relating to the Conclusion in your paper, where you say, ". . . the effectiveness of surveillance, links between surveillance and treatment and the links between surveillance and strategies for preventing infectious disease is weak." Is our teaching in medical schools either at the undergraduate or postgraduate level up to scratch? If it is not, how might it be improved?
  (Professor Finch) I think there is wide variation between medical schools in terms of undergraduate teaching and exposure to infectious disease. Some have intensive and specific courses, others perhaps do it somewhat patchily and not in a joined-up fashion. I think there is an opportunity to look at education at undergraduate level and ask: "What are the core components and skills and how should they be taught and translate to professional life and activity?" There is also the need to sustain education and competence in managing infection which links to the issue of postgraduate training. An example from Nottingham is that we have included within the senior house officer training experience in the management of infection emergencies, so they are familiar with the management of imported fevers and endemic problems such as meningitis, etc. Where you have a nucleus of expertise, that can inform and influence the local training agenda.

Lord Patel

  124. Are you saying that infectious disease teaching is not a core component of undergraduate teaching?
  (Professor Finch) You may find that certain diseases are taught but by different specialities.

  125. It is not a core module.
  (Professor Finch) It is not always a core module. You may get pre-clinical teaching in microbiology, but it does not always connect through to the clinical expression of infection and its management.

  126. So there may be medical schools where infectious disease teaching may not module.
  (Professor Finch) That is correct.

Chairman: Thank you. We have come to the end. If there is any point you feel we have not covered, please feel free to let us have further documentation.

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