Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 860-879)



  860. I suppose I am asking the question in more general terms. How do you go about dealing with an international problem like this? Is there an organisation that will allow you to interact to deal with a problem of this nature? Or do you each work in isolation and then compare notes?
  (Ms Blears) I think that there is a very well established system through the WHO of notification, of international collaboration. I think we are going to come on later to a specific question around the WHO, but I think SARS is probably a very good exemplar of the way the system can and does work in the interests of the world as a whole.

Chairman: I think we will come back to vaccines and quick responses later on in this session, but can we move on to question three? Baroness Warwick?

Baroness Warwick of Undercliffe

  861. Yes, thank you, my Lord Chairman. Minister, the creation of any new body, putting together other bodies, inevitably has restructuring costs associated with it. We have had evidence from a variety of sources expressing a degree of scepticism about the possibility that the Health Protection Agency will be cost neutral. Could you perhaps explain why you think that it is possible that it should be cost neutral and over what time scale it is anticipated that it will prove to be so?

  (Ms Blears) Yes. I think to deal with the phrase "cost neutral" at the outset, I think what we envisage by this is cost neutral in terms of the Department of Health's budget and our settlement in the Comprehensive Spending Review. Clearly, we have got our money for the next three years from the Chancellor. We will not exceed that and all of our organisations and elements of the Department of Health, the NHS will all have to live within that overall spending envelope set out in the Comprehensive Spending Review. I think the figures for the funding for the HPA over the next three years are again significantly enhanced. We have got £112 million this forthcoming year, £118 million the year following that and £123 million for the year following that. And like the rest of the NHS the HPA is in a position that it has got a three year forward funding programme. That is something that we have never been able to do in the whole of the NHS up to now. We have always had annual rounds of funding which have made it very difficult indeed for people to plan their services. But I think any organisation should have at least three years so that they can take, if you like, the swings and roundabouts because some years there will be more costs than others. So they are working within this three year framework that they have got and inevitably there will be some sort of initial costs and we shall be straightforward about those. There will be initial set up costs, which we have already incurred, which were mainly around the costs of the implementation team, the people who came from all the constituent parts of the Agency. We have had to be working over the last year to try and get the transition right. There will be some costs for the establishment of what I am told is a very small headquarters and very modest headquarters, I am being told, but inevitably they will need some central base although most of their workers will be out in the field in their various organisations. There may well be the costs of some redundancies. Obviously we are trying to keep those to an absolute minimum, but certainly where we have got a number of different agencies coming together and they will need obviously only one board, one corporate support system and within those organisations there may well be some redundancies to fund. The third area really is development work and capacity building costs. I think the two areas that have been highlighted to me which are perhaps in need of the biggest boost at the earliest stage are the chemical division, which I think is perhaps not as well organised as some of the other areas, and the development of the new emergency response division, which will be costs as well. So I think that the cost neutral sort of phrase is saying that yes, it will be costed within that envelope, but clearly within those increasing resources, which they are, both in revenue and capital terms, then we do hope that there will be some pretty significant service developments as well. The capital budget is going up not quite as much as the revenue budget from £8.7 million to £9.2 million next year and £9.2 million the year after that. In addition to that funding, they have also got some money to carry forward from this last year. They have got £8 million revenue to carry forward, £2.5 million of capital, that is from slippage of programmes, again inevitably with change and transition some programmes will slip, and I understand that CAMR have had an extremely good year on their contracts and they have got £5 million surplus to carry forward into the organisation. So I am delighted that CAMR have been able to come up trumps with some extra money. So I think there will be savings on some areas because you have got one organisation but clearly increased pressures on costs in other areas too.

  862. So within the three year envelope you will be making judgments about effectiveness and whether or not the HPA is, in the phrase, giving value for money. But what happens if it turns out not to be, however we define this phrase, however many ways in which we move the money around, if it turns out not to be as cost effective as you had hoped? What happens? What is the impact then for the implications for communicable disease work?
  (Ms Blears) I think the Health Protection Agency is going to be in the same position as any other non-departmental public body and indeed in the same position as the National Health Service in that there is a budget and that we all have to live within those budgets and deliver the very, very best service that we can within that. We are going to explore issues around workforce and around information technology, around the redesign of services. The whole thrust now, within the NHS, is to say how can we redesign services that we get better, more effective, more value for money, people working in different ways, I hate to use that kind of almost hackneyed phrase now, but a more modern service that is able to produce from increasing resources as well? We must not forget this, there is increasing investment going in but if we have that investment going in and new ways of working, we ought to get more effective services out of it. So the HPA will be in exactly the same position as every other constituent part of the Health Service. It will have to live within its budget, but I am confident that the budgets that are being proposed for the Health Protection Agency will result, as in the strategy from the CMO, in a significantly strengthened and more effective set of responses to the problems it faces.

Chairman: Thank you. Any other comments? If not, can we move on to question four. Lord Haskel?

Lord Haskel

  863. Thank you. We have already spoken a little bit about the collaboration with the World Health Organisation. We were informed that the World Health Organisation would like to use UK laboratories and expertise, but have often been asked to pay to have the tests done. Obviously they expect some kind of contribution in kind. Are there are any form of arrangements within the Department of Health for providing, at no cost, laboratory support and secondment of experts on short or mid-term bases to the WHO?

  (Ms Blears) I think I might just start off by saying that we think work with the WHO is incredibly important in two ways, I suppose. One is that we want to play our full role in international co-operation and collaboration. We think it is a responsibility of our country and our Government to do that. But secondly, it is also in our own interests too. That we have been able to get experience out in the field of a wide variety of infections that we would not have here in this country means that our clinicians and our experts and our scientists can develop their own practice. So we do it because it is the right thing to do, but we also do it because it makes good sense for our situation here in this country. At the moment I understand that eight of the reference laboratories in the Health Protection Agency are WHO collaborating centres. I think the HPA, when they gave their evidence to you, actually highlighted which ones they were. I think there are five of them, like Colindale, and then there are three other ones; one at Hereford, one in London and the one at Porton Down. So they have already got that kind of collaboration centre status, which is good. That shows me that we are playing a full part in WHO work there. I understand that there are no formal agreements as yet and there have not been in the past. It has been very much a matter of trying to co-operate. I think there are what is quaintly referred to as APWs which are Agreements to Perform Work and how those differ from contracts or memorandums of understanding or concordats is another matter, but clearly they are not legally enforceable contracts. They are Agreements to Perform Work and they set out that we want to work with WHO both through what was formerly the PHLS and indeed from the Department of Health as well. We have always seconded experts to the WHO. I think we sent our experts to work on diphtheria in Russia, on Lassa Fever in Sierra Leone and obviously the work that we are doing on SARS at the moment, working with Hong Kong and China. So obviously we want to carry on doing that. We want to make sure that those Agreements to Perform Work carry on with the organisation. I think DH funds the WHO by about £14 million a year and DIFID gives a similar kind of amount. So we are one of the major funders of the WHO as well. So there are no formal arrangements as yet. In this area, I think it is something perhaps for us to explore, not just in work for the WHO, but I think increasingly, as the Health Protection Agency emerges as a strong and independent non-department public body, it is going to get an identity of its own and rightly so, because we do want it to be a more upfront public organisation than has been the case in the past. And it might be that we need to explore whether or not we should be more transparent and more open about the kind of relationships, agreements, concordats that are out there, but certainly we want to play our full part in supporting WHO work both globally, as I say, but also because it enables us to get our experts extremely well trained and to play our part too.

  864. So are these collaborations at no cost or do we charge?
  (Ms Blears) It is my understanding that they are at no cost. So I am certainly not aware that we charge. That is news to me. And we certainly would not want to be in a position that we were preventing good necessary work taking place because we were simply charging and I do not think that we should be in that position. As I say, I think that maybe there is a case for being more transparent about the kind of work that goes on, the kind of collaborations and what benefits there are out of them, but certainly it is not my information that we charge at the moment. Do you want to give an example?
  (Dr King) Yes. I was just going to give you one example about how we collaborate with the WHO at an official level and at an expert level. They have various working groups and there was one that I was involved in, which was a WHO UN AIDS working group. There were various workshops around the world in different geographical areas that were looking at the demand and the need for an HIV vaccine. One particular group met in Geneva and pulled together conclusions from all the various working groups around the world. This was just before the announcement about the third phase of the clinical trial of an HIV vaccine that fairly recently showed, in fact, that the efficacy was lower than we had anticipated. But that was kind of preparatory work in case it was a higher efficacy and therefore governments around the world would be prepared to see what demand and need there would be in their country. But there was no charge for that. No cost to the WHO.

Baroness Walmsley

  865. Thank you, my Lord Chairman. Minister, you mentioned all these collaborations. I just wondered, does anybody keep a weather eye on the range of collaborations to ensure that our scientists and clinicians are actually covering the ground in terms of the range of expertise of emerging diseases that we are bringing back to this country?

  (Ms Blears) Yes. As I say, the department is aware of the collaborations that go on and clearly the PHLS, before the establishment of the HPA, would be involved in ensuring that their staff were able to be seconded. I know that the PHLS in their evidence to your Committee said that on occasions there were difficulties for staff in terms of getting the time and the space to be able to do that. Really that brings me to the point that I made to Lord Haskel that perhaps there is a need to have a more transparent overview of exactly the extent and range of these collaborations. Clearly that information is available to both the Department and to the constituent parts of the Health Protection Agency, but I do see emerging, as the Health Protection Agency becomes a more integrated body with many more of these relationships, perhaps a more systematic analysis of just exactly where the work is going on, what the benefits are, to ensure that we are using our resources in the best way that we can. We are happy to make the contribution, but we want to make sure that we are involved in the most effective collaborations for the time and the money that we do spend.

Lord Oxburgh

  866. Minister, transparency is fine and overviews are fine, but the Committee was left in no doubt by the WHO that the level of collaboration and exchange which they saw this country providing was much less than they would have liked and, indeed, they would have expected from a country of our standing in health and indeed our size.

  (Ms Blears) If that were the case then I personally would be very disappointed if that were to be the case, because I do think myself that it is important. We are a pretty wealthy country, a developed country in the Western World in the 21st Century and we ought to be making a proper contribution to international collaboration. So if that were the case, then I would certainly have a look myself at that matter and see what the extent of the collaboration is, are we making our proper contribution, because clearly we have a responsibility to do that. As I say, I have got information about a range of collaborations that are going on. I think we have just started a new one where we are sending two workers out to work in Sierra Leone looking at Lassa Fever and Malaria. So I am sure that they are going on. Whether they are enough, if the WHO are saying that we are not playing our part, then I would be very concerned indeed about that and I will look into it personally.

Lord Rea

  867. Lord Oxburgh asked the same question that I was going to ask almost exactly using the same words. But I was very pleased to hear that the Department, through the HPA, is hoping to have very good collaboration with the WHO in the future. Let us hope it is a bit better.

  (Ms Blears) Indeed.


  868. When we were at the WHO, this issue came up and then when we did raise it with other people who came to give evidence, it was stated that the Public Health Laboratory Service found it difficult to send people over to Geneva, for example, or elsewhere, because of lack of capacity, manpower capacity, on a short term or long term basis compared with CDC in Atlanta in the USA where they did have that capacity and had a ready body of people to move. And they laid it into us, if you would like to put it bluntly, that, as Lord Oxburgh said, that we were a well developed country with a good science base for scientists and that should we make this point in our inquiry, which we are doing now to you, Minister.

  (Ms Blears) Yes, you are making the point very forcibly indeed to me and I do think that we have an international responsibility. I would say obviously that CDC in Atlanta is a hugely more resourced organisation than some of ours are. Inevitably we are going to get onto the issue of workforce and I can understand perhaps the PHLS feeling constrained in terms of capacity. It will always be the case, until we have grown our workforce right across both health protection and the NHS, then we will always be under pressure to deliver the day to day business that we are involved with and the margin of our capacity to be able to take part in collaborations will always be constrained. But equally, it brings me back to the point that I was making about the system working in a different way and it may well be that what you gain from collaboration then helps you to run your own system more efficiently and effectively. What we are quite poor at, I think, in public services in general is seeing where initial investment can actually pay off later along the line. It is very hard to do because you are talking about resources from the front end and investing them in longer term collaboration. It is almost searching for the Holy Grail in Government and particularly as a Public Health Minister. If you can get money out of treatment and into prevention, you know very well that it would save you a fortune in terms of the eventual cost, but the actual mechanics of getting that money out to give us that capacity to do it, that is quite difficult. But there will be differences between us and America inevitably because of size and scale, but I want us to play our proper part.

Baroness Finlay of Llandaff

  869. Thank you, my Lord Chairman. I want to, if I might, pursue this a bit further because when we were in Geneva one of the issues that we heard about related to specimens quite specifically. In the new Health Protection Agency, as it has been established, is there a specific remit and budget to contribute to international work, because the laboratories being devolved to NHS Trusts will not individually have a budget within that NHS Trust to take specimens from outside the catchment area or the specific referrers commissions to that Trust, within those Trust-managed laboratories as they are now.

  (Ms Blears) It is obviously very early days for the Agency and they will now need to be establishing their various budget heads for the work that they are going to be involved with. I think that that will be a key task for them and obviously the most important thing for them to do, in terms of deciding where they want to spend their money and where they can best invest to deliver the functions that they have got to set out. In terms of the laboratories at local level, what we have got to try and do, and I do not underestimate the difficulty of this, is to get those laboratories which are going out to the NHS, the 31 laboratories, to still be engaged with the culture that they have a public health function as well as a clinical function for the particular Trust that they are embedded with and therefore making sure that there is support, there is specimen taking for notification, for them going through the whole chain. That is going to be a key part of the relationship between the HPA and those Trusts at local level. Therefore the regional post of the Regional Microbiologist I think is going to be quite key in ensuring that there is still a real and significant and tangible connection of those Trusts in terms of sending samples and of making sure that the public health element of the work that they do beyond their clinical responsibilities continues to happen. What the HPA wants to put in its budget, in order to deliver that, is going to be a matter for the Agency in terms of drawing up its plans, but clearly it will be an important element of their work because they want to continue this kind of collaboration.

Chairman: Perhaps we can move on to the next question, Baroness Finlay.

Baroness Finlay of Llandaff

  870. Yes. If I may, I must declare an interest as a Vice-Dean of the Medical School in University of Wales College of Medicine. Because we have already discussed the problem of Environmental Health Officers and recruitment and retention, we have heard from people about the problems of recruitment and retention of clinical infectious disease consultants and clinical microbiologists and public health doctors and we wondered what your concerns are relating to this and what your plans are to address this health prevention and disease control workforce who are somewhat of a Cinderella group.

  (Ms Blears) First of all, to say that I think it is an incredibly important part of the workforce. I would not want them, for one moment, to think that they are viewed as a Cinderella group. I understand why they might have concerns about that, but for me people working in infection control are one of the bedrock foundations of a health service and again, particularly as Public Health Minister, making sure that we have got these building blocks in place means that hopefully we can prevent disease, which is really incredibly important if we are, as well, to limit the pressures that are on the NHS. If we prevent disease happening, or catch it early, or treat people quickly and get better outcomes, then the eventual cost to the NHS of picking up the consequences of long term disease are much reduced. So, if you like, the reason for my existence is almost to try and get the building blocks of public health in place. In terms of workforce, I think that now the workforce is probably the overriding concern in the health field. In the past we have lacked resources, we have not had enough money for the system to function and I think that now, with the biggest ever increase going into the health budget, a real terms increase over the next five years of 7.5% a year, a real decision to increase investment in this area. The big question now is getting a trained qualified and skilled workforce to be able to deliver what that investment can mean in terms of improving health in this country. And right across the NHS now there is a need to grow not just doctors, nurses, therapists, physiotherapists, occupational therapists, every single specialty you can think of. I think there is something like 82 professions who work in health, at least because whenever we try and make a list we always leave somebody out and they get upset about it. I understand that. Having said that, looking at the numbers in infectious disease, public health and medical microbiology and virology I am a little more encouraged. There are still shortages but if I can just give you some figures. If we look at consultants in infectious disease first of all, in September 2001 there were 88 consultants. By September 2004 we are projecting that we will have 127. So that is a significant increase there. We have got 58 registrars in training and the 127 figure is a net figure taking account of retirements or people not completing. So we will be going up from 88 to 127, which is a pretty significant increase in that area. If we look at medical microbiology, September 2001 we had 379. We anticipate achieving 447 by 2004 and we have got 143 people in training again. And in public health medicine, we have got 633 now and we anticipate having 799 and we have got 283 people in training. So significant increases right across the workforce. That is the same in every part of the NHS. We have already got an extra 40,000 nurses in the NHS and we, in our plan, make a commitment to 1,000 additional specialist registrars as well. Now as well as the figures we set out in the plan, we have also now this last year and in 2003-04 we are giving extra funding to Trusts to create even more training places and posts out there than were originally envisaged. In this coming year we will have central funding to support the implementation of eight additional SpR posts in microbiology and virology, two additional ones in infectious disease, two additional posts in public health medicine and in addition Trusts are now given their own local flexibility if they want to. I mean they have to find the money to do this, but they can fund another 10 additional posts in microbiology, 10 additional posts in infectious diseases and seven additional posts in public health medicine. So a real growth in workforce in all of those areas. The other two things I just really want to mention is that I think that we have got to work with the Royal Colleges to try and make sure that we make this an attractive field to go into, that people want to be part of this workforce and I genuinely think that the development of the Health Protection Agency will give people a real boost that this is going up the political agenda and is an area that we really want to promote. I think that the other thing that we are trying to do generally across the NHS, and it applies in this field just as much, is to get the skill mix in so that people are doing things that perhaps previously they would not have thought about doing. Working in a more flexible way trying to get people to be able to extend their skills into areas that perhaps have been the preserve of particular specialties in the past and beginning to flex around some of the content of those jobs so that the jobs become more interesting, more satisfying, more worthwhile for people who are not necessarily the consultants but are doing the jobs at the next level or the next level below that. If we can make the jobs have better content, then people will want to come into the field. Much more team working, much more multi-disciplinary working, so there is a sense that you are all engaged on the same objective and again you get the satisfaction of the outcomes that you are able to see happen there. And that is what we are trying to do right across the NHS and nowhere more importantly than in this field. I would just say the other part of the equation is that we recognise if we want people to come into this field then, as an employer, whether it is a Trust or whether it is the HPA or whether it is the Department nationally, we have got to ensure that we can give people flexibility. There are issues around child care, about hours of working, about trying to fit in with people's family lives as well. We need a work life balance, trying to make sure that the jobs are attractive places to be. We have just launched the flexible career scheme which helps doctors maintain their careers. If they are able to work up to 49% of their time full time, then we can keep them in their jobs and keep their training and keep their expertise up to date. So retaining people is as important as recruiting them as well. As well as getting the new people in the front door, we want to make sure that they are not leaving us at the same time through the back door because their working lives are not satisfactory. So in this area I think the figures are reasonable but we have still quite a long way to go.

  871. If I may follow on, thank you, Minister. We have had some concerns expressed about difficulties of attracting students onto environmental health courses and yet last weekend I was with medical students at the Medical Students International Network (Med SIN) and very impressed at their desire to engage in global health concerns and their very high level of motivation. I wondered what work—you mentioned Royal Colleges—but what work specifically you have been doing with the Council of Heads of Medical Schools or with the Heads of Schools of Nursing to engage this undergraduate population in issues around infection control, and the dangers of wide antibiotic prescribing and read about anti-micro resistance.
  (Ms Blears) There has been quite a lot of work taking place, certainly with the nursing professions, around this whole agenda of public health activity, of infection control, of appropriate prescribing, certainly the possibilities of nurses undertaking prescribing in the future and extending their skills. It brings me back to the issue about skill mix and making sure that nurses can do things which in the past perhaps they would not have had an opportunity to do. It means that they have to be better trained and to be able to have the integrity of those skills so that we get safety in there as well. I think wherever I go and wherever I talk to a whole range of professionals they are so keen to embrace this agenda and so keen to take on more responsibility that I think that we have a duty to make sure that they can do that, but safely and within a properly organised and managed workforce development programme and training programme to make sure that the curriculum is wide ranging enough to support them in doing this. We have obviously got workforce development with confederations now in every region of the country working very closely indeed with the colleges, the universities and increasingly working with the Learning and Skills Councils almost to try and get people to think about these jobs as careers in unorthodox kind of access routes. It is not the case that everybody has to be a graduate in order to come through the system and increasingly we are developing access courses, foundation courses so that we get people perhaps from backgrounds who would not traditionally have considered this kind of work because they are well motivated and they want to make a contribution. Just finally, I would just like to mention the NHS University because I do not know if your Lordships will be aware of that. We are hoping to launch that in the autumn and again a key part of the work of the NHS University will be to try and give people access to these kind of careers who have not previously been able to do that. I think that will be a big thrust of our policy.

  872. Just on a small point of clarification. I met with the person who is leading on the NHSU recently who was at pains to say that it was not an NHS University, it was the NHSU because of all the issues around the term university and having a university charter and that it was not going to be setting up in competition to those universities who are well established.
  (Ms Blears) I think absolutely the case that it will not be in competition. I stand corrected if it is to be known as the NHSU which I understand—

  873. Just in conversation this was what emerged that the sensitivities—
  (Ms Blears) I understand. It would be Bob Friar probably who is the—

  874. Yes, it was Bob Friar, thank you.
  (Ms Blears) — leading the NHSU. And certainly absolutely no intention to compete, but really to come at these issues perhaps from a different angle and much of its work will be almost, I suppose, the reverse of traditional universities so that rather than, if you like, a tertiary education, much of its work will be building from the bottom up in terms of access and working with patients and the public as well as with professionals. So it will be a different kind of creature, I think. Do you want to give an example?
  (Dr King) Yes, I just wanted to give an example to illustrate some of the points that the Minister has made. The Baroness mentioned antimicrobial resistance and just to say that the Specialist Advisory Committee on Antimicrobial Resistance that the Lord Chairman is a Member of, has a particular sub-group looking at professional education in that area. It is developing a professional module about antimicrobial resistance and promoting prudent prescribing by doctors and by nurses and supplementary prescribers and will be looking to modify that module so it can be used for a number of different professions.

Lord Lewis of Newnham

  875. In considering the problems concerned with the control of communicable diseases, one obvious paramount feature of this is going to be the effective surveillance system that you have for this problem. How far are you investing in information technology and the training of individuals for this, which clearly is going to be a major factor involved in this and possibly the development of future software in order to account for developments and changes that occur in this particular area?

  (Ms Blears) I think this is a very important area not just for infection control but for the whole of the NHS. To be honest, I think that IT is one of the areas where perhaps we are weaker than others and where we need to make really quite dramatic strides forward in harnessing the power of information technology to make our services more responsive, more accessible, more flexible and get better outcomes. I think IT really has to be priority for us and I think it is for that reason that we are dealing with IT now almost as an exception to our general direction of travel in the health service. Where we want to go to through "Shifting the Balance of Power" is to devolve as much decision making as we possibly can to the local level. I think workforce planning and IT are the two exceptions to that rule, where we genuinely think we need more central control, where we need to have a much more kind of hands on approach to specification, to procurement, delivery, to compatibility. Public sector IT programmes are bedevilled with disaster, I think, and we have all seen some of the worst examples. So for the NHS it is absolutely crucial to us. I am told now that 98% of GPs and consultants are at last signed up to NHS Net so they have got email and they are connected. Who the 2% are, I have no idea, but 98% of them are fully signed up now. But we have now got a strategy called "Delivering 21st Century IT". As I say, the centre will take greater control over these items and basically there are four programmes of work in the IT strategy. First of all, to try and improve the infrastructure right across the NHS in terms of access to computers and hardware and systems and networks. Secondly, we have got a big programme on electronic booking which has been going now for quite a while to try and facilitate people so that they can book their appointments and get told there and then when they need to turn up. The third area is electronic prescribing. Again we think there are huge developments to be made through electronic prescribing. The fourth one, which is the most relevant to your inquiry in infection, is the development of the integrated care record service. I think this was previously around the electronic patient record. So it has now developed into the integrated care record service. And what that is, is a real attempt to try and make sure that all the information on every patient is available from any point in the system. Now that is easy to say but very hard to do when you are thinking of a service like ours. We are over a million strong in terms of staff. I think we see a million people in the NHS every 36 hours. The scale of our operation is immense and I think any company or organisation facing this kind of IT challenge would recognise it for what it is. We are putting in £2.3 billion over the spending review settlement period over the next three years. The programme starts in April 2004. We expect it to be complete in 2008. It has got two main phases. The first one is really a kind of viewing phase. So you will be able to view the information around patients. The second phase is the one that we will all be interested in and that is the interactive phase where you can actually input data, get it out, interrogate it, move it around and that is the second phase of the development. So it is in two phases; one viewing, one interactive and it is also in two parts. It is in a national spine so that for every patient you will be able to get the information for them from the national spine. And that will be one major national service provider doing that centrally. And then that will be matched up with, at the moment, I think it is between two and five local providers. So again a fairly small number because we want compatibility to get that local information in the system. We are going through the selection process later on this year to select the national provider. We expect to be doing that by the end of this year, by the end of the December. I would just like to highlight a couple of things which I think are difficulties. One of the biggest challenges around IT I think is privacy, confidentiality and normalisation of data. I had the dubious pleasure of taking the Section 60 regulations through Parliament and I know that Members of your Lordships' House were very much engaged with that process. So I think in this era of increasing concentration on privacy, on data protection, that patients want to know that their information is being used with their consent, and rightly so, so that is a big challenge for us. In terms of surveillance, I think this IT system will really enable us to interrogate our data. I asked officials to do an example for me around, for example, if there were to be a new type of pneumonia emerging, unknown cause, probably viral and how the new IT system was going to help us in making sure that we perhaps were able to do diagnostic tests more quickly, get information from the field in a better way and they have talked me through an example which perhaps your Lordships might find useful that we could send you after today's hearing because for me IT is fine in theory, I want to know what it can do and what the practical effects are of getting it to happen. And the example here is very much that the integrated care record service could provide the networking and the email that would enable people to communicate much faster, much quicker which is the essence of good surveillance and getting the information really accurate. So, as I say, when the system works, I will not say if it works, when the system works there will be surveillance and I think it should help us really quite considerably.

  876. Minister, that is very encouraging but can I just get down to one of the practicalities as far as I am concerned and that simply is that the average GP is going to be your initial source point to provide you with a lot of this data. So you have got to make sure that it is not too complicated otherwise the amount of time taken to fill it in is going to be a sort of deterrent from the point of view of doing it. So once you get to a pile so high you then immediately start panicking or throwing it away. It has got to be customer friendly or GP friendly in some way or other and it does seem to me that this is absolutely essential from the very word go. My experience in dealing with many providers are that they can tell you about some marvellously sophisticated systems but the word "sophisticated" normally means "complicated" and so you can pull everything assuming you have got the information, but if you have not got the information, and that is the source point, then you are in real trouble. That is really where I think I have a certain concern and that is why I asked the question of what training are you going to give to individuals? It is not necessarily the people who are a way along the line, it is essential to the people who are starting and using the system itself.
  (Ms Blears) Yes. I think you are absolutely right to highlight the need for not just initial training as well but ongoing training. One of the things often with IT is that people are introduced to it and for the first day or so when they have been on their training programme they are confident and then, if they are not using it on a daily, if not hourly, basis, they lose the facility to be able to do that and therefore ongoing training is equally important. I think what we do need to do with the IT programme as well is to involve the people who are going to use it in the design of the system. There would be little point in buying a product from an IT supplier unless it is informed by the people at the sharp end who are actually going to have to manipulate the data and put it in. Obviously front line primary care professionals are under huge pressures now to complete data for us because we do have a culture and climate in which we do want to measure and see and evaluate properly what is going on so that we can track improvements and see if we are making progress, and rightly so. We need to have that information but we do not want them to spend all their time filling in data and not seeing their patients. So we have to get that balance right and making it user friendly I think will be very important indeed. In terms of training facilities, I do not know how they will seek to organise themselves, but it may well be that at primary care level they want to do it through their Primary Care Trusts in a collaborative fashion working together again picking up the points about the workforce. Hopefully working in teams, multi-disciplinary teams so that we can see how each person interfaces with their IT system and make it appropriate to them because again my experience is that if people feel that they are making a contribution then they will go a long way with you. If they feel that that data is being collected for some arcane purpose that has no relevance to what they are trying to do with patients, then they will be much less inclined to make the system work.

Chairman: Any further points? Can we then move on to question seven? Baroness Walmsley?

Baroness Walmsley

  877. Thank you very much, my Lord Chairman. Minister, I would like to take you back to the issue of the why the Department decided not to fund a rapid vaccine development centre as proposed by CAMR. I am aware that you partly answered the question in response to a supplementary by Lord Oxburgh earlier, but in your answer you mentioned that there may be both financial and technical reasons why that decision was made. You also mentioned that it probably will take about six months to develop a new vaccine and yet this morning we heard from one of our specialist advisers that the NIH in the United States believe that they can produce a vaccine for testing for SARS within three months. So clearly money and resources can actually deliver a result. I wonder then, you mentioned other partners, that it might be appropriate to work with other partners to deliver these results. Can you perhaps say why you are confident that working with other partners can actually make sure that the right resources are input and the right speed is delivered when such a situation arises because no matter how good our relationships with the United States are they will always, as with smallpox, make sure that they stockpile enough vaccine to protect their own people before they go out to anybody else. So perhaps you could elaborate on the reasons why you are confident in that decision.

  (Ms Blears) Before I do that could I just explain the reasons why we have not proceeded so far with the CAMR proposal? I did have an opportunity at the CAMR accountability review that I held recently to explore this with them and really just to put on the record that there was the issue about whether or not we could get the development time below six months and at the moment the information to me was that we could not do that in terms of the facility. Secondly, there was the issue of costs and I think it is right to be open about that. When we first commissioned the assessment of what it might cost to get this kind of facility, the estimate in September 2001 was £7.4 million over five years. When it came in in May 2002 the estimate was nearly £30 million. So it was four times more expensive than we had previously asked for it to be. That does not mean the door is closed on it and I am certainly still happy to consider it with advice from the HPA and to see if there is a way forward on this. But clearly when any government is faced with a quadrupling of an estimate, then I think it is right to just take a breath and see if that is the right way to go. I also understand that there might be relatively few cases where an emergency vaccine is needed, but obviously we have got the position in relation to SARS at the moment and where there was an emergency that other treatments might be appropriate as well as vaccine, that where it is a real emergency you treat with antibiotics or, I think in the case of some diseases, you can give other treatments rather than a vaccine. So again that is a factor to be taken into account. In terms of working with other partners, I think what I was trying to say in my earlier answer was that we have to analyse who can do what in this system best? Who is it most appropriate? I do not think in any system it is always appropriate for Government simply to say we can do everything and that is what we should do but we should explore with the pharmaceutical companies, the people who traditionally develop these systems who have got laboratory facilities, who have got other facilities to bring to the piece "What can you do?" If at the end of the day they cannot do it and we have a responsibility to the public to make sure that those facilities are available, then that is a responsibility that will lay with me as a Minister and we will have to take steps to ensure that our people are properly protected. That is a responsibility upon us, but I do not think it is automatically and it is not for me an instinctive reaction that we have to do things if we are not the people best placed to do it. But as I say in terms of the emergency facility, we are not saying that we will not do it, but I want to have a close examination of is this a realistic way forward to have that facility as originally proposed by CAMR.


  878. When we were in the USA we visited NIH of course and there they have a small business grant initiative for developing areas, especially vaccines, and where they provide a small amount of money to the small company usually. And we learnt that a campus developed a Western Nile virus vaccine rather rapidly and the company could keep the patent rights so long as they brought the product to market. It did seem to us that that was a very effective way of moving forward, of challenging the small companies who could do that. Last week we had Dr Pat Troop, who is the Chief Executive, as you know, of the Health Protection Agency and we raised this with her. She said that the issue was not closed and we hope that that is the true situation because it does seem to us that an emergency rapid response facility, such as existed at CAMR with anthrax, for example, they were the only firm able to produce anthrax vaccine in large amounts very quickly, but it is a sad decision not to have made that a positive decision by now. That we do not have anything like that in this country and we do need it especially with things on the horizon such as this virus coming from the Far East.

  (Ms Blears) Two things really. I think I would be very interested to see the information about being able to develop the vaccine in three months because that is not information that I have had so far. The time scale that I have had is six months, is a pretty good estimate I think. When we did the Hong Kong flu incident in 1997, it took six months and I am told that there was a shortage of the relevant hens' eggs in order to bring the vaccine on and there were difficulties in getting it down to a very short period. So if the NIH are saying that they could do that in three months, then I would be very interested to look at that and I will certainly undertake to do that. The other point that I would make is that there are a series of small grants available from the DTI specifically aimed at that kind of stimulating small companies. There is the Small Firms Merit Award for Research and Technology that we administer, again really trying to say to those small innovative companies, sometimes right at the cutting edge, to be able to encourage them to develop that. And that is something that, as a Government, we have really tried to encourage out there, to get this new thinking going and there is a range of grants that are available for them. As I say, I am not simply saying that we do not need this facility and it will not happen, but I think that before proceeding we would need to be satisfied around the issues of cost, is it good value for money, is it something that we can do quickly? What is the time scale? Is it something only we can do rather than any of our other partners? And is it something that we ought to be developing as a government through the HPA? So we have still got to look at those factors and I have no doubt that Dr Troop will be coming back to me with a very robust case indeed.

Baroness Walmsley

  879. Thank you, my Lord Chairman. This is about the prioritisation of microbiology laboratories. Clearly microbiology laboratories managed by the NHS would need to be fully engaged with the HPA and contribute to the public health effort. How will the Department ensure that these laboratories managed by the NHS do not focus too much on supporting clinical care and give a low priority to the public health aspects of microbiology? I think one does not need too much of an imagination to suspect that when people are jumping up and down and shouting for the results of tests in order to support clinical decisions the public health priority might slip.

  (Ms Blears) I understand this concern and I have read the evidence from the PHLS and I have had opportunities to discuss it previously with people from the PHLS and I can fully understand the concern there because the PHLS had a fantastic reputation for surveillance and making sure that you have got really good systems in place. I want to pay credit to the PHLS for this and I think that when you get any change inevitably in an organisation people who have been working really well, who have got a good reputation are worried that that will get diluted and that they will no longer be able to operate at the level that they have been at and that is entirely understandable. To some extent you are asking people to take a leap of faith because if you have got a new organisation you cannot prove that it is going to be better and stronger and more integrated. You can say why you think it is, but you cannot prove it until it is actually in existence and working and you have got an evaluation and you can see that it is delivering the results. So we need to give some reassurance to them as far as we can. But the public health element of what those 31 laboratories do out in the service will be protected and I think there are a number of levers in the system to be able to do that. The first really is the role of the new Regional Microbiologist. I think this is going to be key to this. They are going to have a responsibility to make sure that all laboratories within the system maintain reports to the HPA, that they send the samples off to the reference and specialist laboratories and that they are working in the same way as they were working in the previous organisation. In fact, perhaps even working in better ways and sharing new ideas, getting standard operating procedures, making sure that they are really part of the system. We have got a couple of reassurances. The Chief Executive of the Service, Sir Nigel Crisp, has written to all Trusts saying that they have got to have the same funding until March 2005. So there is some security in the system there. We are not going to see their money swiped off into some other authority area during that transition phase, which I think is very important to give people a degree of security. We are going to have the Inspector of Microbiology at the national level who is going to have the responsibility for setting standards and looking at quality in all laboratories, again emphasising the public health outputs of those laboratories and identifying gaps in the service and seeing where we can fill those gaps. Now those are all mechanical things, if you like. I suppose what I think is that we also need some culture change within the NHS and I think I will be saying this loud and clear from a ministerial perspective, that the NHS Trusts have got to see that having a complete health role is important for them, that they are not just there to do that day to day service, which is hugely important. 75% of diagnosis comes through pathology, so it is hugely important for the patients, but that it is not their sole reason for being. Now, I have got to encourage them to do this on a number of fronts. This is not just the infections agenda. This is the public health agenda and unless we get the Trusts to see public health as core mainstream business not an add on at the margins, then we are not going to be getting the kind of overall health and wellbeing service that we want to create. So we are already embarked on this and I think we are beginning to see a bit of a shift in the service now towards the public health agenda, for the first time, in the planning and priorities framework which sets the business of Trusts for next three years. We have got public health indicators in that system. That is a bit of a revolution for the NHS to get the public health agenda into the way the performance management system works. So increasingly Primary Care Trusts and NHS Trusts generally will have public health more on their agenda in terms of infectious disease than they would have had previously and as we develop this shift within the NHS, then I think we should see that translated on the ground in the laboratories. So yes, we can have mechanical things in place but that needs to be complemented by a culture change in the Trusts themselves, that they have a responsibility to make a proper contribution towards public health outputs too.

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