NICE PUBLIC HEALTH PROGRAMME GUIDANCE ON TUBERCULOSIS HARD TO REACH GROUPS 2 nd meeting of the Programme Development Group Floor 24, City Tower, Piccadilly Plaza, Manchester, M1 4BD Final Minutes Attendees: Apologies: Authors PDG Members Imtiaz Ahmed (IA), Alyson Anderton (AA), Ibrahim Abubaker (IAb), Helen Bromley (HB), James Camp (JC), Fran Child (FC), Malcolm Cocksedge (MC), Sue Collinson (SC), Katie Dee (KD), Mark Edginton (ME), Joe Hall (JH), Chiara Hendry (CH), Alan Higgins (AHi), Andrew Hayward Chair (AH), Mubarak Ismail (MI), Joanne Lord (JL), Mary Cate MacLennan (MM), Josie Mavromatis (JM), David Olapoju (DO), Fizza Queshri (FQ), Bertie Squire (BS), Al Story (AS),Tammy Tamne (TT), Anne Tunbridge (AT), Susan Yates (SY) NICE Team Una Canning (UC),Alastair Fischer (AF), Andrew Hoy (AH), Patricia Mountain (PM), Kay Nolan (KN), Laura Norburn (LA) (am only), Catherine Swann (CS), Tarang Sharma (TS) Review Teams HPA and MATRIX Peter White (PW) (am only), Mark Jit (MJ) (am only), Maria Rizzo (MR) (am only), Phil Monk (PMo) (am only), Experts Stephen Davies (SD), Oliver Blatchford (OB) PDG Members Elias Phiri (EP) Patricia Mountain File Ref Version Audience Final PDG members, NICE team, the public (via web publication) p. 1
1 Welcome, Introductions and Aims of the Meeting The Chair welcomed everyone to the second meeting. PDG members, NICE staff, experts and collaborators introduced themselves and the Chair conveyed apologies from members who could not attend. 2 Declarations of Interests and Minutes of previous meeting The Chair explained that verbal declarations of interest are a standing item on every agenda and a matter of public record, and requested that members and attendees summarise any new potential conflicts of interest. There were no new declarations from PDG members or NICE team. The declarations previously declared are available within the minutes of PDG 1. The Chair requested the declarations from those that had not attended the previous meeting. Peter White Non personal pecuniary interest: funding from DH and NIHR to do economic modelling on area of TB Mark Jit none to declare Maria Rizzo none to declare Philip Monk none to declare Stephen Davies - none to declare Oliver Blatchford - none to declare The Chair asked the PDG if the members agree that the declarations of interest declared do not prevent participants from taking part in the meeting. As there were no objections the Chair ruled that none of these interests prevented any member from taking full part in the meeting. The minutes of the previous meeting were approved and all actions had been completed. Matters arising The Chair requested that PDG members continue to suggest experts that they consider to have testimony of interest to the committee. PDG 3 Using evidence from testimony a refresher Kay Nolan, lead analyst for this guidance at NICE, gave a presentation on using different forms of evidence to develop recommendations, including : Scientific evidence research based Colloquial evidence to supplement scientific advice for specific areas to provide context Expert testimony - invited experts to the PDG meetings if there is gap in the evidence or to give a voice to specific groups Kay explained that the PDG should also use their professional expertise to assess evidence from all sources. Expert testimony: Find and Treat service in London Al Story and Joe Hall gave a presentation to the PDG supported by a tabled paper. p. 2
Data on prevalence of TB in London Data on adherence to drug treatment Find and treat model Support available for the most complex cases Methods of awareness raising in hard to reach groups Links with other organistaions Role of illegal drug use in making it more difficult to both find and treat patients Issues surrounding the commissioning of the service Anomised case studies The Chair indicated that there would be time for questions following the next presentation. Expert testimony: King George s Hostel Stephen Davies, manager of King George s hostel in London gave a presentation to the PDG supported by a tabled paper. Links with Find and Treat Details of other healthcare available Methods of awareness raising of the symptoms of TB and the Find and Treat service in the hostel Increased take up and acceptance of the offer of screening by men in the hostel Questions / discussion on expert testimony The Chair thanked the experts for their contribution to the meeting and requested questions on both presentations. A discussion followed and the main points covered were: Clarification of funding and staffing establishment for both services How TB services are commissioned How hard to reach groups are signposted to the Find and Treat service The role that supported housing could potentially play in the support of those who are homeless and diagnosed with TB Expert testimony: TB and hard to reach groups update on work in Scotland Oliver Blatchford, Consultant in Public Health Medicine and TB lead for the Health Protection Network in Scotland gave a presentation to the PDG on supported by a tabled paper. Outline of TB services in Scotland TB guidelines in Scotland Differences in implementation of TB guidance in Scotland Data on incidence of TB in Scotland Proposed TB action plan anticipated in 2011 Clarification of who are the hard to reach groups for TB services in Scotland The Chair thanked Oliver and explained that there would be time for p. 3
questions following the next presentation. Expert testimony: Leicester clinical partnership model Dr Philip Monk from the Health Protection Agency, East Midlands South gave a presentation to the PDG giving a general overview of TB services in Leicester and specifically reaching hard to reach groups within their local population. Clarification of which are the hard to reach groups in Leicester The strategic and operational role of the TB board in Leicester Links with other relevant services and the voluntary sector and role of TB multidisciplinary group How those with suspected TB are found in hard to reach communities The rapid access treatment services in: primary/secondary care; prison services; schools and homeless hostels Direct Observational Therapy (DOT) for the Treatment of Tuberculosis Issues surrounding Public Health Law in relation to TB Questions / discussion on expert testimony The Chair thanked the experts for their contribution to the meeting and requested questions on both presentations. A discussion followed and the main points covered were: Perceptions among some immigrant communities about the cost of TB treatment, or that getting treatment may lead to their immigration status being challenged Mobility of migrant community members which can mean they are hard to find and treat Community based services- benefits of forging links with key community leaders Health economics and cost effectiveness an introduction to the NICE public health approach Alastair Fischer, health economics advisor at NICE gave a presentation to the PDG which introduced the NICE approach to health economics and the role of cost effectiveness evidence in NICE public health guidance. TB and hard to reach groups: Developing the economic analysis Peter White from Health Protection Agency / Imperial College London gave a presentation to the PDG giving an overview of the economic model that they are preparing for the PDG, giving its outline, data sources and analysis. Questions / discussion on health economics The Chair requested questions on both presentations. A discussion followed and the main points covered were: Clarification of terms used Commissioning services Scope / content of the model p. 4
Expert testimony: Screening for latent TB and TB management in primary care Anne Tunbridge, Consultant in Infectious Diseases at Sheffield Teaching Hospitals gave a presentation to the PDG on the services provided at Mulberry GP Practice in Sheffield. This included: Clarification of the hard to reach groups in Sheffield Services provided by the practices for asylum seekers and refugees and patients, who are screened for TB when they register Structure of the practice and how that facilitates attendance of hard to reach groups Benefits of screening for latent as well as active TB Questions / discussion The following discussion included: Diagnosis and treatment strategies; The relative appropriateness of different drug treatments including prophylactic treatments The impact of stigma Recommendations from PDG1: discussion The Chair referred to the paper TB 2-2.3 which was drafted by the NICE team following the group work at PDG 1. The PDG worked through the draft recommendations, discussing and amending the recommendations in plenary. The NICE team took notes and will revise and bring to the next PDG. Developing recommendations: Group work The Chair requested that the PDG break into three groups to: Discuss the findings from the evidence Start to draft recommendations linked to the evidence; the actions and who should be responsible for those actions. Note any possible: research recommendations; equity issues; commissioning issues or implementation issues. Start to draft any related considerations For each group a NICE team member facilitated. Plenary session The Chair asked a PDG member from each group to summarise their discussion and any recommendations. The NICE team recorded the draft recommendations to be brought back to the next PDG meeting for further discussion. AOB and next steps PDG 3 1 st February 2011 The Chair summarised the actions from the meeting. NICE Team Close The Chair thanked all attendees and closed the meeting at 4.30 p. 5