Agenda item

Report of the Corporate Director of Adult and Health Services and the Director of Public Health, Durham County Council.

The Board received a report of the Corporate Director of Adult and Health Services and Director of Public Health in relation to the Health Protection Assurance Annual Report, presented by Joy Evans, Public Health Strategic Manager and Joanne Darke, Consultant in Health Protection, UK Health Security Agency (for copy of report see file of minutes).

The Public Health Strategic Manager noted the report was presented differently this year, with a covering report and separate annual report, to help with accessibility and delineate partnership roles.  She added that the protection of health was one of five mandated responsibilities under the Health and Social Care Act 2012, with the Director of Public Health responsible for public health functions. 

She added that there was significant reliance on upon partnership working and the Health Protection and Delivery Partnership met bi-monthly to seek assurance and share data and communications.

The Consultant in Health Protection noted that organisations involved included: the UK Health Security Agency in terms of surveillance data, infectious disease containment; the Local Authority, with Public Health having strategic oversight, coordination and consumer protection; the Integrated Care Board (ICB), in terms of resource and diagnostics; and NHS England in terms of immunisation programmes.

The Public Health Strategic Manager noted chapter four within the report set out the governance arrangements and how key groups met to facilitate monitoring and maintain close working relationships.  The Consultant in Health Protection noted that it was good that in County Durham a number of Outbreak Control Nurses had been retained, with outbreaks most likely now within either school or care homes settings.

The Public Health Strategic Manager explained that subsequent chapters set out the key pillars, including screening programmes where a ‘life course’ approach was being taken, important post-COVID.  She noted as regards issues in terms of newborn infant screening, with ongoing work looking at data.  She added that diabetic eye screening was looking at increasing the speed in which they were completed, with the current trajectory being positive.  She explained that NHS England had a commissioning role, working with GPs and Community Pharmacies to deliver.  She reminded the Board that County Durham had a strong record in terms of vaccinations, however, those receiving their second dose of the MMR vaccine had reduced, and there were national trends, such as the increase in measles cases, to be aware of.  The Public Health Strategic Manager noted that in terms of adolescent vaccinations, there had been some fluctuations, and there was a new provider in respect of flu vaccinations.  She noted regular meetings with the provider and NHS England, again with recent improvements and an upward trajectory in this regard.  She noted that flu vaccination uptake in the over 65s was very good, and co-location of services for early years, 2–3-year-olds, were showing big benefits, with Horden Nursery given as an example, with 38 families having come forward as a result.  She noted the work the Local Authority carried out in terms of flu campaigns, increasing uptake in older adults from last year.

The Consultant in Health Protection noted that the report referred to surveillance data on outbreaks and the work with the Director of Public Health in respect of response.  An example was noted in respect of a Group A Strep outbreak at a SEND School, with close work with the ICB and Outbreak Control Nurses. 

Other examples of other outbreaks within care home settings were given, in addition to information relating to blood borne viruses and tuberculosis, noting increases within prison populations, those seeking asylum and university students.  The Board noted the work with NHS England, North East Migrant Health and Wellbeing Group as well as Durham University.

She noted that County Durham and Darlington NHS Foundation Trust experienced challenges in 2023 with high numbers of infections, with regular outbreak meetings having been held which included the County Durham and Darlington NHS Foundation Trust, UK Health Security Agency, Infection Prevention and Control and Public Health to support and strengthen the delivery of the Infection Prevention and Control Action Plan over the last 12 months.  She noted the work in relation to increases in gonorrhoea and syphilis, noting that treatment and contract tracing were key in these areas, carried out in line with the County Durham Sexual Health Strategy.

The Public Health Strategic Manager explained chapter eight of the report would have previously been referred to as consumer protection, now known as protection from environmental hazards, widening the scope of that element.  It was added that the Consumer Protection Service Workforce Development Plan had been developed in response increase in demand and amidst a national shortage of Environmental Health and Trading Standards professionals.  The Public Health Strategic Manager explained that the focus was on training, recruitment and retention of those professionals.  She added that climate change was another issue referred to within chapter eight, noting co-benefits in terms of climate and health, feeding into the Climate Change Emergency Plan (CERP3) and the wider Environment and Climate Change Partnership.  She noted wider determinants of health, including contaminated land, and housing as examples.  In relation to chapter nine, the Public Health Strategic Manager noted that in terms of preparedness and response to incidents and emergencies, the lessons learned from the COVID pandemic were valuable, especially in terms of the levels of leadership and response, noting updates to cover more eventualities, such as the ‘cold weather plan’ now being the ‘adverse weather plan’.  She noted chapters ten and eleven referred to working with our communities in respect of community resilience and communications respectively.

The Chair asked the Board if they were assured by the Annual Report. 

F Jassat reminded colleagues that poverty and health we inextricably linked, with the numbers of children in poverty previously referred to being particularly disappointing.  He asked as regards the recent trend of rising tuberculosis numbers.  The Consultant in Health Protection noted that the North East had not seen a large number of tuberculosis cases, it was more so in other areas with higher numbers of migrants. 

She added it was a complex issue, with cases across infectious diseases being more prevalent in more deprived areas.  The Public Health Strategic Manager noted robust epidemiological monitoring of tuberculosis incidents, noting screening programmes at the university and with any overseas workforce, which may have latent tuberculosis. 

S Burns noted regular local collaboration, looking at simple measures to look to change the systems in place to be less labour intensive, and to look to other people moving from other areas of the UK and migrants, and to have appropriate services for those people too. 

The Chair asked as regards working with Sunderland University as well as Durham University.  S Burns noted the increase in the number of overseas students, with many choosing to settle within County Durham and commute due to cheaper housing costs.

Resolved:

(a)         That the report be noted;

(b)     That the Board agrees the report provides broad assurance that effective processes are in place for each of the key strands of health protection activity;

(c)      That the Board note and support the areas for improvement and further assurance, particularly the school-aged immunisation service contract and sexual health contract.  Both of these contracts are priority areas of work for improvement, development and assurance.