The Director of Public Health will provide the Commission with a verbal update on TB rates in Leicester and the ongoing work by the Leicester, Leicestershire and Rutland TB Strategy Group.
Minutes:
The Director of Public Health and the Public
Health Consultant gave a verbal update of the latest position of
health protection, focusing on TB. It was noted that:
· There was no significant change in the other areas of health protection usually covered in this item.
· A TB update was provided 6 months ago at this scrutiny commission. The key points were that it is a disease of poverty, but it is curable and preventable.
· TB mainly affects the lungs, but it can affect any other part of the body. It is only infectious when in the lungs however.
· 10% of cases of latent TB, developed into active TB.
· The symptoms experienced depend on the location of the disease in the body.
· TB rates peaked in the UK in 2011, England had the highest rates due to the highest population level in the UK. In the period after this, there was a reduction in cases.
· Last year saw a sharp rise in rates of TB in Leicester, whilst the England average had decreased. This was the first time in over 10 years that there had been an increase.
· The measured rates only considered active TB and do not account for latent TB.
· Leicester was now the highest rates of TB in England. This was previously Newham, but their rates reduced following financial help that enabled resources to tackle the disease.
· Leicester would like to see similar financial help to ensure appropriate resources can be targeted.
· The disease had impacted primary care services – between 2016/17 and 2023/24, 10111 inpatient days were attributed to TB and 82% of these were emergency admissions.
· There was increased numbers of cases with antibiotic resistance which had increased the complexity of cases, but this had not been a huge issue in Leicester.
· Post Brexit, changes in economic migratory patterns had seen increased migrations from different areas of high incidence. Country of origin had been identified as the single biggest contributor to case numbers.
· There were ongoing budgetary pressures. More resources were required for further case identification.
· Leicester has a TB strategy. This received input from national services and the UKHSA. The key points of the strategy were:
o Increase detection and control of active and latent TB.
o Ensuring a skilled workforce and building on successes as well as working within capacity and resources.
o Raise awareness and reduce stigma around TB.
o Prepare for the future and plan for need.
· The strategy fed into the Health and Wellbeing Board, East Midlands TB Board and the Leicester, Leicester and Rutland TB Strategy and Network.
· A TB JSNA was being finalised. This was going to help identify gaps in services and where and who the cases were.
· A business case had been made to increase TB staffing resources and recruitment was taking place.
· There had been successful lobbying of NHS England for further resources to increase the number of tests performed.
· A research group had been collecting data on the variation found across GP practises in the screening of TB, patient treatment choice, and audits of latent TB screening and patient pathways.
· A new communications strategy was being developed, as well as an online focus group that aimed to further understand the stigmas attached to TB amongst communities.
· A workforce group had been created to work with large key employers and care homes.
· Next steps included:
o Update strategy following completion of JSNA.
o Expansion of TB workforce and available clinic time.
o Ongoing research projects.
o Continued increase in latent screening. Development of latent screening process for eligible social care staff.
o Push on communications and engagement work.
o Update of NICE guidelines.
· World TB Day is 24th March 2025.
In response to questions and comments from members, it was noted that:
· There were excellent partnership workings across all systems in putting together such a persuasive case for additional funding for testing latent TB.
· More information on areas of high prevalence in the city was requested, along with further information which would help Councillors support those affected as well as understand the social complexities that affect the spread of TB. Councillors requested a working group be formed.
· There was uncertainty around how effective the chest x-ray was.
· There had been variation on what latent screening was on offer across the city. Ongoing work with the ICB hoped to address the variation and the efficiency with which the screening was delivered.
· The TB Joint Specific Needs Assessment was awaiting the final proofread and was then to be sent to the strategy group. After this, it was to go to the JSNA Board prior to publication.
· Additional funding had been provided to cover additional nursing staff and clinical times, this has been predominantly outpatients based.
· Concerns were raised that without more funding for prevention and treatment, there would be a greater cost to emergency services.
· It was queried whether the increased rate of TB in Leicester means that what is being done is not working. However, the increased rates were considered to be an outcome of increased testing.
· An issue with treating TB had been that some people who are positive feel well in themselves.
· The testing and treatment cost money. A latent TB test was approximately £140.
· A longer-term financial case needed to be considered.
· Officers had met with Newham representatives. It was not shared what additional funding they received to address TB. Their approach had consisted of a heavy focus on community engagement, investment in a mobile unit which could offer chest x rays and moved around high prevalence areas and involvement of those with lived experiences who promoted treatment and access to treatment. It was considered that a mobile diagnostic van in Leicester would have a significant impact.
· The JSNA included a lot of work around population projects. It is expected that more individuals will come to the area to work and bring their families, as well as an expected increase in international students. These projections suggested that numbers were going to increase.
· It’s an individual’s choice whether to be screened for TB and the emphasis was on inviting people to attend. Work was instead focused on engagement and education to reassure communities.
· The target was to perform 1400 tests this year, which was on track and demonstrated that inviting communities was working.
· It was not known which areas of India had high prevalence of TB to inform the approach.
As part of discussions the Chair invited Healthwatch and youth representatives to make comments and it was noted that:
· Very little work had occurred with young people to help address stigmas in the community or to encourage vaccination uptake, but officers stated they were keen to work with young people on this.
AGREED:
1. The Commission noted the update.
2. Formation of a TB working group.
3. Work together to continue to lobby for funding.