Select Committee on Science and Technology Written Evidence

Memorandum by Dr D A B Dance, Plymouth Hospitals NHS Trust

  I support the formation of the Health Protection Agency, and would endorse the recommendation in "Getting Ahead of the Curve" that the public health activities and outputs of all diagnostic microbiology laboratories should be enhanced. However, I have serious reservations about the wisdom of dismantling the national and regional networks of PHLS laboratories in England, which is proceeding as part of the implementation of the CMO's strategy. Whilst the PHLS is not perfect, and functions with differing levels of effectiveness in different regions, the integration of microbiology and epidemiology that encapsulates the PHLS model has long been regarded as one of the strengths of the system in England and Wales. This arrangement has been the subject of numerous reviews, each of which has concluded that it should continue largely unchanged. For example, the Strategic Review of the Public Health Laboratory Service in 1994 concluded that:

    ". . . the management of a network of laboratories carrying out clinical diagnostic and public health microbiology, and providing microbiological and epidemiological support and advice to all appropriate agencies in their localities, should remain a core responsibility (of the PHLS Board)"

  The report went on to say that, if many PHLS withdrawals from laboratories were necessitated by financial pressures, this would happen . . . "without the same degree of confidence that the public health function could be safeguarded".

  On this occasion, no formal review has been conducted and yet sweeping recommendations have been made and are about to be implemented.

  There are also many experts outside England and Wales who have long regarded the network of PHLS laboratories as an extremely effective system. In a letter to Lord Turnberg, Chairman of the PHLS Board, sent on 29 January 2002 after "Getting Ahead of the Curve" was published, Dr James Hughes, Director of the National Center for Infectious Diseases, CDC, Atlanta, USA, said:

    "In summary, reducing the number and capacity of existing public health laboratories under the proposed reorganisation may be counterproductive. The flow of information between the public health and the clinical sectors will likely be reduced, as will the ability of public health agencies to leverage new information into changes in laboratory practice and policy on a broad scale…. . . I suggest that you carefully assess the potential ramifications of the changes in laboratory services recommended by this excellent report."

  The value of this integration has clearly been recognised by the Welsh Assembly in deciding on the arrangements for Wales, and the proposed National Public Health Service for Wales is a structure which we believe is more likely to deliver the required enhancements to surveillance and other public health functions of microbiology laboratories envisaged in "Getting Ahead of the Curve".

  Some of the risks inherent in the approach for England include:

    —  Dislocation of microbiology from epidemiology, which have previously been incorporated within the same organisation.

    —  Financial pressures on current PHLS laboratories resulting from the process of transfer to the NHS.

    —  Diversion of resources from national and regional public health activities to Trust priorities in those laboratories transferring from the PHLS to the NHS.

    —  A failure to achieve the required enhancements to public health functions and outputs, including surveillance, in current NHS laboratories without additional resources.

    —  Loss of synergies (functional and financial) achieved by PHLS groups when these are fragmented.

    —  Separation of clinical microbiology from Food, Water and Environmental microbiology resulting in impaired surveillance and outbreak investigation.

    —  Difficulty in conducting enhanced surveillance (eg current examples such as Campylobacter infection and West Nile virus), for which the PHLS network has been an invaluable and unique resource.

    —  Loss of key individuals committed to the health protection function from PHLS laboratories that transfer to the NHS.

  I know that these concerns are shared by many of my colleagues in PHLS South West and elsewhere within the Service.

October 2002

previous page contents next page

House of Lords home page Parliament home page House of Commons home page search page enquiries index

© Parliamentary copyright 2003