Volume 9: Wales, Scotland and Northern Ireland
Part 2: Scotland
9. Departmental responsibilities
Scottish Home and Health Department (SHHD)
Medical Services
Public Health Policy Unit (PHPU)
Chief Scientist's Office (CSO)
Communicable Disease (Scotland) Unit (CD(S)U)
Environmental Health (Scotland) Unit
National CJD Surveillance Unit
Scottish Office Food Safety Group

9.17 The Secretary of State had responsibility for public health in Scotland and was advised by a Chief Medical Officer (CMO). Dr Iain Macdonald was the CMO for Scotland in 1986. Dr Kenneth Calman took over the post in 1989, and he was succeeded in 1991 by Dr Robert Kendell. Dr Kendell described his main areas of responsibility as follows:

a. To monitor the state of health and the outcome of healthcare of the population of Scotland.

b. To assess what influences and determines health and ill health, and to advise on measures to improve health and healthcare.

c. To communicate effectively with the medical profession in Scotland, and to maintain effective links with key medical organisations in other parts of the UK and overseas. ¹

9.18 Two groups of officials in SHHD (later the Scottish Office Department of Health - see paragraph 9.21 below) were chiefly involved with the BSE/CJD issue: doctors from Medical Services, (later part of the Public Health Policy Unit), and the Chief Scientist's Office.

Medical Services

9.19 The CMO headed the group of doctors known as Medical Services, which comprised several smaller groups including a Public Health group, headed by a Principal Medical Officer, which gave advice on all aspects of public health including environmental health, epidemiology and communicable disease. Dr Rosalind Skinner was the group's Principal Medical Officer from 1993, when she succeeded Dr Archibald McIntyre. She had previously been Senior Medical Officer within the group with responsibilities in other areas of public health. She took over the remit which covered BSE-related issues from Dr Gerald Forbes, when he moved on to head the Environmental Health (Scotland) Unit in 1990 - see paragraphs 9.26-9.27.

9.20 It was customary in SHHD for each Principal Medical Officer to collate a summary of matters of current interest three times a year for the CMO. This did not have any official status but was intended to help ensure that the CMO was briefed and had an overview of work in progress. ²

9.21 The 1995 Scottish Office management review which resulted in a restructuring of DAFS also brought changes to SHHD. The Department was divided into two new Departments: the Scottish Office Department of Health (SODoH) and the Scottish Office Home Department (SOHD). In turn, SODoH was restructured as two units, each reporting directly to the Permanent Secretary:

• the National Health Service (NHS) Management Executive, which managed and developed policy for the NHS in Scotland; and
• the Public Health Policy Unit (PHPU), headed by the CMO.

Public Health Policy Unit (PHPU)

9.22 The PHPU, created in 1995, had policy responsibilities which included human health aspects of communicable disease and environmental health, improvement of human health and actions to reduce the incidence of disease. Medical and scientific advice in relation to the human health aspects of food safety, communicable disease and environmental health issues, together with CJD, continued to be provided by Medical Services, now brigaded as the Public Health Medical Division of the PHPU. ³

Chief Scientist's Office (CSO)

9.23 The Chief Scientist's Office was responsible for identifying, encouraging, promoting and supporting research for the improvement of health and the NHS in Scotland. ⁴ As a rule, the CSO did not support animal-based research but would consider projects in related areas such as zoonotic diseases or foodborne pathogens. There was no equivalent office in either Northern Ireland or Wales. ⁵

Communicable Disease (Scotland) Unit (CD(S)U)

9.24 The CD(S)U was established at Ruchill Hospital, Glasgow, in 1969 as a consequence of lessons learned from the epidemic of typhoid in Aberdeen in 1964. It later became a division of the Common Services Agency of the National Health Service in Scotland. Its remit was the surveillance of communicable diseases and other infections in Scotland. Dr Iain Macdonald described the functions of the CD(S)U as broadly matching the epidemiological role carried out by the Public Health Laboratory Service in England and Wales. ⁶ These included:

The surveillance of infections through the collection and analysis of microbiological and other epidemiological data from medical, veterinary and environmental sources . . .

Advising the Scottish Office - Home and Health Department on infection problems . . .

Liaison with other national surveillance organisations, eg, the Public Health Laboratory (PHLS) in England and Wales, the US Centers of Disease Control (CDC), and the World Health Organisation (WHO). ⁷

9.25 The CD(S)U collated information sent weekly from medical and veterinary laboratories in Scotland relating to micro-organisms identified in man, animals or other sources, such as food, water, sewage and abattoir drains. Other data sources included the Registrar General's 'Weekly Returns on Notifiable Infections', the family doctor 'spotter' practice and ad hoc telephone information. The data were published in the Unit's 'Weekly Report' for distribution within Scotland, elsewhere in the UK, and to the WHO and national surveillance centres in other countries.

Environmental Health (Scotland) Unit

9.26 The Environmental Health (Scotland) Unit was set up in 1989 by SHHD to act as an independent advisory body on environmental health issues. The principal functions of the Unit, whose Director was Dr Gerald Forbes at the time of its formation, were:

1. to advise and liaise with health boards, local authorities, the Scottish Office and other relevant bodies on the epidemiological and medical aspects of environmental health hazards;

2. to investigate environmental hazards to health and to undertake relevant epidemiological research;

3. to facilitate the education and training of appropriate professions;

4. to publish reports on environmental health in association with the Communicable Diseases (Scotland) Unit; and

5. to publish an annual report. ⁸

9.27 The Communicable Disease (Scotland) Unit and the Environmental Health (Scotland) Unit merged to form the Scottish Centre for Infections and Environmental Health (SCIEH) in 1993.

National CJD Surveillance Unit

9.28 Following the publication of the Southwood Report in February 1989 (see vol. 4: The Southwood Working Party, 1988-1989) and the completion of the Tyrrell Report in June 1989 (see vol. 11: Scientists after Southwood), the national CJD Surveillance Unit (CJDSU) was set up at the Western General Hospital in Edinburgh in May 1990. The purpose of the Unit, under Dr Robert Will, was to identify and investigate any changes in the pattern of CJD which might be attributable to BSE, and therefore to point up any public health risk. ⁹

9.29 The CJDSU collected information from the whole of the United Kingdom. The Scottish Office was not part of the Unit's reporting line, although it provided annually a little over 5 per cent of its funding between 1991 and 1996 (a sum not always sought, but always volunteered). The Unit reported to the Department of Health in London (to Dr Hilary Pickles, and later Dr Ailsa Wight). Since Dr Will was a member and later Deputy Chair of the Spongiform Encephalopathy Advisory Committee (SEAC), he was able to keep the Committee directly informed at its meetings of his Unit's findings.

Scottish Office Food Safety Group

9.30 Following a recommendation by the Richmond Committee, ¹⁰ a multidisciplinary food safety group, chaired by the CMO for Scotland, was established in 1991. Membership was drawn from senior officials of the Health and Agriculture Departments (including vets) of the Scottish Office, Scottish health boards, local authorities, public health laboratories, the CD(S)U (later SCIEH), the Royal Environmental Institute for Scotland and elsewhere. Updates and discussions on the progress of the BSE epidemic were provided by veterinary staff at this forum. ¹¹