Agenda item
Health Protection Assurance
Presented by Denise Littlewood
Minutes:
Denise Littlewood, Public Health, gave the following presentation on Health Protection Assurance:-
The report considered the following key domains of Health Protection
- Communicable disease control and environmental hazards
- Immunisation and screening
- Health care associated infections and antimicrobial resistance
- Emergency planning and response
Specialist Local Response
- Local response to national Measles outbreak
- An outbreak of Legionella in a social housing complex
- Increase in cases of Syphilis and Gonorrhea in South Yorkshire
- Increase in complex cases of TB cases including a South Yorkshire cluster
- Increase in cases of Whopping Cough (Pertussis) locally and nationally
- Large numbers of gastro-intestinal outbreaks in early years, schools and residential care settings
Screening
- Priorities within the breast, bowel and cervical cancer screening programmes included increasing uptake and collaborative work with programme providers and partners to improve uptake of screening for patients with a learning disability
- Cervical screening figures below target due to poor uptake in 25-49 year olds. Work ongoing to understand barriers particularly in individuals who had never accessed screening
- Breast screening figures below target. Change in appointment model and uptake was now increasing
Immunisation
- Seasonal Flu. Rotherham had seen a slight decrease amongst all the eligible cohorts. The reasons for the decline were not yet clear but the downward trend was reflected regionally and nationally. Work would be undertaken to try and understand the reasons behind the decline and inform planning for 2024/25
- The adult vaccination programme had seen a significant change within the Shingles programme (those turning 65 from 1st September 2023 becoming eligible), change of vaccine and schedule (from one dose to 2 doses) and extension to all patients over 50 years of age who were immunosuppressed. The priority for Rotherham had been to ensure all providers were aware of the change and the programme was fully and safely implemented
- For maternal Pertussis, the priority had been to implement the offer and delivery of the vaccine by the maternity provider (along with Flu and Covid vaccines)
- For adolescent (school-aged) immunisations, the priorities had been the procurement and mobilisation of a new contract (commenced 1st September 2023), work to restore uptake to pre-pandemic levels, implement the new HPV schedule (reduced to one dose) and reduce the gap between schools within the highest and lowest uptake. Although showing recovery, all adolescent vaccination programmes remained below the pre-pandemic levels, a trend which was reflected nationally
- Childhood Immunisations. A key focus had been and continued to be on MMR dose one by 2 years of age, achieving and maintaining coverage of above 90% (minimum threshold) with the aim of achieving 95% (optimal threshold)
Health Protection Focus
Preparedness was the key
- Refresh Outbreak Plan
- Refresh Mass Treatment Plan
- Adverse Weather Plans
- All involved work with Emergency Planning and Environmental Health
Upcoming Priorities
- Ensure preparation for future Health Protection events was key
- Ensuring Health Protection roles and responsibilities across Rotherham Place were understood to ensure a Rapid Response to an incident was possible
- To ensure that Rotherham had a competent surveillance system for managing communicable diseases working alongside UKHSA. This work would also continue to focus on new and emerging concerns
- To maintain effective prevention, incident and outbreak response including treatment programmes for all communicable diseases of local concern. Work would continue to explore options to address Rotherham’s deficit in terms of community IPC
Priorities
- To ensure further work was carried out to ensure Health Protection work programme were embedded in local systems to support reducing health inequalities
- Tackling Tuberculosis through improving awareness to increase screening and treatment targeting underserved populations. Undertaking work to understand the latent TB population in Rotherham
- To continue to optimise the role of Rotherham Council in increasing uptake of vaccination and screening in areas of deprivation and under-represented groups. Working with partners to ensure a system response
- Reducing the impact of adverse weather on health ensuring Rotherham was prepared for adverse weather events
- Continue to improve links with the Sexual Health Strategy Group to increase assurance with regard to sexually transmitted diseases
- To ensure a consistent approach for action to address Anti-Microbial Resistance working with partners to provide assurance
Discussion ensued with the following issues raised/clarified:-
• In most local authorities there was an Infection Control Team that dealt with it at a very local level providing that support and responding to incidents. However, that was not the case in Rotherham. The UKHSA provided a lot of support for Rotherham’s schools and care home facilities but that did not provide the very local input and was something the Authority was trying to address
• It was really important that schools and care homes were responsible for their own infection control and the UKHSA would come in and lead on the responsibilities but it was the middle ground that was missing in Rotherham e.g. pro-active support to make sure schools/care homes had the skills and systems in place
• The Covid recovery updates were still supplied to schools and Head Teachers forums which enabled conversations about some of the things cropping up but there was not the capacity on the ground to support schools where they had been taking place with Housing Services around infectious diseases and how they impacted on housing allocations, but probably more work to be done. Regulatory compliance checks were extremely important
• Work took place alongside NHS England, who was responsible for the screening and immunisation programme, to increase uptake amongst those people with learning disabilities who had difficulties accessing services. There was increased contact with the individuals to book their appointment and to make them aware that the screening programmes were there
• The health care associated infections data had only been pulled together very recently and work had started with the Foundation Trust to understand them at a local level. The Rotherham threshold was much lower from those across South Yorkshire and understanding why was quite difficult. Work would take place on comparing with the other South Yorkshire
• The next stage would be to test the master treatment plan in the next few months. The outbreak plan was tested in a number of ways
Helen Dobson, TRFT, reported that the Trust received comparison data for the whole North-East and Derbyshire area and would be able to share that information. For 2023/24, it showed that Rotherham was not an outlier for all 6 themes/infections and under the threshold compared to others. The issue of trajectory, especially for Clostridioides Difficile, was a historical position. The Trust had had a very low incident of infection so was set a very low trajectory. It was already known that the 2024/25 numbers, because there had been high incidences of control and may well continue with the trend seen, however, that was in line with what was being seen nationally.
Resolved:- (1) That the presentation and the assurance functions of Rotherham Council’s Health Protection Committee and the reviews performance of health and wellbeing be noted.
(2) That the 2024/25 work programme priorities be supported.
(3) That an update be submitted in 6 months as to the uptake of the screening programmes by those individuals classified as having learning disabilities.
(4) That future update reports include the testing of the plans that had been carried out.
Supporting documents:
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