Examination of Witnesses (Question number
TUESDAY 1 APRIL 2003
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.
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
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
(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.
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
(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?
(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.
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
topicI beg your pardon.
(Sir William Stewart) My Lord Chairman, are you not
going to allow me to say something about the training of science
(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 atthe total picture. I think we ought to be
seeking to carry both of these forward.
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 agreedand it is the same and it happened
in the PHLS, it happened in all the other organisationsis
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.