Alcohol Strategy

John Glen Excerpts

Tuesday 7th February 2012 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Totnes (Dr Wollaston) on securing the debate. For me and my constituents—as I suspect it is for many in the Chamber—this issue is probably the biggest problem in our area. I deal with related issues concerning community safety every day. I rise to give the perspective from Northern Ireland and to outline the critical and crucial programme that we have to ensure that issues caused by alcohol are addressed.

In Northern Ireland, on 1 March 2010, there were 5,846 individuals in treatment for drug and/or alcohol abuse—a very high number. More than 50% were in treatment for alcohol misuse, some 22% for drug misuse and a fifth of those for both. Approximately 75% were male, 27% female. Although it is predominantly a male problem, clearly a large proportion of females are involved. The hon. Member for Walsall South (Valerie Vaz) said that it is terrible to see young people drunk. It is always particularly upsetting to see young ladies and girls drunk and we certainly have to consider that. The last figures available show that the number of people receiving treatment increased by 5% in just one year, from 5,583 to 5,846—some 500 extra on that list, which again, unfortunately, is an upward-moving figure which we are concerned about.

There are some 1.5 million victims of alcohol-fuelled violence in the UK as a whole. Community safety is threatened by the misuse of alcohol. We have to deal with that. The police superintendents have outlined and advised that alcohol is present in half of all crimes. That worries me and I suspect that it worries all hon. Members here. It also shows that a high proportion of victims of violent crime are under the influence of alcohol at the time of the assault. So alcohol runs, almost like blood itself, through all the violence and the problems.

Some 37% of offenders had a current problem with alcohol use; 37% had a problem with binge drinking; 47% had misused alcohol in the past; and in 32% violent behaviour was related to their alcohol use. As other hon. Members have mentioned, drinking starts slowly with small indulgence and increases, with peer pressure involved, then there is binge drinking and then misuse of alcohol, with the violence that comes off the back of that.

I want to focus on young people, who need to learn at an early age to drink responsibly when they are of an age to do so at 18. In Northern Ireland, the average age for young people to have their first drink is 11. When I read that I said, “My goodness me, that’s shocking.” I am aware, as an elected representative, of people who started with one drink, perhaps when their marital relationship broke down, and drank whenever there was alcohol in the house and whenever there was peer pressure. I fought a case for a liver transplant for a young boy who started drinking at the age that I mentioned and at 17 or 18 he found himself a candidate for a liver transplant. If such facts do not shock people to their core, they should. It certainly shocks me.

[John Glen (Salisbury) (Con)]

Throughout society there are different instances of alcohol misuse. In the armed forces, in the under-35 age group, alcohol misuse among men is more than double that in the normal population. Does the hon. Gentleman not think that that underscores the fact that a Government approach must recognise pressures in all different elements of society and the different phases at which interventions need to take place?

[Jim Shannon]

I thank the hon. Gentleman for his intervention. I agree wholeheartedly and I think that all other hon. Members do. There are different levels. I was developing a point about young people, but there is a drink culture in the armed forces as well. Perhaps that is to do with the job that they do or the time that they spend together. Government has to address those issues.

Around a quarter of 11 to 16-year-olds in Northern Ireland drink regularly and around one in eight have been drunk more than 10 times. One third of 11 to 16-year-olds who have tried alcohol have bought it from a pub, off-licence or shop. There is an issue there for the police in enforcement and for local councils, where the power lies, to monitor and control what happens. There is also a strong link between starting to drink at a young age and problematic alcohol use in later life. A shocking statistic is that one in four young people claim to have been drunk 20 times in the span of a month. The number of 15 to 16-year-olds who binge-drink in Northern Ireland is one of the highest in Europe.

Alcohol use among young people is of particular concern, as they are more vulnerable than adults to suffering physical, emotional and social harm from their own and other people’s drinking. The hon. Member for Totnes mentioned what emerges as a result of that. Drinking leads to a high risk of unsafe sexual behaviour, traffic and other accidents, unintended pregnancies, failure at school and mental health problems, antisocial behaviour, vandalism and violence. This is a serious issue and is not a matter of kids being kids: it goes a lot deeper and the problems caused are a lot longer-lasting and have a great impact on our community as a whole. We have to take on the big issues.

I work in my constituency with many community and residents’ associations that are determined to stamp out abuse in their areas. There are many ways of doing that, including through education programmes for children. A group called the forum for action on substance abuse works hard with young people; it takes on the hard issues, gets the community and young people involved and ensures that a safer option is available for kids, other than standing at street corners being pressured into trying drink or drugs.

Community groups in my area are working hard to do what they can to end the vicious circle of alcoholism and drug use. Yet they cannot do it themselves; they need Government help and educational, health and police strategies as well. There needs to be a system in place that lends support and advice and co-ordinates events and information to ensure that people are informed.

A recent survey carried out by a church group in Newtownards in my constituency found that under-age drinking was a major issue that led to people feeling unsafe in their neighbourhood. The abuse of alcohol leads to side effects being felt by other people who are not involved, including not feeling safe. The fact is that problems arise when people are mixed with a large amount of alcohol. When young people, who have not yet had the time to develop their moral standards and ideals, are mixed with alcohol we get a generation fuelled by a desire to live in the moment without the thought of consequences.

Alcohol changes personalities. When young people are learning who they are, adding alcohol to the mix means that they will never have a good understanding of who they are. That is why it is essential that we put in place a way of combating under-age drinking by ensuring that drink is not available for people under 18.

When wearing my other hat as an Assembly Member, prior to coming to this House, we raised the age on buying cigarettes—that has been implemented—as it was recognised that upping the age limit would make it easier for retailers to demand identification. It is time that we enforced the same rigour and control with regard to alcohol. It is time for the Government strategy to take on board the involvement of councils and all the other bodies, which is important. We need to take on the issue of sales venues, including off-licences and pubs. We must increase police activity and police the councils in their monitoring pubs and off-licences.

We also have to say something about parental control that perhaps has not been said yet: it is neglected many times. Parents do not exercise the control that they should, but they need to do so.

I support increasing the price of alcohol. It is important that we do that. I do not see anything wrong with that. We must ensure that drink promotions do not encourage binge drinking.

Innovation (NHS)

John Glen Excerpts

Wednesday 12th October 2011 Westminster Hall

[John Glen (Salisbury) (Con)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I requested this debate in order to raise important issues about the ongoing review of how the national health service extracts the full potential from innovative, commercially realisable ideas generated by NHS employees and to seek clarification from the Minister about the scope of the Carruthers review of innovation in the NHS announced this July.

I was led to the subject by my involvement with Odstock Medical Ltd in my constituency, a company that has grown from Salisbury NHS Foundation Trust. OML has pioneered a technique called functional electrical stimulation that produces contractions in paralysed muscles by applying small pulses of electrical stimulation. Having experienced it myself, I can attest that it assists walking. OML has developed a range of neuromuscular stimulators to improve the functional ability of people with neurological conditions such as multiple sclerosis. The devices have been developed during many years of collaboration among clinical engineers, clinicians and patients at the National Clinical FES Centre at Salisbury NHS Foundation Trust.

Last year, it came to my attention that, because OML is partly owned by the local NHS foundation trust, under EU rules, it cannot be classified as a small or medium-sized enterprise, and therefore cannot access grants and support through normal Department for Business, Innovation and Skills channels. That seems ludicrous. I met the Minister of State, Department for Business, Innovation and Skills, my hon. Friend the Member for Hertford and Stortford (Mr Prisk), who has responsibility for small business, along with Professor Ian Swain from OML. Little progress could be made, although attempts were made to access specific funds and schemes. It is a systemic failing.

Anxious to overcome that barrier and explore other aspects of innovation in the NHS, more recently, I met with Alun Williams, the CEO of NHS Innovations South West, who has an office in my constituency and is here today. Alun is wholly committed to the NHS and is passionate, as am I, about finding ways to develop streams of revenue for the NHS. I thank him for his support and advice as we have discussed the subject in recent months.

My key concern is this: as populations age, as the cost of drugs and treatments rises faster than inflation and as medical science, thankfully, finds ever more treatments for human ailments and medical conditions, the NHS must be more radical in exploiting the bright ideas of its staff to ensure that the commercial potential of those ideas are realised fully by the NHS.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Gentleman on securing this enormously important debate. I was brought to the subject by NHS Innovations South East. Does he agree that NHS staff can come up with innovations—examples cited to me include improvements in child protection investigations and adolescent mental health programmes—that do not readily or easily translate or crystallise into commercial benefit? Is it therefore not short-sighted for the Government to insist, as I understand they do, that innovation bodies must be totally self-supporting commercially?

--- Later in debate ---

[John Glen]

I certainly contend that there are significant pockets of innovation. The challenge is bringing those ideas to their full commercial potential and getting them into the NHS so that they are cheaper for the user. The adoption and uptake of NHS-grown ideas is not wide or deep enough, few hospitals showcase their ideas and the wider benefits are not really felt across the NHS. Some ideas, when fully exploited, might realise significant streams of revenue, easing the cost pressures that I mentioned.

The review led by Sir Ian Carruthers, announced at the beginning of July by the Department of Health, will seek in its report next month to inform the strategic approach to innovation in the modernised NHS. However, it must not simply set up another framework or broad aspirations; it must deal convincingly with the gritty realities of what is needed to take a proven idea that has been honed, challenged and assessed by the innovation hubs to its full commercially realised potential.

The report must also recognise that, unless a way is found to invest in such ideas, their commercial potential will be exploited by private sector entrepreneurs who can move more rapidly and access finance more quickly. Intellectual property will thus be patented not by individual NHS trusts, as is desirable, but by the private sector, which will then charge the NHS for products and services at rates that the NHS would rather not pay. I urge the Minister to push the boundaries and ensure that we do not risk allowing the ideas of excellent NHS employees to be lost, thus losing the value and savings that could accrue.

[Margot James (Stourbridge) (Con)]

I congratulate my hon. Friend on securing this important debate. Does he agree that, although it is important for the NHS to realise the commercial value of innovation, it is also fundamental to the improvement of patient care that innovations take hold more rapidly? Did he see this morning’s comments by Professor Williams, president of the Royal College of Surgeons, who warned of a 20-year wait before innovations start saving lives if we base innovation progress on previous experience? He cited reduced deaths from bowel cancer as a result of keyhole surgery, which took years to become widespread practice.

[John Glen]

I thank my hon. Friend for that extremely helpful intervention. I met Professor Williams last week, and he made that point to me. That is the nub of the matter. If the NHS does not move quickly on such ideas, someone else will, and it will cost more. My hon. Friend is absolutely right. The impact on outcomes is negative. We must move matters forward so that the advantages can accrue to the NHS.

It is important to realise that, in the big picture of NHS politics, there is an almost pathological fear of doing anything that could imply the use of the word “cut” or the even more toxic P-word, privatisation. I am not arguing for either, but I am saying that, unless we adopt savvy practices to incubate and develop proven concepts more speedily, I fail to see how the NHS can deal with the increasingly more intense systemic supply and demand pressures that it will face. Efficiency savings and ring-fenced budgets, although welcome, will not be enough to save the NHS and provide the money that it needs to continue in its present form. We need more realism about that and a radical solution that has the potential to create more money.

I recognise that it should not be the NHS’s primary objective to develop income streams from medical devices, new treatments or services. Equally, given that great ideas are an unintended by-product of taxpayer investment in providing a world-class national health service, it would surely be wrong not to look hard at making innovation work to the NHS’s advantage. So many ideas derive from employees whom the state pays quite handsomely.

Furthermore, after initial investment, funding innovation could be self-financing, using royalties from previous successful investment. It just needs to unlock that potential. Alongside producing efficiency savings, this significant reform need not require significant capital outlay at the outset.

It feels as though successive Governments have been so concerned to avoid the tag of allowing the waste of capital on ideas that do not immediately point to a return, or being portrayed as blurring the boundaries of the NHS, that they have not fully established the means and mechanisms of making ideas realise their potential. Lip service is paid to the desire to innovate, but practical measures that make it possible on anything like the scale that is possible are not in place. It is more a question of whether the NHS can afford not to exploit the potential savings and revenue streams presented by these ideas.

I am aware that the current position is not completely bleak. The Minister will be able to cite a pipeline of ideas and he will know that the UK has established capabilities in this field. The medical device sector alone makes a significant contribution to the UK economy, with an industry turnover of £13 billion and 55,000 employees. That industry, however, is generally a supplier to the NHS. We need to move to a situation in which the NHS itself generates devices that can save—with a small s—the NHS from bearing the full commercial costs of products that the private sector has developed in its place. Why is it not possible for the Government to establish an innovation strategy with a real focus on extracting value from the pipeline?

I am not suggesting that there should be centrally driven, random speculative investment of taxpayers’ money in half-baked ideas suggested by any clinician. The regional innovation hubs are already primed to sift ideas. For example, NHS Innovations South West has criteria that each product has to meet before it can receive further assistance. First and foremost, it must bring significant benefit to patients in terms of better outcomes and quality of life. It must also be patentable. The return on investment must meet a minimum threshold and it must be commercially viable—that is, there must be an assessment of a global need for the technology, making it a worthwhile investment for commercial partners.

Once that has been established, the issue is how to develop the ideas to their full potential. Several ideas exist in the south-west. A cancer diagnostic endoscope and meniscus knee repair device are both, subject to completing clinical trials, able to meet the criteria to which I have referred. Given that oesophageal cancer is one of the fastest growing cancers globally and early diagnosis can have a significant impact on savings in the NHS, it is highly desirable that that progresses quickly. The meniscus device should significantly improve patients’ quality of life and postpone the need for an expensive total knee replacement by up to five years, thereby again saving the NHS huge sums of money.

My concern is that it is purely by chance that the private sector has not taken this work further. The current NHS process for capitalising on these innovations is not quick enough. There is limited access to NHS funding, and progress is inhibited by insufficient incentives and enabling mechanisms to encourage trusts to invest in such promising cost-saving technologies. Hospitals exploit these ideas elsewhere in the world and significant royalty streams accrue. They would make a recurring contribution to the much required efficiency savings that the chairman and chief executive of my hospital trust are desperately trying to find at present.

In conclusion, I believe that the NHS is a powerhouse of innovation, but that that is not being harnessed sufficiently to accrue the tens of millions that would be available to individual NHS trusts if a bolder approach were taken by Government. I urge the Minister to consider carefully the potential of the ideas in the NHS and to do all he can to ensure that the scope of the Carruthers review is broad enough to deliver recommendations that will allow the huge value that exists to be realised.

Congenital Cardiac Services for Children

John Glen Excerpts

Thursday 23rd June 2011 Commons Chamber

[John Glen (Salisbury) (Con)]

In view of the time, I will be as brief as possible. I thank my hon. Friend the Member for Pudsey (Stuart Andrew) for initiating this debate, and I thank my hon. Friend the Member for Winchester (Mr Brine), who has provided much sound advice and support as we have brought this case to the House.

Two issues about the calculation of quality have come to my attention through my constituents Joanne Diaper and Richard Maguire. Southampton scored extremely well, but I am concerned about the differences between the various hospitals and how they have scored. If there is a range of difference of up to 20% on outcomes, I am concerned that the review could institutionalise mediocrity, not excellence.

There is consensus throughout the medical world that, as the Children’s Heart Foundation chief executive says,

“the majority of parents recognise that paediatric cardiac surgery is a specialist service,”

and that there will need to be some rationalisation nationally. She goes on to say that parents

“support the concept of larger but fewer centres of excellence”—

not of centres that are quite good but could become better over time. Given the complexity of the procedures that need to be undertaken, it behoves those reviewing the decision to note excellence and to embed it in future provision. We need to drive up standards in areas that do not have excellence.

Some clinical experts may move to the other side of the country, or perhaps to another country altogether. Most parents of chronically sick children with conditions that can be treated only by two or three specialists will travel any distance because they want to know that they have the best chance of having their children’s lives extended. The motion makes a sensible case in recognising the need for partnerships, and I welcome the partnership that exists between Southampton and Oxford.

It was announced in the Safe and Sustainable pre-consultation business case that 400 surgical procedures constituted a minimum threshold, but the mix could be extended to include surgery on adults as well as children. It is vital to look at what is clinically the right thing to do instead of imposing a threshold that seems convenient but does not do justice to the skills that exist in individual hospitals.

In the interests of time, I will now conclude my remarks to allow some of my colleagues to make, I hope, some different points.

NHS Future Forum

John Glen Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

Most of that was pure invention, including all the numbers. We are going to save money with these changes to the NHS. We are going to transfer resources from bureaucracy, management and administration into front-line care. Through clinical commissioning groups we are going to empower staff in the NHS, and abolishing two tiers of management in the NHS will save us, in total, a third in real terms out of administration costs.

[John Glen (Salisbury) (Con)]

Will the Secretary of State confirm that despite the existence of clinical senates the primary driving role in commissioning will remain with GPs, who know their patients best and know which services they require?

[Mr Lansley]

My hon. Friend makes an important point. General practice—not just general practitioners but general practice—has a central role for patients because there is a long-term relationship with patients and an understanding of the whole population and the health of a whole area. However, GPs recognise that in order to get the right services for patients, they have to design services alongside the range of professionals whose job it is to deliver them.

Health Protection Agency (Porton)

John Glen Excerpts

Tuesday 22nd June 2010 Commons Chamber

[John Glen (Salisbury) (Con)]

Thank you, Mr Deputy Speaker, for the opportunity to bring the issue of Porton Down’s future to the House this evening.

My purpose in requesting this debate is to highlight the critical role that the Centre for Emergency Preparedness and Response plays in the life of this country, and to raise the question whether the current outline business case that the chief executive and board of the Health Protection Agency have put before the Department of Health to move the CEPR to a site in Harlow is right for the country’s public health needs and right for many of my constituents who work at Porton.

First, it may interest colleagues to know that Porton Down came into being almost 100 years ago, as a response to the horrific chlorine attacks on allied soldiers during the first world war. The institution has been active and working for almost 100 years. It was a chemicals research centre in 1916. In 1930 it became the Chemical Defence Experimental Station, and in 1940 it began looking at biological warfare and carrying out experimental investigations into anthrax.

The current CEPR building was built between 1948 and 1951 and named the microbiological research department. Thirty years later it became the Public Health Laboratory, and subsequently it split from the Ministry of Defence facility at Porton Down, now the Defence Science and Technology Laboratory, which is co-located next door.

In 1993 Porton became an independent agency of the Department of Health, and in 2003 it became one of the founder establishments of the Health Protection Agency, being renamed the Centre for Emergency Preparedness and Response. Now co-located on site with DSTL, it is treated as one site by the Health and Safety Executive. DSTL provides a back up of containment level 4 laboratories for the highest microbiological risks. The work at Porton is complex, involving the study of dangerous pathogens of humans, animals and plants. They can be a major threat to public health and include anthrax, swine flu and foot and mouth.

Porton is a world leader for examining diseases that spread rapidly: for example, insect-borne diseases such as West Nile fever and malaria spreading to new areas. It is a world-class centre for translational research that helps to ensure that new discoveries are developed and translated from the mind of the scientist into real benefits of tested medicines for patients. It routinely works with partners to develop tuberculosis vaccines and vaccines for whooping cough, meningitis and anthrax. Porton has the biggest TB group in Europe. It also has an aerosol delivery function using specialist equipment.

The CEPR is routinely asked to do work by the US Government, as it is one of very few centres in the world with the capability and experienced staff to carry out that work. Through its work, Porton manufactures Erwinase, a drug developed there for the treatment of childhood leukaemia, estimated to save 1,400 lives annually. It has the rare capability to manufacture emergency vaccine in response to emerging disease threats. Porton receives a massive amount of its funding—between 70% and 80%—from the work that it does for academia and Governments overseas.

I wish to make the point that the CEPR at Porton Down has been very long established in my constituency, and it does critical work that is vital to this nation and to the world. However, I am a reasonable man, and if I felt that the proposed move was in the best public interests of the country as a whole, I would have to concede reluctantly and accept the proposals that have been tabled. I do not believe that that is the case.

On the day when my right hon. Friend the Chancellor has indicated that future capital spending should be prioritised on those items of expenditure that give “significant economic returns”, and at a time when £1 in every £4 is being borrowed, why has the option of allowing more operational autonomy for the CEPR not been examined carefully? It is my contention that the best way to maintain excellent service for the public health needs of the country, while achieving cost-effective solutions, is not to spend the estimated £400 million on a move to Harlow when the financial benefits set out in the outline business case would accrue after 60 years. I believe that a cheaper solution exists, whereby the risks of investment can be shared with a new co-operative led by experienced Porton-based scientists who are keen to take on the challenge of building new revenue streams from the US Government and academia while maintaining their vital commitments as an HPA establishment.

Let me move on to the background behind the outline business case proposing a move to Harlow. In 2008, the previous Government announced a major funding initiative—Project Chrysalis, a rebuilding programme to update the facilities at Porton, which was, I acknowledge, much required. Then, in October 2009, out of the blue, a proposal for Terlings Park in Harlow emerged as a option. Then, in January 2010, a new preferred option emerged—the GlaxoSmithKline New Frontiers site in Harlow. Now, the outline business case is being pushed through.

Project Chrysalis has already spent about £10 million on the plans for the rebuild at Porton Down on an site adjacent to the current one. It has been ongoing, assessed and developed over two years. The move to the GSK site in Harlow has been considered only since January this year, and it is thought that the project team is still undertaking assessment of the site. There is therefore significant cause for concern that insufficient information is available to substantiate a compelling business case to make this decision. The £85 million that was budgeted for the moving costs has not been fully scrutinised, and it is likely significantly to understate the true costs of the work required. The GSK site currently undertakes neuroscience research, and the laboratories are mainly chemistry-type labs that are not suitable for easy conversion to the sort of work that is undertaken at the CEPR. At so many levels, the move does not make sense.

Some questions need to be asked about the proposed move to Harlow. As there is to be a break of synergy with the DSTL, which is immediately adjacent to the CEPR at Porton, will it be acknowledged that the new CL4 lab in Harlow, which is to be the same size as the one formerly proposed for the new build at Porton, will cost more in reality? There will be no benefits from having a similar lab next door, as we do at Porton, because there will be nothing next door. What costing and risk assessment has been undertaken with respect to the travel arrangements between Porton and the densely populated town of Harlow?

Has the planning process to allow the construction of such sensitive facilities, where such difficult work is undertaken, been examined? During any proposed transition, staff will need to be trained on both sites in both CL4 labs to ensure that there is no interruption during a national emergency. How will that be achieved initially and kept workable if the CEPR is in Harlow, when I am told that up to 80% of the experienced scientists do not want to move? Has a skills availability assessment been made as part of the outline business case?

What functional dependencies exist with other agencies of the HPA? It is my contention that although their technologies may be similar, the functions of the different HPA agencies are very different. Does the outline business case set out explicitly the financial business case for the co-location of the different agencies of the HPA? The head of the CEPR has said to me that the detailed synergies have not been worked out yet, but it seems that the logic for the business case relies on the notion that all the HPA agencies can be brought together at some time in the future. He also said that potential synergies would be looked for, but they have not been established yet. At a time when every penny counts and the health budget is facing severe pressure, why should we back a move in relation to which the co-location potential and synergies will be “looked for”? Furthermore, if co-location is such a panacea for the operational effectiveness of the HPA, can it be confirmed whether the costs of moving the other HPA agencies from Chilton and Colindale to Harlow have been worked out? When are those moves likely to take place?

Having visited Porton, I am unsure of what overlap there really is. There is the possibility of some animal facilities being shared with the National Institute for Biological Standards and Control, and that some microbiology labs may also be shared. However, any sharing is not really possible, and money cannot be saved, until all agencies are on the same site, and there are no plans in sight for that to happen. Currently, the plans are therefore notional, uncosted and unproven. If the proposed move goes ahead, it will break up translational research—that is, scientists taking stuff from the desk to tested medicine. Manufacturing will remain at Porton, but the key translational function will be lost.

It remains my contention that the proposed Harlow move has not been properly thought through. The benefits of co-location had not been mentioned before the first Harlow site came on the scene, so opportunistic were the uncosted arguments for co-location. The well- intentioned arguments to move the Porton Down facility to Harlow have not taken into account the opportunity that exists for Porton to generate its own income and increase its own revenue. That should be explored before the Government back a move to Harlow, which would be expensive, is unproven and would put at risk the unique, world-class facility that we have been operating successfully at Porton.

The CEPR has its own funding stream from royalties from various vaccines, and it is almost self-sufficient. To upgrade its facilities, it would need help only with capital costs, which it could repay if given the operational freedoms that I have suggested. It has unique synergies with the defence establishment next door. Eighty per cent. of the work force would not like to move. It is important when working in those high containment laboratories to have experienced staff—their combined experience stretches back over many hundreds of years. If those people will not move, the challenge to the public health of this country is significant, putting it at risk.