REPORT OF THE DIRECTOR OF PUBLIC HEALTH SERVICES
Author: Professor Hilary Fielder
Date: 12 June 2012 / Version: 1
Purpose and Summary of Document:
This report contains briefings from the three Divisional Directors, Safeguarding and activity to support medical and nursing professional activity.
Date of Board meeting: 28 June 2012
Please state of the paper is for:
Discussion
Decision
Information / x
Date: 12 June 2012 / Version:1 / Page: 19 of 19
Public Health Wales / Report of the Director of Public Health Services
1 PURPOSE
This report contains briefings from the three Divisional Directors, Safeguarding and activity to support medical and nursing professional activity.
2 MEDICAL DIRECTOR
2.1 Clinical Excellence Awards
The process to support advice on Clinical Excellence Awards began on 28 May with a closing date of 12 August. Consultants have been informed and a Public Health Wales panel will be established to meet on 7 August.
2.2 Revalidation
The Organisational Readiness Self-Assessment for revalidation was submitted to Welsh Government in May. It showed considerable improvement since the last interim ORSA with more than 95% doctors having had an appraisal last year. There is considerable work still to be done to improve the quality of appraisals and to develop the team of appraisers. An all Wales appraisal policy has been agreed by the Revalidation and Delivery Board (including which includes Welsh Government, NHS and British Medical Association representatives) and the Public Health Wales will be expected adopt this.
3 NURSING
3.1 Infection Control
A new Infection Control Nurse is expected to take up post in July.
3.2 Strategic Framework for Public Health Nursing
A first meeting has taken place and a second meeting is planned to take place in a workshop style. This will identify key outcomes for the work.
4 SCREENING DIVISION
4.1 Workplan: Delivery issues
4.1.1 Wales Audit Office review of directorate management arrangements (Division)
The Wales Audit Office (WAO) is reviewing the Division to assess the impact of the Action Plan produced by the Trust in response to WAO’s previous structured assessment.
4.1.2 Centralisation of sample processing (Cervical Screening Wales)
An agreement has been reached with Betsi Cadwaladr UHB to complete the centralisation of sample processing for Cervical Screening Wales (CSW). The processor currently housed in Wrexham will be relocated to Magden Park Laboratory at the end of June.
4.1.3 Introduction of Computer Assisted Screening (Cervical Screening Wales)
The Executive Team have given conditional approval to a business case for the introduction of computer assisted screening in Cervical Screening Wales (CSW). This, along with laboratory and admin centralisation, forms a key step in CSW’s strategic modernisation plan, managing the risk to CSW as work is repatriated from laboratories in England while cytoscreeners numbers in Health Boards fall in anticipation of the eventual introduction of HPV screening.
All cytology samples will be received and processed in Magden Park laboratory in Llantrisant then put through the automated scanner. One fifth of the samples will be categorised as requiring only a rapid visual review, while the remaining 80% will receive a standard manual screen. CSW is currently calibrating the equipment and will bring it in to service shortly.
4.1.4 Age range and screening frequency for cervical screening (Cervical Screening Wales)
The UK NSC is consulting on a change of policy on age and frequency of cervical screening. The Screening Division will lead a response to the consultation on behalf of Public Health Wales, and for Local Health Board Directors of Public Health.
4.1.5 Age expansion of Bowel Screening (Bowel Screening Wales).
At the request of the Wales Screening Committee, the Division has led a task and finish group scoping possible models for expansion of the bowel screening programme. Bowel Screening Wales (BSW) currently invites men and women aged 60-74 for screening every two years for faecal occult blood (FOBt) testing. There is a ministerial commitment to expand the programme to invite men and women aged 50-74 by 2015.
Since this commitment was made, evidence has emerged that flexible sigmoidoscopy can prevent cancer developing and may be a better approach. Health Boards had expressed concern about capacity for either an expanded FOBt programme or introduction of flexible sigmoidoscopy.
The Wales Screening Committee has asked the Screening Division to model and cost in detail three options:
o Status quo i.e. no further expansion
o Expand FOBt age range to invite 50-74 year olds by 2015
o Expand FOBt age range to invite 50-74 year olds by 2018
The results will be presented to the Wales Screening Committee on 4 July 2012.
4.1.6 MCADD screening
The Newborn Bloodspot Screening Project (NBSW) has managed the implementation of screening for medium chain acyl-CoA dehydrogenase deficiency (MCADD). Screening is offered to all babies tested from 1 June 2012. Information for parents and professionals has been developed and distributed including guidance on referral pathways.
4.2 Quality and Safety
4.2.1 CPA accreditation at Magden Park Laboratory (BSW/CSW)
The laboratory is working towards application for accreditation in September 2012. A pre-assessment visit is scheduled for 21 June 2012.
4.2.2 Bowel screening incidents – reported through Quality and Safety Committee
4.2.3 Complex Polyps: Bowel Screening Wales
A paper has been submitted for the Board’s consideration (see agenda item)
4.2.4 Breast Test Wales issues
o Public Health Wales Strategic Equality Plan: The group were asked to consider where BTW was contributing to the Strategic Equality Plan. Areas suggested included
· the introduction of disability accessible mobile breast screening units
· The development of resources for use with women with learning disabilities
· The provision of training for mammographers in transgender issues.
o Implementation of digital mammography is now complete in South and West Wales. Planned building enabling works in Wrexham have been delayed to allow tendering of work in Llandudno to be completed. There is concern that the analogue service is becoming increasingly difficult to deliver.
Following digital implementation in South and West Wales it has become clear that images transmitted to Health Boards via PACS do not include the necessary annotations to allow effective management (e.g. fitting of localisation guide wires) of women. Printing of images onto film is being used as an interim measure, pending an electronic solution.
The process of film reading remains slower than with analogue images, both because of the additional steps in the process and because of the necessity to compare digital images with film images taken in previous screening rounds.
The number of failed attempts at biopsy has risen following implementation of digital technology. The programme is investigating reasons for this, but it seems likely that a combination of factors is involved, including the ability to detect very small lesions on digital imaging.
A number of concerns have arisen regarding the performance of the PACS system on which BTW digital mammography depends. A summary document has been produced and a meeting with the suppliers scheduled.
o MRI surveillance pilot. A pilot was commissioned by Welsh Health Specialised Services (WHSSC), and is being evaluated. It is not clear whether WHSSC will wish to continue the service after the pilot finishes. A report is in preparation.
o Performance statistics covering Jan-March 2012 were received. As expected timeliness of offer of screening and results were out of standard as a result of the slowdown in screening required by digital implementation.
o Incidents and complaints from Jan-March 2012 were discussed, along with ongoing BTW claims – reported through Quality and Safety Committee.
4.2.5 Abdominal Aortic Aneurysm Project Board
The Project board for the Wales Abdominal Aortic Aneurysm Screening Project (WAAASP) met on 15 May 2012. The lack of identified finance for a programme was identified as a risk and project is unable to make progress as initially planned. Slippage on the proposed programme start date is now unavoidable.
4.2.6 Newborn Bloodspot Project Board
o Storage of bloodspot cards. The board agreed that a subgroup would be required to consider legal and ethical issues around the length of time bloodspot cards should be stored and possible uses for the cards. The subgroup’s remit will include consideration of cards currently held in storage, where no consent has been given for further use.
o Current timescales indicate that NBSW will be able to offer testing for sickle cell disease from December 2012.
4.2.7 Colonoscopy waiting times (BSW)
Waiting times for colonoscopy for BSW participants have increased and are now outside standard in some units. The programme is working with the units concerned to bring waiting times down.
4.2.8 Training (Newborn Hearing Screening Wales).
Safeguarding supervision sessions are being undertaken with newborn hearing screeners across Wales. A training pack for screeners based on the results of the most recent parental satisfaction survey is also being delivered across Wales
4.3 Stakeholders
4.3.1 Professional
o Dr Rosemary Fox attended the UK National Screening Committee meeting on 17 April 2012 and the NHSBSP (NHS Breast Screening Programme) Breast Screening Evaluation Group in London on 18 May 2012.
o NBSW has issued its third bulletin, updating stakeholders on project progress including MCADD screening, training, and the introduction of the new test card and parental information leaflet.
o WAAASP: The Screening Engagement team has produced a report on its recent consultation with professionals currently working in vascular services regarding the screening programme
o We have received an update on Cardiff & Vale UHB’s review of its diabetic retinopathy screening programme from the project manager. One area covered by the review is ‘stewardship’, defined as where within NHS Wales the service would be best supported, potentially including Public Health Wales.
o Wales Screening Committee. Rosemary Fox and Sharon Hillier attended Wales Screening Committee on 14 May 2012. Agenda items included the task and finish group’s report on options for expansion of the bowel screening programme (see above) and an update on screening programmes delivered by Public Health Wales, including potential changes.
4.3.2 Public
o NBSW parent information leaflet. A new leaflet for parents with information about newborn bloodspot screening, including MCADD and sickle cell disease, has been distributed for use.
o BBC’s ‘The One Show’ ran an item on bowel screening on 17 May, including information on BSW
o The RNIB (Royal National Institute for the blind) digital radio channel ‘insight’ ran an interview with Hayley Heard, Head of Bowel Screening Wales, about the audio information pack produced by the programme for people unable to read the printed literature. The RNIB had been contacted by a visually impaired participant in the programme praising the quality of the service provided to her.
o Rugby star Phil Bennett promoted Bowel Screening Wales on ITV Wales Tonight, along with Head of Programme Hayley Heard and a participant diagnosed with bowel cancer by the programme.
4.4 Research & development
o BTW is contributing data to the ‘Breakthrough Generations’ study cohort being carried out by the Institute of Cancer Research. The study aims to identify factors affecting mammography participation and outcomes in a cohort of 110,000 UK women.
o The Screening Division Core Research Group has approved a study entitled ‘Randomised Control Feasibility study of Contrast Enhanced Screening Colonoscopy- Quality and Polyp Biopsy (CONSCOP)’. The study will now proceed for Public Health Wales approval.
5 Microbiology Division
5.1 Work Plan - delivery issues
· The service review in North Wales has produced recommendations to be considered by Board. A similar presentation is expected to be made to the Betsi Cadwaladr University Health Board shortly.
· The service review in Abertawe Bro Morgannwg University Health Board (ABMU) has completed an initial options appraisal and produced draft proposals for further consideration. The project report is yet to be finalised.
· The service review in South East Wales has commenced and a number of options have been developed. A final option appraisal meeting is scheduled for 12 June 2012.
· Formal notification confirming arrangements for harmonisation of on call in Wales have been received. An implementation plan is to be developed, including risk assessment for service continuity.
· Service re-design for weekend activity is ongoing.
· Service development scoping day took place 15 May 2012. Developed service design models around identification/ antimicrobial sensitivity technology, serology service delivery, and molecular-based technologies.
· A new Clostridium difficile testing algorithm has been implemented at all sites.
· Treponema pallidum PCR developed in Abertawe Bro Morgannwg Microbiology; joint evaluation of public health benefits commenced jointly with Health Protection Division.
· Olympic preparedness: Plans are in place including direct links with HPA Microbiology Division.
5.2 Quality and Safety
5.2.1 Audits / reports
CPA (Clinical Pathology Accreditation) assessment visit
Critical non-compliances
· Andrology Aberystwyth: Three critical non compliances (and a number of non critical non compliances) will be cleared when the service is withdrawn on 22 June 2012. A letter has gone out to users and a copy has been sent to CPA for information.
· Ambient temperature monitoring in store rooms: All store rooms are now monitored; copies of control charts from each site are being collated as evidence for CPA. One critical non compliance has been sent to the peer assessor to sign off as stated above.
· Turnaround times: Evidence is being gathered for the turnaround times for processing and reporting of C.difficile samples from Bangor and Aberystwyth now that GDH testing is undertaken 6 days a week routinely.
· Action relating to IQC (Internal Quality Control) data: Evidence of corrective action sent to Virology Peer Assessor for clearance.
Non-critical non-compliances
· 31 non compliances already cleared on 14 May 2012.
· A further 6 non compliances were raised at the Carmarthenshire peer assessor visit on 14 May 2012. Two had previously been raised during the main assessment (venting of blood cultures and unrealistic turn around times).
Summary
Staff have worked hard to take the appropriate corrective actions and provide evidence for clearance of all non-compliances. Officially the network has until 29 June 2012 for CPA to sign off the critical non compliances and until the 5 February 2013 for the non critical non compliances.