PHE North West Bulletin - GovDelivery

PHE North West Bulletin Issue 04, April 2016

Contact us: PHE North West Centre, 5th Floor, 3 Piccadilly Place, London Road, Manchester, M1 3BN Tel: 0344 225 0562

Email: [email protected]

Twitter: @PHE_NorthWest

Welcome Welcome to the fourth edition of our North West Bulletin and a warm welcome to the spring – let’s hope we can enjoy some better weather over the coming months. Thank you to everyone who has taken the time to comment on our recent editions and for suggestions for future stories, we shall certainly bear those in mind. As we approach spring those of us involved in public health and health know there is no let-up in issues and activities – just different ones!

Rosemary McCann, Deputy Director of protection Health Protection

Winter may bring concerns such as seasonal flu, norovirus, winter mortality and scarlet fever but the spring and summer bring their own challenges. Now is the time we see increases in gastro infections such as cryptosporidium, salmonella and E.coli. In this issue Welcome

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Zika Virus and congenital abnormalities

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Tackling smoking rates in the North West

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Getting the North West moving!

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Blood pressure

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The Blister Sisters get encouragement from Simon Stevens

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PHE action on health inequalities

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The role of dental public health in the reorganised health and social care system

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Invite to annual North West TB Conference

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Developing a Sustainability and Health Network

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Cumbria one of the first sites in a national diabetes prevention programme

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Older people in North West encouraged to get shingles vaccine

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Increase in scarlet fever across the North West, and England as a whole

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Ways into public health

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Working together to increase cancer screening uptake in Merseyside – the Merseyside 2 Year Cancer Screening Plan 15

PHE North West Bulletin

Issue 04, April 2016

Surveillance allows us to target messages and push for greater public awareness— let’s hope that this year our proactive approach helps people to avoid unnecessary illness and infection. Although we are aware of seasonal trends, sometimes you need to be prepared for the unexpected—who would have thought at the beginning of the year that a little-known virus would be grabbing the headlines? In this edition we look at the response to the Zika virus and advice offered to travellers, especially pregnant women. This edition also explores work and innovations within health and wellbeing, and healthcare public health, such as features on a recent e-cigarette workshop for stop smoking services, a look at the role and work within dental public health and recent efforts to tackle high blood pressure. We also look at our joint work with NHS England in the creation of Diabetes Prevention Programmes—and how Cumbria is leading the way in tackling the rising prevalence of type 2 diabetes. Partnerships are key to the public health agenda and the Merseyside 2-Year Cancer Screening Plan is one example of how stakeholders have come together to address screening issues. Similarly, the recent World TB Day allowed us to showcase the work of the North West TB Control Board and highlight the decline in TB incidents in the region. This edition includes information on how to register for the next North West TB Conference in November. Finally, as well as working with partners to tackle issues as diverse as sustainability, health inequalities and obesity – this edition will also highlight work that PHE North West is undertaking to train the future generation with insights into career development routes. Dr Rosemary McCann, Deputy Director for Health Protection, PHE North West

Zika Virus and congenital abnormalities The Zika virus has been known since about 1947 but, up until recently, it wasn’t considered to be a significant public health issue. Instead, it was seen as an endemic mosquito-borne infection causing mild illness across equatorial Africa and Asia. Since 2007, it has spread considerably, caused large outbreaks, and since 2013, caused outbreaks linked with neurological disorders including Guillain-Barré syndrome and microcephaly across the Pacific region and the Americas.

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The reasons for this change are unclear. The mosquito species currently transmitting the virus has been established in this part of the world for some time and recent research suggests that although susceptible to infection, surprisingly, these mosquitos are not as competent as one would think in transmitting the infection to humans. This may suggest that other factors, such as the large non-immune population and the high densities of human-biting mosquitoes contributed to the rapid spread. For up to 80% of infected people, Zika infection will be mild or without symptoms. However, there is a growing body of evidence linking Zika virus infection to GuillainBarre syndrome, and intrauterine Zika infection in pregnant women to microcephaly and other congenital abnormalities. This is a huge public health issue for the countries affected, particularly Brazil, and WHO declared this a public health emergency of international concern in February 2016. However, the risk to the UK is very low. As the mosquitoes do not live or survive here, there is no chance of having an outbreak situation. The issue is more to do with the risk from travelling to affected areas, particularly for pregnant women or their partners (sexual transmission from symptomatic males to females has been reported but remains rare). Control measures are mostly focused on prevention: travel advice and advice on preventing sexual transmission. Guidance on managing pregnant women potentially at risk has also been published for GPs and midwives. No vaccine or specific treatment is currently available. Unlike with Ebola, no additional intervention is planned, but PHE are working with Port Health authorities and flight operators to standardise disinfection practices on direct flights incoming from affected countries. All guidance and further information is available on the PHE Zika web page: https://www.gov.uk/guidance/zika-virus Contributor Dr Matt Pegorie, Consultant in Communicable Disease Control, PHE North West

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Tackling smoking rates in the North West Although there has been a steady reduction in smoking prevalence over the last few years, smoking still remains the largest cause of premature death in this country. In the North West, over 20% of the population smoke—one of the highest rates in the country. In 2015, the tobacco agenda was dominated by the e-cigarettes debate and the rise in popularity of vaping nationally—last year figures show that 2.5 million people used e-cigarettes. These factors, combined with a concurrent decline in footfall into stop smoking services (SSS) in the last few years and a request for greater clarity on e-cigarettes, led PHE North West to commission partners Tobacco Free Futures (TFF) to organise a one-day insights workshop for practitioners with a smoking cessation remit. The purpose was to explore perceptions and to identify and address barriers to effective work with smokers wishing to use e-cigarettes as part of a quit attempt or harm reduction approach. The learning from the event was used to inform the development of an electronic guidance resource. Through a pre- and post-event survey TFF assessed how the evidence presented in the workshops changed stop smoking practitioners’ perceptions of e-cigarettes as a quit aid, with 80% considering it a good idea afterwards, compared to about 40% beforehand. The resource was launched in November 2015 following the publication of PHE’s national e-cigarettes evidence review in August 2015. PHE North West has been providing ongoing support to embed stop smoking support within an integrated lifestyle service. We also continue to support: • • •

North West mental health trusts to become completely smoke free North West knowledge and intelligence service in the development of an annual and quarterly “North West Stop Smoking Services Report” Partners and senior leaders to look at ways of tackling smoking across Greater Manchester as part of the devolution prevention offer

Looking ahead, 2016/17 is expected to be another busy year as PHE North West prepares to support local implementation on: • • •

the “Revised Tobacco Product Directive”, which means that e-cigarettes will be regulated for the first time vaping indoors and in workplaces as national PHE guidance is due to be launched the ten year “Tobacco Plan”, which is expected in summer

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• •


smoking in pregnancy supporting North West mental health trusts on their journey to go smoke free

Contributor - Tasneem Choudhri, Health and Wellbeing Manager

Getting the North West moving! Lancashire Cricket Ground was the venue in February for a national collaborative aimed at getting the North West moving. Everybody Active Everyday: “Moving at Scale” Physical Activity Evaluation and Scale-up Regional Fora was hosted by PHE, the British Heart Foundation, the National Centre for Physical Activity and Health, the National Centre for Sport and Exercise Medicine and the County Sports Partnership.

Dr Rebecca Wagstaff presenting at the Moving at Scale event

The aim of this, and other events, is to embed the ‘Moving at Scale’ domain of the national physical activity framework, Everybody Active, Every Day, at a local level through developing skills and collaborating for evaluation and adoption at scale of ‘what works’. Outcomes of the day included: • •

A shared understanding of the perspectives of different stakeholders in relation to evaluation and its role in planning and assessing interventions Improved knowledge and skills in evaluation design, identifying and measuring outcomes, assessing implementation and assessing the economic benefits of physical activity programmes

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• •


Development of new collaborations and a way forward to support embedding of evaluation in physical activity interventions Moving at scale—delegates will adopt what works for implementation at scale.

Reference was made to the Standard Evaluation Framework for Physical Activity Interventions and Nick Cavill presented at the event. Follow the link to read the full document https://www.noo.org.uk/core/frameworks/SEF_PA Contributor - Dr Rebecca Wagstaff, Deputy Director, Health & Wellbeing, PHE North West

Blood pressure Blood pressure provides an ideal indicator of overall health and wellbeing, which can be controlled through the healthier lifestyle. Much of our work in 2015-16 was based on the Canadian experience where through sustained effort, the public became more aware of the need to monitor and control their blood pressure. This was in conjunction with extensive clinical leadership and engagement. Cheshire and Merseyside’s local public health collaborative (CHAMPS), supported by PHE North West and other stakeholders, was immensely successful in getting to the final round of NHS test bed applications. At the final touch line, they lost out, coming runners-up and missing out on £5 million of investment into new technologies and apps to support the blood pressure programme. Nonetheless, it was agreed by all partners that the process had been immensely successful and rewarding, forging new relationships and collaborations that will continue. The team spirit and enthusiasm across the area was a pleasure to be part of and was not in vain. After some deep reflection, it has been agreed that the partners will work together, learn from mistakes and submit an even stronger bid in the next wave of NHS test bed bid applications. PHE North West played a significant role in supporting the development of the Blood Pressure Board in Cheshire and Merseyside during the past year, which has had two dynamic and productive meetings. No sitting round a large table for this group, which has been on its feet a lot with sticky notes and flip charts- agreeing the blood pressure strategy, mapping work streams and making personal commitments on how their own organisations are going to move the strategy forward.

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I had the pleasure of visiting Cambridge and Birmingham to showcase our work and approach to system leadership on blood pressure work. It is always a pleasant surprise and honour to see how people are impressed with our work and a little bit more than satisfying to put the North West on the map. Dr Gunjit Bandesha

2015-16 was a successful year in system leadership for this work and brought people together with a common priority and purpose. It is important that we maintain and expand this work for the coming year and deliver some of the key elements of the strategy around intelligence and evaluation, health living pharmacies, clarifying and agreeing to a blood pressure pathway. Contributor Dr Gunjit Bandesha, Consultant in Healthcare Public Health

The Blister Sisters get encouragement from Simon Stevens Chief Executive of NHS England, Simon Stevens, recently visited Preston and heard all about the Public Health Commissioning Team’s contribution to becoming healthier at work and at the same time supporting fundraising efforts by a local cancer foundation.

The "Blister Sisters" are taking part in a two day 50 mile walk from Lake Windermere to the Rosemere Cancer Centre in Preston in May. This challenge was planned to support the local cancer centre after two colleagues (one of whom is completing the walk) were diagnosed and treated with breast cancer over the last couple of years. The team of PHE and NHS England staff are training hard and are currently organising lunch time walks from Preston Business Centre to encourage the rest of the office get involved in workplace health. To keep the team motivated during the

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walk, family and friends are being encouraged to “Walk the Last Mile” of the challenge. The “Blister sisters” —Kerry Crooks, Kathryn Jones, Sue Perry, Carol Ann McElhone, Tricia Spedding and Shelagh Garnett—would like to thank everyone for their support so far. You can keep up to date with the team’s training and the challenge on Twitter at @BlisterSister6. If you would like to join the team on a lunchtime walk or for the last mile on the 22 May, visit www.justgiving.com/blister-sisters9 or contact Kerry Crooks (Screening and Immunisation Manager, Lancashire, PHE) at [email protected].

PHE action on health inequalities Here in the North West we have been working with the National Health Equity Team to deliver our commitments to reduce health inequalities and consider the needs of all individuals in their day to day work in shaping policy and delivering services, and in relation to employees. These commitments are set out in the Health and Social Care Act 2012 and the Equality Act 2010. There are nine protected characteristics, including age, disability, race and sexual orientation, covered by the legislation. We have focused on two main areas of work, taking forward a “Health in All Polices” approach, and the development of an internal Health Inequalities Framework. We organised a joint workshop in December 2015 to support the development of a Health in All Policies (HiAP) Resources Tool. This was one of three events held across the country with partners to go through the draft content of the tool and hear about good practice in the North West. The Tool will include information about the HiAP approach, a presentation that local authorities can adapt for use with partners and councillors to support the implementation of this approach, case studies and guidance on where to get further information. The tool is currently being finalised and should be available later this month. The North West team have also been helping to develop PHE’s internal health equalities framework, which looks to build staff capability on health inequalities in a number of ways. In addition PHE has recently published a health inequalities ebulletin. To find out more and subscribe to this communication please visit http://phe.us11.listmanage.com/subscribe?u=51914a9c8d67601a2a9764580&id=f764b52bbb Contributor - Paula Hawley-Evans, Health and Wellbeing Programme Lead

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The role of dental public health in the reorganised health and social care system Dental public health is a formally recognised specialty that uses the full range of public health competencies and focuses on oral health—measuring, monitoring and improving this, and on treatment services for oral and dental conditions. Dental public health expertise was transferred from primary care trusts to PHE in April 2013, while responsibility for commissioning treatment services stayed with NHS England, and measuring and improving oral health transferred to local authorities. Consultants and specialists in dental public health (CsDPH) now have the role of providing advice and support to NHS England and local authorities to give added value in their endeavours. In the North West, which has such a range of communities and wide inequalities in oral health, the amount and variety of advice required is considerable. In work with NHS England Dental Public Health partners draw on current evidence and their background in clinical dentistry to support procurement of a range of services. They may also prompt service redesign or methods of monitoring activity, and interpreting activity data to implement efficiencies. North West consultants in Dental Public Health have recently been involved in activities such as: • • • • •

the establishment and guidance of local professional networks for dentistry production of guidance to support primary dental care in provision of care for patients with dementia embedding antimicrobial stewardship establishment of a centralised referral system improving the costs of providing orthodontic care

Nearly all public health competencies are required for work with local authorities, which might include assisting with relevant information to go into a Joint Strategic Needs Assessment, attending scrutiny committees with local authority colleagues, supporting steering groups as they implement new oral health improvement strategies or review their oral health improvement team and advising on Freedom of Information requests about fluoride. The transfer of commissioning responsibilities and associated funds is still going on at varying paces across the area. PHE Dental Public Health staff can facilitate

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meetings between relevant agencies to ensure this process is undertaken safely and with minimal loss of skills of a committed and experienced workforce. Contributor - Gill Davies, Specialist in Dental Public Health, Consultant to the Dental Observatory

Invite to annual North West TB Conference The annual North West TB Conference will take place in Manchester on Thursday 10 November at Manchester Royal Infirmary. It has been organised by Professor Mark Woodhead and Professor Bertie Squire in conjunction with the Liverpool Medical Institution and is suitable for health practitioners involved in TB management, GPs, physicians, microbiologists, public health doctors and anyone involved in the care of TB patients and their families. The conference will include a range of speakers looking at issues such as enhanced case management, contract tracing, TB guidelines, whole genome sequencing and more. For further information on the conference including how to register please contact Peter Nield on 0161 901 1903 or email [email protected].

Developing a Sustainability and Health Network Climate change is one of the most prominent environmental issues of our time and last year’s Paris Agreement highlighted that health professionals and health systems have an opportunity and mandate to build actions into the core business plans of their organisations. Public Health England is currently working on a number of initiatives, including the implementation of the PHE and NHS England Sustainable Development Strategy for the Health and Social Care System 2014-2020. This strategy outlines an approach to building a sustainable health and care system that works within the available environmental and social resources to protect and improve health now and for future generations. To support the implementation of this strategy, PHE NW is working with NHS, other PHE centres and local authority colleagues from across the north to build a sustainability network. The network would see opportunities for training and education, sharing of best practices and demonstration projects, and supporting and encouraging local action. The network is supported by the NHSE/PHE Sustainable Development Unit www.sduhealth.org.uk. Contributor - Darryl Quantz, Public Health Registrar, Co-ordinator of the Northern Sustainability and Health Network

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Cumbria one of the first sites in a national diabetes prevention programme In March, Cumbria was one of 27 sites selected as part of the new national Healthier You: NHS Diabetes Prevention Programme, which will provide targeted support to help people avoid the disease.

Those referred will get tailored, personalised support to reduce their risk of Type 2 diabetes, including education on healthy eating and lifestyle, help to lose weight and bespoke exercise programmes, all of which together have been proven to reduce the risk of developing the disease. Diabetes leads to an increased risk of other diseases and complications, such as heart disease, kidney disease, serious eye problems, depression, neuropathy and amputation. The first wave of the nationwide programme will make up to 20,000 places available. This will roll out to the whole country by 2020, with 100,000 referrals available each year after. There are currently 2.5 million people with Type 2 diabetes in England and it’s estimated that over five million people are at high risk of developing the disease. The programme will allow GPs to invite people at high risk to enrol for targeted advice on healthy eating, lifestyle and physical activity. GPs are expected to begin to refer people during 2016. Type 2 diabetes is one the biggest health challenges of our time and millions of people in England are at risk of developing this serious disease. This personalised, tailored programme for people at risk will offer support on improving their lifestyle habits, including getting more exercise, a better balanced diet and losing and keeping off excess weight—helping people to take more control of their health and ultimately

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prevent them developing what is potentially a life threatening condition. The NHS diabetes prevention programme is run collaboratively by NHS England, Public Health England and Diabetes UK. Contributor - Dr Jane Rossini, Public Health England North West deputy centre director

Older people in North West encouraged to get shingles vaccine Earlier this year, PHE North West launched a campaign to remind eligible older people to get the shingles vaccine to help prevent the painful infection. Shingles is caused by the reactivation of the varicella-zoster virus (chickenpox), which is commonly caught in childhood.

After a person has had chickenpox, the virus can lie dormant in the nervous tissue but may reappear as shingles. An episode of shingles typically lasts around two to four weeks. The main symptoms are pain, followed by a rash. It is possible to have shingles more than once. Although shingles vaccination is often offered at the same time as the annual flu vaccination, PHE North West would remind people that the vaccine is available at any time throughout the year to eligible people. Those who were eligible for immunisation in the first two years of the programme but have not yet been vaccinated against shingles remain eligible until their 80th birthday.

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Dr Graham Wardman from PHE North West said: “It’s worth taking the time and effort to visit your doctor to get the shingles vaccine as it protects you against a painful condition. You only need to be vaccinated once and it’s important that you get it while you’re the right age. “We offer the shingles vaccine routinely to individuals at the age of 70 years to boost their immunity to prevent the development of shingles and significantly reduce the incidence of post herpetic neuralgia—persistent nerve pain that can occur at the site of a previous attack of shingles. “Since the introduction of the shingles vaccine there has been a considerable reduction in the number of cases of this debilitating and painful condition.”

Increase in scarlet fever across the North West, and England as a whole There has been a steep increase in scarlet fever notifications across England, and North West numbers show that this has been our experience as well. In England, 10,570 notifications of scarlet fever have been received since September (weeks 37 to 13). Weekly notifications have increased rapidly over recent weeks. Week 13 was 1,319 and is the highest weekly total recorded in recent decades (data available since 1982). An increase in invasive disease caused by the same bacterium group A streptococcus (GAS), which causes scarlet fever, has also been seen. Scarlet fever notifications in the North West 2014/15 (weeks 37 to 13)

2015/16 (weeks 37 to 13)

Cheshire and Merseyside

487

671

Cumbria and Lancashire

464

390

Greater Manchester

502

402

The substantial increase in notifications has led to a lot of questions in local and national media. The investigations into reasons are ongoing with NHS. Results of specialist testing undertaken by PHE show that the rise is not due to the emergence of a new strain. The strains causing scarlet fever are genetically diverse and similar to ones previously circulating in our population.

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This is actually the third season in a row where the incidence of scarlet has been higher than typical years, and usually there are seasonal rises in scarlet fever between December and April each year. PHE has been alerting health practitioners to be mindful of the increase when assessing patients. Close monitoring, rapid and decisive response to potential outbreaks, and early treatment of scarlet fever with an appropriate antibiotic remains essential, especially given the potential complications associated with group A streptococcal infections. For more information, read PHE’s latest scarlet fever news story and updated health protection report. Other scarlet fever resources available online include: • • •

Scarlet fever guidance and data Scarlet fever information page on the NHS Choices website Group A streptococcal infections: guidance and data

Contributor - Dr Evdokia Dardamissis, Consultant in Health Protection, PHE North West

Ways into public health As well as Specialist Training, an alternative route of progression in Public Health exists through the UK Public Health Register (UKPHR) who hold a voluntary register. There are three types of registrant practitioners, generalist specialists and defined specialists. Practitioners Those with wide ranging experience in public health, including health improvement, health protection, data and intelligence, and health promotion activity. This workforce can be based in a range of settings such as the NHS, local authorities and the voluntary community sector. Practitioners are working at Level 5 and above of the Public Health Skills and Knowledge Framework. Specialists These are Public Health colleagues, operating at a senior level: normally perceived as Level 8 and above in the Public Health Skills and Knowledge Framework in public health. According to the UKPHR website, this takes one of two approaches: •

Generalist specialists are required to demonstrate evidence of knowledge and current competence across the full breadth of public health.

•

Defined specialists have chosen to specialise more highly in a narrower area of public health practice. They must show evidence of knowledge across the full breadth of public health to the same standard as generalists. They will also

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demonstrate current competencies in some particular areas of practice at a higher level than that required for generalists, usually reflecting their highly specialised professional experience in service or academic environments. Both practitioners and specialists complete a portfolio demonstrating their taught or ‘know how’ competencies and their experiential or ‘show how’ competencies. This portfolio is produced retrospectively and demonstrates how you have learnt and worked across public health. It is a comprehensive (and time consuming!) process but clearly shows how your path in public health has developed. What are the benefits of registering? Even the process of completing your portfolio is beneficial. It shows how you have developed appropriate standards of competence that can focus your attention on your key strengths and experiences. According to the UKPHR, registration can also bring recognition and status, and assist in public health career progression. Several prominent Directors of Public Health and consultants in local authorities and PHE are Defined Specialists. Contributor Dianne Draper, Sexual Health Lead PHE North West

Working together to increase cancer screening uptake in Merseyside – the Merseyside 2 Year Cancer Screening Plan Research has shown that half of all cancer patients in Merseyside (49%) are being diagnosed late and we have higher rates of bowel, breast and cervical cancer than the English average. Yet we have fewer people who take up NHS cancer screening compared to most of the country. People whose cancers could be detected earlier and treated with more success often aren’t taking up their invitations to screening. The Merseyside 2 Year Cancer Screening Plan was set up in 2014 to help increase cancer screening rates and improve health outcomes for the people of Merseyside. Partners work together to promote the benefits of screening and early detection, and to make it easier for people to take up screening. NHS England (Cheshire and Merseyside) has put £150,000 into the plan. Partners include PHE, Cancer Research UK, Jo’s Cervical Cancer Trust, CCGs, local councils, NHS trusts and GP practices. We run joint initiatives and communications campaigns to increase uptake in those areas where it is the lowest. Our approach is to use methods that have worked before or elsewhere, and to try new ways of reaching those who don’t take up their invitations for screening: the most disadvantaged or minority groups, and those who have not taken up screening before.

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Having reached the mid-point of the plan, twenty three organisations are now signed up and helping to increase screening uptake by taking part in communications campaigns, sharing best practice and helping us to speak to harder-to-reach audiences about the benefits of screening. 610,981 people took up NHS screening for breast, bowel and cervical cancer in Merseyside between 2014 and 2016. This means more lives were saved and cancer was found earlier, so people will live longer and better lives. We believe we are making a difference. Bowel cancer screening uptake is rising, which means lives are being saved (rates are up by over 3% for some parts of Merseyside). Other cancer screening rates are not falling as fast as previously, although it’s too early to say whether these encouraging figures are the start of a positive trend. We are very proud of the work we have done so far and we are committed to continuing to promote our messages about the importance of cancer screening to improve health outcomes for the people of Merseyside. If you have any questions or would like to find out more about the Merseyside 2 Year Cancer Screening Plan, please contact me on [email protected]. Contributor - Marie Coughlin, Screening and Immunisation Manager, NHS England – North (Cheshire and Merseyside)

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