Examination of Witnesses (Questions 260-263)|
TUESDAY 10 DECEMBER
260. You have described a lot of very grass roots,
practical applications for modern technologies, but is there any
way in such a feeding upwards from the grass roots of the needs
for techniques that perhaps do not exist or services or products
that currently do not exist to some sort of organising body that
says,This is what we need to look at and find a solution to"?
(Dr Gelletlie) I imagine that the HPA, the
Health Protection Agency, will be a useful body through which
all of the employees will be able to feed up their needs and which
will have a role in commissioning research in asking. That would
be one of the possibilities because hitherto some of that function
presumably has been carried out with the Communicable Disease
Surveillance Centre by the Department of Health and by the Public
Health Laboratory service, but you are right: there has not really
been an umbrella.
261. The HPA is the answer?
(Dr Gelletlie) Possibly.
262. You feel confident that the HPA can enable this
research that you describe to be done?
(Dr Gelletlie) I hope so because the idea
is that a lot of the research and development funding which is
around will be pulled together and better targeted, one hopes.
The funding will prioritise the targeting. Clearly you are dealing
with a limited pot of money and there will have to be priorities,
but when we are all within the one organisation it should be easier
to communicate some of these needs.
Baroness Finlay of Llandaff
263. You have got sources of information at local
level and you have described, Dr Monk, very clearly some instances
where you have got very good quality data at a local level. What
is the gate that is opened for that to be fed up through whatever
system to a national level and do you think the development of
the HPA will mean that that information is routinely going up
so that if you have got sporadic outbreaks occurring they become
co-ordinated and linked, because it sounds to me at the moment
as if you could have things going on in parallel in different
parts of the country with no awareness in one area except for
a haphazard conversation or phone call between colleagues to really
link in and make connections particularly on the source of infection?
(Dr Monk) I think the answer to that is unequivocally
yes. Molecular typing is difficult. If we illustrate that with
TB, there are three ways that are currently big picture. One of
them is effectively an X-ray plate and comparing them is inordinately
difficult and it is not a national surveillance tool. Another
one is a black and white series of squares which you could capture
into an electronic system. The one that would be most favourable
is a number system. If we went down that system, I put them in
database, feed them into a regional epidemiologist; they could
be aggregated at national level and you would spot that sort of
thing going on. There are some systems therefore which will work
in exactly the way you have described. Meningitis is another one
where you can do it. There are others where at the present moment
the technology is there but they are based effectively on gel
plates which take an X-ray picture on which comparability is a
really difficult problem. As we were alluding to therefore, there
is need for research. Hepatitis B viruses are an example where
you get a gel electrophoretic plate. The technology is there,
I have used it in a local outbreak, but it is difficult to get
that comparability nationally. We have asked questions about whether
a hepatitis B outbreak in sex workers is related to others and
it is difficult because of the comparability issues. The technology
needs to move forward to get it digitised.
(Dr Hawker) The important thing that links
the last two question is that we need to make sure that local
needs and local solutions also fit into a national strategy. If
we take the example of TB, perhaps it is less important which
of the three main methods is the most important than it is to
make sure that everyone uses the same one because then the cases
in Leicester could be linked to the cases in London. If they use
different methods they will not be able to do this. The two areas
we need to address are, first, how the stakeholders get to have
their input into what surveillance should be and how well it is
working, and then the related area is how the epidemiologists
and microbiologists work closely together to make sure that microbiology
developments meet the needs of epidemiologists and public health
practitioners. On the former, the Communicable Disease Surveillance
Centre has held I think a first meeting of a stakeholders' group
which is an initiative we need to support. On the latter I am
not yet sure that there is much of an input, certainly from the
local and regional level of communicable disease control professionals,
into the services that the reference laboratories provide. The
moving of the CCDCs into the Health Protection Agency, together
with the reference laboratories, should be an opportunity to increase
their voice which has not been heard enough.
Chairman: We have come to the end of our time.
We have not got to question 9 but that can be quite adequately
dealt with by asking you to respond to it in writing if you would
not mind, and also to include an evaluation of the chances of
it being achieved and what are the potential drawbacks or problems
in achieving it. Would you be willing to do that? The only other
thing I have to say is that if there are issues on any of the
other questions that you feel have not been adequately aired,
perhaps you would like to put in supplemental comments. The last
thing I have to say is thank you very much for coming along. It
has been a very interesting session. We have had a variety of
views which we will have to sort out in due course. Thank you
very much indeed.