Select Committee on Science and Technology Minutes of Evidence


Examination of Witnesses (Questions 653-659)

TUESDAY 18 MARCH 2003

MR SHAUN BROGAN, MR ROBERT NAYLOR AND DR MARTYN WAKE

Chairman

  653. Good morning, gentlemen. Thank you very much for coming along. We have a very interesting morning ahead of us. For the record could you first of all please identify yourselves and secondly, if you have any introductory comments to make, either collectively or individually, now is the time to make them.
  (Mr Brogan) My name is Shaun Brogan. I am the Chief Executive of the Vale of Aylesbury Primary Care Trust (PCT). We have 195,000 population, budget of around £130 million and we come from Aylesbury in Buckinghamshire.

  (Dr Wake) My name is Martyn Wake. I am co-chair of a professional executive. I am a GP in south-west London. The PCT is in Sutton and Merton, which is an unusual two-borough PCT covering a large population of 360,000 or 370,000 patients. Our budget is around £370 million.
  (Mr Naylor) I am Robert Naylor. I am the Chief Executive of University College London Hospitals, which is a group of eight internationally known hospitals in central London including hospitals such as the Middlesex Hospital, University College Hospital, the National Hospital in Queen's Square amongst others. We are a very complex and very large trust; one of the largest in the health service. We are a three-star trust and have just applied to become a foundation trust. We have the single largest PFI project in the health service. Personally I have been a chief executive at major teaching hospitals for nearly 20 years and my experience, which is perhaps relevant to this group, is that I was the deputy chairman of the national review of pathology services in the mid 1990s and I have recently been a member of the chief medical officers' group which ended up in the publication of the document Getting Ahead of the Curve.

Baroness Walmsley

  654. Dr Wake, is there a parallel lay executive in your PCT? You mentioned that you are the professional executive, so is there a lay executive? Could you explain what that means?
  (Dr Wake) Probably not very well. It is called the professional executive because of the unusual structure we have within the PCT, where essentially you have a more traditional board—and I have a place on the board as well—which does contain lay non-executive members. The professional executive is another structure which arose out of the original structures which we had in primary care groups, which were less formal bodies. They contain professionals in the majority, but also contain officers from the trust, including the chief executive, the finance director and other significant directors within the organisation.

  655. How do the two interact?
  (Dr Wake) There is a formal relationship in that we report to the board and our executive minutes go to the board. Some members of the executive sit on the board, we share meetings together. Non-executives would chair a lot of our sub-committees, particularly in areas where we would have a conflict of interest, for example. There is quite a close relationship. Within the organisation as a whole, there is also a management team. Unusual NHS complexity.

Chairman

  656. Do you have any opening comments?
  (Dr Wake) I am sorry; I am new to this kind of process. The Committee might be interested in knowing that I was a GP representative recently on the group which has given rise to the national strategy on hepatitis C published last year, which has links with the Getting Ahead of the Curve document you are familiar with.
  (Mr Brogan) It may interest the Committee to know that my first health management job between 1985 and 1990 was running four primary health care and public health programmes in Oman in the Middle East: immunisation, mother and child health, control of tuberculosis and prevention of blindness. This has given me a reasonably good background in a managerial sense, not a clinical sense, in the subject we are here discussing today.

  657. Mr Naylor, any comments to make?
  (Mr Naylor) No, thank you.

  658. We shall move right on to the questions. Since contagious diseases are very much in the news and I have an interest to declare in that I am a member of the Scientific Advisory Committee on Antibiotic Resistance, could you briefly outline the role of the PCT and in particular how it contributes to communicable disease control?
  (Mr Brogan) May I start by saying that the role of the PCT overall has three main functions. The first one is the promotion of health and the tackling of inequalities. The second one is the development of primary community care and the third one is the commissioning of secondary and tertiary services. Those are the main overarching roles of the PCT. As far as communicable disease control is concerned, we have a number of roles. First of all, with the HPA, we shall be involved in surveillance, prevention, diagnosis, support and out of hours commitments. All those are roles where we shall have responsibilities with the HPA representative, who actually sits on my PCT for mid and south Buckinghamshire.
  (Dr Wake) The PCTs' role in communicable disease is necessarily and historically quite complex. It is very multi-faceted because of the nature of all the organisations we relate to. We would have a director of public health who is a member of our board and our executive and the director of public health would have a role in planning, monitoring and informing colleagues locally about infectious diseases. That would be a role which affects community services, ordinary GP services and hospital services. In the generality, primary care trusts commission their health protection services—this is general nationally—on a sectorwide basis, so covering quite a large population. In our area we would have a health protection unit which has within it a number of consultants in communicable disease as well as community infection nurses who work together in the area. Health protection units would have quite clear links with occupational health services, for example within local hospital trusts and also within primary care to deal with the very basic, everyday health problems, such as needle-stick injuries, screening of health workers and that kind of thing. Health protection units would also deal, for example, with communicable disease outbreaks in their sector. They would be responsible for co-ordinating childhood immunisation and some adult immunisations as well, for instance influenza. I mention these areas particularly because they are the subject of particularly intense interest and target setting by the government. Community infection nurses in the area where I work have a more hands-on role and they are involved in contact tracing and would give quite detailed advice right down to practice level about handling individual outbreaks, such as outbreaks of meningitis, measles and TB. It is worth understanding how new the role of PCTs is in infection control, because we are able much more now to influence directly the services both that we provide, which are services which come from district nurses, health visitors and others, our own employees, as well as those services which we contract for through primary care services, GPs. That is a new role and we are able to give advice. For example my own PCT publishes infection control guidelines which are now sitting and acted on one hopes in every practice. That is quite a new development and that would include basic advice about needle-stick injuries, hand washing, handling vaccines and storing vaccines, sterilisation, which is of critical importance, monitoring detailed information like the use of autoclaves for sterilisation, ensuring they are the right standard and also such things as waste management. They would also want to have an influence over infection control by helping to prevent development of antibiotic resistance and that can be done in quite detailed ways, either by having a formulary, although we do not operate a formulary in our PCT, or by devising incentive schemes for prescribing for practices, which ensure that practices focus on a small number of sensible antibiotics rather than prescribing unnecessary, sometimes expensive and certainly antibiotics which cause problems with resistance.
  (Mr Naylor) I do not have any comment in relation to the PCT, because it is outside my sphere of responsibility, but maybe a little later I could tell you about the roles of infection control within NHS hospitals.

  659. How does one see the patient in this flow of control? A patient comes in to see his or her doctor. What is the process where the infection control primary care trust cuts in on the care of that patient? Is it quite clear where that happens to the individual GP and to the individual member of the public?
  (Mr Brogan) If the GP detects a notifiable disease they are supposed to report them on a paper form to the CCDC. It is generally understood that there is considerable under-reporting throughout the country. It would obviously be much more efficient if in time this were made into an electronic reporting system, where the disease was registered by a read code on the system and immediately a letter pops up behind it or an e-mail; he fills in the rest of the details, takes the address out of the main computer system without having to take all the other extraneous stuff and sends it straight off by e-mail to the CCDC. We are a little way away from that at the moment. It is a paper-based system and is pretty inefficient; not very inefficient, but not very efficient either.




 
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