We are testing a new beta website for gov.scot go to new site

Hepatitis C Action Plan for Scotland: Phase II: May 2008 - March 2011

Listen

Appendix 7: Summary of Phase II Action Plan actions

Issues

Actions

Outcome

Lead Organisation(s) (Recipient(s) of funding)

Lead Network(s) supporting the delivery of Action

Performance Indicator(s)

Timescale(s)

Testing, Treatment, Care and Support

Widespread variations in the approach to the clinical management and social care of Hepatitis C infected persons exist across Scotland. Only two NHS Boards have a Managed Care Network ( MCN) for Hepatitis C and although guidelines on the clinical management of persons with Hepatitis C exist, formal standards do not.

1. Each NHS Board will have, or be affiliated to, an MCN for Hepatitis C; this Network will comprise representatives of relevant specialists in healthcare and other stakeholder groups including those for the prison service, local authority, social work, the voluntary sector, mental health/addictions, and people living with and affected by Hepatitis C. The Network will be guided in its practice through the use of "Care" Guidelines, prepared by the Hepatitis C Action Plan's Testing, Treatment, Care and Support Working Group, and the Scottish Intercollegiate Guidelines Network ( SIGN) guidelines on the management of Hepatitis C.

These actions will ensure that approaches to the diagnosis and management of Hepatitis C infected persons throughout Scotland are highly effective and, where appropriate, consistent.

NHS Boards

Hepatitis C Executive Leads Network

MCN accreditation.

First meeting of new MCNs by July 2008, towards full establishment by end of 2008, and accreditation by 2010.

2.NHS Quality Improvement Scotland ( QIS) will develop standards for Hepatitis C testing and the treatment, care and social support of persons with Hepatitis C infection.

NHSQIS

MCN Leads Network

Auditing against the published standards.

NHSQIS standards developed by 2010.

The training of the Hepatitis C workforce is ad hoc and often sub-standard with no alignment to quality frameworks.

3. A national Hepatitis C Learning and Workforce Development Framework will be developed.

These actions will ensure that Scotland's Hepatitis C Workforce in its entirety is knowledgeable, skilled and confident.

NHS Education for Scotland

Education, Training and Awareness-raising Network

MCN accreditation (see action 1).

Framework developed and published by March 2009, and implemented throughout 2009-2011.

4.NHS Boards, working with their partners, will identify a Hepatitis C Workforce Development Lead, review the learning and development needs of the Hepatitis C workforce, and implement a co-ordinated approach to Hepatitis C Workforce Development consistent with the national Hepatitis C Learning and Workforce Development Framework.

NHS Boards

i) Education, Training and Awareness-raising Network;

ii) MCNs; iii) Prevention Networks;

iv) NGOs Network

MCN accreditation and review against NHSQIS Standards.

Workforce Development Leads identified by September 2008. The learning and development needs of the Hepatitis C workforce reviewed by March 2009. A co-ordinated approach to Hepatitis C workforce development implemented throughout 2009-2011.

5. Awareness-raising campaigns and communications initiatives will continue to be developed, implemented and evaluated to meet the information and education needs of a range of professional audiences (including those responsible for the delivery of prevention services).

Scottish Government

i) Education, Training and Awareness-raising Network;

ii) MCNs; iii) Prevention Networks;

iv) NGOs Network

Awareness and knowledge of Hepatitis C through national surveys.

Campaigns and communications activity implemented and evaluated throughout 2008-2011.

Insufficient numbers of Hepatitis C infected persons, including prisoners, receive antiviral therapy.

6. Testing, Treatment, Care and Support services within each NHS Board will be developed to increase the numbers of persons undergoing therapy in Scotland from 450/year to 500 in 2008/09, 1,000 in 2009/10, 1,500 in 2010/11 and at least, 2,000/year thereafter.

These actions will increase the numbers of infected persons who clear their infection and thus reduce the numbers of infected persons who develop severe Hepatitis C-related liver disease.

i) NHS Boards; ii) Scottish Government (for National Voluntary Sector contribution), iii) National Services Division of National Services Scotland (Hepatitis C specialist laboratory work)

i) MCNs; ii) MCN Leads Network

Number of persons offered antiviral therapy. Number of persons commenced on antiviral therapy. Proportion of those having received antiviral therapy who achieve a sustained viral response.

Targets for 2008-2011 as indicated.

7. Service Level Agreements / Memoranda of Understanding, between NHS Boards and the Scottish Prison Service ( SPS), to promote the treatment of Hepatitis C infected inmates in prisons, will be developed in the context of the SPS Blood Borne Virus ( BBV) strategy.

SPS

i) MCNs; ii) MCN Leads Network

Number of persons offered antiviral therapy (prisons only). Number of persons commenced on antiviral therapy (prisons only). Proportion of those having received antiviral therapy who achieve a sustained viral response (prisons only).

SLAs/MoUs developed by November 2008. Targets for 2008-2011 as indicated above (see Action 6).

In many parts of Scotland there are insufficient links between social care/addiction/mental health services and specialist services for Hepatitis C treatment. It is not possible to manage and treat Hepatitis C infected persons without considering their social care and drug/alcohol problem needs. There is a paucity of local authority (social care) involvement with Hepatitis C infected persons across Scotland.

8. For each NHS Board a formal plan, indicating how it has integrated or will integrate appropriate elements of Hepatitis C specialist treatment services into those for social care, mental health and addiction in local authority, voluntary sector, primary care and secondary care settings, will be developed and implemented.

An integrated approach to the management of Hepatitis C infected persons involving Hepatitis C treatment, social care, and mental health/addiction will be fostered.

NHS Boards

i) MCNs;

ii) NGOs Network

MCN accreditation.

Plan developed by March 2009 and implemented throughout 2009-2011.

9. Each local authority will identify a Strategic and Operational Lead for Hepatitis C infection.

Local Authorities

MCNs

Local Authority lead identified.

Leads identified by July 2008.

The majority of persons chronically infected with Hepatitis C remain undiagnosed and many of those diagnosed fail to reach and stay within specialist care services. There are widespread variations in testing practice in the community setting. The uptake of Hepatitis C testing among past/current injecting drug users ( IDUs) is sub-optimal following test offer.

10.NHS Boards will work with Community Health Partnerships ( CHPs) to develop and implement a plan, incorporating innovative approaches, to improve Hepatitis C testing and referral activities by General Practitioners ( GPs) and other community setting practitioners.

These actions will reduce the proportion of Hepatitis C infected individuals who are undiagnosed.

NHS Boards

MCNs

Numbers of persons Hepatitis C tested, diagnosed and referred to specialist care services by GPs and other community setting practitioners.

Plan developed by March 2009 and implemented throughout 2009-2011.

11. An awareness-raising campaign, to promote Hepatitis C testing among those at risk of being infected, will be implemented and evaluated.

Scottish Government

i) Education, Training and Awareness-raising Network;

ii) NGOs Network

Awareness and knowledge of Hepatitis C through national surveys. Numbers of persons Hepatitis C tested and diagnosed.

Campaign implemented by September 2009, and evaluated by September 2010.

12. A programme of work to evaluate different approaches to Hepatitis C testing/body fluid sampling ( e.g. near patient testing/use of saliva and dried blood spots) will be undertaken.

BBV Specialist Laboratories (via Health Protection Scotland)

MCN Leads Network

Measures of acceptability and effectiveness of different approaches.

Programme designed in 2008-2009, evaluated throughout 2009-2010, and reported in 2010.

Prevention

Widespread variations in the provision and uptake of injection equipment and educational initiatives to prevent Hepatitis C transmission exist throughout Scotland. NHS Boards do not have formal networks to facilitate the prevention of Hepatitis C. Other than guidelines on the number of sets of needles/syringes that can be given to IDUs, comprehensive National Guidelines for services providing injection equipment do not exist.

13. Each NHS Board will have, or be affiliated to, a Network covering the Prevention of Hepatitis C and comprising representatives of all stakeholder sectors. Guidance regarding Network membership and Terms of Reference for the Hepatitis C component will be established. Each NHS Board will identify a Hepatitis C Prevention Lead.

These actions will ensure that approaches to the provision of injection equipment to IDUs throughout Scotland are highly effective and, where appropriate, consistent.

NHS Boards

i) Hepatitis C Executive Leads Network;

ii) Prevention Leads Network;

iii) Guidelines Development Group

Audit against the guidelines (see action 14).

Prevention Leads identified by July 2008. Hepatitis C requirements for the Network agreed and implemented by September 2008.

14. National guidelines for services providing injection equipment to IDUs will be developed. A Guideline Development Group will be established.

Scottish Government

Guideline Development Group

Audit against the guidelines.

Guideline Development Group established by May 2008. Interim guidelines published by December 2008. Final guidelines published by July 2009.

The re-use/sharing of injection equipment among IDUs is still highly prevalent and Hepatitis C transmission among IDUs throughout Scotland is very common.

15. Services providing injection equipment (needles/syringes and other injection paraphernalia) will be improved in accordance with guidelines (see action 14). Improvements will be made in terms of the, i) quantity (increasing access and uptake of equipment through innovative, including outreach, approaches), ii) quality ( e.g. the colour coding of equipment to avoid sharing) and iii) nature ( e.g. provision of equipment other than needles/syringes), of provision.

These actions, hopefully, will lead to reductions in injection equipment sharing and Hepatitis C transmission among IDUs.

NHS Boards

i) Prevention Networks; ii) Prevention Leads Network

Proportion of injection episodes undertaken with sterile injecting equipment (needles/syringes and other injecting paraphernalia). Proportion of IDUs sharing injecting equipment. Hepatitis C prevalence/incidence among recent onset injectors. Baseline data will be available in 2008 and, thereafter, targets will be set.

Plan of action for each Network developed by March 2009, and implemented throughout 2009-2011.

16. Educational interventions aimed at vulnerable individuals, IDUs and those at risk of starting to inject will be designed and implemented to highlight how Hepatitis C transmission can be prevented. Particular attention should be given to initiatives aimed at identifying existing and newly diagnosed IDUs with Hepatitis C to prevent the onward transmission of infection.

i) NHS Health Scotland;

ii) NHS Boards

i) Prevention Networks; ii) Prevention Leads Network;

iii) Education, Training and Awareness-raising Network;

iv) NGOs Network

See action 15.

Interventions designed by March 2009, and implemented throughout 2009-2011.

IDUs who continue to inject drugs in prison do not have access to injection equipment in that setting.

17. An in-prison needle/syringe exchange initiative will be piloted as one of a range of harm reduction measures to reduce the transmission of Hepatitis C.

This action will demonstrate the acceptability, to users and prison officers, and use of an in-prison service providing injection equipment.

SPS

i) Prevention Leads Network;

ii) Relevant NHS Board Prevention Network(s)

Measures of use and acceptability.

Initiative implemented and externally evaluated by 2011

Persons in school and further education settings receive little, if any, education about Hepatitis C.

18. Hepatitis C guidance and educational support materials (within the context of BBVs/drug misuse) will be developed, disseminated and evaluated to raise awareness among young people in school, and further education and community settings, and other settings which support vulnerable young people. Staff/peer group training initiatives will facilitate the implementation of this action.

This action will increase awareness and knowledge of Hepatitis C among young people in Scotland.

Learning and Teaching Scotland

i) Education, Training and Awareness-raising Network;

ii) NGOs Network

Levels of Hepatitis C education (within the context of BBVs/drug misuse) in schools and further education, and community settings, and other settings supporting vulnerable young people. Knowledge of Hepatitis C among young people and young adults (within the context of BBVs/drugs misuse).

Materials developed by June 2009, disseminated by September 2009, and evaluated by March 2011.

Information Generating Initiatives to Monitor the Performances of Actions

Clinical data to monitor the performance of actions 6 and 7 are required.

19. The further development of the National Hepatitis C Clinical Database, including the establishment of a Generic Clinical System for Hepatitis C will be undertaken.

This action will ensure that measures to improve treatment, care and support services for Hepatitis C infected individuals, and thus reduce their chances of progressing to severe Hepatitis C-related disease, are evaluated effectively.

Health Protection Scotland

i) Action Plan Information Generating Initiatives Network

ii) Hepatitis C Clinical Database Monitoring Group;

(see Outcome)

Generic Clinical System for Hepatitis C established by December 2009. Progress and available NHS Board data published in Annual Report by May 2009, and all NHS Board data published in Annual Report by May 2010.

Data to monitor the performance of actions 10 and 11 are required.

20. The development of a surveillance system to monitor Hepatitis C testing practice in Scotland will be undertaken.

This action will ensure that awareness campaigns aimed at reducing the proportion of infected persons who are undiagnosed are evaluated effectively.

Health Protection Scotland

Action Plan Information Generating Initiative Network

(see Outcome)

Hepatitis C Test Database relating to all NHS Boards established by December 2009. Progress and available NHS Board data published in Annual Report by May 2009, and all NHS Board data published in Annual Report by May 2010.

Data to monitor the performance of actions 14-16 are required.

21. The development of a data collection system to monitor the provision of injection equipment in Scotland will be undertaken.

These actions will ensure that the package of interventions designed to increase uptake and reduce sharing of injection equipment, and reduce Hepatitis C transmission, among IDUs is evaluated effectively.

Information Services Division

Action Plan Information Generating Initiative Network

(see Outcome)

Data collection system on Injecting Equipment Provision established by June 2009. Data published annually in relevant reports, such as Drug Misuse Statistics Scotland by December 2009.

22. Annual surveys of Hepatitis C prevalence and incidence among IDUs across Scotland will be performed.

i) Health Protection Scotland; ii) University of the West of Scotland

Action Plan Information Generating Initiative Network

(see Outcome)

Surveys undertaken annually and data published in Annual Report by May 2009.

If the performance of actions involving the development of prevention, diagnosis, treatment, care and support services in the prison setting is to be gauged, it is important that the proportion of Scotland's prison population who are Hepatitis C infected, the proportion of this group who are undiagnosed and the incidence of Hepatitis C transmission among prison inmates, is understood.

Also, if a sound understanding of the Hepatitis C diagnosis, treatment, care and support needs of i) children and, ii) persons originating from Pakistan (and, possibly, other South Asian countries) - populations about whom little is known, apropos the proportions infected with Hepatitis C - is to be achieved, it is essential that prevalence studies on these groups are undertaken.

23. A survey of Hepatitis C prevalence and incidence among prisoners in Scotland will be undertaken.

These actions will generate data to inform the needs of Hepatitis C infected prisoners, children and Pakistanis and will ascertain how effective measures to prevent the spread of Hepatitis C within the prison selling have been.

SPS

Action Plan Information Generating Initiative Network

(see Outcome)

Surveys undertaken and data published in reports by March 2011.

24. Surveys to estimate the prevalence of Hepatitis C among i) children in Scotland and, ii) people in Scotland who have lived in Pakistan (and, possibly, other South Asian countries) will be undertaken.

Health Protection Scotland

Co-ordination

To ensure that the Action Plan is delivered efficiently, effectively, to timescales, and is governed appropriately, a range of actions at national and local levels will be implemented (see text for detailed understanding of Action Plan co-ordination).

National

25. An Action Plan Advisory Board to advise and comment on issues concerning Action Plan progress and performance will be established.

These actions will ensure the successful delivery of the Action Plan.

Scottish Government

Measures of progress on, and performance of, actions 1-24 (see above).

Action Plan Advisory Board established by July 2008.

26. National Networks to support NHS Boards and other organisations delivering the Action Plan will be established and maintained.

These actions will ensure the successful delivery of the Action Plan.

Health Protection Scotland

National Networks established by July 2008.

27. Action Plan progress and performance will be monitored; an Action Plan Governance Board will be established to facilitate this action.

Health Protection Scotland

Action Plan Governance Board established by July 2008.

28. Communications activities ( e.g. Annual reports, website development and annual Stakeholder Conference) to keep stakeholders abreast of, and receive feedback on, Action Plan progress, will be undertaken.

Health Protection Scotland

Preliminary website developed by May 2008, with full development by December 2008. Annual Report by May 2009. UK Annual Report by November 2008. Annual Stakeholder Conference in May 2009.

29. To undertake the above actions, a Project Management approach will be employed.

Health Protection Scotland

Project Management approach employed by July 2008, and embedded thereafter.

Local

30. Local/Regional Networks to support the delivery of services will be established and maintained.

These actions will ensure the successful delivery of the Action Plan.

NHS Boards

Measures of progress on, and performance of, actions 1-24 (see above).

Networks fully established by December 2008.

31. Local progress and performance will be monitored and support will be given to HPS and the Action Plan Governance Board to facilitate their national monitoring roles.

NHS Boards

Progress and performance mechanism agreed by September 2008 with reporting thereafter.

32. Communications activities to keep stakeholders abreast of, and receive feedback on, Action Plan progress will be undertaken; support will be provided for national communications initiatives.

NHS Boards

Communications plan developed by September 2008.

33. Services will be commissioned.

NHS Boards

Services commissioned throughout 2008-2011.

34. To undertake the above actions, a Project Management approach will be employed.

NHS Boards

Project Management approach employed by July 2008 and embedded thereafter.