Memorandum by the Society of Directors
of Public Protection in Wales
The following is given as evidence to be considered
by the above inquiry and represents the views of local authority
environmental health departments in Wales. These views are limited
to the communicable disease function performed by local authorities
in relation to the investigation of food poisoning and other notifiable
The Society of Directors of Public Protection
in Wales represents the views of all 22 local authorities in Wales
through a series of technical panels dealing with various aspects
of public protection. The Communicable Disease Technical Panel
exists to advise the Society, develop skills and expertise, provide
training, and promote common standards in relation to the communicable
disease function in local authorities. The Panel also represents
local authorities on a series of working groups and joint committees
with partner organisations such as health authorities, phls/cdsc,
and the National Assembly for Wales.
These comments reflect therefore the current
practice and experience of local authorities in Wales and their
involvement in the communicable disease function.
1. What are the main problems facing the
surveillance, treatment and prevention of human infectious disease
in the United Kingdom?
An effective surveillance is a fundamental part
of any communicable disease strategy and other parts of a strategy
will fail unless effective surveillance is in place. The principal
component of the present surveillance system is co-ordinated by
PHLS receiving laboratory confirmed isolates and other reports
from a variety of sources. The local authority role in surveillance
is the receipt of notifications from the medical practitioner
attending the patient. Its effectiveness is easily compromised
for a variety of reasons and modern methods such as laboratory
reporting are now being used more widely. Local authorities also
receive notifications from patients, employers, event organisers
or discover CD incidents during the course of other investigations.
There is a wide variation in the use of reporting mechanisms between
laboratories and local authorities, and variations in methods
of handling such notifications between individual local authorities.
Disease incidence rates in districts/regions show a wide variation
which in part is caused by poor surveillance, ineffectual notification
and a disparity in resulting actions.
The law relating to the investigation of communicable
diseases, including surveillance and notification, is very much
out of date and in need of a major review. Previously anticipated
reviews have not materialised and new threats are being controlled
and managed by old working practices. The advent of a proposed
health protection agency and the recent global threats of biological
terrorism seem to provide a just impetus to a review of the current
The notification aspect of surveillance
needs to be updated to include notification by electronic or telephonic
The notification by medical practitioners
needs to be strengthened by means of guidance and/or coercion.
Provide suitable and sufficient resources
in terms of equipment and training to ensure that future notification
methods meet the essential requirements of the surveillance system.
The receiving, handling, storage
and reporting of data relating to disease notification needs to
The epidemiology and environmental components
of causative organisms can be better understood by timely and
accurate surveillance. This leads to effective treatment and the
development of strategies for control and prevention.
2. Will these problems be adequately addressed
by the Government's recent infectious disease strategy, Getting
Ahead of the Curve?
The present surveillance system covers England
and Wales with Scotland and Northern Ireland covered by a separate
system. A combined surveillance would surely serve the United
Kingdom more effectively. However, the recent devolution of government
has resulted in the division of the health protection agencies
of the four countries. A common surveillance system must be the
aim of any review.
3. Which infectious diseases pose the biggest
threats in the forseeable future?
Generally speaking, the communicable diseases
which are increasingly requiring an environmental health intervention
include E coli 0157, Legionnaires' Disease, Q Fever. However,
of major concern to local authorities is their ability to deal
with cases of disease which are nominally unknown in the UK but
which for a variety of reasons become introduced into the UK.
The effect of climate change, long food chains, global travel
and people migration will contribute to new and emerging threats.
4. What policy interventions would have the
greatest impact on preventing outbreaks of and damage caused by
infectious disease in the United Kingdom?
The best policy intervention is preparedness
backed up by adequate surveillance, effective prevention and control
strategies, timely and accurate treatment regimes and public education.
To this end effective and uniform standards of performance should
be required of local authorities to enable them to discharge their
legal and enforcement duties.