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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