Serving a Nation's Health

When the swine flu pandemic began in April 2009, Joanna Ellis, 49, faced the biggest challenge of her 17-year career at the Health Protection Agency's (HPA's) National Influenza Centre (NIC). She and two colleagues had to develop and validate the United Kingdom's laboratory test for the H1N1 virus in just 10 days, a process that normally takes several months.

"I can't describe the pressure we were under," she says. "But we're used to dealing with outbreaks and working as a team under pressure. We've had the SARS outbreak and suspected avian influenza. We've had to deal with a large number of samples over a short period, working long hours and sometimes weekends to get results."

The swine flu test and protocols Ellis developed were distributed to 22 U.K. laboratories. Since being introduced in May 2009, the tests have detected approximately 20,000 cases of pandemic H1N1 flu in England. The swine flu test protocols have been sent to laboratories in Canada, Japan, Dubai, Italy, Denmark, and other countries. "It's satisfying [that] other people can use the assay and get the same results," she says.
Ellis is a clinical scientist, a designation reserved for specific scientific positions within the National Health Service (NHS) and in satellite agencies like HPA. Clinical scientists do everything from applied research and hospital laboratory diagnostics to helping doctors diagnose a patient’s disease. Scientists in these positions have the opportunity to see their work have a direct impact on public health.

Biological detective work

Ellis first became interested in viruses and bacteria in her late teens. "There was a TV program about food poisoning where they traced the outbreak back to some iced buns in a bakery. I liked biological science and the detective work and thought this was something I'd be interested in doing." She decided to study microbiology at the University of Leeds.

After finishing her degree, she took a 1-year post doing virology research in a diagnostics laboratory at Birmingham Heartlands Hospital. Along the way, she decided she wanted to pursue research and so started looking for Ph.D. programs that seemed interesting.

"In the early 1980s, there was not much to choose from, but I managed to find a Ph.D. program in plant biology" at the University of Hull, she says. She went on to do a 1-year postdoc at Royal Holloway, University of London, studying how plants respond to potato blight. "But I lost my motivation a bit. I couldn't see it as a long-term career. There isn't much investment in the plant world."

She switched to human diseases for a second postdoc at University College London (UCL) and, for 4 years, researched the immune response to arthritis. "At the time, molecular diagnostics was taking off. They started applying those techniques at UCL, and I learned them there," she says. NIC hired her in 1992, in part so that she could bring these techniques to its laboratories.
Today, Ellis is a joint scientific lead at NIC, which employs 27 people. She works with clinical samples to develop laboratory influenza tests, and she supervises the team's work on flu monitoring and diagnosis. The time she spends on each activity varies depending on laboratory priorities. "More research can be achieved when flu activity is low, such as in the summer," she says.


In contrast to academic research, for which scientists often pursue open-ended research questions, Ellis’s research within NIC must have public health applications. For example, she has spent 2.5 years working on a European Union–funded project to design a flu test that works in less than 30 minutes and can be administered in a port, an airport, or a doctor's office. "You wouldn't have to wait to send samples to the lab," she says. "Should someone have an unusual influenza, like avian influenza, you could quickly isolate that person."

Clinical scientist training

Routes into clinical science are more formal today than they were when Ellis entered the field. Now, scientists who want to work for NHS and related organizations must complete the 4-year Clinical Scientist Training Program (CSTP) before they can register with the Health Professions Council (HPC). Only health care scientists registered with and regulated by HPC can call themselves clinical scientists.

The training enables clinical scientists to help doctors diagnose a patient’s disease and suggest treatment. They give doctors advice about interpreting test results from individual, named patients' clinical samples. Their clinical certification allows them to access patients' confidential medical records. Trainee clinical scientists work at NHS facilities such as hospitals while studying for a M.Sc. or other relevant qualification in their specialty.

A new program, the Scientist Training Program (STP), will soon replace CSTP, most likely next year. STP aims to make it easier for trainees to switch specialties by allowing them to try several their first year. For example, an STP in blood sciences might include 3-month rotations through clinical biochemistry, immunology, hematology/transfusion science, and genetics. NHS Careers, the information service for careers in NHS in England, is expected to publish further details about STP soon.

Tom Ford, a 34-year-old NHS clinical scientist at London's Chelsea and Westminster Hospital, completed his CSTP after earning a Ph.D. in molecular evolution. He divides his time between researching immunology, testing clinical samples from the hospital, and interpreting the results for clinicians. "I've got the best of both worlds," he says. "I see the day-to-day impact the immunology laboratory has, but, on top of that, I'm getting to do fairly cutting-edge research."

For his research, Ford is looking into ways to improve the diagnosis of people with immune deficiencies. The research is funded by one of the first National Institute for Health Research fellowships available to NHS health care scientists. He's also been involved in a project to improve monitoring of HIV infections in Third World countries. "I'm effectively 'postdocing' while doing a clinical scientist's job. I think it's a fairly privileged position, and I'm lucky to have it," he says.
Ford says that working in both a clinical laboratory and a research department requires flexibility. "I have to drop my research if something comes up in the routine lab because the patient comes first," he says. Ellis makes the same point: core work takes priority. "As a clinical scientist, I have to split my time between core work and research, whereas, in academia, a scientist can focus more on research," she says.
Prospective Ph.D. or postdoctoral students can work on projects allied with clinical science without leaving academia by joining a university medical school closely linked to an NHS teaching hospital. However, they wouldn't be qualified to access patients' medical records or send reports to doctors, which clinical scientists can do.

"You're more detached from the diagnosis of patient illness than health care scientists," says Michael Kidd, a consultant clinical scientist in virology who works mainly at University College London Hospitals. "It's more forward-looking but nevertheless could be translated back into patient care."

Pros and cons

NHS employs more than 50,000 health care scientists, pharmacists, clinical engineers, and medical physicists. Their work is directly or indirectly involved in more than 80% of clinical decisions, which "signifies what a vital role they play," says Julie Wardle of NHS Careers.NHS health care scientist salaries vary, but Wardle says trainee clinical scientists earn about £25,500. This rises once they've completed their training. Clinical scientists can progress to consultant level and be paid as much as £80,000 to £90,000 per year.

Unfortunately, positions tied to the government are at the mercy of national politics and budgets. For example, just last week a government white paper announced the transfer of HPA's functions to a new public health service, Public Health England. HPA's staff members had faced an uncertain future since the agency appeared on a leaked list of government agencies facing abolition earlier in the year.

Another downside of working in these organizations, some say, is the high public profile. "We're always under scrutiny from the public," Ellis says. "We've also received scrutiny from the Cabinet Office and from government. Anyone entering clinical science from academia has to be aware of this."

Despite the challenges, working to support the country's health presents interesting opportunities for scientists. For Ellis, that may mean planning experiments, reviewing papers, or writing reports. "With flu, every year is different," she says. "That's what I enjoy most. You don't know what's around the corner."