Select Committee on Science and Technology Written Evidence

Memorandum by Leeds City Council, West Yorkshire Environmental Health and CCDC Audit Group and Communicable Diseases Section of the Department of Housing and Environmental Health

1.   What are the main problems faxing the surveillance, treatment and prevention of human infectious disease in the United Kingdom?

  There are important differences in emphasis between local and national surveillance systems. Local action requires timeliness and detail such as patient name, general practitioner and address all essential for prompt control measures. National surveillance is often seeking to identify trends and patterns that lead to longer term control measures.

  It is often difficult to access and interpret national data for relevant areas. In order to improve surveillance systems there is a need to ensure proper feedback to those who report into the surveillance system. Those who report need to know that something is done with the information they share and that it is not simply filed away. Greater awareness of the purpose of surveillance among those who diagnose infections would be helpful. Under-reporting of cases is a fundamental flaw in existing arrangements.

  The lack of uniform case definitions of infectious diseases that are widely accepted is a serious problem. Flexibility to respond to particular incidents in a timely manner requires the ability to develop suitable case definitions for the incident group to work with. We need to be very clear that all areas of the country and reporting bodies are clear and consistent in what they report. For example, food poisoning is one of the notifiable infectious diseases along with Infectious Hepatitis in the Public Health (Control of Disease) Act 1984 whose definition needs to be revised. Locally, to ensure consistency of reporting, Leeds City Council in co-ordination with the West Yorkshire CCDC/EHO Audit Group have developed a flow-chart to address the inconsistencies that were identified in interpretation of Food Poisoning as a reportable illness. A copy of this is appended and we would hope could be incorporated into national guidance which is conspicuous by its absence. The inconsistency in the reporting of food poisoning locally will naturally be replicated nationally and does not currently produce quality surveillance data.

  There is also a need to be able to split imported from UK acquired infections in reporting and recording systems to enable workers to develop suitable controls for each category.

  IT developments are required to assist reports from laboratories as well as clinicians. A real time national IT system accessed by clinicians, laboratories, local authorities and HPA could provide accurate local and national surveillance—giving useful data to aid both investigation and national research alike.

  Confidentiality issues to be clarified, certainly as data is sent away from the local level.

  The development of national surveillance systems that bypass Consultants in Communicable Disease Control are counter productive and lead to duplicated work and misunderstandings.

  Primary Care Trusts are disease focused rather than prevention focused, so it is not clear where resources for prevention will come from.

  Calculations presented to the West Yorkshire CCDC/EHO Audit Group suggest that every single week of the year the equivalent of seven weeks worth of work is devoted to the completion of NOIDS reports for England and Wales by local authorities. It is not clear how that information is being used for the control of communicable disease. Ambiguity in what is to be reported is rife, the accuracy and value of this national "data" is questionable.

2.   Will these problems be adequately addressed by the Government's recent infectious disease strategy, "Getting Ahead of the Curve"

  It is not yet clear how the proposed strategy will be implemented or what can be delivered. The strategy set out in "Getting Ahead of the Curve" is as yet undefined so it is impossible to give an informed response.

3.   Is the United Kingdom benefiting from advances in surveillance and diagnostic technologies; if not, what are the obstacles in doing so?

  Help with defining outbreaks requires better organism identification, but much still needs to be done to get the information promptly to those who need to see it.

  There is a desperate need to establish a meaningful typing system for Campylobacter, if we can establish "environmental contamination" routes for this organism significant reduction in cases could be achieved, the Government's food poisoning target reduction would be met overnight.

  If you do not look you do not find, so users of new identification and reporting systems may be criticised for identifying more problems. (Leeds, which has an active interest in the notification system, frequently reports more Food Poisoning than London.)

  Greater recognition should be placed on the surveillance system capturing information determined on investigation by local authorities on the likely source of illness. Home acquired infections deserve more attention eg food poisoning, to enable resources to be directed where they will do most good and alternative types of intervention developed.

  There are cost implications. Which body will pay for the new technologies, particularly if they are used for public health surveillance? Without resources available the only sampling will be that taken for clinical purposes which will not provide all the information required. Sampling for surveillance and investigative purposes undertaken by local authorities must be similarly resourced—prevention is always better than cure.

  Continuing problems exist in defining denominator populations with population movements in and out for work, leisure and study. The new HPA/PHLS proposal to base sampling resources on residential population is flawed.

4.   Should the United Kingdom make greater use of vaccines to combat infection and what problems exist for developing new, more effective or safer vaccines?

  Vaccines can be used to greater effect. Some existing, proven effective, vaccines such as hepatitis A and hepatitis B should be used for the universal childhood programme.

  New vaccines for meningococcal B infections, tuberculosis and some of the gastro-enteric viruses would be welcome.

  The currently used live polio vaccine should be phased out and replaced with the safer inactive vaccine until polio eradication is achieved.

5.   Which infectious diseases pose the biggest threats in the foreseeable future?

  We suggest that antibiotic resistant organisms, tuberculosis, HIV and vCJD present the greatest challenge for the future. There will also be serious problems with influenza and similar airborne viruses including those causing gastroenteritis eg Norwalk virus.

6.   What policy interventions would have the greatest impact on preventing outbreaks, of and damage caused by, infectious diseases in the United Kingdom?

  Establishing clear roles for the agencies involved and providing adequate resources for them to operate—in both the investigative and health education—preventative fields.

  Most action to prevent outbreaks and to manage them at an early stage is undertaken at local level. The effectiveness of that local action has to be supported and developed. There is a real risk that heavy handed supervision from higher levels will reduce the capacity of local teams.

  Local teams need to be resourced and supported by policies that empower them. Flexibility to deal with local problems needs to be encouraged and when the review of the law on communicable disease is finally moved forward the value of accountable flexibility needs to be recognised and the role of the local authority must be acknowledged as the current model has been appropriate and timely for the local populations at risk.

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