1. Collaborating in a system of Health Protection from a Local Authority perspective 4 October Dr Bruce Laurence Director of Public Health Bath & North East Somerset Council

2. Shaping the system by example

3. TB outbreak in a factory
Outbreak declared in May 2014
Challenges:
Factory location – employees across
Somerset and B&NES (2 x PHE centres).
No. of organisations involved – comms. with GPs
Lack of clarity about money and staff post changes (loss of “custom and practice”).
No. of people testing positive for latent
TB infection: RUH pressure

4. Legionella in a hospital water system
1 death linked to legionella in the water system of a hospital
High profile and high stakes
A number of other possibly linked cases -

5. Local Authority role in a system of Health Protection
Assurance & Oversight V Maintaining Relationships & Offering Support

6. Local Authority Role Local knowledge & good links
Communications with internal and ext. stakeholders, esp. councillors.
Assurance & oversight
Maintaining relationships & offering support
Mobilising resources: human + money
- key role in communicating between different partners to ensure those who need to know, know. We draw in people,
- we make the decision on when to let clls know, and also which cllrs. We didn't tell the RUH that we were going to inform councillors, and learning from the meeting Bruce and mike had will Helen afterwards was that we should have done
- responsible for briefing any or all of cllrs, chief exec, strategic directors at regular intervals. Plus sometimes also briefing the CCG senior management if CCG isn't involved as much as we are
- be assured by the RUH that they are doing what needs to be done - which basically means that they follow HPT people's advice. Interestingly, in this case they didn't follow all of the CCDCs advice, so what should we have done then? We didn't do anything, and we probably should have confirmed with HPU that the advice he had given the hospital had to be followed and why; and then we should have formally advised the RUH that the followed this advice. I think we were a little weak there
we also need to seek assurance from CCDCs colleagues that they have got outbreak situations like this under control. There is variable understanding of this
- with hindsight, a risk assessment of the RUH legionella situation should have identified that LA PH should have gone to the RUHs internal incident management meetings right from the start, and then to keep in close communication with them about it. The risk assessment would have identified the risks of potential media interest, reputational damage (both to the organisation with the legionella case and the organisation giving advice about the situation), and local political interest if the media interest kick off.
- when the situation was over, we pulled together a group together to review learning. But that should have been the HPTs role, not ours.
- fast forward in time and the RUH has positive water sample in a different hospital site that they had just taken responsibility for. No cases. They involved us right from the start on this one, probably because whatever was wrong hadn't been their responsibility as they had only just taken over the site. Plus they realised from the previous situation that they needed to involve PHE and us early on. We had a clear role in chairing meetings and through this, as a neutral player, we could hold all the different partners to account, in the meetings and inbetween, for delivering what we had all agreed needed to be done. A CCDC could also have done this, except that at the start they had a role in providing legionella specific technical information into the meeting, and it's easier to chair if you have a more generic role, as I did.   

7. Implementing Lessons Learned Second case of legionella in a different hospital water system
Better understanding of roles and responsibilities
Building on stronger relationships
Improved incident & outbreak coordination and communication from out-set
Improved assurance
Public Health Consultant chaired incident meetings
But also very complex set of organisational links: RUH, Sirona, CCG, NHS Property, and GWH!
Paulton hopsital. Sample was in the mat unit which was RUH, but sirona also had services there so sirona and ccg were involved,
Then the site estate management is under nhs property services but they had subcontracted it to GWH!

8. Screening Programmes & Reducing Health Inequalities
Across B&NES:
6 Programmes
Several providers and subject to change
Several footprints
Varying data collection & availability of local data
Complicated governance
Resilience in people!

9. B&NES Learning Disabilities (LD) Screening Project
Partnership approach: Community Learning Disability Nurses, B&NES Council, NHS BaNES CCG & NHS England Public Health Commissioning Team Screening providers
We know that people with learning disabilities have a considerably shorter life expectancy and poorer health than the population as a whole, yet are less likely to access healthcare
We know that the uptake of NHS screening programmes is lower for people with learning disabilities than the population as a whole
However collecting accurate data on uptake for people with learning disabilities is challenging due to different screening programmes/data bases and capabilities to record LD information; the ability to share data between organisations and different methods of notifying GPs of results/no responder notifications.
Joint project – B&NES PH, BaNES CCG, NHS E South (South Central) PH Commissioning Team & Sirona Care & Health’s Learning Disability Nurses.
- A spreadsheet has been devised so that the nurses know which of their clients are eligible for each screening programme and have started to map when they were last invited and when they will next be invited where this information is available
- The LD nurses are in the process of obtaining individual consent with each of their clients to share their data with screening programmes to find out when they will be invited or have not responded so that timely reasonable adjustments and support can be put in place.
- The AAA screening programme is working with the nurses to put on specific clinics for people with LD, who have had an invite in the past but not attended.
- Screening programmes are also informing the nurses when they will be attending each surgery.
- Disseminating easy read resources and visual aids to increase knowledge of screening programmes – reduce anxiety and fear linked to the test.
- Train carers, parents/guardians so when invite letters arrive; they can support the person with LD.

10. Aims & Objectives of Screening LD Project
Aim: To increase the uptake of screening for people with learning disabilities
Objectives:
Identifying those eligible for each programme
Establishing accurate uptake figures
Identifying, developing and disseminating easy read resources
Training and support for carers
Consent and data sharing
Establishing pathways to track invitations, results and those that don’t attend, so that adjustments and support can be put in place.

11. Flu Vaccination
Team effort with NHSE and PHE. PH team in council disseminate local publicity materials and generate press releases. NHSE/PHE communicates directly with primary care.
Specific role with social care providers and residential homes.

12. Health Protection Board
Helps to fulfil Director of Public Health assurance role by:
Monitoring performance & risks
Discussion of health protection plans
Identifies opportunities for joint action
Builds strong relationships between agencies

13. Local Health Resilience Partnership
Strategic forum to facilitate health sector preparedness and planning for emergencies
Risk register
Develop Plans
Exercises
Assurance process
Training
Health Protection Incident Response Plans