Select Committee on Science and Technology Minutes of Evidence


Examination of Witnesses (Questions 839-859)

MS HAZEL BLEARS MP, DR GRAHAM BICKLER, DR VICKI KING AND DR AILSA WIGHT

TUESDAY 8 APRIL 2003

Chairman

  839. Good morning, Minister. Thank you very much indeed for coming along. We have been going for quite a while with our evidence and you will be delighted to know that this is our last public session. So we have the honour of having you here. Firstly, for the record, could you introduce yourself and your colleagues and then if there is any opening statement you would like to make, now is the time to make it before we go into the questions.

  (Ms Blears) Good morning. My name is Hazel Blears. I am the Parliamentary Under-Secretary for Public Health and I have policy responsibility in the Department of Health for the whole range of health protection including, clearly, communicable diseases which is the subject of this inquiry. I am delighted to be here. I would like to introduce my colleagues who are with me. On my far right there is Dr Ailsa Wight, who is the Unit Head responsible for emerging infections and biotechnology. On my immediate right is Dr Vicki King, who is our Unit Head responsible for blood and Healthcare Associated Infections. And on my left is our relatively new Dr Graham Bickler, who is the Head of the Communicable Disease Branch. I think he has been with us just for two weeks now, so this is a very new experience and, I hope, quite a formative experience for Graham to be before the Committee. By way of an opening statement, I did have a lengthy statement but I am sure your Lordships do not want to hear me go on at length from my prepared notes and would much rather get to the meat of the investigation and the questions that you have raised. I think that what I would like to say is that we genuinely welcome the ongoing interest of this Committee in this very important area of work. I know that you have been sitting now for quite some time. You have taken evidence from the PHLS, from the FSA, from the Department of Health and, I think just last week, from the Health Protection Agency, the very new fledgling Health Protection Agency, as well. I think as far as I am concerned, this is a very important area of my policy responsibility and, clearly, with recent events in a number of fields it is becoming ever more important. Obviously with the creation of the Health Protection Agency one of my prime concerns is to make sure that the systems that we have in place to deal with communicable diseases in this country retain that very, very high level of respect and regard that our previous organisations have had and, if anything, for us to build on, augment and take those systems forward. I think that all I would like to say really at the opening is to place on record my huge thanks to every member of staff in this period of transition that they have all been going through and the way in which they have pulled together really so far. I do have every confidence in them, but I am sure that your Lordships will want to pursue and drill down on some of the challenging issues that we are still facing.

  840. Thank you very much indeed, Minister. If we can go to the first question, which I will take. In doing so, I need to declare an interest which is as a member of SACAR, which is the Scientific Advisory Committee on Antibiotic Resistance. What are the formal and informal relationships that the Department has with the Veterinary Laboratory Agency, DEFRA, the Food Standards Agency and local authorities and, in particular, with Environmental Health Officers because we have heard from them that they feel, in a way, rather outside the main drift of health control. As you were saying in your opening statement, there is a need to bring all these people together from the point of view of public health.
  (Ms Blears) Yes, I think relationships and partnerships and mechanisms and systems, as I said at the outset, are going to be absolutely key to success in this field. In terms of our formal relationships, I suppose where I would want to start is really to emphasise the very good partnership there is at government level between the Department of Health, the Food Standards Agency and DEFRA. There is an extremely good cross-government working in all of these areas. Now, clearly it is not enough for officials in government departments to be connected because what they really need is expert advice and guidance on these very technical and very specialised areas as well. What we have formally is we have got the UK Zoonoses Group, which is a very high level group. That is chaired by the Chief Medical Officer. I suppose mirroring that, we have got the Surveillance Group on Diseases and Animal Infections, to give some kind of parity, chaired by the Chief Veterinary Officer. So we have got two very high level groups here looking at these issues. They are underpinned by the two expert advisory bodies; the Advisory Committee on Dangerous Pathogens and the Advisory Committee on the Microbiological Safety of Food. So again, mirrored with very wide ranging expert advisory groups. Again, I think groups that have got a great deal of respect and regard for the work that they do. If I can use initials. I do apologise, I do not usually like to use acronyms, but in this field I think that it is inevitable, but having placed on record their formal names. We have the UKZG, we have got the SGDAI and the ACDP, all of which report to Ministers, all of which are connected to the Department of Health, the Food Standards Agency and DEFRA. I think increasingly the part that I would want to kind of add into that equation will be the Horizon Scanning Panel, the Emerging Infections Panel that is to be established following the Chief Medical Officer's Strategy "Getting Ahead of the Curve". The key new mechanism for strengthening these relationships and these partnerships will be the Horizon Scanning Panel who will, very clearly, be looking forward trying to anticipate the problems that arise and making sure that that Panel is informed by both the Zoonoses Group and the Animal Infections Group. I think it is going to be a key strengthening mechanism for us. I also think that we have now got this draft Animal Surveillance Strategy which is out for consultation at the moment. That proposes a real strengthening of the relationship between the Chief Medical Officer and the Chief Veterinary Officer. I think that that has been a weakness, that relationship, in the past. I am aware that some issues have been raised about whether or not we can get more incentives, certainly into the veterinary side, around notifications. I think two issues that were raised were that the cost of testing and possibly doing something more about vets training, to try and ensure that there are incentives in the system for them to report just as much as, if you like, the health side reports. I think that perhaps there is an imbalance there at the moment and that is an area that we need to do more work on. There is a regular exchange of animal surveillance information between the State Veterinary Service, between Veterinary Laboratories Agency and DEFRA. DEFRA then shares that information with the Department of Health and the Food Standards Agency. So there is a route through DEFRA. The policy on these areas; for Zoonoses it is shared jointly between the Department and DEFRA. So very much a bi-partisan approach there. The policy on food is clearly a matter for the Food Standards Agency, but the FSA cooperates very much with DH and with DEFRA and I am the Minister responsible in the Health Department for relationships with the Food Standards Agency and I have ongoing and very regular meetings with Sir John Krebs and other officials from the Agency. So there is some synergy in there. I think the area of local relationships is an area that needs strengthening. I think that the relationships at National Government level and within the groups and the advisory and expert committees is fairly robust, it seems to me. And yet, when I think about it, the whole system is dependent on the quality and the integrity of the information that comes up from local level. I think that that is less well developed. It is perhaps my experience in government so far, and that is only not quite two years yet, but it is my experience that Government mechanisms are often very robust but then when we get beyond the Government sphere into local communities, then it begins to be less structured. Maybe that is inevitable because local communities are varied and they are different and you will have different systems. But I think that probably at the local level, in terms of the Environmental Health Officers, the local authorities, then that is an area that perhaps needs some more attention from us because, for me, it is a very important area indeed. If you think that the whole of the public health mechanism was originally built on the work done by local authorities around sanitation, around those very fundamental contributors to good health, then I think perhaps the local authority contribution is not as emphasised these days as it really ought to be. I say that as a former local government lawyer. I used to advise my Environmental Health Department on its various statutory responsibilities. So Environmental Health Officers are very dear to my heart and certainly across the Department we are trying to encourage much closer working relationships with them. So I think the national systems are pretty strong. I think the local systems do work and we are getting data up and we are sharing the data. I would not for one moment say that they are in any danger, but I think that if there is one area that needs a little bit more attention, it is those relationships at local level.

Lord Oxburgh

  841. May I declare an interest as a former Member of the Hammersmith Hospitals Trust and occasional Advisor to Food Distribution Systems Europe. Minister, just to pursue the remarks you have been making, I think you have indicated that nearly all of the bases are covered, but we are in a rapidly changing and, in a sense, new situation. Veterinary officers are almost exclusively concerned with domesticated animals of various kinds. We may have to look at vectors which are in the wild animals; birds or insects, things of that kind. How do you see that being covered?

  (Ms Blears) I think you are absolutely right and as the world changes, we have already seen issues, I think, around Avian Flu, for example, the incident that arose just a few years ago, and with new and emerging infections. I think that one of the things that will assist with this is the Emerging Infections Panel that I have already mentioned and the Horizon Scanning work that we will do, because this is really to respond to the new world that we are all in now, increasing global travel, increasing interfaces between new diseases that are emerging and things that we have perhaps not anticipated in the past. Therefore I think it is important for the Emerging Infections Panel to have good robust links with the Surveillance Group on Diseases and Animal Infections. I think it will be important to make those links across there. I think that the Zoonoses Group clearly is going to continue to be a very important body in making sure that we make those links even stronger than they are now.

  842. With respect, Minister, it is not so much the links as the primary observations.
  (Ms Blears) I think that the work of the Chief Veterinary Officer and the strengthening of the relationship between the Chief Veterinary Officer and the Chief Medical Officer, which is contained in the surveillance strategy which is currently out for consultation, will ensure that the Chief Veterinary Officer, with his links through the field and through his operatives in terms of that surveillance and that notification, will give us more information, wider information, better links through. And I think that that strengthening between the CMO and CVO will be absolutely crucial here to enable us to draw on more of that primary notification of a wider variety of agents than we might have seen before.

Chairman: Lord Lewis, do you have a comment or do you wish to—

Lord Lewis of Newnham

  843. Could I just ask a subsequent question on this, if I may? It does seem to me that the interaction is often very difficult to establish because, of course, it is a recognition of a need before you can actually get the thing in operation there. One of the things that worries me at the moment is the problem over waste and waste disposal and the potential that we have here for public health associated with that. Now, who would hold this responsibility? It could be DEFRA. It could be yourselves. It could be having something to do with the local authority. All these are participating parts of this particular problem and with the new Waste Regulations coming in, the fact that waste is increasing at the rate that it is increasing, it does seem to me that this a major problem which is going to cause considerable concern, even from the point of view of just where you are going to actually put the waste, from the point of view of establishing sites, things of this nature.

  (Ms Blears) I think clearly the issue of waste disposal is an increasingly important issue for many, many communities, particularly as we see landfill sites begin to fill up and become exhausted. We are looking for other methods of waste disposal. They are all controversial. They all seem to be equally controversial, whether it is incineration or any other kind of waste disposal. They are controversial at local level, in terms of planning permissions in local communities, and they are controversial at national level because clearly the scientific information that we have can vary in terms of the medium and long term impact of various schemes of waste disposal. Clearly the primary function, I think, rests with DEFRA in terms of the waste disposal function, but certainly in the Department of Health we have an ongoing and very real interest in the kind of emissions that will come from waste disposal and the effects at local community level. I think this is one area where that joining up of the local level with the national level is absolutely key for us in terms of surveillance and being able to do some long term surveillance as well because often the health effects on local communities are not apparent for some years down the line.

Lord Haskel

  844. Thank you, my Lord Chairman. You spoke about weaknesses at the local level and I presume you mean about the Environmental Health Officers. I do not know whether you have been watching television recently, but there is now a series on television about Environmental Health Officers. The first one was last week, which was about the Environmental Health Officer in Islington. It must have put hundreds of people off eating out in Islington, but what it does show and what a visit of this Committee has shown to me is that it is a pretty low grade job and that I wonder if you have got any plans to do anything about raising the level of the status and the professionalism of the people at the coal face because it seems to me that this is very, very important and very central to the whole problem.

  (Ms Blears) I think that is exactly the point that I was trying to make. I certainly do not see them as a weakness in the system. They do a fantastic job, but I think that perhaps less recognised than they ought to be. I say that with some feeling. The "Life of Grime", part of it is actually filmed in my constituency in Salford and some of the Environmental Health Officers involved are actually Salford City Council employees and doing a wonderful job indeed. I think that that is right. For me, the Environmental Health Officers are a key part of my public health workforce. They are not employed by the Department of Health, they are employed by local authorities, but they are incredibly important right across the whole field of public health, whether it is housing, whether it is safe drains, clean water, a decent environment, all of the things that go to contribute to people's overall health and wellbeing. Many of them are rooted in local government in environmental health departments. I think in the early days of local government they were some of the key drivers of big major public health changes. I think as local government got more complex perhaps Environmental Health Officers have not had the profile that they have had previously and certainly it is an area that I am quite keen to see how we can raise their profile, their status, their integration into the rest of the public health workforce. They are just as much public health workers as health visitors at the local level. I think increasingly perhaps their training has not emphasised their real public role that they can make a significant difference. When I talk to Environmental Health Officers individually they are pretty passionate motivated individuals. They do some of the dirtiest jobs, but they know why they are doing it and they know they make a contribution. I think it is right that we should not just have warm words for them but actually really seek to raise their status and their profile as part of the public health system.

Baroness Walmsley

  845. Thank you, my Lord Chairman. Minister, all this integration takes time and time costs money. Are you satisfied with the resources available to the local authorities to resource their environmental health function?

  (Ms Blears) What I would say about local government is that I am always conscious of the pressures that are on local councils. We ask them to do an awful lot of things. They are very much our delivery agents at local level right across the piece. But local government, as I have to say in the Health Department, has had a pretty significant real terms increase in its resources during the period of this Government and indeed the Government since 1997. I still recognise that there are pressures out there and clearly they need to raise resources, but for local government as a whole there has been a significant increase in the central grant allocated to them and my experience is that the vast majority of local authorities are doing an excellent job in terms of environmental health work and indeed their other responsibilities. They recognise how much good environmental health enforcement work at local level can underpin the rest of the statutory responsibilities that they have. And as I say Environmental Health Officers work not just in terms of the drains on the "Life of Grime", important though that is, they also work on public sector housing, on houses in multiple occupation, trying to ensure that people have a good, healthy and safe environment which clearly has an enormous impact on infectious disease as well.

Chairman

  846. If we could just return to the Environmental Health Officer situation, there is a problem in recruiting people into the Environmental Health Officer service and of training them too. Have you any plans to alter that situation? Or are you aware of it, in the first place, and if you are aware of it what is the Department's attitude to the problem of recruitment there?

  (Ms Blears) Clearly there are problems with recruitment right across the board in the public sector. Specific in the NHS recruitment and capacity is our biggest problem. And there will be problems in recruitment for local government as well. In terms of the Department of Health, we do not have any direct connections or levers into local government recruitment, but I think that what we can do is to try and enhance the status and the profile and the importance of the job of an Environmental Health Officer. That is why in the public health networks that are now being established in local communities, Environmental Health Officers have to see that they are key players in that. The new public health landscape, after "Shifting the Balance of Power", is going to look very different in that we have got Regional Directors of Public Health working in Government Offices. We will have Directors of Public Health now in every Primary Care Trust, so really bringing the public health function up front at local level. Those Public Health Directors in Primary Care Trusts will be working in networks across their communities and trying to mobilise the whole of the public health workforce and that does include people like health visitors, Environmental Health Officers, a whole range of officers for whom they will not have direct managerial responsibility but whom they will be able to draw in to that public health network. I think that that is a much more exciting place to be, if you are an Environmental Health Officer, than perhaps working in an isolated outpost in a small district council where you perhaps do not have those opportunities to share good practice, to develop your own practice and really feel part of a public health kind of push on this. So I think the new organisational structure of the NHS, in drawing together public health networks, will help to encourage more young people, when they are thinking about a career, to think about going into environmental health.

Chairman: Thank you. Perhaps we should move on to the next question. Lord Oxburgh?

Lord Oxburgh

  847. Minister, I would like to turn to the question of the development of new vaccines and perhaps new diagnostic tests. Clearly this is an area in which your Department has a role. The DTI, in its support of business, has a role and indeed the Office of Science and Technology, in its support of research, has a role. How do you see your Department's position in this?

  (Ms Blears) I think we have got a very central role in trying to encourage new research for vaccines and for diagnostic tests. I think in the CMO strategy this was an area that was highlighted, where we really did need to press on and do much more work. I do understand that there might be some concern that the majority of funding in this area comes from the DTI rather than DH when the Department of Health does fund as well, but the industry interface is very much with the DTI. I would make no apology for that because the DTI are extremely well placed in ensuring that companies can get access to a whole range of resources, whether it is from the European Union, whether it is the Technology Enterprise Programme, whether it is the University Challenge Fund. The DTI is working with every sector of industry and therefore rightly will work with the biotech industry as well in making sure that they can have access to all of these funds. But where our Department comes in I think specifically we have been funding CAMR in terms of development work for diagnostic tests. I think we have given them £3 million, what we are doing at the moment for vaccine development and we are also funding the Vaccine Evaluation Consortium, the collaborative that is working across the country. I understand that they are funded for half a million pounds each year for the next three years and up to 2002 we had actually funded £5 million for development of the AIDS vaccine as well. So the Department of Health is very much involved in trying to stimulate research and evaluation and new techniques in this area. But I think if we can draw in support from the DTI and from industry itself, then again I suppose we are back to that first word which is about partnerships and in this field of development and innovation I think those partnerships and joint ventures are absolutely key to getting as much development work in this area as we can.

  848. If we pursue this in a little more detail, if you think of the different organisations that might be working here, you have the Medical Research Council, you have the Wellcome Trust, you have yourselves and you have industry. Now, do you envisage any strategy here or is it a matter of sprinkling some money round and hoping that the right vaccines will emerge by one route or another?
  (Ms Blears) No. I think it is right that we should really try and identify where the gaps are and then to direct our research into those areas where we think we will be able to fill those gaps with the development work that is going on. I think we should have a strategy to try and ensure that the investment that we are making—

  849. You should, but do you?
  (Ms Blears) Well, yes. I think we certainly do.

  850. Do tell us, please.
  (Ms Blears) Well, the Bioscience Innovation and Growth Team that is working with the DTI and with industry and with the Department of Health is bringing together all the companies, all the relevant stakeholders. It is under the chairmanship of Sir David Cooksey. It is looking at how Government policy and investment can encourage innovation and growth amongst UK biosciences companies. They have got four working groups looking at specific topics and one of those topics is about NHS and industry partnerships and how it can be configured to try and ensure that we do draw through as much development for new technology, for vaccines, for diagnostics and for medicines. I think the conclusions of that working group are likely to be available in July this year, when we will be able to present those conclusions coming through. In terms of the vaccine related research that is going on, there are a number of different programmes. We have been concentrating around the areas of TB, meningococcal B, diagnostic tests for the new fevers, Lassa Fever, Ebola Fever and also looking at the new Hendra and Nipah viruses as well. So those new and emerging infections, very important for us to see is it possible for us to do development work around there. So I think yes, there is a strategy which is about trying to identify gaps and seeing how we can fill them.

  851. Do you see different roles in this strategy for the different groups that I mentioned? I mean are there particular kinds of conditions that you would regard as more the responsibility of the Research Council than the Department of Health, for example?
  (Ms Blears) I am not aware of that. I do not know whether any of my officials are aware of different infections that might be more appropriate to different bodies.
  (Dr Wight) I suppose in terms of developmental work, traditionally we have always looked to, say, the MRC or perhaps the Wellcome to help us with those sorts of areas. I think we very much need to involve all of these groups as we work through what the gaps are and how we plan to address them. I do not think it is necessarily sort of sector specific at the moment. I think it is just bringing everybody in and saying what is it that needs to be done and therefore who is best placed to do it. The Biotechnology Industry Association, I think, will have a major contribution to make there as well, but I think it is, as the Minister said, very much a question of partnerships and identifying—

  852. Is there a forum where this discussion can take place at present between these funding organisations?
  (Dr Wight) At the moment in terms of new technologies and the initiatives that the Minister mentioned, the Department's R and D Division are the main input in terms of research. So I think it depends what the output in terms of the report is going to be produced this summer and I think then it will be up to the Department to go away and say "What are the key messages for us?" and "Who do we need to go and talk to?" and bring the research aspects to the attention of MRC.

  853. But what you are saying is that there is not a regular meeting, it does not have to be frequent, between the MRC and yourselves and Wellcome, for example, in order to say how are we going to—
  (Dr Wight) No, there is not a forum at the moment.

  854. Thank you. Could I finally ask you; how would the UK promote the rapid development of a vaccine for an emerging infection like SARS?
  (Ms Blears) I am sure that we are going to get onto the question of the rapid vaccine development proposal that has been made at CAMR as to whether or not this is a real gap that needs to be filled in terms of our strategic sort of capability and clearly there, at the moment, we do not have a facility that is able to rapidly develop those vaccines. There are a number of reasons why we are at the position that we are in now and some of those are financial, some of those are technical in terms of how feasible is it to have a rapid system for developing a vaccine? The information that I have is that almost the description of something as an emergency facility is almost a misnomer because of the development time that it takes to bring this kind of product on board. It may well be that with emerging technology those development times can be concertinered and more focussed, but at the moment the information that I have is that a six month period is a likely period for the development of a new vaccine and therefore we are not in a position to produce something instantaneously to be able to combat those new and emerging infections.

  855. Would we be in a position to produce something in 12 months?
  (Ms Blears) Certainly the time scale that I understand is at least six months, so that implies that within 12 months that that may well be feasible.

  856. But how would one do it? I mean what mechanism would you use?
  (Ms Blears) It would depend whether or not it is appropriate for DH to do it, through the Health Protection Agency, through CAMR, as was, or whether or not it is appropriate for another partner to do that, whether or not it is a commercial development, whether or not there is sufficient interest in pharmaceutical partners to be able to develop that and I think we would have to take a view. I mean it is my understanding that our reason for looking at the possibility of having an emergency facility ourselves is that we would be able to do that as Government in order to respond and again it is a matter of getting the balance right between us doing what we can do and what is appropriate for us to do and what it is appropriate for other partners to do in a field in which clearly they have got a great deal of expertise.

  857. You would regard it as your responsibility to take a lead here and either decide to do it yourselves or to make sure that someone else did it?
  (Ms Blears) To ensure that it was done, absolutely.

Chairman

  858. Dr Bickler, did you have a comment on this?

  (Dr Bickler) No, I was nodding in agreement.

Lord Lewis of Newnham

  859. Can I ask you what you are doing about SARS?

  (Ms Blears) About SARS we are obviously in the kind of surveillance phase at the moment. There is a huge amount of work going on in terms of trying to develop a diagnostic test. I know that we are collaborating with the WHO, with laboratories right across the world to try and develop this and so far, luckily, I think we have only three possible cases in this country and each of the people has recovered. But I think there is a hive of activity going on internationally at the moment to try and see if we can develop a diagnostic test. I do not think that we are approaching that just at the moment.
  (Dr Bickler) There is a possible one in Hong Kong but there are question marks about it still. It is very early.


 
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