New agency could be bad for health

Monday 16 September sees the deadline for voicing opinions about the Chief Medical Officer's plans for a radical overhaul of the systems that safeguard public health in England and Wales. His aim is to fold four key agencies into one, and experts in public health believe they have cause for concern.The idea is to amalgamate the Public Health Laboratory Service (PHLS), the National Radiological Protection Board (NRPB), the Centre for Applied Microbiology and Research (CAMR) and the National Focus for Chemical Incidents (NFCI) into a new Health Protection Agency (HPA).Most experts agree that the current set-up is less than optimal and welcome any attempt to strengthen public health protection. But many are anxious that the pace of change is too fast to be safe — the Chief Medical Officer seems determined to complete the changes by 1 April 2003. The Board of the PHLS believes that, at the very least, a shadow HPA should be set up first. If all goes well responsibilities could then be transferred in April 2004. PHLS laboratory managers think that 2005–06 is more achievable.Others are concerned that the proposals show an alarming ignorance of the nature of the work done by the four current bodies. "When you are looking at risk-management and horizon scanning, microbiological risks are fundamentally different from chemical and radiation. To start with, microbes evolve and are out of human control, which is not the case for chemicals and radiation," says Hugh Pennington, professor of microbiology at University of Aberdeen and outspoken advocate for food safety. In addition, he points out that the technologies used in each area are completely different.Similarly, the NRPB is anxious that the proposals do not address the unique nature of its work. The NRPB believes that it should remain as a separate entity, with a ministerial directive to work with the HPA in emergency situations, explains spokesperson Liz Francis. The NRPB is also concerned about any loss of its ability to give impartial comment and advice. At the moment it is an independent body, but if incorporated in the HPA it would become part of the National Health Service.For the NRPB there is another issue. It was established by a 1970 Act of Parliament and needs approval from MPs to change it. "The Chief Medical Officer, however, is planning to avoid this by using the Regulatory Reform Act. This Act was designed as a red-tape buster for business, and we feel is being used inappropriately in this situation," says Helen Stevens, a spokesperson for Prospect, the union that supports staff at the NRPB. "If they are not careful the government will create a bit of a 'Rail Track'," comments Pennington, implying that, like the body set up by the previous government to run the UK's railways, the HPA could get lost in a system of contracts and confused responsibilities, with disastrous consequences.Pennington is also anxious that disbanding the PHLS will lose the disease surveillance structure that is the envy of the US and most other European countries. "In the US, the Centers for Disease Control relies on information generated by individual states. While the best states are excellent, you don't want to talk about the poor ones," he says. This blunts any ability to spot epidemics. He is afraid that making local National Health Service trusts responsible for surveillance will lose the national cover, and end up with the very system the US is longing to abandon.In addition, breaking up the PHLS risks weakening the network of personal connections with European neighbours. "Currently the UK takes a lead in disease surveillance — it would be a shame to lose it," says Pennington.

New agency could be bad for health

Serious concerns raised over UK government's haste in setting up new Health Protection Agency.

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