Good morning and thank you all for coming, I know that many of you have travelled far to be here today. I hope you excuse my late arrival but I was responding to a debate in Parliament just now.
I am pleased that we’ve got experts in the field of tuberculosis and hepatitis as well as representatives from the NHS, Public Health England and colleagues from both Houses who have an interest in these infections.
I would also like to extend a warm welcome to our colleagues from various local authorities. If you are representing your authority today, you’ve probably recognised that TB and Hep C infections rates in your communities are above the national average and you want to do something to reduce them. You are in the right place because this summit is all about how we can help you to achieve this goal.
I would also like to thank Professor John Watson, our Deputy Chief Medical Officer, who kindly agreed to chair and facilitate this summit as I will unfortunately not be able to stay for the end.
Why this summit?
TB and Hepatitis C are 2 public health issues of personal priority to me as public health minister. I am eager to see us tackle both infections thereby reducing health inequalities and premature mortality.
The way to bend the curve on infections in a sustainable way is to focus on prevention. Prevention will have to be an integral objective of every local authority’s strategy and it will take political leadership to achieve it. Our new health system is geared towards empowering local leaders and I hope that today we can convince you that TB and Hep C require your urgent attention and sustained leadership.
Both infections are challenging to control and share a range of common problems. They affect similar groups of people and sufferers share common problems around access to care.
Today’s summit aims to outline the actions and interventions that can be taken at local government level to significantly reduce the burden of Tuberculosis and Hepatitis C in England.
All key parts of the health care delivery system are here today and our offer is clear: we want to equip you as local authority leaders with the necessary tools to fight these infections with the rigour it requires, the focus it deserves and with the resources we’ve made available.
Need for joint local action
I wanted political leaders to start thinking about how they work together with clinical leaders in the new public health system, to tackle issues which need work across wider geographical communities. While NHS input is crucial, I believe local authority political leadership and influence is just as vital.
Working with clinical leaders, the key responsibility for improving the health of local populations, including reducing health inequalities, rests with democratically accountable local authorities and their health and wellbeing boards.
They need to drive local commissioning and integration of all health services, based upon local needs, giving new opportunities to improve the health and wellbeing of local communities’ right across the life course.
Constructive local authority challenge – action is needed
While your communities are among those with the highest rates of infections and therefore of onward transmission, it appears that some of you do not have TB or Hepatitis C on your Joint Strategic Needs Assessments (JSNA). So my question to you is how do you think these infections should feature in your strategies in the future?
There is also a need for greater emphasis on prevention with the eventual rolling-back of these infections that would see significant reductions in numbers. So – are directors of public health raising these concerns with elected members or other services, such as housing officers, to ensure a whole person approach is being delivered?
I want to start a conversation about the things that we can do now or in the near future to tackle these infections. And yes – I am aware that funding plays a huge part in local authorities’ ability to address these issues which is why this summit seeks to offer alternative interventions at low (or zero) cost.
One objective of our work must be to drive down the health inequalities. We know that both diseases are unevenly distributed across England and socio-demographic groups.
TB and Hep C are largely seen as diseases of poverty and inequality, affecting primarily – but not only – underserved and marginalised members of our communities. These hard-to-reach groups have poorer healthcare access and health outcomes and are vulnerable to a range of other infectious diseases.
However, in this context we mustn’t forget about those who may not fall into these hard to reach groups but are nonetheless at risk of infection. As I have learnt recently on a visit to a Sikh community in West London, there continues to be a reluctance to address TB because of the stigma and taboo attached to it by the community. This stigmatisation reduces our ability to effectively tackle these infections and must end.
In this context we must increase awareness of these infections and work to eliminate the stigma attached to them and I understand that both TB Alert’s and the Hep C Trust’s presentations address this.
I would also like to see improved support mechanisms to help individuals through the clinical process once they test positive and a joined-up treatment handling process.
The work so far
In recognition of persistent high rates of TB and the public health challenges posed by them, PHE and NHS England launched their Collaborative Tuberculosis Strategy for England 2015-2020. Copies are in your delegate pack.
The strategy developed jointly by both organisations seeks to improve national TB control and aims to achieve a year-on-year decrease in incidence, a reduction in health inequalities, and ultimately the elimination of TB as a public health problem in England.
Moreover, as some of you will be aware, NHS England and Public Health England are working alongside a coalition of other organisations and patient groups to publish the Hepatitis C improvement Framework.
The framework will set high level aims for the public health system towards elimination of Hepatitis C related liver disease as a significant public health concern and we had hoped that it would be ready for today. Unfortunately it is not, but it is important to ensure that it is right rather than to simply rush it out.
Possible solutions – ‘Find and Treat’ vans
I specifically wanted to highlight the great work that ‘Find & Treat’ are doing. ‘Find & Treat’ are a London-based NHS initiative that has for some years used a mobile x-ray unit to screen almost 10,000 homeless people and drug users a year for active TB and support treatment compliance in these groups.
I attended the launch of the second Find & Treat van in January this year and was delighted to learn that that commissioning arrangements are now in place for the crew to also test for Hepatitis C and HIV.
This is welcoming news from a public health perspective. The van aims to plug people into local primary care services who would otherwise be using hospital A&E departments as their one and only point of access to the health service.
I am pleased that Dr Al Story, the service’s clinical lead, is with us today, along with his colleagues from the Find and Treat service. I would encourage you to speak with Al and his team during the break to gain an understanding of the service and the potential for your own areas to help address the problems you face.
Possible solutions – prevention
Another important theme of today’s summit is prevention and the presentations and people in the room should help you identify, encourage and share good practice in this area.
While there is great work in some local areas, I think we need a stronger focus on ‘prevention’ and begin to think innovatively about introducing alternative interventions to JSNA processes. As always the challenge will be to allocate funds for prevention in the context of other pressing demands for services.
You may wish to explore investment in, and provision of, substance misuse services and needle and syringe programmes and ensure they provide an appropriate range of services with sufficient coverage as recommended by the National Institute for Health and Care Excellence (NICE).
Evidence suggests that offering needle and syringe programmes for those who inject drugs may be an effective way to reduce the chance of Hep C infection and there is guidance on the effective and appropriate provision of these interventions.
Conclusion – raising awareness
Finally, I wanted to raise the issue of how best to promote local services for the treatment of both these conditions and there are 2 dates I think you may want to put into your diaries:
the first is World TB Day on 24 March. I have asked to accompany the Find & Treat outreach service to see for myself the impact this van makes and to promote their work more broadly
the second is 28 July which marks World Hepatitis Day
I would hope that, for both dates you take the opportunity to raise awareness of the work you and your local services are doing – or will begin to embark on as a result of this summit – to reduce the numbers affected by both these infections.
The lunchtime networking session is an opportunity for you to talk with, and take details of those TB and Hepatitis C services you have heard about today and I hope you are able to work in partnership to begin to tackle the growing problems we have identified that exist in many local authorities.
I hope that you find today’s event thought provoking and informative and that you return to your local areas with an outline and ideas for an effective plan of action to tackle these infections within your communities and ‘bend the curve’.
I want to thank you all for again for recognising the importance of these 2 public health issues and demonstrating by attending this important event today and I look forward to hearing about your progress.