Report of the Director of
Public Health Services
May 2013
Author: Dr Quentin Sandifer
Date: 1 May 2013
Version: 1
Distribution:

Public Health Wales Executive Team

Public Health Wales Board

Senior Management Forum

Public Health Wales Internet
Purpose and Summary of Document:
This purpose of this paper is to provide the Public Health Wales Board, and
Senior Management Forum with a report on key issues from the Executive
Director of Public Health Services including:
Public Health Services Directorate
o Updates on current/ future activity
Trust generally
o Medical Director
The Executive Director of Public Health Services report will be presented to
the Board at each formal meeting.
Date of Executive Team Meeting: 8 May 2013
Please State if the Paper is for: Executive Team
Discussion
Decision
Information
X
Public Health Wales
Report of The Executive Director of Public Health Services, May 2012
PURPOSE
This report contains briefings from the three Divisional Directors and
activity to support medical and nursing professional activity.
1
MEDICAL DIRECTOR
No update this month.
2
SCREENING DIVISION
2.1
Workplan: Delivery issues
2.1.1
Wales
Abdominal
Aortic
Programme (WAAASP)
Aneurysm
Screening

Following a successful meeting with the representatives of the South
Wales vascular network, the project team was able to recommend a
launch date of 1 May 2013 for the programme.

The first invitation letters will be mailed to participants on 1 May
2013, with the first screening clinic arranged for 22 May 2013.

The programme will cover the whole of Wales from its launch, and
will invite around 20,000 men to attend for screening in 2013.

As well as Screening Division staff, we have been helped in the
development of the programme by many people, including:
o Clinical and managerial colleagues from Health Boards, in
development of vascular networks and offering clinical training
placements to screeners
o A major Information Technology (IT) development by NHS
Wales Informatics Service (NWIS).
o Extensive public and professional engagement in the
development of the programme model and its supporting
literature
o The awarding of a contract to deliver a screener training
course to the University of Glamorgan, and the planning,
delivery and evaluation of that course
o Procurement of ultrasound and IT equipment following a
robust appraisal process
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Public Health Wales

Report of The Executive Director of Public Health Services, May 2012
The programme will continue to develop after its launch. In
particular, the vascular networks to which we will be referring men
with aneurysms detected within the programme will require
intensive quality assurance to achieve the reductions in mortality
that have been experienced in England following the implementation
of AAA screening.
2.1.2
Cervical Screening Wales (CSW)

An implementation date of 1 September 2013 has been agreed with
Welsh Government for the changes to the age range and frequency
of invitation for cervical screening in Wales.

In addition to the age range changes, CSW faces other major
changes in the near future, including the implementation of testing
for human papilloma virus (HPV) and the requirement to develop
and alternative information management system in readiness for the
eventual decommissioning of the Exeter system currently used in
England and Wales. We have also been asked by Welsh Government
to develop next steps for the introduction of HPV testing within
Cervical Screening Wales.

In order to ensure that these major CSW developments are funded,
coordinated and implemented effectively, we are establishing
CRAMP (the Cervical Screening Wales Reconfiguration and
Modernisation Project), which is currently developing its project
initiation document (PID).
2.1.3
Antenatal Screening Wales (ASW) Downs syndrome
screening project

Progress continues to be slow.

Welsh Government (WG) has indicated that they wish to set an
implementation date of 1 November 2013 and Health Board
colleagues have been asked to prepare implementation plans. Some
Directors of Public Health have indicated that they do not consider
this timing to be achievable in their Health Boards.

A workshop for Health Board implementation teams to share good
practice was held on 24 April 2013. We will continue to work with
Health Boards and Welsh Government to facilitate implementation in
this financial year.
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Public Health Wales
2.1.4
Report of The Executive Director of Public Health Services, May 2012
Breast Test Wales (BTW) Pilot of Magnetic Resonance
Imaging (MRI) surveillance for young women at very
high familial risk of breast cancer

At the request of the Welsh Health Specialised Services Commission
(WHSSC) , BTW has planned and managed a three year pilot
programme looking at models of provision of MRI screening for
young women at very high familial risk of breast cancer

The pilot ran from 2010-2013 and is now complete

The Project Board met for the final time on 5 April 2013, when it
received the evaluation report produced by Dr Sikha De Souza,
along with an appraisal of possible options for future service
provision.

No decision has been taken by WHSSC regarding the continued
provision of a service in Wales
2.1.5
BTW Conference ‘To Digital and Beyond’

Following the successful implementation of digital mammography
throughout BTW, a staff conference held on 15 April took stock of the
transition, and the development of a recovery plan.

Comparative UK figures
detection rate of any UK
service needs to pull back
implementation, and to
provided to women.
2.1.6

show that BTW has the highest cancer
breast screening programme. However, the
the delays to invitation caused by the digital
increase the speed at which results are
Newborn
Hearing
Screening
Professional Lead training
Wales
(NBHSW)
NBHSW delivers regular training to its network of Health Board
Professional Leads. The most recent training day covered topics such as
cytomegalovirus infection, language outcomes, parental; views of
assessment, the NBHSW care pathway and quality assurance.
Evaluation was very positive, with 100% of attendees rating the
educational content excellent, and 75% saying that they plan to modify
their practice as a result of the day.
2.1.7
Newborn Hearing Screening Wales annual report
The annual report is available from the NBHSW website at
http://www.wales.nhs.uk/sitesplus/documents/. The report confirms that
the programme continues to perform to the highest standards.
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Public Health Wales
2.1.8
Report of The Executive Director of Public Health Services, May 2012
Diabetic Retinopathy screening
Further discussions have taken place with colleagues from Cardiff & Vale
UHB on the process for transferring the Diabetic Retinopathy Screening
Service for Wales (DRSSW) into Public Health Wales. Methodology and
timeframes are yet to be agreed.
2.2
2.3
Quality and Safety
2.2.1
NBHSW Quality Assurance (QA) Adviser. Dr Sally Minchom
will retire from her post on 30 April. No applications were
received in the recent recruitment exercise to replace Dr
Minchom. The programme has QA embed in each region of
Wales via its Divisional Coordinators, and will not
immediately attempt to fill the vacancy. The absence of a
QA adviser for the programme has been added to the
Division’s risk register.
2.2.2
Magden Park laboratory Clinical Pathology Accreditation
(CPA) assessment has been postponed as a result of a
shortage of assessors. The assessment will now take place
in July 2013.
Stakeholders
2.3.1
Public
o WAAASP held a pre-launch stakeholder day on 23 April 2013. The
event was held in Mid Wales and was attended by colleagues from
Health Boards, Primary Care and Community Health Councils
o CSW has worked with the TV production company Boomerang for
S4C on an edition of the ‘Doctor Doctor’ programme focussing on
the cervical screening programme. We have not been given a date
for the broadcast to date.
2.3.2


Professional
The Health minister will visit Bowel Screening Wales on 29 April
2013.
The Wales Screening Committee met on 9 April 2013. Decisions not
noted elsewhere in this update included:
o The Committee to receive minutes from Screening Project
Boards in future for information.
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Report of The Executive Director of Public Health Services, May 2012
o Screening Division to provide an update on progress in the
electronic issuing of results to GPs at the next meeting in June
o Screening Division to develop a bid for research funding for a
fully evaluated pilot of flexible sigmoidoscopy screening in
Wales
2.4
Research & development

The FH01 study (‘a multicentre Health Technology Assessment of
mammography provision for young women at increased familial risk
of breast cancer’ ) has been published as a Health Technology
assessment monograph (Health Technol Assess 2013; 17(11):1-95).
This multicentre study was coordinated and managed by Breast Test
Wales, which also recruited a substantial proportion of the
participants. Two current, and two former members of staff are
named authors on the paper.

The FABS (‘Factors Affecting Bowel Screening’) study has presented
a poster at the Cancer Research UK National Awareness and Early
Diagnosis Initiative Conference in Cambridge. The FABS study is
collaboration between the Division and Cardiff and Swansea
Universities, making use of the Secure Anonymised Data Linkage
(SAIL) database to examine differences in health service usage
between participants in the bowel screening programme and those
who do not return their test kits.
3
MICROBIOLOGY DIVISION
3.1
Work Plan update – delivery issues
3.1.1
Emergency On–Call
90-day notice of contractual change circulated to all non-medical staff in
Microbiology Division. Out-of-hours rotas agreed for one year in all sites.
3.1.2
North Wales Microbiology Service Review
Project Board Meeting due 01 May 2013 with updates from the three
workstreams (Service redesign, Human Resources and Finance). Lack of
progress on IT issues remains a limiting factor.
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3.1.3
Report of The Executive Director of Public Health Services, May 2012
LIMS implementation
Due for discussion at National Pathology Programme Board on 03 May
2013.
3.2
Quality and Safety
3.2.1
Clinical Pathology Accreditation (CPA)
Non-conformance is still under review. Transfer of molecular service from
Swansea to Cardiff may result in reversal of non-conformance. Awaiting
response from CPA to revised service delivery of molecular virology.
Quality Improvement Audit programme on schedule, no major issue
identified.
3.2.2
External quality assurance (NEQAS)
No unsatisfactory reports received.
3.2.3
Internal quality assurance audit programme
No major issues identified.
3.2.4
Incidents/Complaints/Claims
An Information Governance complaint was reported last month; an
internal meeting highlighted the need for protocol (including specimen
letter) for dealing with written requests from patients for results. Draft has
been circulated by Gay Reynolds and we are awaiting comments.
An HIV serology incident in Abertawe Bro Morgannwg University Health
Board service is being investigated. A look-back exercise is in progress.
Reported to Quality & Safety Committee 18 April 2013; a report to Welsh
Government is in preparation.
3.2.5
Risks
Service continuity in emergency on-call response (see above).

External Health & Safety audit – none.

Internal Health & Safety audit – no major issues identified.
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3.2.6
Report of The Executive Director of Public Health Services, May 2012
HSE inspection visit to Carmarthen Laboratory.
Containment Level 3 completed 16 April 2013. No non-compliances were
identified in the inspection and suggestions were made for continuous
improvement. Paul Swaney, the HSE Inspector, was very impressed with
the Health & Safety documentation available on Quality Management
System, the Health & Safety audit schedules at Carmarthen laboratory
and the management of Category Level 3 facility and the other laboratory
areas.
3.3
Stakeholders
Engagement with Health Board’s is ongoing to determine the clinical
services requirement, particularly responsibilities and support for Infection
Control systems. It is anticipated that Service Level Agreements will be
revised to reflect any specific change in requirements, including any
agreed additional resource provision.
3.4
Research and Service Development

Research projects are progressing to agreed schedules.

Service Development framework being finalised, it is anticipated that
an upgraded formal managed process will be introduced to oversee
all service development proposals and ensure enhanced scrutiny. To
be discussed at next Microbiology Services Management Team
meeting.

Meeting to discuss development of Whole-Genome Sequencing in
Wales and possible bid to Welsh Government for funding scheduled
for 02 May 2013.

Project to move to a Managed Service Contract for serology
progressing.
3.5
Other
Consultant appraisal and re-validation process in progress, training on
new system commenced.
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Report of The Executive Director of Public Health Services, May 2012
4
HEALTH PROTECTION DIVISION
4.1
Welsh Healthcare Associated Infection Programme

“HALT2” prevalence survey of infections in long term care facilities:
One of the nurse specialists is working with colleagues in Health
Protection Teams and Health Boards, both organising and collecting
the Welsh data for this Europe wide study.

The team are looking to develop a risk register to contribute to the
divisional and corporate risk register as appropriate – update: this is
now pending the new corporate system being currently implemented

A senior scientist member of the team presented a poster at the
International Forum on Quality & Safety in Healthcare (London)
2013

Project plans are in development for the Surgical Site Infection
Reduction Programme, the changes (if approved by Welsh
Government) to, and developments of, the current mandatory
healthcare associated infection surveillance programme including
finalising the programme of work for critical care and the study to
identify modifiable risk factors for E. coli bacteraemia in Wales.

The team has representation (Senior Scientist) on the English
“Infections in Critical Care Quality Improvement Programme”

A final draft, following comments from the service, of a template
hospital outbreak plan is ready for final consideration by the working
group and then Welsh Government

Members of the team have been involved in providing advice and
support to Her Majesty’s Prison Cardiff regarding infection
prevention and control in their healthcare facilities pending transfer
of prison health services to the Health Boards

The team has representation (Nurse Consultant) on the Public
Health England led working group to produce evidence based
guidance on toxigenic Staphylococcus aureus.
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4.2
Report of The Executive Director of Public Health Services, May 2012
Vaccine Preventable Disease Programme

The Division has provided advice to Welsh Government with
planning and delivery of four new immunisation programmes:
Rotavirus for babies at 2 and 3 months of age, MenC for adolescents
in School Year 13-14, universal influenza vaccination by nasal spray
for all children 2-16 years, and shingles vaccine for those aged 7079. Ann announcement from Welsh Government is awaited.

Extensive support for measles outbreak control and promoting MMR
vaccination programme.

10th Wales Immunisation Conference in SWALEC stadium Cardiff on
30 April

Working to deliver annual reports on the influenza vaccine
programme 2012-13, and annual COVER report on childhood
vaccination 2012-13.
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