Communicable disease control in England; recommendations from an American.

The problems associated with the Wakefield salmonella and the Stafford Legionnaires' disease outbreaks and the recommendations of the Acheson Committee formed in response led to the creation of the position of Consultant in Communicable Disease Control (CCDC) within the District Health Authorities. The reality of the position as implemented differs from that envisaged by the Acheson Committee and has resulted in ambiguities about the role of the CsCDC, the source of their support, and the range of their responsibilities. This paper, by an American invited to review the position, outlines the history of the position, the current status of CsCDC, and the barriers to effective performance of the position. It ends with a series of recommendations for improving disease control within England by solidifying the position, establishing its role in disease control within the National Health Service and recommending an educational/training pathway to attract and prepare physicians for the position.