Director of Public Health
Services Report
August 2012
Author: Professor Hilary Fielder
Date: 25 July 2012
Version: 1
Distribution: Public Health Wales Executive Team
Purpose and Summary of Document:
This paper is to provide the Public Health Wales Executive Team with a
formal report from the Director of Public Health Services including:
Public Health Services Directorate
o Updates on current/ future activity
Trust generally
o Medical Director
Date of Executive Team Meeting: 31 July 2012
Please State if the Paper is for: Executive Team
Discussion
Decision
X
Information
X
Public Health Wales
1
Report of the Director of Public Health Services, August 2012
PURPOSE
This report contains briefings from the three Divisional Directors and
activity to support medical and nursing professional activity.
2
MEDICAL DIRECTOR
2.1
Revalidation
The Deanery has held training the trainers meetings in readiness for
the roll out of the Medical Appraisal Revalidation System (MARS).
Three of our staff have been trained. The Deanery has given further
dates for training and these have been circulated to all appraisers.
Members of our revalidation team team have met the Deanery team to
discuss when and how to implement MARS in Public Health Wales. It is
likely that we will begin to implement in October 2012.
2.2
ACCEA
The 2012 round for Clinical Excellence Awards is underway.
Consultants have been requested to submit their forms for Public
Health Wales consideration by 24 July. The Trust’s panel will meet on
7 August and will write citations following this meeting. The deadline
for submission to WG is 17 August 2012.
Date: 25 July 2012
Version: 1
Page: 2 of 14
Public Health Wales
Report of the Director of Public Health Services, August 2012
3
SCREENING DIVISION
3.1
Workplan: Delivery issues
3.1.1
Testing for Sickle Cell disease: Newborn Bloodspot Screening
Wales (NBSW): It was originally planned that newborn bloodspot
screening for Sickle Cell Disorders would begin in December
2012. Following discussions with the NSC and WG, it has been
agreed that further work is needed to develop and evaluate a
standardised protocol for the test. This will introduce a delay in
implementation, and it is at present unclear when screening for
sickle cell will be introduced. We are working with Welsh
Government to communicate this decision appropriately.
3.1.2
Further age expansion of Bowel Screening Wales (BSW): a paper
comparing costed options was presented to the Wales Screening
Committee on 4 July 2012.
3.1.3
Implementation of digital mammography: Breast Test Wales
(BTW). The introduction of the new technology is complete in
West and SE Wales, and building enabling works are currently
underway in Wrexham. Numerous technical problems, along with
the need to redesign patient pathways, have led to delays in
women being offered screening, and in the issuing of results.
3.1.4
Service planning: Cervical Screening Wales (CSW). A planning day
for cervical cytology labs was held in Mid-Wales on 9 July 2012,
with clinical and managerial attendees from across Wales. CSW
faces a number of major changes in the coming years, including
changes to the age range and frequency of screening, the
implementation of HPV testing, and the impact of HPV vaccination
on disease prevalence. The planning day was designed to start to
map the potential impact of these changes on workforce and
financial planning, to ensure that we are able to continue to
provide a high quality service throughout the period of change.
3.1.5
Funding has been secured to implement the programme to screen
for abdominal aortic aneurysms.
Detailed work is being
undertaken by a multi-disciplinary team.
3.2
Quality and Safety
3.2.1
All-Wales Management Group, BSW: the Group met on 25 June
2012. Topics discussed included:
Date: 25 July 2012
Version: 1
Page: 3 of 14
Public Health Wales
Report of the Director of Public Health Services, August 2012
o Waiting times for colonoscopy: waiting times for
colonoscopy are outside standard in three Health Boards
(BCUHB, ABMUHB and one unit in Hywel Dda) and are
expected to rise further over the summer holiday period.
Participants are being offered earlier appointments at
alternative units where possible.
o A draft Quality Assurance (QA)
assessment centres was approved.
framework
for
local
o Draft English bowel screening programme QA standards for
CT scans of the colon suggest radiologists should report a
minimum of 100 scans per years. Several units in Wales do
not currently see sufficient volumes of cases to achieve this,
which may cause difficulty for BSW in the future.
o Updates to the BSW Quality Manual were approved.
3.2.2
Information governance: following the recent fine levied on a
Welsh Health Board for breach of information governance, the
Division has developed a procedure which will be incorporated in
Quality Manuals to ensure no such incident occurs here.
3.3
Stakeholders
3.3.1
Professional
o Wales Screening Committee: Rosemary Fox and Sharon
Hillier attended Wales Screening Committee on 4 July 2012.
Agenda items included planned and potential changes in the
cervical screening programme, possible expansion for the
bowel screening programme, and feedback from a four
nations teleconference of the UK National Screening
Committee (NSC).
o Mrs Hayley Heard, Head of Bowel Screening Wales (BSW),
attended the Bowel Cancer Screening Programme Evaluation
Group in London. Topics discussed were types and rates of
adverse incidents associated with bowel screening, an
evaluation strategy and an overview of research currently
being undertaken in England.
o Mrs Hayley Heard also attended the Bowel Cancer Screening
QA Coordinators’ Group meeting in London. Relevant topics
included quality of pathology data available in the English
programme, training and flexible sigmoidoscopy.
Date: 25 July 2012
Version: 1
Page: 4 of 14
Public Health Wales
Report of the Director of Public Health Services, August 2012
o Mr Dave Nuttall, Head of Laboratory Services for the
Division has been elected vice-chair of the LSSC (Laboratory
Services Subcommittee to the Welsh Scientific Advisory
Committee).
o Dr Rosemary Fox, Director of the Screening Division came
into post as Faculty Adviser for Wales on 17 June 2012.
o Mr Bryan Rose, head of Cervical Screening Wales (CSW)
was a member of the expert panel at three study days
organised by the NHS Cervical Screening Programme
(England), examining audit of invasive cervical cancer.
o NBSW circulated its fourth newsletter, updating stakeholders
on the project. Items included and explanation of the
purpose of newborn bloodspot screening, the conditions
screened for, the new bloodspot card and parent information
leaflets, changes to testing for cystic fibrosis, sample taker
registration and the launch of the programme’s website.
o The UK National Screening Committee (NSC) is currently
consulting on changes to the age range and frequency of
invitation for cervical screening in the United Kingdom. Dr
Rosemary Fox has responded on behalf of Public Health
Wales, and has provided Directors of Public Health with
background information to enable them to respond on
behalf of their Health Boards.
o Northern Ireland’s Public Health Agency has written to the
Wales Abdominal Aortic Aneurysm Screening Programme
(WAAASP) project team, thanking them for their support in
developing the programme which was recently launched in
Northern Ireland.
3.3.2
Public
BTW issued a press release regarding delays in issuing invitations
for breast screening as a result of the implementation of digital
mammography.
Date: 25 July 2012
Version: 1
Page: 5 of 14
Public Health Wales
Report of the Director of Public Health Services, August 2012
3.4
Research & development
3.4.1
Symposium Mammographicum: Breast Test Wales had five
posters on display at this national symposium, and the oral
presentation given by Medical Student Laura Matyntsina on
Screening in the Elderly was awarded the prize
3.4.2
BSG (British Society of Gastroenterology) Conference: BSW staff
presented five posters at this event.
3.4.3
Association of Coloproctologists: BSW staff presented on variation
in surgical management of screen detected bowel cancers.
4
MICROBIOLOGY DIVISION
4.1
Work Plan - delivery issues
o Service Review North Wales has produced recommendations
to be considered by Board at August meeting.
o Service Review ABMU has completed initial options appraisal
and produced draft proposals for further consideration,
project report to be finalised. Draft Project Report in
preparation.
o South East Wales Microbiology Modernisation Board has
produced a draft report on the option appraisal outcome. A
final report was presented to the South East Wales
Pathology Collaborative Group on 13 July 2012 for
endorsement before being presented to the South East
Wales tripartite Chief Executive Officers and the Chief
Executive Officer, Public Health Wales. Awaiting feedback
from meeting.
o Olympic preparedness:
Validation of gastro-intestinal
pathogens molecular panel complete. Microbiology Division
will input into Health Protection Agency HPA Microbiology
Division daily teleconference (10.00h) throughout Games
period.
o Procurement
of
automated
microbial
identification
equipment progressing. Agreement on Antimicrobial
sensitivity testing process pending.
Date: 25 July 2012
Version: 1
Page: 6 of 14
Public Health Wales
4.2
Report of the Director of Public Health Services, August 2012
Quality and Safety
o Audits / reports
MH/ Ann Thomas presented to last Q&S Committee on the
Microbiology Division QMS. Developing an assurance
framework to present annually.
o CPA assessment visit:
Critical non-compliances
o Andrology Aberystwyth: Three critical non compliances
(and a number of non critical non compliances) cleared.
o Ambient temperature monitoring in store rooms: cleared
o Turnaround times: cleared.
o Action relating to IQC data: Evidence of corrective action
sent to Virology Peer Assessor for clearance.
Non-critical non-compliances
o 16 non compliances remain to be cleared and are either
with CPA having the evidence reviewed or still having
evidence gathered
Incidents/ complaints/ claims
o Complaint received over handling of an HIV test result.
Complainants offered meeting with Bob Hudson.
Meetings with ABMUHB and Rosemary Johnson
(Antenatal Screening) ongoing reviewing the handling of
HIV test results by midwifery services.
Risks
o On-call harmonisation arrangements confirmed unlikely
to be acceptable to staff, service continuity risk being
assessed.
4.3
Stakeholders
o Public – no update this month
o Professional – no update this month
4.4
Research and development
No update this month.
Date: 25 July 2012
Version: 1
Page: 7 of 14
Public Health Wales
4.5
Report of the Director of Public Health Services, August 2012
Other
o LIMS. Implementation of all Wales LIMS progressing.
Carmarthen laboratory now gone live; issues around clinical
portal development are delaying implantation in Rhyl
o ABMUHB have agreed to fund a 10 session consultant
microbiologist/infection control doctor post. Job description
being prepared. SLA to uplifted.
5
HEALTH PROTECTION DIVISION
5.1
Work Plan - delivery issues
Substance misuse
Steroids and Image Enhancing Drugs: Working in partnership with
accredited training providers, NHS Scotland and the UK Steroids forum,
Health Protection have developed a programme of work aimed at raising
awareness and providing harm reduction information for those using
steroids and image enhancing drugs and health professionals working with
them. A website has been developed along with a practical DVD on
Steroids
and
image
enhancing
drug
use
(available
at:
www.siedsinfo.co.uk). To date this website and film has been accessed by
individuals from 25 countries worldwide. Alongside the website, an
accredited training course has been developed and 16 ‘Steroid Area Leads’
identified and trained as trainers to roll out the training course to around
260 relevant substance misuse professionals and youth workers across
Wales.
E-Health Awards: Health Protection have been shortlisted for the EHealth Awards in the category of ‘Best use of IT to improve Patient safety’
following developments of the web-based ‘Harm Reduction Database’
(HRD) – a system of patient management and surveillance on those
accessing needle and syringe programmes across all statutory and
voluntary sector harm reduction services in Wales. The system also
incorporates the roll-out of the Take-home Naloxone programme aimed at
reducing drug related deaths. Outcomes of the next round of
presentations for the award will be announced in October 2012.
Vaccine Preventable Disease Programme
The Vaccine and Immunisation Team has contributed to a paper on
influenza vaccine efficacy which is being submitted to Eurosurveillance this
week, results came from our routine flu surveillance with the Public Health
Date: 25 July 2012
Version: 1
Page: 8 of 14
Public Health Wales
Report of the Director of Public Health Services, August 2012
Wales Specialist Virology Centre. The paper highlights waning immunity
from the vaccine during the 2011-12 season.
The Vaccine and Immunisation Team been asked by the Five Nations
Influenza Surveillance Group to lead a working group looking at how
influenza vaccine uptake data is collected in the UK nations and how
comparable uptake data from UK countries is in reality.
Due to the ongoing increase in cases of whooping cough, the Vaccine and
Immunisation Team were asked to investigate how timely pertussis
immunisations are in Wales for children aged under 1 year. Results of the
analysis were reassuring, 92.5% of all first doses of 5 in 1 (dip, tet, pert,
Hib and polio) immunisations delivered in this age group were given by 10
weeks of age. (This immunisation is scheduled at 8 weeks of age).
The annual flu surveillance wash-up and planning meeting will take place
on Tuesday 24 July 2012, with contribution from Health Protection Team,
Communicable Disease Surveillance Centre, Vaccine Prevention Disease
Programme and Public Health Wales Specialist Virology Centre. Ongoing
plans for new surveillance of flu in intensive care unit and assessing
hospital admissions due to flu will be discussed.
Healthcare Associated Infection Programme
Surveillance review: The surveillance review is ongoing. To date we
have received over 100 responses from our stakeholders. A meeting has
been convened for 5 October 2012 to meet with stakeholders and agree a
programme of information that meets their needs.
A proposal for an IT solution to support healthcare associated infection
clinical management in health boards while improving data collected by
Public Health Wales, together with a specification of service, has been
submitted to Welsh Government. We understand a submission to take
this forward will be going to the Minister of Health and Social Services
within the next two weeks.
Environmental Health Protection
Strategic
o Environmental Public Health Workplan (2012/13) developed and
being implemented.
o Response to Welsh Government’s Housing White consultation paper
written on behalf of the Wales Health Protection Committee.
o Environmental health protection service activity summary report (for
period 1 January 2012 to 30 June 2012) produced and circulated to
Directors of Public Health and Health Protection Team staff.
o Shared database development nearing completion – going live in
August/September 2012.
Date: 25 July 2012
Version: 1
Page: 9 of 14
Public Health Wales
Report of the Director of Public Health Services, August 2012
o Work commenced (in conjunction with the Welsh Health Impact
Assessment Support Unit) to develop a protocol for use of health
impact assessment in Wales for proposed developments with
environmental health-related consequences.
o Working in association with Welsh Government to review Science
and Technical Advice Cell arrangements for Wales.
Operational
o Continue to support multiagency response to major gas oil spill at
Semlogistics (control of major accidents and hazards site), Milford
Haven.
o Provision of advice in respect of recent floods in Ceredigion –
ongoing response
required for identified post-flood lead
contamination of soils at allotments affected by floods.
o Work on Fforestfach epidemiological study commenced now data has
reached Secure Anonymised Information Linkage database; also,
paper on the Fforestfach fire published in Health Protection Agency
Chemical Hazards and Poisons Report.
o Paper being developed on effective housing interventions to tackle
asthma as a result of exposures to damp, mould and house dust
mites (feeding into the work of the Welsh Collaboration for Health
and the Environment).
o Audit of control of major accidents and hazards sites commenced.
o Undertaking a review of existing arrangements for responding to
planning and environmental permit consultations.
o Agreed to respond to a Welsh Government policy review question
around the effectiveness of Air Quality Management Areas as an
intervention to improve community health (using environmental
public health tracking approach).
o Discussing with Welsh Government around other possibilities for
data linkage around environmental hazards (particularly using
accident and emergency data).
o Ongoing responses to other incidents and queries (including fires,
chemical contamination of water supplies, blue green algal blooms
etc.)
Sexual Health
Public health Wales has agreed with Welsh Government to launch a HIV
awareness raising campaign on 1 December 2012 World Aids Day.
Information on long acting reversible contraceptive for service providers
and users has been distributed to all general practice practices in Wales
and via community midwives, health visitors, youth services, substance
misuse services etc.
Date: 25 July 2012
Version: 1
Page: 10 of 14
Public Health Wales
Report of the Director of Public Health Services, August 2012
Blood Borne Virus
The Health Protection Division has contributed to the annual report on
Hepatitis C in the UK 2012.
Olympic Preparedness
The Health Protection Division are providing daily public health SitReps on
current health protection issues that have the potential to impact on the
Olympics. These are circulated to all key partners and feed into the all UK
public health surveillance reports.
In addition they contribute to the UK health
teleconference and the UK microbiology teleconference.
5.2
protection
daily
Quality and Safety
o Audits / reports
o Programme of clinical audit is now underway.
o Incidents/ complaints/ claims - none
o Risks
o Highlighted – nothing to report this month
o Risk register – nothing to report this month
5.3
Stakeholders
o Public – no update this month
o Professional – no update this month
5.4
Research and development
A meeting has been convened between the Blood Borne Virus team,
virology department, UHW, and the Director of Screening Services to
tender for a European Centre for Disease Prevention and Control ECDC
project to measure the impact of antenatal screening on blood borne
viruses across Europe. This is a two year project.
Date: 25 July 2012
Version: 1
Page: 11 of 14
Public Health Wales
6
Report of the Director of Public Health Services, August 2012
VACANCY CONTROL
Following scrutiny of submitted cases, the Director of Public Health
Services recommends that the following vacancies be recruited to:
6.1.1
Safeguarding Children’s Services
o Secondment to Cardiff University, 2 sessions per week for 6
months.
o Same sessional commitment to be backfilled by part time
Designated Doctor.
o GP secondment to safeguarding for 2 sessions per week for
3 months.
Following scrutiny of submitted cases, the Director of Screening
Division recommends that the following vacancies be recruited to:
6.1.2
Band 2 newborn hearing screener, North Wales
o Temporary, cover career break
o part time (20 hrs), will be allocated flexibly amongst
existing staff
o Finance and HR approval have been given
6.1.3
Band 4 regional secretary, Mid & West Wales Cervical Screening
Admin Department (CSAD)
o Part time, 0.53 WTE
o Permanent, replacement post
o Finance and HR approval have been given
6.1.4
Band 3 backfill for bowel screening admin staff on secondment
o Part time (0.5 WTE)
o Temporary- 6 months
o Finance and HR approval have been given
Date: 25 July 2012
Version: 1
Page: 12 of 14
Public Health Wales
6.1.5
Report of the Director of Public Health Services, August 2012
Band 3 backfill for bowel screening admin staff on secondment
o Full time
o Temporary- 6 months
o Finance and HR approval have been given
For Information:
A request for VERS from a band 3 staff member has been approved
Following scrutiny of submitted business cases, the Director of
Microbiology Division recommends that the following vacancies be
recruited to:
6.1.6
Biomedical Scientist,
Llandough Hospital
Band
6,
WCM
–
TB
laboratory,
o New post
o Fixed term until 31 March 2013 funded by Aneurin Bevan Health
Board
o 0.5 WTE
o Finance and HR approval confirmed.
Following scrutiny of submitted business cases, the Director of the
Health Protection Division recommends that the following vacancies be
recruited to:
6.1.7
Health Protection Nurse Secondment 12 month, band 7
from 1 August 2012, M&W
o Post currently within establishment
o Fixed term, 12 months (covering adoption leave)
Date: 25 July 2012
Version: 1
Page: 13 of 14
Public Health Wales
Report of the Director of Public Health Services, August 2012
o 1.0 WTE
o Finanace and HR approval confirmed.
6.1.8
Heath Protection Nurse, Band 7, M&W
o Post currently within establishment
o Substantive
o 1.0 WTE
o Finance and HR approval confirmed.
Date: 25 July 2012
Version: 1
Page: 14 of 14