02 October 2012 	
 	
Dear Colleague 
Room 524 Wellington House
133-155 Waterloo Road
London 
SE1 8UG

	
Subject: Technical Engagement on the new UK Five year Antimicrobial Resistance Strategy and Action Plan.	

Dear colleagues 

This letter invites you to provide input into the new UK five year Antimicrobial Resistance (AMR) strategy and action plan, which the Department of Health (DH) has been developing in collaboration with Defra, the Devolved Administrations and other government departments.  We have been assisted in this work by a number of experts from external bodies including academia, the Research Councils, the Health Protection Agency, DH and Defra government advisory committees (Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) and Defra Antimicrobial Resistance Coordinating Committee (DARC)).  We are now seeking your views on a number of specific aspects of the draft strategy, action plan and accompanying impact assessment to help us finalise the package. Development of the final strategy and action plan will also take account of affordability.

By way of background, antimicrobial resistance has been a European priority since 2001 when the Council Recommendations on prudent use in human medicine were adopted.  Activity has increased in recent years because of the rapid spread of multi-resistant bacteria and provides a driver for action in this area.  Last year the EU announced a 12 point strategic action plan for both the human and veterinary sectors.  This has been followed by the adoption of Council Conclusions the impact of AMR in the human health sector and in the veterinary sector – a “One Health” perspective on 22 June 2012, that invites Member States to develop and implement national strategies and action plans. The work being led by DH responds to this call. 

The proposed UK five year AMR strategy has a holistic integrated approach and is non-regulatory in nature. It builds on the 2000 UK AMR strategy and subsequent work to improve public and professional knowledge, promote behaviour change and best practice to preserve existing therapies, encourage greater collaborative action to address evidence / data gaps, as well as innovative research to facilitate development of diagnostics and new therapeutics. 

A wide programme of work to tackle antimicrobial resistance is underway and by bringing it together in a UK strategy and action plan, we expect to accelerate progress on this important health issue. While implementation of the strategy is expected to result in savings in terms of costs to the UK health economy eg preventing infections in the long term, it may involve some associated opportunity costs for the Health Protection/Public Health Agencies across the UK, the NHS and others, including farmers in the short to medium term. It may also create potential revenue and business opportunities in terms of innovation and research development in the health area. 

An impact assessment is being prepared which will estimate the scale of the costs and savings.  As data on implementation costs are limited, this technical engagement exercise will help to develop the impact assessment. Information to inform an equality assessment is also welcomed.

Although the initiative is non-regulatory in nature, the issue is politically important as it provides an opportunity for the UK to lead work in this area, influence the global agenda and therefore contribute to the wider health economy.  Given the potential financial and business implications we will be seeking Regulatory Policy Committee views and cross government agreement, in time for us to publish the strategy and action plan later this year. 

I will look forward to receiving your input by 23 October 2012. 

Please respond to our dedicated email address at: HCAI@dh.gsi.gov.uk.

Yours sincerely 
 
Dr Ailsa Wight
Deputy Director Infectious Diseases and Blood Policy Branch, Public Health Directorate  

TECHNICAL ENGAGEMENT QUESTIONS 

We would particularly like your feedback on the following aspects:

Strategic Aims 

A) Do you agree with the 7 key aspects which will form the focus for the integrated UK five year AMR strategy and action plan, which have been developed to align with the EU AMR strategy, and reflect UK needs? If not, please explain why and indicate what you would suggest instead? 

Yes		No

Comments:

Outcome Measures 

B) The proposed high level outcome measures for the health, animal and research aspects of the strategy, will be used to assess progress on an annual basis.

Do you agree that there is a need for national outcome measures? 

Yes		No

Do you agree with those proposed?

Yes		No

If not, please explain why and indicate what you would suggest instead?

Comments:

Action Plan

C) Do you agree with the suggested action points in the overarching UK action plan and the proposed timeframe for their delivery?

Yes		No

 Comments:

Impact Assessment

D) Do you have any data which you could share to help inform the impact assessment? Our initial assumptions of the impact are laid out in annex 3 of the strategy, with some more detailed questions presented there - We are particularly keen to receive information on associated costs or cost savings and revenue generation which could result from implementation of the strategy/action plan

 Comments:

Equality Assessment

E) Do you have any data which you could share to help inform the equality assessment? We are particularly keen to receive evidence of the impact or potential impact of the proposed strategy/action plan on people sharing the following protected characteristics: age; disability; gender reassignment; pregnancy and maternity; race; religion or belief; sex and sexual orientation. 
It also applies to marriage and civil partnership, (in respect of the requirement to have due regard to the need to eliminate discrimination) and carers ‘by association’ with people sharing some of the characteristics.

Comments:

Please respond to our dedicated email address at:  HCAI@dh.gsi.gov.uk by 23 October 2012.

Circulation list of stakeholders:

Organisation	Organisation	
Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI)	British Veterinary Poultry Association	
Animal Health and Welfare Board for England	British Retail Consortium	
Antibiotic Action	British Society of Antimicrobial Chemotherapy (BSAC)	
Association of British Healthcare Industries	British Small Animals Veterinary Association	
Association of British Pharmaceutical Association industries	British Thoracic Society	
BBSRC & GO Science 	C. diff support	
Bella Moss Foundation	Care Quality Commission	
Bill & Melinda Gates Foundation	Chemical Biology Ventures	
BIS	Defra	
BIS Office for Life Sciences	Defra Antimicrobial Resistance Coordinating Committee (DARC)	
Britain Veterinary Association	DFID	
British Association of Sexual Health and HIV (BASHH)	DHSSPSNI (Department of Health and Social Security and Public safety Northern Ireland.	
British Cattle Veterinary Association	Directors of Public Health	
British Chiropodists and Podiatry Association	European Centre for Disease Prevention and Control (ECDC)	
British Dental Association	Economic and Social Research Council (ESRC)	
British Equine Veterinary Association	Ethical Medicines Industry Group (EMIG)	
British Generic Manufacturers Association (BGMA)	Faculty of Public Health	
British In Vitro Diagnostics Association (BIVDA)	Fish Veterinary Society	
British Infection Association (BIA)	Food and Drinks Federation	
British Medical Association	Food Manufacturers Federation (Health Food Manufacturers Association-HFMA)	
British Pig Association	FSA	
British Pig Veterinary Association/Pig Veterinary Society	ACMSF Secretariat - FSA	
British Small Animals Veterinary Association
	Healthcare Infection Society (HIS)	

Organisation (cont)	Organisation (cont)	
HPA	Sheep Veterinary Society	
Imperial College London	Society of Chiropodists and Podiatrists	
Infection Prevention Society (IPS)	The International Scientific Forum on Home Hygiene	
Infectious Disease Research Network	The Soil Association	
Local Government Association (DPH)	UK BioIndustry Association (BIA)	
London School of Hygiene and Tropical Medicine	UK Clinical Pharmacist Association	
MHRA	University College London	
Ministry of Defence (MOD)	University of Birmingham	
Monitor	University of Cambridge	
Medical Research Council (MRC)	University of Cardiff	
MRSA Action	University of Edinburgh DIID Leg	
National Concern for Healthcare Infections	University of Liverpool	
National Farmers Union	University of Nottingham	
National Institute for Health and Clinical Excellence	University of Oxford	
National Pharmacist Association	University of Reading	
National Voices	University of Southampton	
NHS Confederation	University of Warwick	
NOAH	University of West London	
NPHS - Wales	Department for Health, Social services and Children -Wales	
Patients Association	Wellcome Trust	
Public Health Observatories	Contacts for Northern Ireland	
RAND Europe	Chief Executive of HSC Trusts	
Responsible Use of Medicines in Agriculture (RUMA)	Chief Executive of PHA	
Roslin Institute	Chief Executive of HSC Board	
Royal College of General Practitioners	Chief Executive of PCC	
Royal College of Nurses	Chief Executive of BSO	
Royal College of Pathologists	Chief Executive of NIAS	
Royal College of Physicians	Chief Executive of RQIA	
Royal College of Veterinary Surgeons	Executive Medical Director/Director of Public Health, Public Health Agency 	
Royal Pharmaceutical Society	Assistant Director of Public Health (Health Protection), Public Health Agency	
Royal Veterinary College	Director of Nursing and AHPs, Public Health Agency	
Sanger Institute / University College London	Director of Research and Development, Public Health Agency	
Scottish Government		

Organisation (cont)		
Assistant Director of Integrated Care, Pharmacy and Medicines Management, HSC Board		
Heads of Pharmacy and Medicines Management, HSC Trusts		
Family Practitioner Service Leads, HSC Board		
GP Medical Advisers, HSC Board		
Medicines Management Advisers		
Medical Directors, HSC Trusts		
Medical Director, NI Ambulance Service		
Nursing Directors, HSC Trusts		
RQIA (for distribution to independent hospitals)		
SEHSCT (NI Prison Service)		
Dean, School of Medicine, Dentistry & Bio-medical Sciences QUB		
Head of Life and Health Sciences, UU		
Head of School of Nursing and Midwifery, QUB		
Head of School of Pharmacy, UU		
Head of School of Pharmacy, QUB		
Head of School of Nursing, University of Ulster Staff Tutor of Nursing, UU		
Chief Executive, NIPEC		
Postgraduate Dean, NIMDTA		
NICPLD		
Members of the Antimicrobial Resistance Action Committee		
NI Medicines Information Service		
Director, Safety Forum		
Lead, NI Medicines Governance Team