Communicable disease control must remain at local level

Editor—We doctors are becoming used to learning about important government policies through the media, and so I was not surprised to learn of the probable demise of my own health authority in this way in a recent news item.¹

I believe, however, that the Department of Health needs to think carefully about what will happen to communicable disease control when the number of authorities is reduced. The 30 remaining “strategic health authorities” will monitor the performance of local health services and provide a link with the Department of Health.

Each authority will cover an average population of 1.5m. Control of infectious disease and environmental hazards depends entirely on close working relationships with colleagues in primary care, local councils, school health, and other local agencies. In North Cumbria we have seen the importance of this close working in recent years when we faced a large outbreak of Escherichia coli O157, as well as with the current outbreak of foot and mouth disease. Clearly, communicable disease control must remain at a local level.

The chief medical officer has been working on a strategy for communicable disease control for about three years. It is time that the Department of Health showed its cards and told the profession what its plans are.

It is interesting that the same issue of the BMJ carries Smith's editorial on unhappy doctors.² I can only speak for myself, but the uncertainty caused by the long awaited review of the chief medical officer coupled with the government's preference for conducting much of its business through the media do little for my mental health.