Memorandum by Dr Stephen Radwanski, Public
Health Laboratory Service, South-West Group
I am writing on behalf of myself, a Bio-Medical
Scientist (Microbiology and Virology), and as the PHLS (South
West Group) Staff-Side Representative of the National Joint Staff
Consultative Committee (NJSCC).
As you are aware, in January the Chief Medical
Officer published his strategy, proposing the formation of the
Health Protection Agency (HPA), combining the Public Health Laboratory
Service, the Centre for Applied Microbiology and Research, the
National Radiological Protection Board and the National Focus
for Chemical incidents, to take effect from 1 April 2003.
This strategy has been widely supported, and
when announced produced excitement throughout the ranks as a means
of radically rethinking and restructuring the above services,
with all departments working "shoulder to shoulder"
under the same banner. However, the proposal that the majority
of the Public Health Laboratory Service (PHLS) laboratories in
England should be transferred to NHS management by 1 April 2003
has been met with opposition, both in principle and particularly
in terms of the unrealistic timeframe, by a majority of staff
in the PHLS. This includes the PHLS Board, who have expressed
serious reservations about the public health implications of the
proposals, and in particular the speed at which the process has
Furthermore, while full consultation on the
creation of the HPA has been carried out under a Regulatory Reform
Order, the transfer of the PHLS laboratories has been deliberately
excluded from that consultation process because it does not require
the use of such an Order. Instead, a separate restricted consultation
(Trade Union and Staff-Side Groups were not consulted with at
any time) was conducted by the Department of Health regarding
the transfer of laboratories.
As you know, the PHLS was originally established
as an emergency PHLS, at the beginning of WWII, to protect the
UK against the potential infectious hazards of warfare, including
the use of biological weapons. The PHLS has been reviewed on numerous
occasions, and on each occasion the management of a network of
diagnostic laboratories has been considered a strength of the
service, and has been recommended to continue. For example, the
Strategic Review of the PHLS in 1994 concluded that: ". .
. the management of a network of laboratories carrying out clinical
and public health microbiology, and providing microbiological
and epidemiological support and advice to all appropriate agencies
in their locality, should remain a core responsibility (of the
The report went on to say that, "if many
PHLS withdrawals from laboratories were necessary by financial
pressures, it would happen . . . without the same degree of confidence
that the public health function could be safeguarded".
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
sent on 29 January 2002 after "Getting Ahead of the Curve"
was published, Dr James Hughes, Director of the National Centre
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 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."
Following the 1994 Strategic Review, the PHLS
was organised into a number of regional groups of laboratories.
Originally the South West group comprised of the laboratories
in Truro, Plymouth, Exeter, Taunton, Bristol/Bath, Gloucester
and Hereford. The group now also includes Dorchester, Poole/Bournemouth
and Salisbury. PHLS South West has been an extremely effective
group of laboratories, with both senior and more junior members
of staff wishing to see the benefits that have been achieved from
this regionally managed network being extended and implemented
by NHS laboratories. However, the decision by the Permanent Secretary
and the Chief Medical Officer has snuffed out and possibility
of this ever happening, with the recommendation that there is
to be only a single HPA laboratory in Bristol, initially only
for one year, with all other laboratories in the South West Group
returning to NHS management by 31 March 2003.
On a personal note, I have been employed as
a Bio-Medical Scientist at Poole PHL for some 12 years now. I
sought out employment within the PHLS network because of my determination
to work for the benefit of public health with my efforts ultimately
extending to the rest of the UK. The work I undertake on a daily
basis is rewarding, but ultimately I put myself at risk. Although
utmost care is taken regarding the techniques used to examine
microbiological and serological specimens there is always the
possibility of becoming contaminated with pathogenic organisms,
some of which are life-threatening. In addition to this, low pay,
a mixture of unsociable hours, and the continual pressure to be
100 per cent accurate in my work, is sobering and negates some
of the rewards of the profession. Staff morale has steadily declined
over the last decade, and the proposed destruction of the PHLS
network has taken morale into an even steeper decline, despite
the assurances from the CMO that swift action would stave off
a worried work force. Many staff have telephoned me over the last
few months asking for clarification as to why they are to be abandoned
to NHS management. Great fear and anguish has been expressed,
especially as there is the perception that NHS Trusts already
over budget will have a major effect upon the Microbiology and
Virology service funding. Whilst assurances have been given by
the CMO for the first year post-transfer, there is a "fog"
still obscuring our futures. The formation of the HPA is a wonderful
concept. But the timescale proposed is unrealistic to ensure continuity
of service on a national scale, especially in light of the spectre
of war in the Middle-East, and therefore likely repercussions
here within England from the risk of bio-terrorism. Myself, and
my colleagues are here to passionately continue serving our communities
and by doing so, ultimately this great country of ours, through
our work as Microbiologists and Virologists. But we ask for a
realistic timescale to implement such a valuable asset to this
country, the formation of the HPA.
I sincerely hope that caution will be heeded.
The PHLS is vital to the surveillance of public health, and it
would be tragic if lives were lost due to unnecessary haste in
dissecting it. Perhaps a stronger outcome would be achieved if
all NHS laboratories became PHLS laboratories, and their standards
raised to those currently being employed by the PHLS.