Letters

I was interested to read Frederick Marais's feature ('Lung haul', feature, page 31, 22 June). He refers to the findings of the report commissioned by the then Thames regional public health directors in 1998, which reviewed the tuberculosis situation in London and made recommendations for change. This formed the basis of discussions with the many groups of professionals associated with tuberculosis control in London at the beginning of last year and there was strong consensus on what should be done and how.

These developments are being progressed. They include the development of integrated care pathways for the management and control of tuberculosis across the five sectors within London to reduce the fragmentation of services across health service boundaries; action plans to address sector priorities; and the specification for a London TB register to assist in the follow-up of patients who move between services.

In addition, task groups have been established to deal with some of the pan-London issues, such as the early diagnosis of tuberculosis in people arriving from countries where tuberculosis is prevalent and the recruitment of nurses to work in this field. Londonwide targets have been set for improving treatment completion rates and nurse: patient ratios. Public health development funds have been obtained to assist these developments.

There are many challenges to tuberculosis control in London, which require a coordinated approach across many boundaries - not just between different parts of the health service, but between health services and local authority services and across geographical boundaries.

The inadequacies Mr Marais refers to were true for when the report was written, but much has been done since, and is being done, to improve tuberculosis control across London.

G Duckworth Consultant regional epidemiologist London