- Email: [email protected]
UK health department urged to take the lead
Diana Walford, there is no systematic Russian medical aid for national database on hospital-acquired The Public Health Laboratory Service for infections. Furthermore, surveillance of England and Wales is embarking on a these infections is becoming increasingly Russia’s Finance Ministry last week earseries of changes recommended by an important since the trend towards minwill blur the bound5 billion roubles (US$1-25 milindependent strategic review. The review imising hospital stay aries between and for "basic outlay" in rebuilding hospital lion) community was prompted by the National Health Serinfections. and medical facilities in Chechacquired : hospitals vice reforms. : The other priority areas are improving nya. A further 4-5 billion roubles (US$1.1 The PHLS has, for some 50 years, carunderstanding of environmentally derived million) has been allotted to maintain the ried out several of its functions-surveillance of communicable disease as well as infections, training PHLS staff and other nearly 200 Russian medical teams in and around Chechnya and to finance the the provision of various microbiological public health professionals, and developmolecular for enhanced ing technology special package of welfare benepromised services-through its network of laboratoWalford and surveillance. fits and says diagnosis supplementary pay that virtually ries in NHS hospitals. The internal market and independent trust status forthat discussions are being held with the doubles the basic salary for health workers who volunteer for Chechnya. hospitals introduced by the health serviceMedical Research Council and the Well: in come Trust to According to the Russian Ministry of provide joint fellowships, reforms meant that the PHLS had to since the start of the Chechnya an effort to train high-quality academic Health, compete for contracts for its services and PHLS is also conRussian medical teams have The conflict, microbiologists. that the future of its laboratories based at to treated 3318 tributing joint training patients, of whom just under programmes trust hospitals would vary according to other one-third had with Union countries. : injuries related to the fightEuropean of the trusts concerned. Other plans : An overriding concern is that the PHLS ing. These figures presumably refer to the for the review included the imperatives civilian casualties. The Russian army has need to ensure that the service could should continue to have its own nationwide network of Walford its own medical service, and the Russian laboratories. respond to new situations-eg, the threat where cites the surmedia is convinced that the military casu. USA, epidemiological of emerging infections. A catalyst for the veillance is carried out state state; by alty lists are being under-reported. review process was efficiency savings of The volunteer Russian medical teams 10% over the next three years, imposed by drug-resistant tuberculosis might not have: the government, which funds the PHLS spread so widely had states not neglected had, the Russian Ministry of Health : reports, by the end of last week vaccinated public-health services. : tuberculosis surveillance. The PHLS surveillance has ben7500 refugees against diphtheria, tetanus, system The key recommendations were that a efited much from free, given input, by and measles. The figure seems impresprogramme of developments across the laboratories. One uncerother sive-until one realises that the estimated hospital whole range of PHLS services; a restrucmust face the PHLS is whether total of refugees to date is well over that tainty of the PHLS and betlaboratories; turing these laboratories can continue to do so.: 190 000. The International Committee of ter use of resources. In view of the limitations on resources, the PHLS has The service says it is encouraged to find the Red Cross is now talking in terms of a budget of more than$40 million over the identified four priority areas for service managers specifying the need for contrito the in bution surveillance next six months to meet the basic needs of system : developments over the next three years. contracts. the refugees and civilian population. microbiology purchasing : is the surveilOne of these
Towards
a
tighter PHLS
Chechnya
marked
priorities
lance and control of hospital-acquired infection. According to PHLS director DrVivien Choo
Vera Rich
not all of the fledgling local purchasers seem to have a firm grasp of what they are trying to achieve. "Some News in brief purchasers clearly seem to know what they The health department was criticised lastare doing and where they are going: others Director of PAHO Sir George Alleyne of week for giving muddled messages to it would seem have yet to find the map Barbados has been inaugurated as Director of the Pan American Health Organizaand are drifting", they said. The commitmanagers and clinicians over which essential services they should be providing for tee therefore wants to see a comprehention. He replaces Dr Carlyle Guerra de their patients. The reprimand came from sive system at the national level to evaluate Macedo of Brazil, who is leaving after the House of Commons all-party health all aspects of local purchasing and decicompleting three terms. Alleyne, formerly committee.’ While acknowledging that the sion making. The results of such an analyprofessor of medicine at the University of sis should then be disseminated back . the West Indies, has been a member of the department has started to clarify national health priorities for the committee also down to the local level, perhaps by regular WHO nutrition advisory panel since 1970 criticised the department’s tendency to bulletins so that purchasers can learn from and has been assistant director of PAHO dictate "new" priorities to the health serthe experiences of their peers. : since 1990. vice in an ad hoc manner. Above the the : all, says committee, As a result of the reforms of the Nationhealth department must come up with a Ciguatera in farmed salmon A 30-yearal Health Service, decisions about health set of clear and realistic principles to old woman in the USA had diarrhoea and severe headache due to ciguatera poisonservice purchasing have been devolved guide purchasers. In addition the governdown to the local level. Managers and ment should provide a longer term stateing from eating salmon (Ann Intern Med clinicians have therefore had to start ment of how they expect the health service 1995; 122: 113-14). Usually, reported almost from scratch to devise appropriate to develop over, for example, a three to cases have arisen from consumption of fish from coral reefs (Lancet health-care purchasing plans for the popufive year period. ; predatory lations they serve. Although the commitDec 17, p 1698). In this case the salmon was farmed, most likely came from Chile, tee heard of examples of innovative ways Sarah Ramsay and presumably ingested the toxin in conin which these new purchasers had risen taminated feed. The woman’s neurotoxic to the challenge, there was no way of 1 House of Commons health committee. symptoms lasted for two years and includjudging whether these initiatives are workin the NHS: Priority setting purchasing. ed tingling in her hands exacerbated by ing. London: HM Stationery Office. 1994. To their disquiet, the committee also drinking tea or coffee. Pp 54. £15.60.
UK health department urged to take the lead
found that
.
380
Towards
a
tighter PHLS
Chechnya
marked
priorities
lance and control of hospital-acquired infection. According to PHLS director DrVivien Choo
Vera Rich
not all of the fledgling local purchasers seem to have a firm grasp of what they are trying to achieve. "Some News in brief purchasers clearly seem to know what they The health department was criticised lastare doing and where they are going: others Director of PAHO Sir George Alleyne of week for giving muddled messages to it would seem have yet to find the map Barbados has been inaugurated as Director of the Pan American Health Organizaand are drifting", they said. The commitmanagers and clinicians over which essential services they should be providing for tee therefore wants to see a comprehention. He replaces Dr Carlyle Guerra de their patients. The reprimand came from sive system at the national level to evaluate Macedo of Brazil, who is leaving after the House of Commons all-party health all aspects of local purchasing and decicompleting three terms. Alleyne, formerly committee.’ While acknowledging that the sion making. The results of such an analyprofessor of medicine at the University of sis should then be disseminated back . the West Indies, has been a member of the department has started to clarify national health priorities for the committee also down to the local level, perhaps by regular WHO nutrition advisory panel since 1970 criticised the department’s tendency to bulletins so that purchasers can learn from and has been assistant director of PAHO dictate "new" priorities to the health serthe experiences of their peers. : since 1990. vice in an ad hoc manner. Above the the : all, says committee, As a result of the reforms of the Nationhealth department must come up with a Ciguatera in farmed salmon A 30-yearal Health Service, decisions about health set of clear and realistic principles to old woman in the USA had diarrhoea and severe headache due to ciguatera poisonservice purchasing have been devolved guide purchasers. In addition the governdown to the local level. Managers and ment should provide a longer term stateing from eating salmon (Ann Intern Med clinicians have therefore had to start ment of how they expect the health service 1995; 122: 113-14). Usually, reported almost from scratch to devise appropriate to develop over, for example, a three to cases have arisen from consumption of fish from coral reefs (Lancet health-care purchasing plans for the popufive year period. ; predatory lations they serve. Although the commitDec 17, p 1698). In this case the salmon was farmed, most likely came from Chile, tee heard of examples of innovative ways Sarah Ramsay and presumably ingested the toxin in conin which these new purchasers had risen taminated feed. The woman’s neurotoxic to the challenge, there was no way of 1 House of Commons health committee. symptoms lasted for two years and includjudging whether these initiatives are workin the NHS: Priority setting purchasing. ed tingling in her hands exacerbated by ing. London: HM Stationery Office. 1994. To their disquiet, the committee also drinking tea or coffee. Pp 54. £15.60.
UK health department urged to take the lead
found that
.
380