Section 4 Treatment, care and support
4.1 In April 2004, the Royal College of Physicians of Edinburgh held a national Consensus Conference on Hepatitis C. In the Consensus Statement issued after this conference, attendees made the point that: "Current services do not have the capacity, nor are they configured appropriately, to meet the needs of the majority of [Hepatitis C] infected individuals." The statement also highlighted that, "Only half of those referred [for treatment] attend clinics."3 There is a serious problem in many areas of Scotland with the accessibility of treatment services, and this situation must urgently be addressed.
4.2 Stakeholders from around Scotland have argued for new community-based models of care for Hepatitis C-infected individuals. It has been suggested that these new models of care could take the form of outreach, nurse-led clinics in primary care services, in prisons and / or in drug treatment services. In fact, a number of areas in Scotland have begun to employ Blood-borne Virus Nurses in this capacity, and anecdotal evidence suggests that these posts are playing a significant role in testing, vaccination, support, education and training.
4.3 In addition, Managed Care Networks ( MCN) - involving not only NHS clinical services, but also social work and voluntary sector services - are seen to be the way forward in providing better, more integrated treatment and care services. An MCN has been in operation in Tayside for a number of years. More recently, the Scottish Executive has allocated two years pump-priming funding to NHS Greater Glasgow and Clyde to appoint a manager of a Hepatitis C MCN in that area. The expectation is that this centrally-supported network will demonstrate tangible improvements in the quality of care for individuals who have Hepatitis C, and also that developing MCNs in other areas of Scotland will benefit from the lessons learned. As part of this Action Plan, the managers of the Tayside and Glasgow and Clyde MCNs will report annually to the Action Plan Co-ordinating Group on developments in their respective areas.
4.4 The voluntary sector can have an important part to play in providing care, support and information to individuals who may be waiting for treatment, or who are between clinic appointments. In particular, there is a great deal of excellent work being undertaken in Scotland by a small number of voluntary sector Hepatitis C support services - for example, in Glasgow, Edinburgh and Tayside. This work deserves support and recognition.
4.5 Meanwhile, the Scottish Intercollegiate Guidelines Network ( SIGN) are due to publish their guideline on Hepatitis C later this year. This will include evidence-based recommendations for clinicians on diagnosis and management of Hepatitis C, including screening, testing, diagnosis, and the management of chronic Hepatitis C and advanced infection. The publication of this guideline will have an important role in ensuring that treatment for Hepatitis C is carried out to a uniform, high-quality standard across Scotland.
Improving service capacity and accessibility - the first steps
4.6 Despite all these activities and positive developments around Scotland, the Scottish Executive recognises that there is a need for a substantial new funding to expand Hepatitis C treatment, care and support services. However, details are lacking about the precise level of funding that is required, and how and where it should best be targeted. During the period of this Action Plan, the Scottish Executive will address this information gap by commissioning a study to assess the nature and level of the need for Hepatitis C treatment-related funding in each NHS board area around Scotland. This needs assessment will involve:
- Identifying the locations of existing Hepatitis C testing, treatment, care and support services in Scotland,
- determining the existing capacity of those services (looking at referral practices, waiting times, numbers tested, numbers entering and completing treatment),
- identifying gaps in existing service provision, and
- providing detailed, costed options for addressing the gaps.
4.7 The work will take into account the requirement that some NHS boards have of providing Hepatitis C-related care for large prison populations.
4.8 At the same time, Health Protection Scotland will undertake statistical modelling to estimate the cost of the current and future burden of Hepatitis C-related illness on the NHS and on Scottish society in general, and to determine the cost-effectiveness of different HCV screening approaches designed to detect infected persons most in need of antiviral therapy.
4.9 The Scottish Executive will also provide funding to support the continued development of the Hepatitis C clinical database - which collects extensive data on individuals who have attended at least one hospital appointment for specialist care or treatment for Hepatitis C. Reports of this data will be published by Health Protection Scotland in their annual report on The State of the Hepatitis C Epidemic in Scotland.
4.10 The results of all this work will inform a bid for phased new funding beyond September 2008, in Phase II. It is important to be clear that, at this point in time, that there can be no guarantee about the level of funding that might be made available for Phase II. However, the first step in addressing the need for new resources is to identify the precise nature and level of those needs.
Actions on treatment, care and support
From Sept 2006 - Aug 2008
NHS boards and community health partnerships will consider how they can use the funding allocated to them in the two years of this Action Plan to develop or improve local community-based treatment, care and support services for people who have been diagnosed with Hepatitis C.
By Oct 2006
The Scottish Executive will provide two-year funding to Health Protection Scotland and the Viral Hepatitis Group to support the continued development of the national clinical database on Hepatitis C, which records details of all individuals who attend a specialist clinic for Hepatitis C. Reports of this data will be published annually in the report, The State of the Hepatitis C Epidemic in Scotland.
By Oct 2006
NHS Education Scotland, working together with the UK Hepatitis C Resource Centre, will publish a directory of Hepatitis C-related services in Scotland. This information will feed into an in-depth needs assessment of Hepatitis C testing, treatment, care and support services.
By Dec 2006
SIGN will publish their Guideline on Hepatitis C.
By Oct 2007
The Scottish Executive Health Department will publish the findings of an in-depth needs assessment undertaken in relation to Hepatitis C testing, treatment, care and support services in Scotland. This work to commence in Oct 2006.
By Oct 2007
Health Protection Scotland will complete a two-year modelling study to estimate the cost of the current and future burden of Hepatitis C infection on the NHS. An interim report of this work will be produced by Oct 2006.
By Mar 2007 and annually
The Managed Care Networks in Greater Glasgow and Clyde and Tayside will report annually to the Action Plan Co-ordinating Group on developments in their respective areas.