What’s new? Guidance Public Health England (PHE) in partnership with NHS England, local government and TB Alert (third sector partner) have developed a new resource1 to guide the actions of TB control boards (TBCBs) in identifying and meeting the health and social care needs of under-served populations (USPs) in relation to prevention, diagnosis and treatment of TB. Body of text In 2016, 11% of all TB cases in England had at least one social risk factor.2 Cases with social risk factors are twice as likely to have infectious TB and twice as likely to die of TB.3 They had poorer treatment outcomes and are more likely to have drug resistant TB. TB in people with social risk factors can be seen as a barometer of health inequalities and tackling it will play a key role in enabling local authorities, the NHS and PHE to successfully reduce health inequalities. The resource ‘Tackling TB in USPs’ provides England’s seven TB Control Boards (TBCBs) and their partners with recommendations for action (Box 1) and exemplars of good practice around which to reduce the burden of TB among USPs. In doing so, the resource supports implementation of one of the key objectives of the ‘Collaborative TB Strategy for England’.4 Box 1 Overarching recommendations from tackling TB in under-served populations: a resource for TB Control Boards and their partners Work to address the issue of homelessness and TB The resource provides many recommendations including: TBCBs collaborating with local authorities, housing associations, voluntary and third sector organizations to address issues of homelessness, indebtedness, unemployment and patients with No Recourse to Public Funds (chapters 6 and 7) TBCBs working with local authority housing, TB services, CCGs and hostel accommodation providers to develop streamlined accommodation pathways to help house homeless TB patients into housing. TBCBs working with CCGs and local authorities to agree the best way to fund temporary housing for homeless TB patients, until treatment is completed (chapter 6) Raise awareness of TB in USPs and those who work with them. This could include: TB awareness raising sessions, run by a local TB nurse using the nationally developed TB nurse resource pack (available on Truth about TB website) with primary care, community groups working with vulnerable new migrants, people who misuse drugs and alcohol and the homeless. Encourage greater use and dissemination of TB awareness raising materials particularly information produced by the National Knowledge Service for drug and alcohol misusers, prisons, the homeless, new migrants and their key workers (available in relevant chapters hyperlinked to the resources). Work to provide more integrated services for USPs TBCBs, CCGs and partners to work to develop integrated, patient centred services and pathways with strong links to primary care and existing health and social care services e.g. ‘one-stop shops’ and ‘outreach services’ for people with TB who have mental health, drug or alcohol problems or who are homeless (chapter 2). TBCBs and local partners to consider new model of care including use of mobile x-ray unit to reach marginalised populations and support integrated care pathways for new cases of TB diagnosed in this way e.g. people in prisons, homeless people. (chapter 6 & 6) TBCBs to work with local Directors of Public Health, local authorities and CCGs to ensure that USPs and their needs are recognized and considered in local JSNAs, Joint Health and Wellbeing Strategies and Sustainability & Transformation Plans (chapter 7) TBCBs, NHS England Health & Justice commissioners, Her Majesty's Prison & Probation Service (HMPPS) and PHE Health & Justice leads to work with the prison estate to prioritize and embed approaches that will lead to early detection and treatment of infectious TB (chapter 3) including use of digital x-ray machines at or near reception to detect active pulmonary disease. CCGs, primary and secondary care providers to work to increase the uptake of latent TB (LTBI) testing and treatment among new migrants (chapter 2) This resource brings together, in one place, information related to USPs and TB and supports stakeholders build collaborative programmes of work to reduce the burden of TB among local vulnerable and marginalized people with multiple complex needs.1 In this guidance the definition of USPs includes vulnerable migrants; the homeless; people in contact with the criminal justice system; people who misuse drugs and/or alcohol; and those with mental health needs. Chapters written by subject area specialists take each USP group in turn and define them; describe the burden of TB among this population; discuss the challenges (both health and social care) and make recommendations on how to meet those challenges. Each chapter includes hyperlinked resources, e.g. leaflets and websites and exemplars of innovation and good practice to stimulate local action.1 The resource also provides information on the roles and responsibilities with respect to local government, TBCBs, CCGs and the third sector and includes a chapter on TB ‘models of care’. Success in meeting the needs of USPs depends on bringing together all appropriate health and social care commissioners and service providers to develop multi-agency programmes and services to better meet the needs of the under-served with TB. These include many organizations, not only in the health sector but also local government, social care, housing, justice, NHS commissioners, the third sector and voluntary groups.1 References 1 Tackling Tuberculosis in Under-served Populations—GOV.UK [Internet]. [cited 2017 Nov 13]. https://www.gov.uk/government/publications/tackling-tuberculosis-in-under-served-populations 2 Tuberculosis in England: Annual Report—GOV.UK [Internet]. [cited 2017 Nov 14]. https://www.gov.uk/government/publications/tuberculosis-in-england-annual-report 3 Health Matters: Reducing the Burden of Tuberculosis—Public Health Matters [Internet]. [cited 2017 Dec 8]. https://publichealthmatters.blog.gov.uk/2016/10/20/health-matters-reducing-the-burden-of-tuberculosis/ 4 Tuberculosis (TB): Collaborative Strategy for England—GOV.UK [Internet]. [cited 2017 Dec 8]. https://www.gov.uk/government/publications/collaborative-tuberculosis-strategy-for-england © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: email@example.com
Journal of Public Health – Oxford University Press
Published: Mar 2, 2018
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