GWENT PSB 15.12.22 AGENDA ITEM 09
Gwent Test Trace & Protect Update
Report
15th 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 1st
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 1st July to the 5th 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 30th
June 2022:
Meeting
Date |
Decision |
20th
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.