Published: 12/09/2002, Volume II2, No. 5822 Page 6 7
Chief medical officer Professor Sir Liam Donaldson has recognised some of the concerns of critics opposed to the transfer of microbiology services to trusts next April. But the government seems almost certain to push ahead with the plans on the current timescale.
In a response to a discussion document seen by HSJ, Sir Liam has reasserted the government's belief that more than 30 of the laboratories currently managed by the Public Health Laboratory Service should be transferred to trusts in seven months' time.
The PHLS - which will effectively be scrapped as part of the creation of a new Health Protection Agency in April - has argued that the transfer should be phased to coincide with the creation of pathology managed clinical networks.
Concern over the possible safety implications - the fragmentation of the current system in an NHS already swamped by other priorities - was so great that the PHLS board took the unprecedented decision to demand that they should be 'directed' by the secretary of state to stick to the government's timetable.
That direction has yet to be made, but NHS chief executive Nigel Crisp has 'informed' the PHLS that NHS trusts will take on its laboratories, as has already been proposed.
Sir Liam's response to the discussion document describes a managed clinical network as 'essential' - but also says that the pace of progress across the NHS 'will on reflection not be rapid enough' to meet the April start date for the Health Protection Agency. Nor will it be rapid enough to meet the 'need to have a vision of NHS microbiology service for the next five years or so'.
Any NHS trust which has a 'strong reason' for not feeling able to take on the responsibility of the transferred services following the creation of the HPA, therefore, will be able to have the issue considered by the chief medical officer himself in discussion with the relevant strategic health authority.
But Sir Liam warned: 'If the HPA is to develop as an organisation fulfilling its responsibilities... it cannot take the operational management responsibility for providing a routine diagnostic microbiology service for almost half the NHS.'
He also claimed that delays in the transfer would 'perpetuate uncertainty for staff with the risk of high staff turnover among current PHLS employees'.
The financial implications of creating the HPA has also caused concern.The January 2002 consultation document Getting Ahead of the Curve, which first proposed the new body, only said that the restructuring would be cost neutral.
In his latest response Sir Liam believes it is 'a matter of history' that core PHLS funding has often supported routine diagnostic microbiology services in the past - a subsidy he says will continue for 2003-4.
Trust boards will all be 'encouraged to ensure' the level of funding available for such services between April 2003 and April 2005 is 'not less' than contracted with the PHLS this year. From 2004-5, the PHLS 'subsidy'will be completely removed and passed out to primary care trusts as part of general allocations.
PHLS staff transferred to the NHS will be guaranteed continuity of employment for up to 12 months after the transfer takes place.
'With careful and sensible partnership-working between NHS trusts and the PHLS, I am confident that potential risks during the transitional period can be managed, ' Sir Liam says.
The PHLS is to consider its formal response at a board meeting next week.