Streets of London: Compulsory HIV and Hep Tests
By Malcolm Aitken
Compulsory HIV and hepatitis tests for potential NHS recruits, with those who test positive becoming ineligible for posts entailing a higher risk of infecting patients, came a step closer last week. Moreover, Britain’s major doctor’s union and a leading HIV charity have voiced concerns.
An expert group comprising doctors, nurses, dentists and other health professionals has recommended testing for blood borne viruses among candidates potentially undertaking exposure prone procedures (EPPs). These arise mainly with surgery, obstetrics, gynaecology, dentistry and midwifery.
On January 2 the Department of Health stated the expert group’s proposals had been accepted by the chief medical officer and government Ministers and were being put out to consultation.
The proposals have brought criticism from the British Medical Association (BMA), a professional association and union that represents about 80 percent of British doctors.
‘Patient safety is paramount but the reality is that health workers are much more likely to be at risk from patients than the other way round. We must have complex processes in place that diminish the likelihood of blood-to-blood transmission between patients and health care workers. There is a need to ensure whatever is done is properly supported by providing NHS staff with the right equipment to do the job properly and by providing necessary retraining,’ says BMA head of science Dr Vivienne Nathanson. ‘We would want to look carefully at the science of why they are doing this. The viruses are all different and differences in transmission require different solutions. We mustn’t be reliant on simply testing before commencing employment.’
A leading UK HIV-Aids charity, the Terrence Higgins Trust, says the tests shouldn’t be compulsory. However, director of operations Andrew Ridley says HIV positive people or those who refuse to take the test should ‘not be excluded from working within the NHS, but should be offered work in one of the many areas which do not involve invasive procedures.’
The UK’s deputy chief medical officer Pat Troop has defended the proposals. ‘The measures will help doctors, nurses and other health care workers, by giving them access to tests for these serious infections when they apply to work in the NHS and immunization or treatment if needed. The new checks will also help those planning a career in the health service make informed career choices early on.’
Pre-empting accusations of HIV status-based discrimination she says: ‘The measures are not intended to prevent those with blood born viruses [HIV, hepatitis B and C] from working in the NHS, because most health care procedures do not pose a risk of transmitting these infections to patients or colleagues.’
An NHS spokesperson denied the absence of compulsory testing for health professionals currently carrying out EPPs created a window of vulnerability.
He told Scoop: ‘ I think it’s important to understand the background in terms of what the controls are at present. There are already quite stringent procedures in place. All the main professional bodies have codes of practice which state very clearly that if any health worker thinks that they may have been exposed to infection somewhere, they should get testing and treatment if necessary right away. They are professionally bound. It’s their professional bodies rather than the NHS but there are regulations in place.’
Moreover, there have been only two recorded cases of HIV transmission from health care workers to patients during the past 20 years, neither of them in Britain, the spokesperson says.
Rather than legal repercussions or employer-employee relations issues, practical considerations are behind current EPP staff not being tested, he says.
EPPs don’t include common procedures like taking blood, giving injections or having stitches.
Malcolm Aitken is a freelance journalist based
in London. He can be contacted at