Select Committee on Science and Technology Minutes of Evidence


Examination of Witnesses (Question number 820-838)

TUESDAY 1 APRIL 2003

SIR WILLIAM STEWART AND DR PAT TROOP

  820. Do you think it is going to be possible to bring this about?
  (Dr Troop) It is one of my ambitions to do so.

Lord Turnberg

  821. I was encouraged by Dr Troop's response. As she knows, it is critically dependent on having the funding to do all this and the PHLS and, I presume, the HPA's prime role is protection of the public in the UK yet repeated bids for funding to do more international work from the Department and through DEFRA were rejected. I am really quite keen to know how, now you have turned poacher from being gamekeeper, you will be able to overcome this reticence in the Department. Can I broaden the question to whether the funding for the HPA will come from centrally funded resources, is it a centrally funded activity from the Department of Health or will it come through the NHS budget? The centrally funded budgets are constantly kept under very tight control in order to provide monies for waiting list initiatives and the like in the public gaze.

  (Dr Troop) As with the other organisations, there will be the core grant coming from the Department plus funding from the NHS where we provide services for them. Before I even applied to be the Chief Executive of the HPA I had been working on how we might enable the HPA to have a wider international role and I was canvassing support from people who I thought might be important across Government to help with that thinking and I was getting a lot of support on the basis that it is also good for "UK plc" if you like. It was very important for us to demonstrate internationally that we had all this expertise. I think the whole international agenda has become much more important within the Department of Health in the last two or three years and a recognition that if we are going to tackle many of the problems we have to do it on an interactive global basis and I have seen interest in this agenda change quite significantly in the time that I have been there. That does not mean to say I think it is going to be easy, but I think the climate is better than it was a year or two ago. I think it will be up to us to make a very good case where, as you said, it brings us benefits as well as benefits for other people. I think we also need to demonstrate that with our expertise we should be helping with what are the global problems with infection. This is such a major issue internationally that it should be part of our approach, just as with DFID giving development money, to be helping with that expertise and I think we can use that argument. Also, we have things like infections increasing in this country. One way to tackle that is to support the other countries who have those diseases. I think we will have to use a number of arguments like that.

  822. They sound familiar arguments. I wish you the best of luck!
  (Dr Troop) I do not expect it to be that straightforward, but I did try and start canvassing support.
  (Sir William Stewart) What has changed is that health protection is now global in outlook. If that is the case, small amounts of money can make a huge difference on the global scene if it is targeted in the right place because, overall we have got to work on the basis that prevention is better than cure.

Lord McColl of Dulwich

  823. To what extent do you envisage the HPA providing the focal point for highlighting the public health agenda to the media and the public on issues of vaccine safety and the risk of contracting diseases, and also for ensuring that the public health agenda is considered in international fora such as those related to trade, particularly food trade?

  (Sir William Stewart) First of all, the point that you made is one that we must pay attention to. The HPA must play a key role. What the HPA has to do is to present the best evidence that we have got in a dispassionate way. We have to be able to communicate with the public in a way that perhaps we have not done sufficient of in the past. If we do not know the answer to something then I think we have to stand up and say, "Look, we don't know, but here is the balance of evidence": Let us take the simple example of vaccines: I read in a broadsheet recently that the smallpox vaccine caused some deaths and it was not recommended for use, but that is when there is no smallpox about. The risk benefit analysis would vary enormously if there was smallpox about. We have to try and get some of that information out and about. In relation to international trade, we simply have to be involved internationally. Whether it is imported food, whether it is antibiotics, we have to seek to use UK standards. We also have to help UK industry when it is in the public interest to do so.

  824. Some years ago when I was trying to get public interest in changing their diet onto a high roughage diet I went to The Archers programme producer and explained to him, a professional, what the problem was and he did the rest. It worked very well because the public will listen to The Archers but they will not listen to professionals with their propaganda. Would you consider that?
  (Dr Troop) One of the things we are planning this year is a communicating strategy. I think we have to look at all the different ways that you can tackle this. Over the next few months we will be developing our website, because people have started to use websites a lot, to make it very user-friendly, to have lots of information, to make it easy to go round and put very much in lay terms. Our website going live today is mainly informative and we have put a few things on, but it is not where I want to be in six months' time and we will be learning from others like the Food Standards Agency and the National Radiological Protection Boards who have got very publicly facing websites, but we need to look at a whole lot of other ways in which we can enable people to understand the issues around health protection so that, first of all, they can make their own decisions about things that they can do for themselves but also then look at these issues such as risk and benefit. Going on to various media is a very good way of doing that. The programme makers are sometimes resistant to that. When I was in the Department I did quite a lot of work on nutrition and we did get things into some of the programmes and we also tried it in Eastenders and Casualty and we did get some in and they were very effective. Eastenders did something on antenatal screening. I think what we have to do as a precursor to that is we have to get everybody in the Agency thinking about how they communicate as well. As we have been writing our plans we have been trying to encourage people to get away from the scientific language. Our corporate plan we will have been edited by somebody who is not a scientist in order to de-jargon it if you like. I think you have to have an internal strategy as well so that people learn how to do that kind of communication, we see that as a very high priority. We see ourselves, we hope, as the authoritative voice so that, should they want to, the public would come to us first. We are doing that for the bio-terrorist area at the moment and we are building that up as well, but that means we have to build up our website and that is a major priority for us.
  (Sir William Stewart) Use television, that is the long and short of it, if you are able to do so. It is no use saying that putting something on the web is sufficient because not everybody looks up the web. Most of us watch television but not all of us watch The Archers.

  825. You listen to The Archers.
  (Sir William Stewart) That shows you that I do not.

Lord Turnberg

  826. My question concerns training and what role the HPA is going to be playing in training across the board in epidemiology, microbiology/ID, environmental health officers, infection control nurses and even, although this is slightly different, science journalists. Leave that aside, just think about the others first.

  (Dr Troop) We see ourselves as being the major focal point for encouraging a lot of training, but it has to be in partnership and amongst our own staff. We have a major cross-section of people, a whole range of disciplines and we are very keen that they should have strong development. One of the pieces of work that has been done already is to outline a five-year strategy for education and training in health protection, some of it for our own staff but some of it also in partnership with other bodies, for example, on the wider range of health protections, as you said the environmental health officers and so on, we do see that as one of the major plans. There are areas in health protection where we need to develop capacity. I think we need to develop capacity more at the local level, I think we need to develop more in the chemicals area, we need an understanding of those areas, but we also need to look to see joint working between microbiologists and public health people in their training and development. We are ultimately a service that depends on people and therefore developing people both in their numbers and their education and training I think must be a high priority and that in turn just allows an ordered response to take place.

  827. There is a need that many people perceive to bring the training of epidemiologists and microbiologists closer together and the HPA does have an opportunity to provide that environment. Are you going to take advantage of that?
  (Dr Troop) We have already had joint discussions with the Royal College of Pathologists and the Faculty of Public Health Medicine about joint training, for example, in microbiology and public health. We have started to have discussions about joint training with infectious disease, that is already going on, about bringing infectious disease and microbiology closer together. I think there is a lot of opportunity both at a general qualification level but then development to make sure that we get much more mixing that we have had before. I think it will be stronger if we do that.

  828. Do you have rotational programmes and that sort of thing within your organisation?
  (Dr Troop) I would hope so. We have just been given two additional posts for public health training and what we are suggesting is that we rotate these people round each section of the HPA as part of a rotational programme, and I think that would be very attractive.

Lord Lewis of Newnham

  829. How far are you going to deal with things like appraisal in training? It seems to me one of the biggest dangers we face in modern day medicine or science as a whole is the rate at which progress is growing and the information flow back, and it is all very well being trained this year or five years ago but there is an element of timing that is involved in this. Have you any plans or intention of dealing with that problem?

  (Dr Troop) You mean continuing development?

  830. Yes.
  (Dr Troop) Certainly amongst medical staff it is a requirement now, we cannot get re-accredited by the GMC unless we do. I think that is a discipline that should apply to all the different groups and we should be encouraging that. For the staff within the organisation I would want to do that through their normal appraisal system. I am a great believer that you should have good developmental appraisal for all staff and part of that appraisal must be discussion of their personal development and ensuring that they do continue with their professional and personal development and I think that is something that I would want to foster. Where I have been involved in organisations before it is something I have always given a lot of priority to.
  (Sir William Stewart) Dr Troop mentioned the Faculty on Public Health Medicine. I would simply want you to have it on the record that I had a letter yesterday from the President of the Faculty of Public Health Medicine who wrote, "I am writing as President of the Faculty of Public Health Medicine to say that we are delighted to welcome the launch of the Health Protection Agency." The other point that I was going to make in relation to Lord Lewis' comment is that it is hugely important, not only within the HPA, that we get good training given, but the HPA has some of the best facilities for some of the things that we need to get training on, for example, on dangerous pathogens, not everybody can do that and CAMR have obviously the best containment facilities in the land and we are seeking to use that to make sure that across the UK there is better training than hitherto has been the case in these areas.

Chairman

  831. With regard to training and epidemiology, when we were in the States at CDC we were most impressed by their programme called "gumboot epidemiology", where all the epidemiologists had to do some fieldwork and that is an area that is not well developed at least in England. It would be interesting to find out whether the HPA would consider developing or encouraging others to develop this sort of activity.

  (Dr Troop) What they do not have are these general public health professionals in quite the depth that we have and, of course, my core training in public health was in epidemiology so I am very keen that we build up the local capacity of people in health protection which would include epidemiology as part of their training, but that has to be put alongside all the general public health skills you would need to create change in a local community and also to respond to emergencies. I hope that in the Agency we will have the opportunity for people of a whole range of disciplines to move around and experience different parts of the organisation in two directions. Now that we are one organisation the local people can rotate centrally and vice versa. I think there will be an opportunity for much wider experience for the whole range of people in the organisation.
  (Sir William Stewart) You are right, my Lord Chairman, we have got to work at the coal face and make sure that we know precisely what is going on among the "gumboot epidemiologists". You have really got to focus some of your attention down at that level rather than all of us sitting in some lecture theatre saying this is what has got to be done or not got to be done.

  832. If there are no more questions on that topic—I beg your pardon.
  (Sir William Stewart) My Lord Chairman, are you not going to allow me to say something about the training of science journalists?

  833. Please.
  (Sir William Stewart) I think it is quite wrong to suggest that science journalists by and large need training. Science journalists by and large are actually very professional in this country and we have to treat them as equals, we must not try to manipulate them, I think you should trust them until they let you down. In relation to the HPA, I believe we have got to be open with the journalists, we have to show them examples of where they can get good copy and by having them, for example, up at Colindale at CPHL, at CDSC or down at CAMR. We have to bring them in and get back to this thing about good messages — about what the HPA is doing for the health protection of this country: Get the information across and out as my Lord, Lord McColl said, into the community.

Lord Lewis of Newnham

  834. One of the problems surely is the fact that when you actually are dealing with certain elements of journalism good news is no news; it is bad news that is good news as far as they are concerned. If you take the MMR situation over vaccination, once an idea is developed and is popularised by a relatively small group of press it holds and the public require a lot of persuasion out of it. That is where one of the dangers comes in my mind, it is getting in early enough to be able to establish the realities of these situations.

  (Sir William Stewart) That is fair.
  (Dr Troop) My experience on the take of MMR, which I had to front a lot of, was the science journalists on the whole were quite supportive. The problem is when it gets beyond the science journalists into the political journalists and that is what happened with that particular issue. I remember having to do something on landfill sites, which was quite complex, bringing the science journalists together, having the experts who had done the study, taking them through the information and as long as we did that with the science journalists we usually got a very good, balanced report, usually about page 11 and that is fine. It is not fine when it goes beyond that and it ends up on page 1 with the sub-editor choosing a headline which the science journalists might not have done. You do not win all the time, but on the whole we found our relationship with them was much better.

  835. Please do not misunderstand me, I am sure that what you are saying is right because one of the most difficult concepts is the assessment of risk and I think that is where the whole of this problem sits. Very often when we look at any problem of this nature it becomes very much a personalised problem and then the word risk comes into it and the whole definition and the problems involved with that are enormous. I am not trying in any way to underestimate it. I do genuinely believe now that an organisation like yours is going to face the responsibility of having a consultative group who are able to provide the information in a digestible form, in the right form to the press, but inevitably, as you rightly pointed out, page 11 is where it will appear. When it will have impact is when it comes on page 1.
  (Dr Troop) When it is on page 1 it is usually negative. Media strategy is one strand of our communications strategy.

  836. I was most impressed by the enormity of the problem Sir William very aptly illustrated to us at the beginning. So you are going to have to face orders of priorities in what you are going to do. One of the interesting features that has come forward recently is that some chronic diseases that were not necessarily thought to be concerned with infection have been shown to be related to it. How is the HPA going to develop programmes in this particular area or would you have to put this down at a lower priority? Your initial impact as far as I am concerned is tremendously impressive. You have a tremendous problem, you have a large number of variables. How far do you view this particular area as a problem?
  (Dr Troop) It is one that the CMO picked out in his strategy and it is therefore one of the priorities that we will pick up because under our priority areas we will be responding to the ones put in Getting Ahead of the Curve and a lot of work went into identifying those priorities. Obviously we will respond as well as to the FSA and to the other strategies. When I was referring earlier to looking at long-term chronic effects in different sectors, that is part of the problem that we are setting, whether it be the long-term effects of low exposure to chemicals and the long-term effects of exposure to infections and looking at this rather common methodology and we have got a group starting to look at how we might develop that methodology.
  (Sir William Stewart) My Lord Chairman, it is not one or the other, is it? I am not a medic. However in coronary heart disease, for example, which is a Government priority, I understand that there is the example of chronic effects caused by chlamydial infection. That is the sort of thing that we have got to look at—the total picture. I think we ought to be seeking to carry both of these forward.

Chairman

  837. I think we recognise you have quite a task on your hands to prioritise areas. Does anything come to mind at the other end in the PHLS that you consider might be redundant?

  (Dr Troop) Not yet! As Sir William says, we are now 12 O' hours old and I have been there a month, but what we have all agreed—and it is the same and it happened in the PHLS, it happened in all the other organisations—is that when you start looking through your priorities you have to examine all of your work and sometimes problems are getting less and infections may not be as much of a priority as they were maybe a few years ago and you have to redirect your resources and that happens in every organisation and it is obviously something that we will do. We are quite ambitious over things that we want to do. We will make the savings we can and we will attract which funding we can, but then after that we will have to choose priorities.
  (Sir William Stewart) Let me just make one comment. We have three boards at the present time or we did have; we do not need three for the future.

  838. Sir William, Dr Troop, thank you very much indeed for coming along. We have covered a very wide area and you have been very open and helpful to us. We have yet to read your preliminary thoughts and we may find some—
  (Sir William Stewart) My Lord Chairman, can I just make a point about that? That came in very recently, but it was not at all associated with today's appearance, it was because I was encouraged by some of it.

Chairman: Thank you very much for that. If there is any point you feel that we have not touched on or should be elaborated upon and you have not had time to do so, please feel free to submit additional material on it. You will get a copy of the transcript and you will have an opportunity to correct factual errors. I think it only remains for me to thank you very much for coming along, it has been a very interesting and informative session. Thank you.







 
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