Where now for infection services in the NHS? How lessons from the pandemic should drive long-overdue integration of microbiology and infectious diseases

During its first 20 years, the NHS witnessed the almost entire disappearance of epidemic, community-acquired infections such as scarlet fever, tuberculosis and measles with the resulting closure of hundreds of ‘fever hospitals’. Meanwhile, social and medical advances ushered in different problems, for example, infections related to an ageing population or proliferation of immunosuppressive treatments. An estimated 300,000 NHS patients develop a healthcare-associated infection (HCAI) each year, incurring costs estimated at up to £2 billion. Antimicrobial-resistance (AMR) threatens to undo decades of medical progress and is predicted to cause more deaths than cancer by 2050. Causing over 500,000 UK hospitalisations, COVID-19 has recently highlighted that life-threatening pandemics are not consigned to history and crucial lessons must be learnt from our national response. A fundamental review of NHS ‘Infection’ (Infectious Diseases, Microbiology and Virology) provision is overdue and must resolve long-standing training issues that hamper integration of these key component services. Profound changes to system-wide healthcare, including creation of Integrated Care Systems (ICSs) and the UK Health Security Agency (UKSHA) - formerly Public Health England (PHE), create an opportunity to coordinate these distinct but integral disciplines to ensure parity of access to high-quality infection prevention, diagnosis and management expertise.