Summary Report. Introduction and setting the scene Autilia Newton, Public Health England, Health & Justice Acting Deputy Director
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1 Summary Reprt Having identified Liverpl and the surrunding areas in Merseyside and Cheshire as ne f the highest prevalence areas fr hepatitis C in England, HCV Actin and Public Health England staged the first f their hepatitis C gd practice radshws in the city n 6 th March. The radshw featured a range f presentatins frm relevant experts and health prfessinals, including Public Health England summaries f the natinal and lcal cntext fr hepatitis C, as well as talks frm lcal MP Luciana Berger, the Reginal Directr fr Specialised Cmmissining, NHS England Alisn Tnge, and Cnsultant Hepatlgists Prfessr Martin Lmbard and Dr Steve Ryder (HCV Actin Chair). A full list f the talks n the day is belw. The radshw als sught t share examples f gd practice in the lcal area thrugh presentatins frm representatives frm the Brwnlw Health practice and frm the Liverpl Addactin team, bth f whm explred the barriers they had encuntered instigating service changes, and detailed hw they managed t vercme their challenges in rder t imprve the awareness, testing and treatment f hepatitis C lcally. An interactive wrkshp in the afternn was aimed at encuraging attendees t cnsider hw they culd make psitive changes t their wn services with the aim f eliminating hepatitis C as a serius public health cncern in the area, the utcmes f which can be fund in the summary belw. Earlier in the day, attendees were als able t put their questins t a panel f cmmissiners and health prfessinals experienced in addressing hepatitis C in a range f different cntexts. Over 100 peple attended the radshw, including cmmissiners, nurses, GPs, drug wrkers, prisn health prfessinals and a hst f thers wrking in r arund hepatitis C in the Cheshire and Merseyside area. The full set f slides presented by each f the speakers can be fund n the HCV Actin resurce library here. Intrductin and setting the scene Autilia Newtn, Public Health England, Health & Justice Acting Deputy Directr
2 Addressing public health challenges in the Nrth West Luciana Berger, MP fr Liverpl Wavertree Lcal epidemilgy Evdkia Dardamissis, Public Health England Hepatitis Lead fr the Nrth West Intrductin t the HepCATT prject in Liverpl Dr Steve Ryder, Cnsultant Hepatlgist, Nttingham University Hspitals NHS Trust and HCV Actin Chair BBV pt-ut testing in prisns Natalie Rbinsn, Healthcare Supprt Wrker, HMP Kirkham Mike Rlland, Nurse Practitiner, Blackpl Fylde and Wyre Hspitals NHS Trust Treatment f hepatitis C and pssibilities fr eliminatin Prfessr Martin Lmbard, Cnsultant Hepatlgist, Ryal Liverpl University Hspital Cmmissining landscape fr hepatitis C Alisn Tnge, Reginal Directr fr Specialised Services, NHS England Hepatitis C patient perspective Kelly-Ann Hughes Panel discussin: Prblems and slutins fr tackling hepatitis C lcally HCV Actin: Sharing gd practice Charles Gre, Chief Executive, The Hepatitis C Trust Hepatitis C in primary care: The Brwnlw mdel Dr Diane Exley and Jayne Wilkie, Brwnlw Health Wrkshp: Hepatitis C Testing in Liverpl Presentatin and Wrkshp Dr Sandra Oelbaum, Addactin
3 The Anchr Mdel f Care: Securing peple in health and recvery Wrkshp Ntes Belw are a mixture f the answers prvided by the nine different grups wh tk part in the interactive anchr mdel element f Dr Sandra Oelbaum s wrkshp: 1. Target grup: Participants were asked t cnsider, wh are the target grups at whm t fcus awareness and testing effrts? All current and frmer drug users - Injecting drug users, and in particular thse that have shared equipment - Intra-nasal drug users (e.g. pwder ccaine users) - Sterid users - Legal high users Alchl users Hmeless peple Migrant grups (e.g. Suth Asians / Eastern Eurpeans) All partners f drug users Children f service users (testing f service users children culd even be cnsidered) All family members f thse with hepatitis C Thse wh have had unprtected sex Yung peple Men wh have sex with men (MSMs) HIV (c-infectin) Thse wh have had a medical prcedure abrad 2. The Anchr pint: Next, grups were asked t think abut where these target grups mst reliably access the system Prisns Sexual health services GPs Needle exchanges Pharmacies GUMs Peer supprt at ther services Third sectr agencies Self-referral Bking appintments at maternity and A&E Outreach services Drug services
4 Hstels Primary care Walk-in centres A&E Maternity services Immigratin services Cmmunity centres r msques 3. Grups went n t cnsider what interventins we want t deliver at the anchr pint? Peer educatin sessins and supprt, including assistance in attending appintments Screening f all kinds: Oral swabs / dry bld spt (DBS) testing, r signpsting t testing An ffer f testing at different stages Helplines Access t treatment / initiatin f treatment Offer infrmatin n transmissin, including useful literature Specialist wrkers General awareness raising, including thrugh educative questinnaires and literature prviding infrmatin n preventin, testing, treatment and supprt Bld tests Clinics in-huse Fibrscans Pre- and pst-test cunselling Cmplete SVR Referral t hspital Harm reductin initiatives All staff able t ffer hepatitis C interventins One-stp-shps Wrap-arund supprt and multi-agency cllabratin 4. Grups then explred wh is ging t deliver the interventins at the anchr pint, and wh are key delivery partners? Everyne wh has cntact with clients / the anchr pint (with adequate training) Key wrkers Nurses GPs Vluntary sectr e.g. The Hepatitis C Trust Drug wrkers Maternity midwives Cnsultants Prisn staff Sexual health services
5 Lab staff 5. Wh are the ther key stakehlders? The peple wh have the mney and make the decisins - cmmissiners GPs s that they can pass n fr DBS after swabs Charities NHS England Service prviders Peers supprt Clinical netwrks CCGs Patients Public health Public Health England Hspitals Drug teams Pharmacies Husing teams / rganisatins 6. Lastly, grups were asked t think abut hw their anchr mdel culd be sustainably delivered? Prmpt: Think f the furthest place in yur area and ask can we deliver this interventin there? Everyne wrking in partnership Cntinued funding Cst-effective planning, realistic expectatins Next Steps fr Merseyside and Cheshire It is vital that lcal cmmissiners, health prfessinals and ther influencers in the Cheshire and Merseyside area can seize the pprtunity that exists t eliminate hepatitis C as a serius public health cncern, building n the messages presented during the radshw talks and wrkshp. Belw are sme immediate steps that culd be taken t imprve hepatitis C services in Merseyside and Cheshire: Frmulate a clear plan fr tackling hepatitis C in Merseyside and Cheshire: Ensure that Health and Wellbeing Bards in the area include a sectin n hepatitis C in their Jint Strategic Needs Assessments and plans, assessing the risk grups and including detailed targets. Utilise the suggestins frm the afternn wrkshp t assess which hepatitis C interventins culd be integrated int existing services, and engage with a range f key lcal stakehlders t plan new interventins and ensure they are sustainably and effectively delivered.
6 Design and publish an integrated care pathway fr hepatitis C thrugh partnership wrking between the Lcal Authrities, CCGs, and NHS England Specialised Cmmissining which includes the key anchr pints discussed belw. Data cllectin: Gain a picture f the effectiveness and necessity f hepatitis C services and measure prgress by ensuring cmprehensive cllectin and detailed recrding f data. Health prfessinals seeking t establish new hepatitis C services can use strng data t gain funding fr their services, and lcal authrities can ensure that, as a cnditin f cmmissining drug and sexual health services, the right datasets are cllected fr hepatitis C. Cmmissin fr hepatitis C imprvements in drug and sexual health services: In additin t cmmissining imprved data cllectin, lcal authrities in Merseyside and Cheshire, respnsible fr cmmissining drug and sexual health services, can check: Are staff adequately trained t deliver infrmatin and testing fr service-users? Are drug service-users wh inject drugs tested fr hepatitis C n an pt-ut basis? Utilise HCV Actin s resurces: Explre the case studies f gd practice, research reprts, tls and templates that are available n the HCV Actin website at and share yur wn gd practice stries with HCV Actin. Feedback What will yu d differently in yur wrk as a result f this event? Test mre patients fr hepatitis C. If psitive, talk t them abut their result and its implicatins befre referring n t secndary care. I ll pass n learned knwledge t clleagues and clients. Engage with cmmissiners Try and gain funding fr DBS testing As Deputy Directr f Nursing & Midwifery fr Public Health England, I will cnsider wrking mre clsely with the RCM reginally, i.e. t raise awareness f the 7% antenatal wmen testing psitive fr HCV. I ll wrk mre clsely with the Health and Wellbeing Directrate n alchl and drugs and its assciatin with viral hepatitis.
7 Try and wrk better with secndary care agencies t prmte mre effective treatment, supprt peple in hepatitis C treatment and reduce DNA rates Which sessin did yu find the mst useful? I enjyed Prfessr Lmbard s sessin, as well as Sandra Oelbaum s wrkshp, as bth these sessins cvered hw we can be mst helpful in identifying and treating peple with hepatitis C virus The cmbinatin f talks was gd, as they cmplemented each ther BBV pt-ut testing in prisn All f it D yu have any cmments r questins which yu did nt have the pprtunity t raise during the day? Thanks t Kelly-Ann fr raising the imprtance f educating yung peple regarding HCV. I am cncerned that a new ppulatin f yung peple (under 18) are starting t inject and lack educatin regarding transmissin, safer injecting etc. When is the next ne?
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