GWENT PSB 15.12.22 AGENDA ITEM 09

Gwent Test Trace & Protect Update Report

15^th December 2022

Author: Ruth Betty, Service Manager

Contribution from: Tracey Deacon, Locum Consultant in Public Health, and the ABUHB Regional Cell Delivery Team

1.0 Purpose

1. To update the GTTPS Regional Board (GPSB) on the Gwent Test, Trace Protect transition to an integrated health protection Service (herein referred to as the Service).

2. To ask that the Regional Board note and approve the contents of the report.

2.0 Background

Gwent Public Services Board is the Regional Board for the Service responsible for:

· Ensuring the Service is delivering against its stated purpose, aims, objectives and principles.

· Representing the interests of their respective organisations.

· Agreeing the financial framework.

· Ensuring effective governance, leadership, and management of the Service.

· Ensuring the effective planning and delivery of the Service.

· Scrutinising the performance of the Service.

· Ensuring the Service is operating in alignment and complementing wider Covid-19 strategies.

· Promoting the interests of the Service to national partners.

3.0 Finance

3.1 The full year funding for Gwent is £6m, which equates to forty percent of the 2021-22 return.

3.2 In setting the 2022-23 budget, the Minister highlighted a strong expectation that contact tracing roles are broadened wherever possible to strengthen the wider health protection system. This has been embraced by the Service and updates within this report will evidence this.

3.3 Finances are being managed within the funding envelope. There are risks associated with potential continuous service payments. All recruitment has been frozen to mitigate against this risk in the absence of confirmed funding for 2023/24 and/or a redeployment process being completed.

4.0 Transitioning to an Integrated Health Protection Service for Gwent

4.1 Welsh Government have not confirmed funding for 2023/24 at the time of authoring this report. An announcement is expected by the end of December 2022. Planning of the Service to further transition is in progress.

4.2 Officers have worked with Welsh Government colleagues to inform on the benefits of the regions approach to integrated health protection.

4.3 Officers across the Service have participated in the Welsh Health Protection System review and look forward to the final recommendations.

4.4 As a partnership we are enthusiastic to continue the transition of the pandemic legacy system to one that will strengthen the Gwent Health Protection system.

One that will facilitate:

Health Protection Preparedness.

a) Outbreak Management Plans.

b) Developing Pathways for Testing and Vaccinations.

c) Local Level Surveillance.

d) Support for resolution of backlogs.

Health Protection Response

e) Outbreak response to respiratory infectious disease e.g., Vaccinations; Contact Tracing; Welfare Provision; Infection Prevention & Control.

f) Mobilisation across local partners in Gwent.

Wider support to the All-Wales approach to Integrated Health Protection Services at a Regional Level

g) Building on track record of digital innovation.

h) Strengthening the foundation economy.

4.4 The above list is not exhaustive, as experience shows, we need to be agile and responsive in facing emergent Health Protection threats.

4.5 There are risks associated in not continuing the transitioning of the Service including, increased transmission of infections, increased rates of disease, which disproportionately impacts the most vulnerable across Health and Social Care that can lead to increased hospital admissions and adverse outcomes and widening health inequities.

Without a sufficiently resourced Health Protection service, staff will need to be drawn - in an inefficient and ad-hoc manner - from existing functions such as Primary Care, Local Public Health Team, GPs, Respiratory Teams etc. to the detriment of continuing service delivery in those areas. Compounding existing non-Covid harms and risking further inequities.

A return to a pre-pandemic fragility across the Health Protection system e.g., similar to March 2020 and not embedding the lessons learnt of the pandemic.

4.6 As covid 19 case numbers decline wider public health initiatives have already been introduced to support the clearing of backlogs in health and public protection services and bringing the wider system together in routine disease control activities.

4.7 Some examples of the wider public health initiatives that have been introduced are:

Monkeypox UK outbreak

Supporting the following elements of the programme:

Ø Testing pathways for possible and probable cases. Working with colleagues across ABUHB, including Microbiology, Infection Prevention & Control and the Covid-19 Testing Team, pathways continue to be refined to ensure prompt testing and feeding back of results for possible and probable Monkeypox cases.

Ø Pre and post exposure vaccination programme

Ø Support to Sexual Health service by resourcing a helpline support and clinical duties.

Ukrainian Resettlement Programme

Supporting the following elements of the programme:

Ø Health assessments to hundreds of individuals resettling within Wales.

Ø Supported the planning of pop-up Blood Bourne Virus clinics, inviting and booking individuals for testing.

Ø Since the start of the Ukrainian resettlement programme the Service have supported the verification process of the Disclosure and Barring Service (DBS) check against criminal records to support the setting up of host families.

Infection Prevention and Control (IP&C)

Clinical Leads have completed training and developed a standard operating procedure to enable them to assist in the prevention and management of care home outbreaks. The Clinical Leads regularly attend cluster meetings and have commenced care home visits undertaking risk assessments.

This extra capacity will be invaluable should a surge in Covid-19 occur, and where IP&C resource is under pressure. Whilst the focus is Covid-19, the work should also help to control other infectious disease.

Antiviral Infusion Clinic

For one day per week a Clinical Lead has supported the Health Board’s Antiviral clinics based at Ysbyty Ystrad Fawr. The clinic provides antiviral infusions to extremely clinically vulnerable Covid-19 patients, helping to reduce the likelihood of serious illness and possible hospital admission.

Private Water Supply Registers

As part of the Covid recovery activities the Service have started to update registers relating to private water supplies which is not provided by a water company.

All private water supplies in Wales are regulated under the Private Water Supplies (Wales) Regulations 2017. The Regulations have been introduced to ensure that water from private supplies is wholesome, so that people who drink water or consume food or drinks made from private supplies may do so without risk to their health.

Campylobacter Contact Tracing

The Service within one Local Authority is supporting the following elements in relation to Campylobacter surveillance, to detect significant trends, identify and manage disease outbreaks and to alert appropriate professionals and organisations to infectious disease threats and preventative measures.

Asylum Seeker Relocation / Ukrainian Refugee

The Service is working with the ABUHB public health team and other colleagues to support twice daily calls to the hotel for situational awareness of new arrivals, symptomatic cases, emergency prescription requirements etc. On establishing changes, the team are completing basic health screening questionnaires with the guests to prioritise ongoing support. Where applicable escalate any areas of concern.

Childhood Immunisations Catch Up Programme - Polio

The Service is working with the ABUHB public health and Primary Healthcare teams to support the ‘targeted’ immunisation catch-up programme across Wales to ensure children under five with partial or no vaccination against Polio are offered the vaccination. The support will, in the initial stages, be follow up calls with parents who have declined or not responded to the invitation for a child to be vaccinated and where an appointment has not been attended.

5.0 Targeted Contact Tracing

5.1 The aims of TTP have changed, as we move from pandemic to endemic and as we begin to manage Covid-19 alongside other respiratory infections, to:

Ø Focus on protecting the most vulnerable people by:

o Ensuring they can access treatments when they need to

o Limiting their risk of infection

Ø Keep plans in place so that we can respond to any local outbreaks

Ø Keep surveillance in place so that we can detect new variants

Ø Ensure that we can respond to a possible resurgence of the virus

5.2 Since the 1st August 2022, the Service has transitioned in its structure where ABUHB Regional Cell Delivery team have worked with Caerphilly County Borough Council as the lead Authority, working on behalf of all local authorities across Gwent.

5.3 The current workforce across the Service is:

	Planned FTE	Actual FTE
ABUHB Regional Team	56.00	43.27
CCBC Host LA Team	42.25	36.50
Total	98.25	79.77

5.4 The Service has fully transitioned to a targeted contact tracing service to protect the most vulnerable. The team are supporting:

Ø Hospitals, GPs, pharmacies, and dental practices within the ABUHB estate.

Ø Over one hundred care homes.

Ø Ten special schools

Ø One prison.

Ø Vulnerable citizens and employees of vulnerable settings that reside in Gwent but work in another region.

5.5 From the 1^st July 2022 performance reporting has changed to reflect the targeted contact tracing approach. National performance targets are:

Ø Eighty percent (80%) of Cases eligible for follow up to be completed with 24 hours.

5.6 As a region 86% of eligible cases are followed up within 24 hours which is above the national target of 80% and overall performance across Wales of 81%.

5.7 For the period of the 1^st July to the 5^th December 2022 the Service has supported 84 outbreaks within care homes in Gwent.

5.8 At the Wales Care Awards 2022 social care providers nominated the Service for special recognition. We were awarded the Covid-19 Heroes, Best Health Board Supporting Care Homes. This recognition is something we are very proud of and reflects the benefits of the integrated approach we use to support the most vulnerable.

6.0 Governance - Gwent Leadership Group Decisions

6.1 The Leadership group have made the following decisions since the 30^th June 2022:

Meeting Date	Decision
20^th October 2022	To agree revised Terms of Reference for the Leadership Group.

7.0 Summary

Gwent Public Services Board are asked to:

Agree to support the continuation of work to transition the Service to an Integrated Health Protection Service for Gwent to support the benefits to population health outcomes.

Note and agree the actions taken by the service detailed within the report.