This project is aligned to the NICE Public Health Guidance Hepatitis B and C: ways to promote and offer testing to people at increased risk of infection and more specifically Recommendation 1 'Awareness-raising about hepatitis B and C among the general population' and Recommendation 2 'Awareness-raising for people at increased risk of hepatitis B or C infection'.
In 2010 the Yorkshire and Humber Hepatitis Project was formed. The project is co-ordinated by a part time project manager (employed by the Health Protection Agency [HPA]) who works with a wide range of stakeholders to raise awareness amongst professionals and the public around hepatitis B and C, improve case finding and diagnostics and improve the pathway for access to treatment and general management.
Aims and objectives
b) Develop a quality framework document for raising awareness, testing and treatment.
c) Develop regional guidance for testing for hepatitis B and C.
d) Raise awareness amongst professionals and the public around hepatitis B and C through a regional event, training through local Primary Care Trust (PCT) based initiatives.
e) Improve data collection and monitoring of hepatitis B and C across the region through the publication of an annual report.
Reasons for implementing your project
How did you implement the project
- Draft Terms of Reference were developed for a regional steering group and a Chair was identified from the Strategic Health Authority (SHA) within Public Health. Work took place across all PCT areas to ensure a hepatitis lead was identified in each PCT following which other suitable representatives were identified from hospital consultants, nurses, Drug Action Teams, prison healthcare, drug services, HPA, GPs, PCT public health and commissioning, NTA and service users. The group was convened, agreed their Terms of Reference and then developed an action plan for the work.
- All the objectives were achieved and the HPA continue to provide training to healthcare professionals around general awareness and immunisation. The general awareness training is tailored to suit the audience but is usually aimed at professionals working with clients affected by hepatitis although this isn?t their main role. The training is delivered in a range of locations such as drug services and other community services. The immunisation training is aimed at drug service nurses delivering immunisations and is tailored to specifically meet their training needs.
- The barriers faced by the project were mainly around the complexities of the commissioning process and where responsibilities lay with the commissioning of hepatitis C treatment as this varied across PCTs and usually formed part of a much larger block contract. Detailed mapping was done across the region which identified the gaps and barriers with regards to hepatitis B and C services. With this information discussions took place with individual PCTs regarding the work that needed to take place in their area.
- Costs for the project were minimal; initially a project manager was funded for 3 days a week, Directors of Public Health, the NTA and HPA all contributed to this. However from 2012 funding was reduced and there is now a project manager in post for 0.5 days a week. Other than this there was no ring fenced budget and all other developments have been made independently across PCT areas. Pharmaceutical funding was secured for the regional launch and costs of printing the guidance document.
- A common dataset for hepatitis B and C has been agreed across the region to allow for improved comparisons to be made around service activity. Stakeholders are asked to submit this data on an annual basis for the report.
- Patient outcomes have improved across many areas where service developments have taken place, e.g. better access to treatment for hepatitis C in areas where previously this was difficult.
Evidence of this include:
- The availability of testing has increased across Yorkshire and the Humber which is evidenced through the number of laboratory confirmed cases of hepatitis C which has increased from 980 in 2010 to 1486 during 2011.
- In-house access to treatment for hepatitis C in the 14 prisons in Yorkshire and the Humber has increased from 6/14 in 2009 to 12/14 in 2012
- Access to local community treatment is now available in 12/14 local authority areas with an increased number of local hospitals providing treatment as well as an increase in nurse-led community clinics in drug services resulting in the number of people in treatment in 2010 was 598 compared to 2011 which was 896.
Key learning points
- Communicate effectively with stakeholders and agree a communications strategy with the hepatitis leads.