tb update 14 6-2016 for fph conf
TRANSCRIPT
Tackling TB in the South East
14 June 2016
Dr Bernadette PurcellCCDC and TB lead
Key discussion points
Background: key drivers Local TB Control Board (South England) Proposed delivery plan for Collaborative TB strategy TB networks and cohort review PHE role – examples of local cases
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Why TB and Why now? 1. TB incidence in England was rising…
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2. TB is unequally distributed
Rate of TB by deprivation , England 2014
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TB case notifications and rates by place of birth, England 2000-2014
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3. Drug resistance
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TACKLING DRUG-RESISTANT INFECTIONS GLOBALLY :FINAL REPORT AND RECOMMENDATIONSTHE REVIEW ONANTIMICROBIAL RESISTANCEJIM O’NEILL MAY 2016
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Collaborative TB strategy for England: 2015-2020
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TBCB - South Chaired by Dr Jenny Harries OBE – RD South of England - PHE
Good representation from – DDs of PHE (South), DPHs (SE&SW), Lead CCGs representatives, TB clinicians, lead nurses, paediatrician, microbiologist, CCDCs, and national TB leads.
Agreed – ToRs and strategic plan
Meets quarterly and provides;
an over-arching support to six local TB networks in planning, overseeing, supporting and monitoring all aspects of local TB control.
an accountability structure for TB control supported by the National TB office.
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SE networkThames Valley
WessexSurrey & Sussex
Kent
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SW networksDevon, Cornwall &
Somerset
Bristol, North Somerset, South Glos
Bath & North East Somerset,
Gloucestershire, Swindon and Wiltshire
PHE TB Co-ordination BoardTB Strategy time limited working groups
TB Delivery BoardChaired by Head of TB Strategy Implementation
PHE National Executive
National TB Programme BoardCo-chaired by PHE and NHS England director
NHS England National Executive
SE TB consultant lead
SW TB consultant lead
South of England TBCBChaired by Regional Director,
PHE South
Structure & Governance of SoE TBCB
SW TB networks
SE TB networks
Special features of South TBCB1- Large geographical patch – 49 CCGs and multiple LAs
• South has the highest number of TB cases of any region outside London
• Some key hotspots such as Slough, Reading, Oxfordshire and Bristol.
• Raising TB as a priority for low prevalence areas/CCGs and hospitals.
2- Unique epidemiology (2014)
• Over 50% of the cases were pulmonary
• 60% of SW and 55% of SE cases were among males.
• Majority of the cases were among young population 30-40 years (mobile).
• 47% of SW and 24% of SE cases were from white ethnic background.
•
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2011-2013
Our Delivery Plan
SE
………………………………………………………………………….
SW
1. Surrey and Sussex2. Kent3. Thames Valley4. Wessex
1. Devon, Cornwall & Somerset
2. Bristol, North Somerset, South Glos
3. Bath & North East Somerset, Gloucestershire, Swindon and Wiltshire
HNA
HNA
HNA
HNA
HNA
HNA
HNA
Gaps, needs,
strengths identified
Collaborative TB strategy
with 10 recommendat
ions
Collaborative TB strategy
with 10 recommendat
ions
+
+
=
=
1. local Action /Priority
2.local Action /Priority3. local Action /Priority
1. local Action /Priority
2.local Action /Priority
3. local Action /Priority
Quarterly progress reports for the
board
Quarterly progress reports
for the board
Formation of Task and finish groups
for large action requiring collective work btw networks
+ Quarterly progress reports for the
national teams as per their matrixes
+
+Quarterly
progress reports for the national teams as per their matrixes
April/May 2016 May/June 2016
+Formation of Task and finish groups
for large action requiring collective work btw networks
June/July 2016
Ongoing activities - Cohort Review + Specific audits at regional or local level + Internal & External communications
Gaps, needs,
strengths identified
Local risk register to identify any risks and issues
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Progress of the board so far;
TB Update: Tackling TB in the South East
Bristol CCG
7 CCGs met eligibility for LTB screening programme
Southampton -CCG
West Sussex CrawleyCCG
Combined Reading and Slough CCGs
Oxfordshire CCG
North East Hampshire and Famham CCG
HNA – Good progress and expected to complete with recommendations in next 6-8 weeks
Collaboration with national delivery team and participation on national T&F Groups
Established Cohort Reviews and network meetings
Bids approved, funds received and screening started in three areas already
Building strong relationships with health and social care partners (LA, CCG, 2ndary care and 3rd sector organisations)
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Plans for coming months• Development of TB indicators for monitoring local progress
• Development of TB indicators for monitoring TBCB’s progress
• Quarterly monitoring/reporting of these indicators at both network/TBCB
• Complete Health Needs Assessments
• Development of T&FGs based on specific gaps/themes identified via HNA
• TBCB to support local networks with any issues reported by them
• Improve communication, co-ordination, management of information.s- C
• Cross- cutting areas: e.g. prisons and detention centres, homelessness, asylum- seekers
• CCG, Primary care and patient engagement
• Ideas/ suggestions?
• ross- cutting areas: e.g. prisons and detention centres, homelessness, asylum seekers 15 TB Update: Tackling TB in the South East
TB networks and cohort reviews
• Four well established across the South East• Cohort reviews running 3-6 monthly since 2012• Guest chair, external speakers, CPD• Improving measurable indicators (treatment
completion, losses to follow up, HIV testing, contact screening)
• Peer support, mutual aid, morale and career development for TB nurses
• Quarterly review of TB Clusters across South East TB Update: Tackling TB in the South
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Managing TB situations: example TB screening among homeless in Hastings after a TB related death, 2015
112 people were assessed and x-rayed5 with abnormal CXRs45 IGRA tested3 positive t- spotKeep under surveillanceTB cluster strainGood feedback from those screened- raised awarenessNeighbourhood police fully engaged.
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Managing challenging cases…• Non- compliant,
poor discharge, intentionally homeless, behavioural issues +++
• Multiple agencies involved over 15 months
• 10 Part 2A Orders in total (each order costs £1k-£6k- LA funded
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It’s a team effort…
NHS TB nurses and clinicians, microbiologists, network membersPHE SE TB network leads (Muhammad Abid, Clare Humphreys, Anand Fernandes, Karthik Paranthaman, Angeline Walker) HP nurses (Sara Blake, Jen Duffy, Ann Black, Alexis Stevens) surveillance and information officers (Nigel Bainton, Nigel Freeman, Sue White, David van Santen,) Kevin Carroll, Trish MannesTBCB members, inc CCG leads, primary care, 3rd sector
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