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Health Protection in Scotland - A Consultation Paper

Chapter 5 - The contribution of microbiology services to health protection

Introduction

98. The commitment of microbiological services across Scotland is highly valued in the health protection and public health fields. Microbiological services confront a range of challenges which are common to many clinical and laboratory services. These include increasing workload, recruitment and retention of staff and other operational matters. This consultation document focuses on issues specific to health protection function, with a view to strengthening arrangements which already exist rather than proposing wholesale change.
99. NHS microbiology services should seek to balance their public health and individual patient care obligations. In respect of the former, the priorities for microbiology services are:

• improving the contribution of clinical diagnostic laboratories to health protection;
• continuing the drive to improve the standards of microbiology services;
• enhancing joint working among those involved in human microbiology services and with colleagues working in other types of microbiology e.g. food, animal, water and environment;
• enhancing the provision of reference and specialist public health microbiology;

Increasing the effectiveness of microbiology services’ contribution to health protection

100. Microbiology services are the cornerstone of the surveillance of communicable disease. The advice of microbiologists is essential in managing incidents and outbreaks of communicable disease. To help develop these functions, it is proposed that in each NHS Board area there should be a lead microbiologist with an interest in health protection who will promote good practice and be the main microbiologist providing an input into local policy.
101. In line with improving local arrangements, there is a need to strengthen the participation of microbiologists in national policy setting on matters related to infection. It is therefore proposed that a Standing Sub-Group of the Advisory Group of Infection be established to provide advice to SEHD on the microbiological aspects of health protection and clinical management.

Continuing the drive to improve the standards of microbiology services especially those which relate to health protection

102. All NHS microbiology services in Scotland participate in the CPA and/or UKAS accreditation schemes. In England in addition to these, two other improvements to NHS microbiology services are proposed:

• to extend standard operating procedures developed in England and Wales to all NHS laboratories and develop national standards based on these;
• to establish an Inspector of Microbiology who will review microbiological laboratories to identify major problems in their functioning.

103. It is proposed that NHS microbiology services in Scotland participate in these two initiatives if further information provides a compelling case for so doing. In relation to the latter option in particular, there is a need to fully consider the range of possible functions, and what benefits might accrue in Scotland, and related to that, whether those functions could or should be delivered on a statutory or administrative basis.

Enhancing joint working among those involved in human microbiology services and between these and their colleagues working in other types of microbiology e.g. food, animal, water and environment

104. A key aim of the drive to make health protection better is further integrating human health with animal and other types of surveillance. This is required to control food and water borne infections, enable the detection of emerging infections and monitor and prevent the spread of anti-microbial resistance. It is proposed that the Standing Sub-Group of the Advisory Group of Infection dealing with microbiology should include representatives of those working in other areas of microbiology to develop common approaches to the testing of samples and isolates, share information on good practice and advise the Scottish Executive on policy issues related to microbiology.

Enhancing the provision of reference and specialist public health microbiology services

105. The current network of microbiological reference laboratories covers tuberculosis, E. coli O157, gonorrhoea, legionella, MRSA, meningococci and pneumococci, parasitology, salmonella, and toxoplasma. In addition, the Public Health Laboratory Service (PHLS) provides cover for any other highly specialist reference services not dealt with by the Scottish laboratories.
106. This chapter poses a number of questions around current organisational arrangements for reference laboratories. In addition, views are sought on:

• whether the current network of microbiology reference laboratories should be extended to deal with other micro-organisms and if so which;
• if their remit should be extended to test isolates from non-human samples;
• the scope for centralising all, or the majority of, reference laboratories in one NHS Trust or other appropriate service unit.

107. It is proposed that the new Health Protection Agency will assume responsibility for the provision of reference laboratories in England, many of which will provide a UK-wide service. The Scottish Executive will ensure that a service level agreement on these is drawn up with the Agency.

     Conclusion

108. Except for Reference Laboratories, the Scottish Executive sees no need to alter the organisational arrangements for microbiology services. However, in line with progress being made in other UK countries, there is a requirement to improve the effectiveness and quality of NHS microbiology services’ input to health protection.

Questions

Do consultees agree that:

• no change should be made to the organisational arrangements for non-reference microbiology services in Scotland?
• national standards should be adopted by all NHS laboratories in Scotland, based on standard operating procedures developed in England and Wales?

It would be helpful to have views on:

• whether the current network of microbiology reference laboratories should be extended to deal with other micro-organisms and; if so, which;
• if their remit should be extended to test isolates from non-human samples;
• the scope for centralising all or the majority of reference laboratories in one NHS Trust or other appropriate service unit;
• whether you see a role in Scotland for the Inspector of Microbiology, expected to be appointed in England; and what that role might be;
• the arguments for and against having the same standard operating procedures throughout the UK.

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