Select Committee on Science and Technology Minutes of Evidence

Supplementary memorandum by Ms Hazel Blears MP, Minister for Public Heath


An example illustrating how the Integrated Care Record Service could contribute to Improved Surveillance for Micro-organisms.

New Disease Alert

  The Health Protection Agency (HPA) is notified through WHO of a new type of pneumonia of unknown cause, probably viral. First identified in Southern China and Hong Kong. WHO asks to be kept informed of any occurrences within the UK.

  The HPA sends what details there are on the new condition to all microbiologists and to front line clinical staff via the Health Protection alerting system, asking that any possible cases be reported to local HPA staff and to its Communicable Disease Surveillance Centre (CDSC). An identical alert is sent via the CMO's Public Health Link.

  Local microbiologists inform their Infection Control Staff of this new condition and ask them to survey the wards to identify possible cases. At this stage all that is known is that there is a severe form of pneumonia, most likely caused by a virus but no organism has been identified.

  In three different localities the Infection Control Staff use the national patient record analysis service to interrogate the local ICRS spine and identify small clusters of three to five cases. The microbiologists are able to get clinical details from the ICRS Spine including treatments given. These details are sent to the HPA electronically in accordance with current data protection legislation and the Health Service (Control of Patient Information) Regulations 2002.

  The microbiologist also notifies the local Health Protection Unit, who investigate the situation and discover for each cluster there was a common contact of someone returning from conference in Hong Kong. They update each patient's record with this information from terminals in their offices.

  The microbiologist gets together all the requested clinical and laboratory data by accessing the ICRS spine and through this the local electronic record of each patient (again, in accordance with the Health Service (Control of Patient Information) Regulations 2002).

  The HPA collates all the information by combining information from different elements of the local electronic records linked through the ICRS spine to get a more accurate picture of the disease in terms of symptoms, helpful treatments and likely outcomes. This information is published electronically on the HPA web site and this is drawn to the attention of all GPs and appropriate hospital consultants, including microbiologists, via e-mail.

  Some time later a virus is identified as the cause. All the microbiologists who submitted cases are asked to test for that virus in any specimens they have from the original cases and to take convalescent serum for central testing.

  In this scenario, the ICRS could contribute to the networking and e-mail facilities for the HPA and the microbiologists to communicate with each other.

  The ICRS "Spine" provides basic clinical details, which both the microbiologist and the local Public Health teams could access and update.

  Through the ICRS "Spine" the local microbiologist could access the full electronic records of the patients in his hospital(s) and abstract relevant data for transmission to the HPA in an anonymised format.


  1.  The ICRS (integrated care record service) is one component of the "National Programme for IT" launched in June 2002. The ICRS is the electronic medical record component. The programme to develop it is managed by Richard Granger, Director General for IT in the NHS with a National Programme team, which includes a Design Authority responsible for the details of the ICRS.

  2.  The ICRS will consist of two parts a national component which consists of a Common Patient Data, known as the "Spine" and local systems already in existence covering the day to day activities of general practice, community and hospitals.

  3.  The national component or "Spine" will hold some data for all NHS patients in England. The data will include demographics, summary of health events provided by local systems, and significant clinical data such as current drugs, allergies and alerts, see below. Through the Spine access to local systems will be possible.

  4.  Local systems, which either exist or will be acquired, will provide support for day to day care. These are still called EPRs they will communicate with the Spine to send data to it and to access the data that is there. They will also communicate with each other to provide some integration of all patient's health details.

  5.  The ICRS replaces the previous programme for the introduction of EPRs (electronic patient records) and EHRs (electronic health records). However, existing EPRs will continue to be used and upgraded to reach a level where they provide a basic set of functionality and can communicate with each other and the Spine.

  6.  The ICRS Spine will be developed and delivered in a number of phases. The first phase will provide largely data for viewing, the second phase data from users interacting with systems such as prescribing and order communications.

  7.  Phase 1:

    —  Demographics

    —  Some clinical correspondence

    —  Laboratory results

    —  Radiology results

    —  Support for NSF data collection

  8.  Phase 2

    —  Phase 1

    —  Specialist results

    —  GP prescribing record

    —  Hospital discharge summaries

    —  Some clinical correspondence

  9.  The timescales for introduction are

    —  Phase 1 available across England by end of 2004

    —  Phase 2 available across England by end of 2006

    —  Phase "other" available across England by end of 2008

  10.  At the moment the ICRS does not encompass data extraction for administrative purposes.

  11.  At this time, no provisions have been made to link the ICRS with HPA systems.


We have heard disquiet about the integration of virology into the HPA and that the proposed arrangements will not make the best use of the available expertise in virology. Do you consider that virology was considered fully during the consultation exercise and as virological expertise is in short supply how can it best be accessed to the benefit of the Public Health?

  We consider that the arrangements for integrating virology into the HPA are at least as good as those by which it was integrated into the PHLS and the NHS previously, except that—as for bacteriology—the general clinical diagnostic service is now located in the NHS where it is more accessible to the clinician and therefore to the patient. The specialist virology laboratories in the central public health laboratory at Colindale are unchanged, except that they are now part of the Health Protection Agency.

  The consultation exercise comprehensively consulted all the clinical and professional bodies and we are confident that it reached all the key players—including virologists. It was certainly clear from responses we received that it had been disseminated very widely.

  The discussion exercise on the laboratories was about the broad spread of microbiology services and how they could best be positioned to support public health. It did not specifically consider virology or virological services as a discrete entity, since the exercise was not about the role of individual disciplines or specialities.

  The Health Protection Agency will clearly have an ongoing interest in applying virological services and expertise to best effect and integrating it into its structure if that is, indeed, the best way to go. Exactly how it does so will have to be a matter for its Board and its executive management to determine and to take forward, as appropriate, in their corporate and business plans.

  Regarding the supply of virological expertise, it may help to refer to some of the information we supplied in response to the question about the training and recruitment of infectious disease consultants. At 30 September 2001 there were 58 registrars (ie doctors in the registrar group) for infectious diseases and 143 registrars in medical microbiology and virology in the NHS in England. The output from these existing registrar training places, when combined with other increases through improved recruitment and retention, international recruitment and promotion of flexible retirement and offset by expected retirements, is expected to result in around 127 trained specialists being available in infectious diseases by 2004 and 447 trained specialists being available in medical microbiology and virology by 2004.

  The NHS Plan made a commitment to 1,000 additional specialists registrars (SpRs), across all specialties, by March 2004. Central funding to support 300 additional training opportunities was distributed in 2001-02, a further 300 in 2002-03 and the final 400 for 2003-04 will be distributed shortly.

  In addition, in 2002-03 we introduced a new approach, which allows Trusts to increase the pace of SpR expansion. We have created opportunities for Trusts to fund additional SpR posts, up to a limit in each specialty.

  We are building on this in 2003-04, allowing Trusts to fund substantially more SpR posts. This allows Trusts to create the workforce they need to deliver services, and provides the opportunity to create up to 1,500 additional SpR opportunities. In 2003-04 central funding will be available to support the implementation of eight additional SpR posts in microbiology and virology and two additional SpR posts in infectious disease. In addition, Trusts will be given the opportunity to fund up to ten additional posts in microbiology and virology locally and ten additional posts in infectious diseases.


We have received evidence which expresses concern about the suitability of the current Public Health Acts for enabling effective communicable disease control. To what extent is the Department of Health concerned about this and what, if any, plans do you have to update these Acts?

  We are committed to a review of public health law, as made clear in Getting Ahead of the Curve. This review will take account of the new emergency powers, which it is planned to provide through the Civil Contingencies Bill. We envisage that the review will look at the responsibilities of the NHS and local authorities in relation to infectious disease. It will consider whether changes in legislation or practice are needed to enable them to work more effectively together and whether any existing legislative provisions need repeal or replacement.

  We would be interested to see details, if possible, of the evidence expressing concern about the current legislation so that we can take this into account in the planned review.


  Our discussions with senior WHO officials since 8 April indicate that there may be some misunderstanding about WHO's view of the level of support provided by the UK. Both WHO and senior Department of Health officials responsible for international health policy were surprised at the Committee's comments on this question. I attach, for ease of reference, a copy of a letter from Dr Heyman, the WHO executive director, Communicable Diseases to you on 19 April, which describes a different view of UK support for WHO than that reported to us at the hearing.

  In addition to our earlier evidence, the UK has played a key part in supporting WHO's development of the Global Outbreak and Response Network (GOARN), which is an international network of associates who collaborate in alerts to possible outbreaks and in responding to those outbreaks. The Health Protection Agency's Communicable Disease Surveillance Centre is a member of GOARN.

  The UK has particularly supported WHO in its response to the current SARS outbreak and there are at least 11 UK experts seconded to the WHO to assist in this and other activities.

  WHO are generally appreciative of the support they receive from this country although we both recognise, of course, that there is always more that could be done—Dr Heyman's letter illustrates one such example. We will continue to work with WHO, both directly and via the Department for International Development, to ensure that we contribute effectively to international communicable disease control.

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