Agenda item

[Councillors S Davies and J.P. Hart, having earlier declared an interest in this item, remained in the meeting as observers and did not partake in the discussions or voting thereof].

The Committee received a presentation from Dr P. Kloer, Medical Director for Hywel Dda University Health Board (HDUHB), Dr G. Shankar, Director of Health Protection Public Health Wales (PHW) and Professor K. Neal, Public Health Consultant which summarised the outcome of the external review commissioned by HDUHB and PHW on the tuberculosis (TB) outbreak in the Llwynhendy area.

The presentation focussed upon the public health management and response to the four phases of the outbreak.  Members were informed that initiation of an outbreak control team (OCT) during the first phase had been closed down prematurely and was subsequently reopened on three other occasions.  The findings of the report indicated that the initial response was deemed inadequate, however processes had since been significantly strengthened with the introduction of a formal TB service in 2014 and a dedicated TB nurse in 2019.  In this regard, an overview of the progress made in recent years, together with the organisational learning to enhance management of the outbreak was provided to the Committee and it was recognised that there was scope for further development and improvements to be made in this regard.

An assurance was provided to the Committee that the recommendations set out within the report had been fully accepted and a joint action plan had been implemented within HDUHB and PHW to address the issues raised and ensure closer working arrangements between both organisations. 

The issues/observations raised by the Committee were addressed as follows:-

Reference was made to the conclusions set out at section 8 of the report whereby the Public Health Consultant confirmed that whilst the national rate of TB continued to fall, there were no figures are available beyond 2018 and he was not aware of any new cases since 2018.

In response to a query regarding the action plan target dates, the Medical Director clarified that progress reports on the actions, together with updated target completion dates would be submitted to the Quality and Safety Committee meetings.

The Public Health Consultant, in response to queries by the Committee, clarified that there was no legal basis to mandate individuals to attend TB service clinics, however a total of 50 of the identified contacts had been interviewed to ascertain the reasons for not doing so and the results would be analysed in an endeavour to address the issue. In accordance with PHW’s statutory responsibilities for the surveillance of infectious diseases, the Director of Health Protection provided Committee with a synopsis of the monitoring processes undertaken by the OCT to monitor active and latent cases, profiling of new cases and the use of technology to establish related cases.

Reference was also made to the TB Cohort Review led by the Respiratory Delivery Group which undertook a peer review of the management of cases in a constructive environment to improve services ensure better outcomes for citizens.

Following a question regarding the actions to be implemented to improve the TB service, the Committee was informed of the support mechanisms to be implemented to strengthen the provision following the appointment of a TB Lead Consultant and a dedicated full time TB nurse.  Furthermore, it was explained that all chest consultants received standard training in the management of TB which ensured continuation of service provision. An assurance was provided that improvements had been made since the onset of the outbreak and service provision would be further enhanced going forward.

Concerns were raised that there was no national strategy for TB in Wales, despite TB mortality rates being twice as high than that of England.  The Director of Health Protection confirmed that the draft TB strategy, prepared by the all-Wales TB Group, was being further refined to take account of the learning outcomes emanating from the pandemic, the improvements made by the HDUHB and PHW approach to TB management and the learning derived from the migrant screening, which included testing of latent and active TB.  It was reported that a revised strategy would be put forward to Welsh Government for approval in the coming months. 

The Medical Director, in response to a query, agreed to forward up to date figures pertaining to the number of cases for both active and latent TB, the number latent TB individuals over the age of 65 and the number of deaths attributed to TB arising from the outbreak.

Reference was made to recommendation 2 pertaining to the Standard Operating Procedure for the conduct and recording of outbreak management.  In this regard an overview of the membership of the OCT was provided to Members.  The Committee was further informed that the guiding principles for the management of an outbreak of infectious diseases was laid out within the Communicable Disease Outbreak Plan for Wales and would address the need for consistency in the senior management membership of the OCT as part of its 3 year review scheduled to be undertaken in July 2023.

It was queried whether any potential future outbreak could result in drug resistance due to the prevalence of latent TB in the Llwynhendy area.  The Public Health Consultant confirmed that drug resistance in this regard was unlikely.  Rather, the concerns of Health professionals centred upon reactivation of undiagnosed latent TB in individuals with underlying health conditions.

In recognition of the ongoing concerns of the residents of Llwynhendy, it was agreed that the contact details of local councillors would be provided to HDUHB and PHW with a view to determining appropriate engagement with residents to address anxiety.  The Director of Health Protection noted that the matter would be considered at a meeting of the OCT.

In response to a request by a Member for Welsh Government to be approached to seek financial support for the ongoing TB issue in Llwynhendy and the surrounding areas, the Cabinet Member agreed in the first instance, to make further enquiries in respect of Recommendation 7 pertaining to Welsh Government’s funding for a TB plan.  Pending the outcome of those enquiries, it was agreed that if appropriate, a letter be sent to Welsh Government requesting financial support.

The Chair and Cabinet Member extended the Committee’s gratitude to Dr Kloer, Dr Shankar and Professor Neal for their address to the Committee and the clarity and assurance provided on the endeavours made to deliver the recommendations made within the review.

UNANIMOUSLY RESOLVED