Tameside Strategic Partnership

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4. Health Protection

4.1 Air Pollution

Outcome Framework:

Public Health 3.1

Implications for the population’s health and well-being:

Air pollution is currently estimated to reduce the life expectancy of every person in the UK by an average of 7-8 months with estimated equivalent health costs of up to £20 billion each year. Very high concentrations of some pollutants are associated with the development of cancer, in particular leukaemia.

At risk or vulnerable groups:

Older and younger people may be more susceptible to poor air quality episodes. Individuals with pre-existing medical conditions such as heart disease, bronchitis, asthma and other types of lung disease are most at risk of suffering adverse health effects from poor air quality.

Policy context:

Under the requirements of Part IV of the Environment Act 1995, all local authorities are required to periodically review and assess air quality in their areas against health based objectives prescribed by the Government.

Where it is found that the objective levels are unlikely to be met, local authorities must declare Air Quality Management Areas (AQMAs) and draw up an Air Quality Action Plans (AQAPs) for improving air quality in those areas.

Benchmarking:

In GM, a regional approach to dealing with air pollution has been adopted, recognising that the sources of pollution do not respect political boundaries. A GM Air Quality Strategy, ‘Clearing the Air’, was produced in 1997 setting out the framework for improving air quality in the region. It links air quality to planning, transport, sustainability and environmental health functions.

Tameside MBC and the other Association of Greater Manchester Authorities (AGMA) authorities contribute to a GM wide air quality monitoring and modelling programme. The authorities have also worked with the Greater Manchester Transportation Unit (GMTU) and update the Emissions Inventory for Greater Manchester (EMIGMA). This database records all emissions from stationary point sources (industry), mobile line sources (road and rail links) and area sources (domestic emissions), across 1272km2 of GM.

This database allows the magnitude and spatial distribution of emissions across the City region to be investigated.

What interventions work?

Currently the health based objectives are being met for all pollutants of concern with the exception of nitrogen dioxide and particulates. There are still significant areas across GM, predominantly associated with the road network where these two pollutants may exceed the objectives.

What are we doing now?

Tameside MBC and the other authorities in the Greater Manchester (GM) city region identified these areas of poor air quality, designated them as AQMA and introduced a joint AQAP. Given that the predominant source of this pollution is from road traffic, the air quality action plan was absorbed into the Greater Manchester Local Transport Plan.

The links between improving air quality and reducing our carbon footprint continue to be strengthened and developed.

What needs to happen next and who needs to do it?

To continue to proceed with the implementation of the GM AQAP. It is imperative that a joint approach to improving air quality across GM is maintained and strengthened. A closer working relationship with public health experts needs to be developed to encourage an exchange of information and expertise.

4.2 Chlamydia diagnoses (15-24 year olds)

Outcomes Framework:

Public Health 3.2

Implications for the population’s health and well-being:

Chlamydia is caused by bacteria and is the most common Sexually Transmitted Infection (STI) in the UK. It is sometimes asymptomatic, and non treatment of the condition can lead to infertility, as well as pelvic inflammatory disease (PID) and ectopic pregnancy in women, and epidydimitis in men.

Programme spend:

Locally, the NHS spends around £160,000 each year on delivering the National Chlamydia Screening Programme (NCSP), which specifically targets young people under 25 years. However, in addition to the NCSP, young people and those over the age of 25 years can access screening in GP practices, Genitourinary Medicine (GUM) clinics and the Community Contraception and Sexual Health (CaSH) service.

At risk or vulnerable groups:

Chlamydia is most common in sexually active young people under the age of 25 years, although people of any age are at risk of chlamydia infection if they practice unsafe sex. Locally, men that undertake screening tests are more likely to test positive compared to women.

Benchmarking:

Although none of the Greater Manchester (GM) PCTs have achieved the target of screening 35% of people aged 15-24 years during 2011/12, Tameside and Glossop’s performance was the highest in GM: 32.4%.

Figure 44: Proportion of young people (aged 15 to 24 years) tested for chlamydia, Greater Manchester PCTs, 2011/12

Proportion of young people (aged 15 to 24 years) tested for chlamydia, Greater Manchester PCTs, 2011/12

Source: Health Protection Agency, 2012.

A new diagnosis based target is being introduced for 2012/13: 2,400 to 3,000 diagnoses per 100,000 young people aged 15-24 years. Applying 2011/12 data to this new target, gives a local rate of 3,150, which again is the highest in Greater Manchester. Whilst this indicates good access to screening opportunities, it also indicates that there are high levels of chlamydia infection amongst local young people.

Figure 45: Chlamydia diagnosis rate per 100,000 young people aged 15-24 years, community and GUM screens, Grater Manchester PCTs, 2011/12.

Chlamydia diagnosis rate per 100,000 young people aged 15-24 years, community and GUM screens, Grater Manchester PCTs, 2011/12.

Source: Health Protection Agency, 2011.

Policy context:

A new national Sexual Health Policy Framework is due to be published in 2012. This new strategy will replace the existing 2001 strategy: “National Strategy for Sexual Health and HIV”. It is expected that the new strategy will include an ongoing commitment to the National Chlamydia Screening Programme (NCSP), as chlamydia screening in the under 25s is one of the outcomes within the new Public Health Outcomes Framework which local organisations need to achieve during 2013-16.

The current local Sexual Health strategy has been refreshed and is due for publication shortly. This refreshed strategy highlights the need for local young people to be screened for chlamydia, as well as receiving quality information about infection prevention and how to access young person friendly sexual health services.

What interventions work?

Screening should be embedded in the normal healthcare that young people receive when accessing health services, e.g. GPs, pharmacies, CaSH and Termination of Pregnancy (TOP) services. This stops individual young people feeling singled out for screening and promotes normality, so that young people are more likely to take up the screen when offered.

What are we doing now?

  • We are increasing the total number of screens carried out locally, and increasing the proportion of screens that are carried out in core service, i.e. GPs, pharmacies, CaSH and TOP services.
  • CaSH have changed their opening hours to become more young person friendly, e.g. they now open on a Saturday. CaSH provides the largest proportion of all screens carried out in Tameside and Glossop.
  • YOUthink is a sexual health outreach team jointly commissioned by the local authority and NHS, which delivers sexual health workshops in schools and colleges and delivers more targeted work with vulnerable young people. YOUthink promote, and carry out, screening
  • The Lesbian and Gay Foundation promote Tameside and Glossop sexual health services so local young people know where to access quality services.
  • The Tameside Pregnancy Advisory Service (TPAS) based at Tameside General Hospital only performs TOP treatment if chlamydia screening has been carried out.
  • A SAFE (Sexual health Advice for Everyone) campaign is being delivered over the next 2 years. This has included the development of a website containing relevant and reliable sexual health information for young people, including how to access services and chlamydia screening. The website is being promoted by a marketing campaign which includes facebook, and is used during YOUthink workshops.

What needs to happen next, and by whom?

  • GPs and their practice staff should provide peer support to ensure screening is being offered in a more systematic way across primary care
  • The CaSH service need to continue to increase access for young people by ensuring their service is young person friendly and is open at times wanted by young people.
  • NHS Clinical Commissioning Groups (CCGs), local authority and Public Health need to ensure that all young people receive quality information, advice and support about good sexual health.
  • To ensure high diagnosis rates, frontline practitioners need to effectively promote and target screening to vulnerable and at risk groups.

4.3 Population vaccination coverage

Outcomes framework:

Public Health 3.3

Implications for the population’s health and well-being:

Immunisation plays a critical role in preventing ill health and helping people to lead healthier lives. Serious complications, disability and deaths, from vaccine preventable diseases such as measles, whooping cough, meningococcal serogroup C, tetanus and influenza have been greatly reduced since the implementation of routine immunisation programmes. Achieving high levels of vaccination not only benefits the individuals having the vaccination but can also provide indirect benefits to people not immunised via herd immunity. The higher the proportion of the population vaccinated against an infection, the lower the proportion at risk of becoming infected and the lower the chance of spread.

At risk and vulnerable groups:

There are targeted programmes for infants and children at risk of Tuberculosis (TB) and immunisation to prevent Hepatitis B among babies and young children born to mothers who are chronically infected with the virus or who have had the disease during pregnancy.

Vulnerable children such as those in traveller families, asylum seekers or the homeless, parents with many children, children of lone or teenage parents, looked after children, those in non English speaking families, those with physical or learning disabilities and those not registered with a GP.

At risk adults include the over 65’s, pregnant women and those under 65 with underlying health risks along with healthcare workers.

Policy context:

The national routine vaccination programme covers childhood vaccinations against diphtheria, tetanus, pertussis (whooping cough), Haemophilus influenzae type B, polio, meningococcal serogroup C, measles, mumps, rubella (MMR), pneumococcus, human papilloma virus (HPV), and adult vaccinations against influenza and pneumococcal disease for those at risk.

Benchmarking:

In 2010-11NHS Tameside and Glossop achieved higher immunisation rates for routine childhood immunisations and over 65s seasonal influenza campaigns than the average rates achieved for England or the North West.

Figure 46: Children immunised by age 5 Tameside and Glossop in 2010-11

Children immunised by age 5 Tameside and Glossop in 2010 -11

Figure 47: Percentage of over 65s immunised against influenza in Tameside and Glossop, 2010-11.

Percentage of over 65s immunised against influenza in Tameside and Glossop, 2010-11.

Source: NHS Information Centre 2012

What interventions work?

Immunisation itself is a central public health intervention but to be successful a high proportion of the eligible population must be offered and take up the vaccinations.

Effective and cost effective interventions for maximising uptake include:

  • Tailored invitations and reminders for ‘Did Not Attends’ by text or telephone
  • Improved access to clinics e.g. extended times, weekends
  • School based programmes and venues for vaccination
  • Access to health professional to discuss concerns
  • Dissemination of good practice
  • Domiciliary and outreach services
  • Brief advice and referral
  • Opportunistic vaccination
  • Appropriately trained and up to date staff
  • Ensure staff in place to monitor uptake
  • Tailored information and support
  • Immunisation status checks at first health assessment for Looked After Children
  • Targeted promotional campaigns (social marketing techniques) including benefits/risks
  • Immunisation checks at entry to school, nursery, play groups; Sure Start Centres, school transfer

What are we doing now?

  • Providing regular training for all staff that advise on or administer immunisations, including non clinical staff
  • Monitoring uptake monthly and issuing reports to individual GP practices
  • Monitoring performance and uptake of immunisation services delivered by other providers
  • Practice visits by Immunisation lead nurse to advise and support those with treatment centre queue lists
  • Implementing change to service provision for the targeted childhood programmes namely BCG and Hepatitis B, with the aim of achieving early identification and timely vaccination to give maximum protection
  • Providing clinical support and advice to health professionals involved with immunisation
  • Dissemination of policy change, good practice and current infectious disease information to practitioners
  • Supporting practices with clinical guidance documents

What needs to happen next, and by whom?

  • NHS Clinical Commissioning Group (CCG) to disseminate good practice and work with poorly performing practices
  • All healthcare staff to opportunistically encourage vaccination at every opportunity
  • PCT commissioners to include core service specifications as agreed by Greater Manchester for Tuberculosis services and maternity services. This will include antenatal flu vaccination for pregnant women and BCG vaccination of infants postnatal
  • Immunisation Lead Nurse to evaluate difficulties around delivery of preschool booster and 2nd MMR and initiate strategies to improve uptake
  • Immunisation Lead Nurse to review 2011/12 flu campaign and plan for coming season. Need to improve uptake in the under 65 at risk groups and continue to improve on uptake with the over 65’s
  • Immunisation Lead Nurse to work with Tameside MBC contacts to access nurseries and Sure Start centres to promote importance of immunisation

4.4 People presenting with HIV at a late stage of infection

Outcomes framework:

Public Health 3.4

Implications for the population’s health and well-being

Human immunodeficiency virus (HIV) attacks the cells used for fighting infections. If these cells fall below a certain critical level the condition develops into Acquired Immuno Deficiency Syndrome (AIDS), in which the immune system begins to completely fail and the body is extremely vulnerable to opportunistic infection.

Over half of people newly diagnosed in the UK are diagnosed late (i.e. with CD4<350 or an AIDS diagnosis within 91days of HIV diagnosis). Late diagnosis of HIV is very important as it leads to poorer health, reduced life expectancy, and markedly higher health and social care costs. Indeed, 90% of the deaths amongst HIV positive people within 1 year of diagnosis are among those diagnosed late.

At risk or vulnerable groups:

Men who have Sex with Men (MSM) are most at risk of HIV, and men in general are potentially underrepresented within new cases of HIV, as they are less frequently tested for HIV compared to women who can encounter routine testing during antenatal visits. Most common routes of HIV infection in Tameside and Glossop are via MSM (usually men identifying as gay or bisexual), or through heterosexual sex. Most of those infected heterosexually are migrant black Africans, some of whom are (or were) asylum seekers. There are also small numbers infected through sharing injecting drug equipment.

Almost half the people in the UK who are diagnosed when they are over 50 year old are diagnosed late, which leads to serious health problems. Older people diagnosed late are 14 times more likely to die within a year than people diagnosed when less than 50 years of age. Locally, the highest proportion of HIV cases are within the 30 to 44 year age group, indicating that over the next 10 years there may be a substantial increase in the number of people over 50 with more complex HIV related needs.

Benchmarking:

The proportion of late diagnosis is variable in Tameside and Glossop due to the small number of people involved. The majority of testing locally is undertaken within Genito-urinary Clinics (GUM), with a low proportion in primary care.

Figure 48: Proportion of diagnosis of HIV with CD4 count of less than 350 for Tameside and Glossop and the North West 2006 to 2010

Proportion of diagnosis of HIV with CD4 count of less than 350 for Tameside and Glossop and the North West 2006 to 2010

Source: Health Protection Agency, 2011.

Figure 49: HIV testing by location, Tameside General Hospital laboratories, 12/03/11 to 11/03/12

HIV testing by location, Tameside General Hospital laboratories, 12/03/11 to 11/03/12

Source: Department of Pathology, Tameside General Hospital, 2012.

Policy context:

A new national Sexual Health Policy Framework is due to be published in 2012. This new strategy will replace the existing 2001 strategy: “National Strategy for Sexual Health and HIV”. It is expected that the new strategy will include an ongoing commitment to early identification of HIV as this indicator has been included within the new Public Health Outcomes Framework which local organisations need to achieve during 2013-16.

The current local Sexual Health strategy has been refreshed and is due for publication shortly. The strategy was informed by the local HIV needs assessment (2011) which was commissioned by NHS Tameside and Glossop from the George House Trust. The refreshed strategy highlights the need to reduce local late diagnosis rates.

What interventions work?

The Health Protection Agency report, HIV in the United Kingdom: 2011 Report , recommends that to prevent late diagnosis, there needs to be an increase in HIV screening within high prevalence areas (rates higher than 2 per 1,000 among 15 to 59 year olds) or within high risk groups. As Tameside and Glossop does not have a high prevalence of HIV, recommendations to increase screening within at risk groups are more relevant:

  • Universal routine offer of HIV testing to all pregnant women (to prevent mother to baby transmission) and sexual health clinic attendees
  • Increasing the uptake of HIV testing among at risk groups such as MSM and Black African communities

To ensure reduction of late presentation:

  • Ensure front line health professionals, including those within Primary Care, are competent in recognising potential symptoms of HIV infection and at risk behaviour and then offering an HIV test accordingly

What are we doing now?

  • Providing high levels of access to local Genito-Urinary Medicine (GUM) Clinics
  • Increased HIV testing amongst GUM clients
  • Increasing access to local CaSH services
  • The George House Trust and the Lesbian and Gay Foundation are members of the Sexual Health Clinical Advisory Group (SHCAG) which is a local strategic partnership group that develops and implements local strategy to tackle late diagnosis of HIV
  • Working with RUClear who offer free access to postal dry blood spot testing for HIV
  • Promoting HIV testing within at risk groups via the Lesbian and Gay Foundation
  • Delivered clinical training during TARGET (aimed at GPs and practice nurses) and for junior doctors in Tameside General Hospital to develop competency amongst frontline professionals in identifying symptoms of HIV infection

What needs to happen next, and by whom?

  • The SHCAG needs to ensure primary care professionals are alert to the need for HIV testing where appropriate to ensure early identification, and are confident and competent to offer HIV testing accordingly
  • The local SHCAG needs to implement the NICE guidelines for increased HIV testing among MSM and black African communities
  • The local SHCAG needs to ensure integration of HIV prevention with treatment and care, which post March 2012 will be delivered by Tameside MBC and the NHS Commissioning Board respectively

4.5 Treatment completion for tuberculosis (TB)

Outcome Framework:

Public Health 3.5

Implications for Population Health:

Tuberculosis (TB) has re-emerged nationally as a serious public health threat. Incidence in the UK has risen over the past 2 decades, rising above the European average. TB usually causes disease in the lungs (pulmonary), but can also affect other parts of the body (extra-pulmonary). Only the pulmonary form of TB disease is infectious through coughing of infectious droplets, and usually requires prolonged close contact with an infectious case. TB is curable with a combination of specific antibiotics, but treatment must be continued for at least six months. In the UK there are around 9,000 cases of TB reported each year and there are approximately 350 deaths. Most cases occur in major cities. TB incidence in the North West Region is strongly linked to deprivation.

Timely treatment for TB is essential to saving lives and preventing long-term ill health as well as reducing the risk of new infections and development of drug resistance.

Preventing the development of drug resistant TB is important as it has more severe health consequences and is more expensive to treat. People with untreated pulmonary TB are an infection risk to others. Incomplete treatment is associated with the development of drug resistant TB which is more difficult and more costly to treat.

Programme spend:

The Department of Health estimates that it costs £5,000 to treat a case of “ordinary” TB, compared to £50,000–70,000 for drug resistant TB.

At risk groups or vulnerable groups:

  • People from ethnic minority groups, immigrants from high-prevalence countries, particularly South Asia and Sub-Saharan Africa
  • People with HIV
  • Prisoners
  • Homeless people
  • People dependent on drugs and alcohol

Benchmarking:

In 2010 TB in the North West increased by 1% whereas nationally it declined by 7%. The NW was the only region to see an increase in the disease. Within the NW there is significant variation in numbers, with the Greater Manchester cluster having the highest rates. For TB control to be effective it is important that each locality offers standardised care.

Figure 50: Tuberculosis case reports and rates by region, England, 2010

Tuberculosis case reports and rates by region, England, 2010

Sources: Enhanced Tuberculosis Surveillance, Office for National Statistics mid-year populations estimates: TB Section - Health Protection Services, Colindale

Figure 51: Incidence of Tuberculosis in the North West, 2008 - 2010

Incidence of Tuberculosis in the North West, 2008 - 2010

Sources: Enhanced Tuberculosis Surveillance, Office for National Statistics mid-year populations estimates: TB Section - Health Protection Services, Colindale

Policy context:

What interventions work?

  • Patients should be involved in making decisions about their treatment
  • Patients should undergo a risk assessment for treatment adherence and people with adverse factors on their risk assessments should be considered for directly observed therapy (DOT)
  • Clinicians should consider how to mitigate the adverse social factors
  • Patients should have a named key worker and know how to contact them
  • The key worker should promote treatment adherence, considering use of the following approaches to improve adherence to treatment:
    • Reminder letters
    • Health education counselling
    • Home visits
    • Patient diaries
    • Objective monitoring e.g. urine testing
    • Information about help with paying for prescriptions
    • Help accessing benefits, housing and social services

What are we doing now?

  • The Health Protection Agency (HPA) coordinates TB control by local and national surveillance and the laboratory diagnostic services
  • Last year NHS North West established a TB Summit to direct TB prevention and control activities across the region
  • NHS North West works with local Directors of Public Health to ensure the various aspects of the TB summit are implemented with partners in the Local authorities and local health providers
  • Tameside Foundation Trust manages the TB Specialist Service which is commissioned on a GM level. A GM level specification has been introduced into GM acute trust contracts for 12/13

What needs to happen next, and by whom?

Work is underway to address the immediate clinical issues that need to be addressed with:

  • Several work streams to address urgent issues including: New Entrant Screening, Cohort Review, TB in Children, BCG Vaccination, TB Nursing Workforce
  • Need to begin work on the Local Authority role and how the wider determinants of TB can be addressed through local leadership
  • Tameside Hospital Foundation Trust has a key role in ensuring that the Greater Manchester TB specification is implemented locally

4.6 Public sector organisations with broad-approved sustainable development management plan (SDMP)

Outcomes framework:

Public Health 3.6

Implications for the population’s health and well-being:

The change in climate will alter the physical geography of the world, leading to major changes in the human geography– where people live and how they live their lives. Even at more moderate levels of warming, studies show that climate change will have serious impacts on world output, on human life and on the environment.

The changes threaten the basic elements of life for people around the world – access to water, food, health, and use of land and the environment. Hundreds of millions of people could suffer hunger, water shortages and coastal flooding as the world warms, and millions of people will potentially be at risk of climate-driven heat stress, flooding, malnutrition, water related disease and vector borne diseases.

Sustainable development plans provide the framework for balancing economic, social and environmental considerations, including climate change, and looks to communities’ resilience and adaptation in the years ahead. The first step to monitoring sustainability is a process measure for board approved Sustainable Development Management Plans (SDMP).

Benchmarking:

Figure 52: NHS organisations with Board approved SDMP, Strategic Health Authority (SHA) clusters, 2012.

NHS organisations with Board approved SDMP, Strategic Health Authority (SHA) clusters, 2012.

Source: East of England Public Health Observatory (ERPHO), 2012

Policy context:

What interventions work?

The local Tameside strategy highlights the need to:

  • Make more efficient use of energy and natural resources, and tackle fuel poverty
  • Reduce carbon emissions and develop a strategy for adapting climate change
  • Reduce the impact of transport on our highways, reduce reliance on the car and encourage people to make more use of sustainable ways to travel, e.g. cycling and walking
  • Raise awareness of our impact on the environment amongst local people and businesses, and encourage a more sustainable approach to everyday life
  • Support Tameside’s businesses, organisations, community groups and residents in the transition to a low carbon economy
  • Adopt a sustainable approach to procurement and economic growth

What are we doing now?

Locally, a multi agency Tameside Sustainable Use of Resources Group developed Low Carbon Tameside – Sustainable use of Resources Strategy 2010-2020.

More recently, the Association of Greater Manchester Authorities (AGMA), published a Climate Change Strategy in 2011. This provides a framework for local authorities and their partners to focus on reducing carbon emissions within local communities and partner organisations.

NHS Tameside and Glossop Board approved the 2010- 2015 Sustainable Development Plan in January 2010 and the underpinning five year plan in May

The 10% carbon reduction in 2010 was achieved and in 2011/12 and 11% reduction from baseline is anticipated. Specific developments that have contributed to this achievement are:

  • Increased insulation
  • Installing hot water at the point of delivery systems
  • Lighting improvements
  • Reduction in vehicle fleet
  • Promotion of recycling and waste management

In addition:

  • Schemes to increase biodiversity have been implemented at two sites
  • Heat wave resilience measures have been implemented at Shire Hill Hospital
  • The new GP surgery build is expected to achieve BREEAM excellence
  • Standard NHS Contract includes a clause on expectation regarding progress on climate change adaptation, mitigation and sustainable development, including carbon reduction
  • Estate rationalisation has aligned with workforce changes

What needs to happen next and by whom?

Due to the reorganisation of public sector organisations, there needs to be a refresh and refocus of the Tameside Sustainable Use of Resources Group. They can then review and update the Low Carbon Tameside Strategy and work plan in line with new emerging successor organisations and the recently published Greater Manchester Strategy. Examples of work streams within the work plan are:

  • Carbon literacy: improving local peoples’ understanding of carbon emissions, their impact, and how actions can help to reduce emissions
  • Reduction in water consumption; increase water conservation
  • Development of green travel plans

4.7 Comprehensive, agreed inter-agency plans for responding to public health incidents

Outcomes framework:

Public Health 3.7

Implications for population’s health and well-being:

Emergency preparedness encompasses emergency planning and business resilience. It is essential to protect the safety of the population from serious adverse incidents e.g. severe weather disruption of services, pandemic flu or even a Chemical, Biological, Radiological, Nuclear (CBRN) event. Organisations need to understand their capacity and capability to respond to a range of incidents affecting their workforce, estates and communications functions; and therefore their ability to deliver services to the affected population and their normal daily business. The focus in planning is risk mitigation and articulating contingencies. Whilst each organisation needs to have a robust and comprehensive set of plans many can only be effective if done in conjunction with partners as a change in service in one sector is likely to affect others. Therefore emergency preparedness is a multi-agency activity that proactively plans, trains staff and tests resilience.

At risk groups:

This will depend on the nature of the incident but it is important to identify mechanisms for contacting a range of organisations that provide for vulnerable groups/populations either by characteristic or geography.

Benchmarking:

To be determined when indicator available

Policy context:

The Civil Contingencies Act 2004 requires Category 1 responders (NHS acute trusts, local authorities, blue light services) to discharge specific functions in order to ensure resilience in any emergency response to an incident. Public Health England (PHE) and the NHS Commissioning Board will be Category 1 responders.

Category 1 responders are subject to the full set of civil protection duties. They will be required to:

  • Assess the risk of emergencies occurring and use this to inform contingency planning
  • Put in place emergency plans
  • Put in place Business Continuity Management arrangements
  • Put in place arrangements to make information available to the public about civil protection matters and maintain arrangements to warn, inform and advise the public in the event of an emergency
  • Share information with other local responders to enhance co-ordination
  • Co-operate with other local responders to enhance co-ordination and efficiency
  • Provide advice and assistance to businesses and voluntary organisations about business continuity management (Local Authorities only)

Category 2 organisations (e.g. Health and Safety Executive, transport and utility companies) are less likely to be involved in the heart of planning work but will be heavily involved in incidents that affect their sector. Category 2 responders have a responsibility for co-operating and sharing relevant information with other Category 1 and 2 responders. NHS Clinical Commissioning Groups (CCGs) will be Category 2 responders.

In relation to infection control providers of regulated activities should be able to demonstrate the need for compliance with Criterion 9 of the Code of Practice for the prevention and control of infection and any related guidance. Local systems are required to report significant outbreaks of infection to the Health Protection Unit/Public Health England (PHE).

Each NHS Trust is responsible for planning its response to incidents which cannot be dealt with as part of the normal, day to day activity of the NHS. This is a statutory duty under both the requirements of the Department of Health and also the Civil Contingencies Act 2004.

What interventions work?

Having robust tested emergency plans covering a comprehensive range of potential incidents developed with category 1 responders. Organisations should be resilient by ensuring they have up to date business continuity plan and a trained workforce capable of responding to emergencies.

What are we doing now?

  • Comprehensive emergency plans in place covering a range of potential incidents
  • Up to date business continuity plan
  • Trained workforce capable of responding to emergencies

What happens next, and by whom?

Currently the NHS Greater Manchester (GM) Emergency Resilience Team discharges the statutory and legal functions on behalf of the GM Directors of Public Health (DPHs). They will need to continue this work with PHE. The team has adopted the approach of standardisation of policies and plans on a range of common risk areas e.g. severe weather contingency plan. Infection prevention and control functions are similarly being developed into a GM level service on behalf of the GM DPHs, working with PHE. The aim is to maximise the resource effectiveness dedicated to the specialist function of infection control and prevention at a strategic level. Standardisation of policies across the health economy and providing an advisory role for other relevant partners e.g. care home sector will be key to improve the quality of outcomes.

The NHS CCG will need to ensure they are able to discharge their emergency resilience functions as a Category 2 responder. A local multi-agency training event is being planned for summer 2012. In addition, Tameside MBC Chief Executive is the lead Association of Greater Manchester Authorities (AGMA) Chief Executive Officer for emergency preparedness.

4.8 Incidence of healthcare associated infections (HCAI): MRSA and C. Difficile

Outcomes framework:

  • NHS Outcomes Framework 5.2: Incidence of Healthcare Associated Infection(HCAI) : MRSA and C.Diff
  • NHS Operating Framework PHQ27 HCAI measure (MRSA)
  • NHS Operating Framework PHQ28 HCAI measure (C Diff)

Implications for the population’s health and well-being

Reducing health care associated infections (HCAI) is a key public health priority causing major health implications for vulnerable people and wide public concern following any outbreak. There is a zero tolerance approach to all avoidable HCAIs, and the Department of Health are seeking the NHS to minimise those infections that have occurred through non-adherence to best practice in infection prevention and control practices. However, it is recognised there are some infections that cannot be prevented.

National importance has been given to reducing Clostridium Difficile infections (CDI) and Methicillin-resistant Staphylococcus Aureus (MRSA) Bacteraemias and this is reflected within challenging targets set for all PCTs and acute trusts. CDI and MRSA bacteraemias can cause illness and, sometimes, death. It can be very distressing for patients who acquire an infection, for their family and friends and for staff who treat them. Reducing HCAI will lead to significantly improved patient safety, outcomes as well as deliver cost savings and reputational gains for the NHS.

MRSA bacteraemias: is still a significant patient safety issue with over 1,200 bacteraemias reported in the 12 months to September 2011 in England.

CDI: infections are also a significant patient safety issue with almost 20,000 reported cases in the baseline 12 month period (October 2010 to September 2011) in England.

At risk or vulnerable groups

  • People aged 65 and over
  • People with long term conditions
  • Patients requiring invasive procedures
  • Patients who due to terminal conditions are placed on palliative end of life care pathways

Benchmarking:

MRSA Bacteraemia: Nationally during 2011/12 the NHS North West Strategic Health Authority (NW SHA) had the second highest number of MRSA cases, and an infection rate of 0.2 cases per 10,000 (weighted) population. This shows a notable improvement from the March 2011 rate of 0.3, but remains higher that the England rate of 0.2.

Eight PCTs including Tameside and Glossop exceeded their annual plan totals during 2011/12: locally, there were 10 cases against a target of 8.

Figure 53: No of reported MRSA Infections

No of reported MRSA Infections

Source: NHS Tameside and Glossop, 2012

CDI: Nationally during 2011/12 NW SHA recorded the highest number of CDIs, accounting for 15.7% of the England total. Ten North West PCTs exceeded their annual plan totals, including Tameside (by 43%). NHS Tameside and Glossop reported 52 CDIs over target: 173 versus a target of 121. 80 were apportioned to Acute Providers, of which 66 were Tameside Hospital Foundation Trust (TFT) and 93 apportioned to the non-acute.

Figure 54: Clostridium Difficile Infections (CDI) Performance: 2011/12 for acute, community sectors and Whole Economy

Clostridium Difficile Infections (CDI) Performance: 2011/12 for acute, community sectors and Whole Economy

2011

2012

April

May

June

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

March
Acute Actual
9
12
4
11
7
4
8
5
7
5
4
4
Community Actual
14
9
11
7
6
7
6
8
7
9
6
3
Whole Economy Plan
15
13
10
14
12
11
11
8
6
10
7
6
Whole Economy Actual
23
21
15
18
13
14
14
13
14
14
10
7

Source: NHS Tameside and Glossop, 2012.

Locally, there has been a stepped reduction over the past 3 years in both the Acute and the community settings.

Figure 55: CDI Health Economy Performance, 2009/10, 2010/11, 20011/12

CDI Health Economy Performance, 2009/10, 2010/11, 20011/12

2011

2012

April

May

June

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

March
2009/10 Actual
24
53
81
123
151
166
182
202
219
238
253
269
2010/11 Actual
24
48
63
88
107
122
140
152
167
199
221
246
2011/12 Actual
23
44
59
77
90
101
115
128
142
156
166
173
2009/10 Trajectory
27
54
80
106
131
156
180
203
226
248
269
289
2010/11 Trajectory
20
38
56
73
90
106
121
136
150
164
177
189
2011/12 Trajectory
15
28
38
52
64
73
84
92
98
108
115
121

Source: NHS Tameside and Glossop, 2012

Policy context

What interventions work?

Once an organisation has identified where they need to focus efforts to have maximum impact, a HCAI prevention and control plan can be implemented using a wide choice of tools and guidance, the detail of which can be found on the DH weblink and includes information about screening for MRSA, patient isolation, infection control and prevention good practice, and high impact interventions.

Department of Health advice was issued in 2009 on the most effective methods of prevention and control of CDI and the management of outbreaks,“Clostridium Difficile: How to Deal with the Problem”. A critical intervention for CDI is raising awareness among prescribers of the risk associated with antibiotic prescribing in high risk groups.

What are we doing now?

Tameside and Glossop health economy recognises that there needs to be a sustained improvement in performance for CDI as we were a regional outlier and national outlier for 2011/12.

HCAI performance is continually scrutinised and health economy performance management processes have increased during 2011/12, with the full collaboration of relevant health providers. Local providers have their own organisational HCAI reduction plans but there is also a health economy strategic plan. The District Infection and Prevention Control Committee will continue to oversee progress on actions for HCAI prevention and reduction. Commissioners will continue to use the HCAI Assurance Framework to monitor progress against organisational HCAI reduction action plans.

Plans for acute infections (TFT) and non acute infections (encompassing Stockport Community Healthcare) are monitored and updated on a monthly basis and submitted to the NHS Greater Manchester. The 2012/13 HCAI ambitions are:

  • MRSA Bacteraemias: PCT= 4 and TFT = 1
  • CDI: PCT = 121 and TFT =60

What needs to happen next, by whom?

Health and social care commissioners will continue to use a variety of communication, education including the Green Card Project for patients at high risk of CDI. In addition, audit tools are utilised to promote best infection control practise and adherence to the antibiotic guidelines both within the acute sector and in primary care.

High risk antibiotic prescribing and total antibiotic prescribing monitoring will continue to be assessed by the PCT Prescribing Team.

The Community Antibiotic Pharmacist will continue to support best practice and target outliers by practise visits and reporting non adherent practices to the Medicine Management Committee. Similar audits are conducted in the acute trust.

Root Cause Analyses (RCAs) will be completed within 10 working days to draw a conclusion to whether a case of infection was avoidable or unavoidable. All avoidable infections will be reported as Serious Untoward Incidents (SUIs) to NHS Greater Manchester. Lessons learnt from all RCAs will be implemented and reported to the WHE RCA Panel which has a clinical and commissioner membership.

 
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