Report of the Director of
Public Health Services
June 2015
Author: Dr Quentin Sandifer
Date of Meeting: 12 June 2015
Version: V0a
Distribution:

Public Health Wales Executive Team
Purpose and Summary of Document:
The purpose of this paper is to provide the Public Health Wales Executive
Team and Board 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.
Please State if the Paper is for: Executive Team
Discussion
Decision
Information
x
Public Health Wales
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Report of The Executive Director of Public Health Services, June 2015
MEDICAL DIRECTOR
The first round of job planning meetings has concluded. Over 60 staff
attended 6 sessions across Wales. Feedback will be analysed and followup of those who did not attend arranged.
2
SCREENING DIVISION
General:

A new Head of Nursing has been appointed to replace Linda Lewis, who
retires in August. Deborah Thomas will join us from Abertawe Bro
Morgannwg University Health Board (ABMUHB), where she is currently
strategic nursing lead for the Andrews Report ‘Trusted to Care’
taskforce.
Cervical Screening Wales (CSW):

Laboratory Information Management System. The go-live date of 29
June is unlikely to be met. Every effort is being made to ensure
implementation can happen before the installation of new Liquid Based
Cytology (LBC) and Human Papilloma Virus (HPV) testing equipment in
August.

Waiting times for smear results have increased with 75% women
receiving their results within four weeks in April, compared with 97% in
March. This is a result of increased demand, with large numbers of
samples (approx 25% above baseline) being received by the lab in
March and April and reduced capacity as a result of staff sickness and
reduced availability of support from Sheffield. The situation is unlikely
to improve, as reorganisation of lab services in North Wales means we
will be losing three screeners currently based in Wrexham. Although
the Health Board should be able to maintain the service to their own
residents, we will no longer be able to look to them to screen samples
from other areas.
Bowel Screening Wales (BSW):

Only Hywel Dda Health Board was in standard for colonoscopy waits in
April. This was partly due to staff sickness, annual leave and bank
holidays, and we expect the situation to improve in May as additional
lists have been put on to reduce backlogs. Problems persist in ABMUHB
as a result of the withdrawal of the Bridgend service and frequent
cancellations of the remaining weekly list in Singleton, without
compensatory backfill.
Breast Test Wales (BTW):

An upgrade to the Picture Archiving Communication System (PACS) is
in progress. This is increasing image reading times and assessment
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Report of The Executive Director of Public Health Services, June 2015
clinics. We are working closely with the manufacturer to minimise
service impact.
Wales Abdominal
(WAAASP):

Aortic
Aneurysm
Screening
Programme
The Four Nations Aneurysm Screening Programmes Group, of which we
are a member, is developing a UK level statistical report on
performance indicators. The group has reviewed the standard for
aneurysm detection in the light of new evidence on prevalence and
recommended that the standard be reduced from >=2% to >=1%.
This has been agreed at Programme Board and Screening Division
Senior Management Team, and will bring us into line with the other
Home Nations.
Maternal and Child Screening:

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Newborn Bloodspot Screening Wales lab standards for accepting
samples were tightened in April, bringing them in line with the wider
UK. As expected, there was a rise in the number of samples rejected by
the lab (to 18%). This has now fallen following training and feedback.
HEALTH PROTECTION DIVISION
Welsh Healthcare Associated Infection Programme (WHAIP):

The final 2014/15 Clostridium difficile and Staphylococcus aureus
bacteraemia data is being prepared for distribution to the NHS in
Wales. The 2014 Top 10 bacteraemia report has been distributed to
the Health Boards/Trust and Welsh Government and published on the
WHAIP website.

A draft report on C. difficile death certification has been sent to Welsh
Government for comment.

Invitations to the Aseptic Non Touch Technique Launch/Train the
Trainer Events have been sent out, to be held in Swansea on 29 June
and in St Asaph on 1 July. Preparation for a third event for university
colleagues is underway.

Some analytical support has been provided by the Welsh Healthcare
Associated Infection Programme to the Exercise Seren (see below) and
Mycobacterium chimaera look back exercises.

The first meticillin-resistant Staphylococcus aureus Screening Audit
Task and Finish Group meeting has been organised for the beginning
of June.

The first National Prevalence Survey Steering Group meeting has been
organised for the beginning of June.
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Report of The Executive Director of Public Health Services, June 2015

The orthopaedic electronic data capture Task and Finish group met in
May to gather feedback on the pilot of the new web form for collation
of data. Minor changes are required and further piloting.

WHAIP met with midwifery staff at University Hospital of Wales (UHW)
in April in response to elevated surgical site infection rates in maternity
services (C section). Members of WHAIP will now conduct an audit of
the data collected at UHW to determine the accuracy and reliability of
the data. In addition WHAIP will investigate the data collection process
in place and the need for training on surgical site infection surveillance
definitions.

Public Health Wales are procuring the Infection Prevention Society
Quality Improvement Audit Tool database. These are tools designed for
detailed measurement of all aspects of practice/ environment or a
specific clinical practice. They can be used to measure baseline
compliance with standards and identify areas for improvement work.
Vaccination and Immunisation:

The latest Cover report, January to March 2015 shows that the uptake
of MMR vaccine in two year old children decreased to 93.6% from
94.6% the previous quarter. One local authority area had an uptake of
less than 90%. A teleconference is planned with the wider public health
system (Directors of Public Health, Health Protection teams, Local
Authorities, and Health Board vaccination and immunisation coordinators) to agree a plan to improve uptake.
Environmental Public Health:

The team has drafted a national indicator on air quality to be included
in the national indicator set for Welsh Government aligned to the
Future Generations work.

Responded to 5 enquiries (all relating to drinking water), 7 planning /
permitting applications (including wind farms) and 6 incidents (all fires
and including the fire at Lancashire Fuels4U, Saltney).
Emerging infections:
Ebola Virus Wales preparedness:

The Health Protection Teams continue to monitor returning workers
from Sierra Leone.

Over the past few months Dr Harriet Hughes, Consultant Microbiologist
in Cardiff, has supported the UN/WHO/(US)CDC Ebola Preparedness
Response in Unaffected Countries in West Africa – Ghana, Cameroon,
and Côte d’Ivoire.

In October 2014, in collaboration with PHE, she delivered workshops
on Infection Control for regional health officials and partners in
Ghana. As a result, Public Health Wales strengthened collaborations
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with CDC and WHO, and were subsequently invited to develop a ‘Train
the Trainer’ course for ‘Rapid Response Teams’ in Cameroon which
took place in February 2015. Together with the National Ambulance
Resilience Unit, teams were trained on the practical aspects of infection
control during their response to suspect cases, including Personal
Protective Equipment (PPE) training and practical simulation
exercises. They also wrote a series of Action Cards for use ‘on the
ground’, which may be used as a generic baseline for other unaffected
countries.

Most recently, together with a team of six from PHE, and NARU, Dr
Hughes went to Cote d’Ivoire where they had been deployed to run a
similar programme to that delivered in Cameroon. The main remit had
been to address key areas for improvement of preparedness, response
and monitoring of a possible EVD case in country, as highlighted by the
WHO’s framework for response to a public health event in the African
region. US CDC had already started training programmes to assist
Cote d’Ivoire to develop preparedness and response functions.

On arrival however, they found the needs of the team to be very
different to those expected, and they therefore completely redesigned
the course to focus more on Emergency Operation Centre
development, risk communications, and multi-agency table top
exercises. Included in the training was basic education on the infection
control aspects of Ebola, and specifically, a review of their processes
and training for use of PPE.
Outbreaks/Incidents:


550 clients of a tattoo and piercing studio in Newport in South Wales
have been invited to attend for precautionary health checks including
testing for Hepatitis B and C and HIV. This followed concerns after five
people with serious skin infections requiring inpatient treatment were
identified as having had a piercing or tattoo carried out at the
premises.
So far over 677 people have been tested in the specially organised
clinics. Of these around 62% have been those who have received
letters from us and 38% have self presented via the Public Health
Wales helpline. Nearly 500 calls were received by the Public Health
Wales helpline before it closed on 29 May. Public Health Wales has
expressed its concern about the need for tighter regulation of the
tattooing and piercing industry in response to this incident.
Psychoactive Substances Bill:

On 28 May 2015, Parliament tabled the ‘Psychoactive Substances Bill
[HL]’ outlining a blanket ban on the production, distribution, sale and
supply of psychoactive substances in the UK. Josie Smith, Head of
Programme for Substance Misuse, Public Health Wales, was provided
with an opportunity to contribute to the Welsh Government response
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prior to UK Government amendments at the Lords Committee. A
number of recommendations were made.

Public Health Wales manages the WEDINOS project and this will be
unaffected by the legislation as concerns were addressed in early
drafts and communication with the Home Office in early spring. It is
expected that the Bill will move to the House of Lords in June.
InterAction Council:

4
The Executive Director of Public Health Services attended a meeting on
global health security at the Celtic Manor Resort on 1 June 2015, as an
invited expert contributor on behalf of Public Health Wales and the
CMO Wales. The meeting was chaired by a former President of Nigeria,
with health minister, WHO and high level representatives of public
health agencies internationally invited. Public Health Wales is planning
a session on ‘global health’ for the Informal Board in July, with internal
and external contributions.
MICROBIOLOGY DIVISION
Service Overview
Governance:

A network quality meeting was held on May 12 2015 where quality
leads reviewed the gap analysis for transition to ISO 15189:2012.
Dates for annual management reviews have been set with the final one
scheduled for 1 July 2015. The network report will be available by the
end of July. The UKAS assessment has been postponed to at least
April/May 2016 and will last approximately 25 days.
Health and Safety:

Emergency Efficacy studies on Containment Level 3 were undertaken
in two laboratories and work is underway to address issues to ensure
compliance. An incident was reported involving unsafe storage of
pressurised gas cylinders in the Cardiff Microbiology Laboratory and
meetings have taken place with Cardiff and Vale University Health
Board to discuss storage management.
Laboratory Information Management System (LIMS):

LIMS functionality in Microbiology remains less than optimal with the
clinical authorisation process in particular more time consuming and
complex than previously. The Microbiology Standardisation Group is
identifying problem areas that need addressing.
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Report of The Executive Director of Public Health Services, June 2015
Staffing Update:

The Mid and West Wales Regional Laboratory Service Manager post
has been advertised on NHS jobs and interviews are planned for 24
June 2015. The consultant microbiologist vacancies in North Wales are
also currently out to advert and interviews are planned for 30 June
2015.
West Wales:

The Abertawe Bro Morgannwg Microbiology consolidation onto the
Swansea site has been fully operational for the past 10 weeks.
Continued review of the new working patterns are still showing that
new working patterns are generally working well. Decommissioning of
the laboratory facilities at the Princess of Wales Hospital continues so
the laboratory has not yet been handed back to the health board.
North Wales:

The clinical microbiology service remains under pressure because of
consultant vacancies and interim arrangements involving locum staff
and support from Cardiff has been agreed for the next four months.

Kiestra Laboratory Automation initially started well in March, but
during April and early May has experienced a number of errors leading
to significant down time. The service has been working with the
supplier to seek resolution. Implementation of Automated Urine testing
is on track for early June with full centralisation by the end of June.
This will finalise movement of planned work and staff to Rhyl.
Scientific/Technological Developments:

The Cardiff Laboratory has been undertaking validation of the Launch
β-D-Glucan Assay. This is a retrospective and anonymous evaluation of
archived samples to determine the clinical validity of the commercially
available assay with the aim of repatriating the test to Wales.

Dr Rachel Chalmers, Head of the Cryptosporidium Reference
Laboratory, is co-author of a peer reviewed paper reporting an
outbreak of Cryptosporidium parvum, mainly in northern England,
associated with consumption of fresh pre-cut salad leaves. The
Reference Unit had a crucial role in the outbreak investigation as the
typing outputs defined the sampling frame for the case control study
and the subtyping helped to pin point the cause of the outbreak.
Microbiology Modernisation:

A detailed report has been presented to the Executive Committee
under separate cover.
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