WIRRAL COUNCIL Community Infection Prevention and Control Service 20th September 2016 WIRRAL PLAN 2020

Current landscape All NHS bodies and providers of independent healthcare and adult social care in England must comply with a code of practice for the prevention and control of infections. Health and Social Care Act (2012) requires local councils to commission community specific Infection Prevention and Control (IPC) Service. Specific provision of community IPC. Preventing and controlling infections requires co-ordinated approaches across organisations and systems. Wirral Demographics   The most appropriate place to start is the demographics of the area, to illustrate the context that Wirral Council operates within. According to the latest Census, Wirral is home to around 320,000 people. That makes us the 2nd largest Council in the City Region; we’re also bigger than many cities, including Newcastle, Derby and Nottingham. We’ve currently got around 8,800 FTE including school staff and a gross budget of £950 million, which is decreasing rapidly along with most other local authorities. Some of you will see evidence later on when you tour our borough, that the inequalities we face in health, housing and economic activity are our biggest challenge. Rebalancing those and reducing the gap between the richest and poorest parts of our borough will be the acid test of whether our 5-year Plan for the borough has delivered.

National and local drivers The Health and Social Care Act (2008, 2010, 2011, 2012) Clostridium difficile infection objectives for NHS organisation in 2016/17 and guidance on sanction implementation (NHS England, 2016) The MRSA Post Infection Review (PIR) Process Health Technical Memorandum (HTM) 01-05: Decontamination in primary care dental practices (DH 2008) Clostridium difficile; how to deal with the problem (DH/ HPA (now PHE) 2008) National specifications for cleanliness in the NHS (NPSA 2007, rev 2010) National specifications for cleanliness in Nursing and Residential care homes (NPSA 2010) National specifications for cleanliness in primary medical and dental practices (NPSA 2010) Infection: prevention and control of healthcare associated infections in primary and community care (NICE 2012) All current and any new DH guidance and technical memoranda related to the work programme. All Public Health England (PHE) protocols, guidance and policy related to the work programme NICE TB guidelines and Hard to reach groups. Other national, regional and local guidance and standards Local Wirral Health Protection Group Annual Report Healthy Wirral Local Delivery System Plan - Improving Key Standards of Quality and Safety Wirral Infection Prevention Control Network Wirral Demographics   The most appropriate place to start is the demographics of the area, to illustrate the context that Wirral Council operates within. According to the latest Census, Wirral is home to around 320,000 people. That makes us the 2nd largest Council in the City Region; we’re also bigger than many cities, including Newcastle, Derby and Nottingham. We’ve currently got around 8,800 FTE including school staff and a gross budget of £950 million, which is decreasing rapidly along with most other local authorities. Some of you will see evidence later on when you tour our borough, that the inequalities we face in health, housing and economic activity are our biggest challenge. Rebalancing those and reducing the gap between the richest and poorest parts of our borough will be the acid test of whether our 5-year Plan for the borough has delivered.

Context Wirral is home to around 320,000 people. That makes us the 2nd largest Council in the City Region; we’re also bigger than many cities, including Newcastle, Derby and Nottingham. Wirral has a higher proportion of older people compared to England and the 65+ age group is expected to increase faster than any other group. Wirral is one of the 20% most deprived districts/unitary authorities in England. Life expectancy for both men and women is lower than the England average and varies by up to 10 years between wards in the east and west of Wirral. There are 53 General Practices, 1 Community NHS Foundation Trust, 133 Care Homes and 39 NHS Dental Practices. Wirral University Teaching Hospital NHS Foundation Trust and Cheshire and Wirral Partnership NHS Foundation Trust. Wirral Demographics   The most appropriate place to start is the demographics of the area, to illustrate the context that Wirral Council operates within. According to the latest Census, Wirral is home to around 320,000 people. That makes us the 2nd largest Council in the City Region; we’re also bigger than many cities, including Newcastle, Derby and Nottingham. We’ve currently got around 8,800 FTE including school staff and a gross budget of £950 million, which is decreasing rapidly along with most other local authorities. Some of you will see evidence later on when you tour our borough, that the inequalities we face in health, housing and economic activity are our biggest challenge. Rebalancing those and reducing the gap between the richest and poorest parts of our borough will be the acid test of whether our 5-year Plan for the borough has delivered.

IPC Indicators Infection prevention and control identified by CQC as an area for improvement within Primary Care. Wirral is an outlier for broad spectrum antibiotic prescribing and is currently ranked 28 (Where 1 is the worst) out of 209 CCGs for antibiotic prescribing. Healthcare Associated Infections and Outbreaks There were 93 reported cases of C.difficile in Wirral during 2015/16; exceeding the 75 case threshold. There were 7 reported cases of MRSA BSI in Wirral during 2015/16; exceeding the zero tolerance threshold. There were 33 reported outbreaks in care home in 2015/16. There are 133 care homes in Wirral representing a outbreak rate of 24.8/100 care homes. Wirral Demographics   The most appropriate place to start is the demographics of the area, to illustrate the context that Wirral Council operates within. According to the latest Census, Wirral is home to around 320,000 people. That makes us the 2nd largest Council in the City Region; we’re also bigger than many cities, including Newcastle, Derby and Nottingham. We’ve currently got around 8,800 FTE including school staff and a gross budget of £950 million, which is decreasing rapidly along with most other local authorities. Some of you will see evidence later on when you tour our borough, that the inequalities we face in health, housing and economic activity are our biggest challenge. Rebalancing those and reducing the gap between the richest and poorest parts of our borough will be the acid test of whether our 5-year Plan for the borough has delivered.

Challenges and Opportunities Provision of IPC is fragmented, and arrangements vary, across the health and social care economy. Competing priorities and constrained public resources. Availability of IPC expertise, capacity, processes and training can be limited in small health and social care providers. Public and private providers. Meeting CQC requirements whilst prioritising support in high risk settings is challenging. Increasing community based care provision. Ageing population and increasing long term conditions. AMR and emerging infections. Wirral Demographics   The most appropriate place to start is the demographics of the area, to illustrate the context that Wirral Council operates within. According to the latest Census, Wirral is home to around 320,000 people. That makes us the 2nd largest Council in the City Region; we’re also bigger than many cities, including Newcastle, Derby and Nottingham. We’ve currently got around 8,800 FTE including school staff and a gross budget of £950 million, which is decreasing rapidly along with most other local authorities. Some of you will see evidence later on when you tour our borough, that the inequalities we face in health, housing and economic activity are our biggest challenge. Rebalancing those and reducing the gap between the richest and poorest parts of our borough will be the acid test of whether our 5-year Plan for the borough has delivered.

A vision for the future The health and social care system will have integrated, robust and evidence based processed to ensure good infection prevention and control measures, and adherence to them, are the norm. A move from control to prevention Wirral Wide Both the public and professionals will have a greater understanding of infection prevention and control including the appropriate use of antibiotic treatment regimes. Health and social care acquired infections will reduce as will costs associated with morbidity. Wirral Demographics   The most appropriate place to start is the demographics of the area, to illustrate the context that Wirral Council operates within. According to the latest Census, Wirral is home to around 320,000 people. That makes us the 2nd largest Council in the City Region; we’re also bigger than many cities, including Newcastle, Derby and Nottingham. We’ve currently got around 8,800 FTE including school staff and a gross budget of £950 million, which is decreasing rapidly along with most other local authorities. Some of you will see evidence later on when you tour our borough, that the inequalities we face in health, housing and economic activity are our biggest challenge. Rebalancing those and reducing the gap between the richest and poorest parts of our borough will be the acid test of whether our 5-year Plan for the borough has delivered.

Service objectives Provide strategic support to the local health economy on IPC working collaboratively. Assure lPC standards within community based health care and social care providers working in collaboration with other parts of the health and social care economy. Use data and intelligence to develop service provision which responds to known threats and risk within the community. Provide specialist IPC information, advice and support to community based health care and social care providers, commissioners and the public utilising root cause analysis (RCA), post infection review (PIR), training, expert advice, audit and responses to cases, outbreaks and incidents. engage staff at all levels, through effective leadership, in order to develop and embed a culture that supports IPC and helps minimise and mitigate against the threat posed by infective agents within the community and across the health economy. Wirral Demographics   The most appropriate place to start is the demographics of the area, to illustrate the context that Wirral Council operates within. According to the latest Census, Wirral is home to around 320,000 people. That makes us the 2nd largest Council in the City Region; we’re also bigger than many cities, including Newcastle, Derby and Nottingham. We’ve currently got around 8,800 FTE including school staff and a gross budget of £950 million, which is decreasing rapidly along with most other local authorities. Some of you will see evidence later on when you tour our borough, that the inequalities we face in health, housing and economic activity are our biggest challenge. Rebalancing those and reducing the gap between the richest and poorest parts of our borough will be the acid test of whether our 5-year Plan for the borough has delivered.

Service objectives Prevent and control healthcare-associated infections; supporting commissioners to achieve a reduction in the rate of C difficile infections, in line with national objectives and support the CCGs to deliver on the requirement for zero tolerance of avoidable MRSA bacteraemias. Respond to cases, clusters and outbreaks of communicable disease within the community (include healthcare associated infections) in partnership where necessary and following agreed Public Health England and other relevant protocols. Prepare for, and respond to, emerging organisms and infections supporting the local response to AMR. Develop the service systems, processes and protocols to ensure that there is a whole system approach to IPC to ensure a seamless service for all residents. Wirral Demographics   The most appropriate place to start is the demographics of the area, to illustrate the context that Wirral Council operates within. According to the latest Census, Wirral is home to around 320,000 people. That makes us the 2nd largest Council in the City Region; we’re also bigger than many cities, including Newcastle, Derby and Nottingham. We’ve currently got around 8,800 FTE including school staff and a gross budget of £950 million, which is decreasing rapidly along with most other local authorities. Some of you will see evidence later on when you tour our borough, that the inequalities we face in health, housing and economic activity are our biggest challenge. Rebalancing those and reducing the gap between the richest and poorest parts of our borough will be the acid test of whether our 5-year Plan for the borough has delivered.

Service requirements Infection Prevention and Control Standards Audit and Observation Training Specialist Infection and Prevention Control and Information Professionals Commissioners Prevention and Control of Healthcare Associated Infections Response to Cases, Clusters and Outbreaks of Communicable Disease Whole system approach to Infection Prevention and Control Wirral Demographics   The most appropriate place to start is the demographics of the area, to illustrate the context that Wirral Council operates within. According to the latest Census, Wirral is home to around 320,000 people. That makes us the 2nd largest Council in the City Region; we’re also bigger than many cities, including Newcastle, Derby and Nottingham. We’ve currently got around 8,800 FTE including school staff and a gross budget of £950 million, which is decreasing rapidly along with most other local authorities. Some of you will see evidence later on when you tour our borough, that the inequalities we face in health, housing and economic activity are our biggest challenge. Rebalancing those and reducing the gap between the richest and poorest parts of our borough will be the acid test of whether our 5-year Plan for the borough has delivered.

Expected Outcomes Contribute to a year on year reduction in healthcare associated infections (HCAIs) in particular Meticillin Resistant Staphylococcus Aureus (MRSA), Clostridium difficile (C.diff), MSSA and E-coli. Contribute to a year on year reduction in care home outbreaks. Contribute to year on year reductions in readmissions, length of stay and mortality associated with HCAI’s. Quality assure improved infection control standards in all primary health care and social care settings. Demonstrate improved infection control knowledge and skills within primary health care and social care providers and standardised approaches. Demonstrate safe, timely response to cases, clusters and outbreaks of communicable disease in conjunction with PHE. Evidence a Wirral wide approach to infection prevention and control. Wirral Demographics   The most appropriate place to start is the demographics of the area, to illustrate the context that Wirral Council operates within. According to the latest Census, Wirral is home to around 320,000 people. That makes us the 2nd largest Council in the City Region; we’re also bigger than many cities, including Newcastle, Derby and Nottingham. We’ve currently got around 8,800 FTE including school staff and a gross budget of £950 million, which is decreasing rapidly along with most other local authorities. Some of you will see evidence later on when you tour our borough, that the inequalities we face in health, housing and economic activity are our biggest challenge. Rebalancing those and reducing the gap between the richest and poorest parts of our borough will be the acid test of whether our 5-year Plan for the borough has delivered.

Contract and procurement The successful provider must collaborate with other Wirral health and social care providers 3 years Total annual budget £150k Advertise tender week commencing 14th October Evaluate tenders week commencing 14th November Intention to award letter to successful provider week commencing 19th December Service to start 1st April 2017 Wirral Demographics   The most appropriate place to start is the demographics of the area, to illustrate the context that Wirral Council operates within. According to the latest Census, Wirral is home to around 320,000 people. That makes us the 2nd largest Council in the City Region; we’re also bigger than many cities, including Newcastle, Derby and Nottingham. We’ve currently got around 8,800 FTE including school staff and a gross budget of £950 million, which is decreasing rapidly along with most other local authorities. Some of you will see evidence later on when you tour our borough, that the inequalities we face in health, housing and economic activity are our biggest challenge. Rebalancing those and reducing the gap between the richest and poorest parts of our borough will be the acid test of whether our 5-year Plan for the borough has delivered.

Any questions? Wirral Demographics   The most appropriate place to start is the demographics of the area, to illustrate the context that Wirral Council operates within. According to the latest Census, Wirral is home to around 320,000 people. That makes us the 2nd largest Council in the City Region; we’re also bigger than many cities, including Newcastle, Derby and Nottingham. We’ve currently got around 8,800 FTE including school staff and a gross budget of £950 million, which is decreasing rapidly along with most other local authorities. Some of you will see evidence later on when you tour our borough, that the inequalities we face in health, housing and economic activity are our biggest challenge. Rebalancing those and reducing the gap between the richest and poorest parts of our borough will be the acid test of whether our 5-year Plan for the borough has delivered.