A BBI
The UK's new Health Protection Agency (HPA) last month published its five-year plan, a program of work to tackle what it described as "a broad range of threats to health." Its goals include preparing for new and emerging diseases and dealing with threats to health as well as investigating childhood diseases associated with infection, chemical and radiation hazards. Established as of April 1, the HPA brings together existing organizations and staff dealing with infectious diseases, chemical hazards and poisons, and emergency planning.
The HPA has combined the functions of the Public Health Laboratory Service, the National Poisons Information Service and other National Health Service (NHS) staff and bodies responsible for controlling infectious diseases and emergency planning. The agency will be responsible for improving preparation among health and emergency services for major incidents and also aims to provide authoritative and impartial information and advice to the public.
Dr. Pat Troop, chief executive of the HPA, said, "Integrating the knowledge and skills from these established organizations is a huge gain for public health in this country, but the agency is more than a simple merger of expertise. There is a whole raft of new work we are embarking on, from establishing a network of local health protection teams around England, through to taking international collaboration to another level."
HPA Chairman Sir William Stewart, said, "the 21st century brings new problems which need new solutions. It's time to step up our health defenses." He said the "speed and ease of global travel" means there is "a much greater potential for the rapid transmission of infectious disease." In addition, "our climate is clearly changing, bringing the potential of more insect-borne disease. resistance to antibiotics is a growing problem, and there is increasing public concern about the long-terms effects of chemicals on health." Citing "the added threat of the deliberate release of harmful agents," he said "we have to ensure our health services are as fully prepared as possible to pick up and respond to any incident."
The organization's plan is a joint document with the National Radiological Protection Board, whose functions will transfer to the HPA, subject to further legislation.
The plan cites a dozen strategic goals for the HPA to achieve in its first year, including strategies to reduce the impact of infectious disease, prepare for new and emerging diseases and threats to health, and investigate childhood diseases associated with infection, chemical and radiation hazards.
It also includes strategies to investigate illness associated with exposure to hazardous chemicals, improve health service preparedness for certain major emergencies and provide the public with authoritative, impartial information and advice.
Troop said, "no other developed country has brought together this range of skills and expertise into one organization. It gives us a powerhouse of scientific knowledge that we can focus on new targets, such as childhood diseases, illness caused by long-term exposure to chemicals and predicting and preparing for new diseases, like SARS."
Among the new areas of work in the HPA are a training program for healthcare professionals so that they can recognize, diagnose and manage patients who have been exposed to chemical, biological, radiological or nuclear agents; development of new standardized laboratory tests for biological agents to ensure rapid and accurate diagnosis, and working with the NHS and local authorities to develop criteria for investigating suspicious clusters of diseases potentially linked to chemical exposure.
The organization also is developing new oral swab tests for key diseases, to replace what it referred to as "invasive and time-consuming blood tests." The HPA is working on a swab tests for pertussis (whooping cough) in children and for syphilis. "Given the ease of use, the swab test will provide a better picture of how common these diseases are nationwide," the organization said in a press statement. "And for syphilis, it means no risk of needlestick injuries for healthcare staff testing HIV/AIDS patients and intravenous drug users."
The HPA said it also is developing ways to deliver local and regional advice on radiological protection and researching a safe way to effectively decontaminate surgical instruments that may have been exposed to the prion-causing vCJD. "The development of this decontamination method, using an enzyme to destroy infectious prions, would mean that surgical instruments used on patients suspected of vCJD would no longer need to be disposed of," the organization said.
The HPA "has started its job in earnest," Troop said, "but there is a long-term program of work ahead of us."
'Boundaries' set for German reforms
Faced with continuously mounting costs for healthcare, the German parliament is taking up wide-ranging reform of the country's health system. The ruling Social Democrats and the opposition Christian Democrats last month agreed to compromises on an array of issues, producing draft legislation that would command majorities in both houses of parliament.
"We have set the boundaries for a comprehensive, structural renewal of the German healthcare system," said Minister for Health and Social Security Ulla Schmidt.
The main interest of the reform is to reduce the cost paid by employers and employees to cover health insurance. These have risen to an average of 14.3% of income this year, and high non-wage labor costs are often cited as contributing to unemployment in Germany. The draft law aims to reduce insurance premiums to an average of 12.95% in 2004 and 12.15% in 2005.
The 435-page draft law agreed to in late August covers many topics beyond the costs of premiums, including regulation of doctors, druggists and pharmaceutical companies.
The healthcare reform law will be taken up by the German parliament in early September. With the backing of the ruling coalition and the largest opposition party, its passage is nearly certain. Changes to elements of the legislation could take place in a conference committee that will iron out differences between versions passed by parliament's upper and lower houses. The final form of the law will take effect on Jan. 1.
NICE to recommend LBC for screening
The UK's National Institute for Clinical Excellence (NICE) has issued a Final Appraisal Determination recommending the adoption of liquid-based cytology (LBC) for cervical cancer screening in England and Wales. That recommendation will be used as the basis for NICE's guidance to the National Health Service (NHS) on the use of the appraised technology in England and Wales. The cervical screening programs in England and Wales represent more than 4 million tests. It is expected that implementation will commence immediately and will be completed over the next three to five years.
The NICE Appraisal Committee stated in its report that "potential advantages of the LBC method include an improved means of slide preparation, producing more homogenous samples than the Pap smear (which may make slides easier to read), increased sensitivity and specificity, and improved efficiency of handling laboratory samples, resulting in increased laboratory productivity."
In terms of cost-effectiveness, the committee said its analysis demonstrated that liquid-based cytology "dominated the Pap smear at each screening interval, as it was less costly and more effective." The NICE committee addressed such factors as sensitivity, specificity, specimen adequacy, lab efficiency and cost.
Two U.S.-based firms, Cytyc (Boxborough, Massachusetts) and TriPath Imaging (Burlington, North Carolina), are the major current suppliers of LBC products.
Consultation aimed at key NHS issues
Britain's National Health Service (NHS) is starting a broad-based consultation exercise directed toward helping the NHS address some of the key issues it is facing. NHS Chief Executive Nigel Crisp issued an invitation to patients, user groups and both NHS and social care staff last month to participate in the effort to focus on ways in which the organization's delivery of health and social care can offer more choice, become more responsive to patients and tackle inequalities in access to care.
The NHS said it is "starting an intensive period of consultation on what patients and users want in terms of choice, involvement and flexibility in their care and treatment." It said the consultation will run to November and "will enable patients, service users, voluntary groups and health and social care staff to help shape future national policy and plans in this area."
Crisp, who will chair the Project Board that is overseeing the consultation program, cited the rapid growth of the NHS, adding that it will continue to do so over the next few years. "As we grow, we have the opportunity to offer people more choice over their care and more involvement in decision-making; we can become more responsive to patients, design services better and tackle inequalities." To do that, Crisp said, "We need to know what patients want in terms of choice, involvement and flexibility. We need to involve not only patients, but also their carers and professional staff. We need creativity and new ideas, as well as to know what is working well now."
Fischer Imaging makes moves in Europe
In moves designed to strengthen an already growing presence in Europe, Fischer Imaging (Denver, Colorado) has moved its European headquarters to Geneva, Switzerland, and has revised its distribution efforts through the establishment of direct subsidiaries in Germany, Italy, France and the UK. The company previously sold its digital breast imaging systems in Europe through strategic partnerships.
Harris Ravine, president and chief executive officer, said the decision to sell its SenoScan TrueView systems directly was made as a result of the company's "growing installed base and investment in Europe," combined with what he said was "increasing acceptance of our technology."
Fischer said its most recent installation in Germany is the first in the world integrated with iCAD's (Nashua, New Hampshire) CompanionCAD computer-aided detection system. The SenoScan system was installed at the department of diagnostic radiology at University Hospital (Erlangen, Germany) under the direction of Dr. W.A. Bautz. The hospital complements its screening SenoScan system with the company's digital MammoTest systems for diagnostic care.