Shared learning database

Public Health England
Published date:
April 2013

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.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

a) Develop a network of professionals whereby good practice and expertise can be shared.
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

Following concerns raised from professionals across Yorkshire and the Humber representatives from the HPA and the National Treatment Agency (NTA) met to discuss the need for a more co-ordinated approach to hepatitis B and C services and commissioning throughout the region. It was recognised that whilst there was good practice taking place around testing, treatment and raising awareness, this was not being shared effectively with other areas. Numbers being tested and treated were not consistent for local populations and this needed to be addressed.

How did you implement the project

In order to achieve the projects objectives various work took place:
- 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.

Key findings

- An annual report is published by the HPA which provides details on service provision, developments and activity.
- 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

- Identify local hepatitis champions who can act as the central communication point for any work. Many PCTs already had an identified hepatitis lead prior to the project but in areas where this was not the case the HPA made contact with the Director of Public Health to ask that they identify one. - All work should be done in partnership with key stakeholders including service users.
- Communicate effectively with stakeholders and agree a communications strategy with the hepatitis leads.

Contact details

Cathie Railton (nee Gillies)
PHE Public Health in Prisons (PHiPs) Team Scientist
Public Health England

Is the example industry-sponsored in any way?