Published: 24/04/2003, Volume II3, No. 5825 Page 18 19
A panic measure to deal with the post-9/11 world, or a measured response to a whole raft of potential public health emergencies? Pat Troop, who took up her new job as chief executive of the Health Protection Agency on the day war against Iraq broke out, knows she has has a lot of work to win supporters for the new organisation
The timing could not have been better - or worse, depending on your point of view. Just 10 days before the new Health Protection Agency was due to take responsibility for dealing with chemical, biological, or radiological attacks in the UK, war broke out.
So for Pat Troop, the HPA's inaugural chief executive, it really was something of a baptism of fire.
The launch of the HPA on 1 April was deliberately low-key - 'like the Oscars we didn't roll out the red carpet' - and Dr Troop, formerly the deputy chief medical officer, says they were keen to reassure the public that there would be a smooth transition of work to the HPA.
Not everyone was convinced of this and there have been suggestions that the creation of the HPA, and the publishing of Getting Ahead of the Curve, the document that produced the idea, were panic measures in order to be seen to be 'doing something' following the 9/11 attacks.
Dr Troop denies that: '9/11 was a trigger, but we had already started thinking about it; 9/11 was a final push and not a starting point.
What it really illustrated - and this has been recognised internationally - was that if you want to respond to a bioterrorist attack or a chemical attack or a dirty bomb, it will only work if you build on what is there for normal problems.You can't plan separately for an anthrax attack; it has to be based on the parallel response for something like a big legionnaire's outbreak.
If you have a smallpox response it has got to build on what you do for influenza because it is so similar. And people are always far more comfortable if you say 'do what you normally do'. If people do that then they know how to respond. The key is robust infrastructure: have people in place, trained, working together, knowing the system. If you have that, it doesn't matter what hits you; you have people there and they can respond.'
It was the creation of this network that was the main focus during the setting up of the HPA. Dr Troop says public health experts had wanted this sort of organisation to be created for some time, a call that grew following the foot and mouth outbreak two years ago. Dr Troop chaired a group on the safest way to dispose of the animal carcasses. She says: 'The group I pulled together to look at overall risk assessment from the health sector were all people who are coming into the agency. It was only by pulling their expertise together that I think we came out with a really robust response. The next incident that really pushed it even further was 9/11.
Over the next few days I pulled in people from around the country...and it was only by pooling their expertise, learning from each other, that we were able to put very rapid guidance out. Every time we had one of these problems at the department we had to put a team together.They increased their joint working, but it was just so obvious that you would get a much stronger response from working together like that that we needed to bring them together.'
Dr Troop says the pieces of the jigsaw were always in place, it was just a question of getting them to fit together in the most efficient way: 'We have a lot of very good parts of an infrastructure, we have several independent groups that advise on chemicals, we have two bases for infectious disease, we have people working out in the community, and by bringing them together We are bringing all that expertise together and creating a robust infrastructure that will be consistent right across the country from the local to the regional to the national. It is the consistency, the standardisation, the working together and the synergy that should make it a very strong organisation.'
Despite these positive messages, there were rumblings from some of the bodies being subsumed into the HPA - particularly the Public Health Laboratory Service, which was unhappy that expertise would be lost when 31 public health laboratories were transferred to NHS trusts.
Dr Troop dismisses fears that trusts will not treat the laboratories with sufficiently high priority.
Two-thirds of their funding will come from trusts and the rest from the HPA. NHS chief executive Sir Nigel Crisp wrote to trust chief executives to instruct them to give their public health labs the support they need.
Dr Troop says 'every possible check and balance' has been built into the system and she is keen that trust-run laboratories still feel part of the national network.
'The PHLS is not like the NHS.
The NHS has been through lots of change and has got used to it.
Trusts merge and demerge all the time, but that has passed them by, so the idea of change was actually quite a big issue. So it took people a while to realise that it wasn't such a dreadful thing.'
Concerns were also expressed that the PHLS would 'haemorrhage' staff once the HPA took over responsibility for public health laboratories, but Dr Troop says that so far only a tiny number of staff have left. In fact, she says, she has been inundated with CVs from people keen to come and work for the HPA.
So is the role of dealing with the aftermath of a terrorist attack on this country a weight to bear for Dr Troop? 'Well it is, ' she says, 'but I used to lead on this for the Department of Health on behalf of the chief medical officer and the ministers. And I led all the work after 9/11; I led all the work around anthrax. I was the one they phoned when they found the ricin. Obviously I have always felt, not anxious, but concerned that we would respond well.
'I have always been confident that we have such a good senior team that we would make it work well, and in our run-up to this I said that if anything happened on 1 April we would have to respond.'
It is less than a month since the HPA began work, but already Dr Troop says the agency's work has been recognised abroad: 'They are all looking at us. We are the first organisation with comprehensive expertise at national level, linked to the infrastructure at a local level. In Europe they are trying to set up a clinical disease centre...We have had interest from Europe and the World Health Organisation.'
Dr Troop says she was amazed at the number of international links that already exist across her organisation and wants to pull it together into a coherent picture so that it has real influence internationally.
Although the man in the street could be forgiven for thinking it, the HPA was not set up solely to deal with terrorism.As well as the PHLS, the HPA has taken on the roles of the Centre for Applied Microbiology and Research, the National Focus for Chemical Incidents, the National Poisons Information Service, and NHS public health staff responsible for infectious disease control and emergency planning.
It will work in conjunction with the National Radiological Protection Board, but the intention is to merge the two organisations eventually. It is far from a body developed solely to deal with terrorist incidents, so has the brouhaha around a possible terrorist attack overshadowed the rest of the agency's work?
Dr Troop admits that some of her staff may sometimes feel that, but she says she explains to them that it is a public concern, and part of the agency's responsibility is to respond to public concern.
'That is why we have to give it the kind of importance so that the public feel confident that we are delivering. I also explain to them that if they didn't do what they were doing in other areas we could not respond [to terrorist incidents]. I wouldn't want the agency in the long term to be just thought of as anti-bioterrorism.'
Confidence is the key behind making the HPA a success.
Although Dr Troop was keen not to launch the agency with too much of a song and dance, she does want people to know that they are in place and doing their job.
'I would like to feel that a little way down the line people in the community know who we are, why We are there and are confident that we are doing a good job on their behalf because that is why We are there.We are there for the community, we are there for health, that is our only raison d'être.'