You Ask The Questions: Sir Liam Donaldson, chief medical officer

How difficult can it be to get doctors and nurses to wash their hands?
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What three simple measures should everybody take to improve and maintain their health?

ED DERBY, Brighton

One, eat less and build more fruit and vegetables into your diet. Two, walk more. Three, never smoke and don't breathe other people's smoke.

Is there too much change and reform in the health service?

BEN CONGDON, Guildford

Medical and scientific advance depends on change, new ideas and innovation. Structural change and administrative reorganisation is, in my experience, over-rated as a way of bringing improvement. Communication to staff of the reasons for change and the benefits it will bring is often poor and results in a lack of buy-in to reform at grass roots level. The message? Establish that reform will bring real gains, engage the frontline and communicate the benefits in people terms, not technocratic terms.

Why are we performing so much worse than the rest of Europe in treating cancer among children?

ANDREW YOUNG, Newcastle

I don't agree that we are performing badly. There are areas we can improve on, but there have been great advances in the treatment of childhood cancers which have resulted in markedly improved survival rates. Recent reports on poor survival were based on data which is between ten and 30 years old. Overall, around 75 per cent of children with cancer are now successfully treated, compared to about 25 per cent in the 1960s, and for some types of cancer survival are more than 90 per cent.

Can you envisage cancer being eradicated?

MATTHEW STREET, London SW6

We are making great strides in cancer treatments, some of which we couldn't have predicted even 10 years ago. We may well eradicate some specific cancers but it is unlikely that we will ever eradicate cancer altogether. Some of this depends on individuals' lifestyle choices such as not smoking. Also, cancer is largely a disease which affects older people and the population is ageing. However, with new technologies being developed all the time, we are moving to the point where some cancers are much more preventable and treatable.

Will we eventually see human cloning?

JOHN LINES, Dulwich

Difficult to say whether society's attitudes will change in the distant future. On the horizon, though, is the very exciting prospect of therapeutic cloning, ie cloning at the cellular level. Through this, it may be possible to replace damaged organs and tissue and treat previously incurable illnesses and injuries. Britain is one of the leading countries for research in this area.

Breast cancer remains on the rise. Should we reduce the age at which women are automatically invited for screening? And what about prostate cancer? Should men be offered screening automatically?

FRANK HOOPER, Birmingham

There is no evidence for reducing the age range for breast screening, but Nice has produced clinical guidelines for the management of women with a genetic risk of developing breast cancer. At the moment, there isn't a reliable method of screening for prostate cancer. However, several research studies are looking at this and we will be looking carefully at their findings. Until screening is available, we have produced guidance to help men make an informed choice about whether they have a test for prostate cancer or not.

Can you understand the concern over vaccinating pre-pubescent girls against cervical cancer?

DIANA NIXON, Slough

Yes, I understand parents' concerns and take them very seriously. We have researched parents' attitudes about the best age to give HPV vaccine and will continue to do such studies. Based on what we have learned, we have made sure that our plans reflect what parents have told us they want. Parents and young people want clear, accurate information on which to base their decisions. It is important that we offer that. We musn't forget that this vaccine, like many others, can be a life-saver.

Why were you so opposed to single vaccines for measles, mumps and rubella when they would have allayed parental fears over the possible link between the MMR jab and autism?

MARK EDWARDS, London N7

An option for single vaccines would never have allayed parental fears - it would have had quite the opposite effect, implying that there was some valid reason to have an alternative to MMR. There never was any evidence for a causal link between MMR and autism, there was no evidence that single vaccines would prevent autism, and there were good reasons to believe that single vaccines would actually put children at risk. It would have been the wrong thing to do then and every study before and since then has reinforced that standing fully behind MMR was the right thing to do.

Will the government meet its target of halving MRSA rates by 2008?

TANIA GEE, Cardiff

The most recent data shows a third annual decrease in numbers of MRSA bloodstream infections which we hope to build on with an additional £50m funding for reducing all HCAIs and increased funding for the HCAI Improvement Teams which have already provided direct advice and support to over 70 NHS trusts. Intense effort is going into achieving further and sustained reductions.

Hospital infections are rife - what's so difficult about getting doctors and nurses to wash their hands?

BARRY ANDREWS, London NW6

Getting doctors and nurses to clean their hands in the right way and at the right time is in fact fraught with serious difficulties. A number of these difficulties are due to the way that patients are cared for and treated, and influenced by the ease with which microbes can spread at the bedside.

We know that it is not uncommon for a nurse or doctor to be required to clean their hands anything up to 20 times in a single hour. We know that nurses and doctors work in ever more challenging environments, seeing large numbers of patients over short periods of time. Strong role models and champions of hand hygiene are small in numbers and hand hygiene often has a low priority in health care. This is why a concerted and serious campaign to make hand hygiene improvement a high priority is in train.

Which British politician has most impressed you? And which has most depressed you?

PETER HEAD, Basingstoke

I am a bit of an amateur historian so a question like yours makes me think beyond the contemporary political scene. A few years ago I published an history of the Chief Medical Officers of England. Talking to one of my distinguished predecessors (who is still alive and in his nineties), he told me about working with the inspirational Nye Bevan to implement a National Health Service. I would love to have worked with him. From the same historical study the actions of Iain MacLeod (otherwise treated kindly by historians) were depressing ? under pressure as Health Minister to make a statement about the link between cigarette smoking and lung cancer, he procrastinated. At the eventual press conference he chain-smoked through it. The tobacco companies' influence was in the ascendancy then.

Have you used illegal drugs?

K OSMAN, Birmingham

Never.

Would you like to see drugs legalised so that we can concentrate on the medical and addiction issues?

JULIE O'NEILL, Wimbledon

No. In most fields of addiction, limiting access to the product is a key control measure. Also what Society accepts as normative behaviour is an important influence, particularly amongst young people. I agree that education and treatment are very important but maintaining a legal framework and strongly enforcing it is also vital.

Is obesity the biggest health threat we face?

PHIL PETERS, Daventry

It is certainly one of the main ones and set to fuel big increases in heart disease, diabetes, cancer, arthritis and other chronic diseases unless the current trajectory is reversed. In evolutionary terms, our bodies are adapted to an environment where food was scarce and you had to work hard to get it. In developed countries like ours, food is plentiful and easy to obtain. The solutions are not easy and like many public health problems require action at multiple levels, e.g. individual responsibility, education, food industry, town planning and information.

Were you surprised by the strength of opposition to your idea that everyone should be assumed to be a potential organ donor?

CRAIG MCDONALD, Canterbury

I was a little surprised by how headline-grabbing the proposal became. Although views were divided, the majority on media websites and phone-ins (admittedly not a scientific study of public opinion) were positive. If we don't follow my proposal we need to ask ourselves, as a society, are we prepared to leave one of our fellow citizens to die every day waiting for a transplant?

Can the life expectancy of humans keep increasing?

CAROLINE WALLIS, Cambridge

We expect life expectancy to increase, but not infinitely. Living is hazardous, the body is undergoing a continual cycle of damage and repair and this process increases as we get older. So while we can expect more humans to live beyond the 100-year mark, it is unlikely we would ever see humans living to the age of Methuselah.

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