Hepatitis C Action Plan Local Authorities…… Local Authorities…… ….and how to engage them ….and how to engage them

Hepatitis C Action Plan “It is not possible to manage and treat Hepatitis C infected persons without considering their social care, and any drug/alcohol problem, needs.” “It is not possible to manage and treat Hepatitis C infected persons without considering their social care, and any drug/alcohol problem, needs.” However However - “There is a paucity of local authority (social care) involvement with Hepatitis C infected persons across Scotland.” - “…only one-quarter (of Scotland’s main Hepatitis C treatments centres) have outward referral links with social care services.”

L.A.s – Areas of strength Difficult to reach patient group Difficult to reach patient group - Chaotic individuals in chaotic contexts - Complex and varying needs - Difficult to support L.A.s in contact with many patients L.A.s in contact with many patients - L.A.s - multifaceted role - Complementary/partnership role - Integral to engagement and retention - L.A.s can support – given resourcing

More than Social Care? Education Education Housing Housing Youth work Youth work Community work Community work Innovative and holistic approaches Innovative and holistic approaches Role in prevention? Role in prevention? Awareness raising Awareness raising …and case finding?????? …and case finding??????

Fife - a mixed bag Advantages Coterminous LA/HB boundaries Coterminous LA/HB boundaries (Relatively) small pond (Relatively) small pond (Relatively) developed networks (Relatively) developed networksDisadvantages Dispersed semi-rural area Dispersed semi-rural area (Relatively) small pond (Relatively) small pond Tendency to reinvent the wheel Tendency to reinvent the wheel

Fife Positive Support Fife Council Social Work Service Fife Council Social Work Service Hepatitis and HIV Hepatitis and HIV Integrated with BBV clinic Integrated with BBV clinic Good links - GUM/Addiction Services Good links - GUM/Addiction Services Stat & Vol orgs - broad links Stat & Vol orgs - broad links Work flexibly - diverse cohort Work flexibly - diverse cohort Social work/support function/finance Social work/support function/finance Housing support/care (up to 24/7) Housing support/care (up to 24/7)

Fife Positive Support - services Pre- and post-test discussion Pre- and post-test discussion Information and prevention Information and prevention Practical and emotional support Practical and emotional support Facilitating access to services Facilitating access to services Support with childrens issues Support with childrens issues Carer/family information and support Carer/family information and support Advice on safer practices Advice on safer practices Flexible housing support Flexible housing support Case finding/outreach testing Case finding/outreach testing

More services Assistance in accessing housing Assistance in accessing housing Access to legal/immigration advice Access to legal/immigration advice Support with mental health issues Support with mental health issues End of life/bereavement support End of life/bereavement support Training - design and delivery Training - design and delivery Local/national strategy & policy input Local/national strategy & policy input Comprehensive Comprehensive Enabling Enabling Flexible Flexible

FPS Strategic Links Fife BBV Task Group Fife BBV Task Group Fife Sexual Health Strategy Group Fife Sexual Health Strategy Group Hep C Resource Centre Scotland Hep C Resource Centre Scotland Action Plan TTCS Working Group Action Plan TTCS Working Group Fife Drugs Forum Fife Drugs Forum etc etc

Engaging Local Authorities Obstacles (in L.A.s) Obstacles (in L.A.s) - Burden of statutory responsibilities - Competing priorities - Trench thinking - BBV = NHS issue - Cultural and attitudinal - Lack of “big picture” thinking

Engaging Local Authorities Obstacles (in Health sector) Obstacles (in Health sector) - Burden of statutory responsibilities - Competing priorities - Trench thinking - BBV = NHS issue - Cultural and attitudinal - Lack of “big picture” thinking

Phase II Solutions Financial allocation to increase capacity in relation to Hep C (Action 6) Financial allocation to increase capacity in relation to Hep C (Action 6) Workforce development aims to address understanding, role and context (Action 4) Workforce development aims to address understanding, role and context (Action 4) Underlined by engagement between NHS and LA (Actions 8 and 9) Underlined by engagement between NHS and LA (Actions 8 and 9)

Phase II Solutions - Engagement Action 9: “Each Local Authority will identify a Strategic and Operational lead for Hepatitis C infection” Action 9: “Each Local Authority will identify a Strategic and Operational lead for Hepatitis C infection” This might be sufficient (initially) if…… This might be sufficient (initially) if…… - Committed leads are identified - Strategic and operational - Leads have sufficient knowledge - Leads prioritise Hepatitis C - Adequate resources were available

Facilitating engagement? Facilitating engagement? Use of existing infrastructure? Use of existing infrastructure? - E.g. Executive Leads write to L.A.s - E.g.. Engage LA Chief Execs - Little existing national infrastructure … Use of new infrastructure? Use of new infrastructure? - National LA Leads Network National facilitation activity? National facilitation activity? - Role for the LA Leads Network Chair? - National Coordination/Liaison Post? - Sessional work undertaken by the Chair? Combination of the above…. Combination of the above….