1. This document sets out the Scottish Executive's Hepatitis C Action Plan for the period September 2006 - August 2008.
What is Hepatitis C?
2. Hepatitis C is a blood-borne virus that can seriously damage the liver and affect its ability to function. The spread of Hepatitis C is a growing public health concern in Scotland. An estimated 50,000 Scots, or 1% of the population, have been infected with Hepatitis C. This compares with estimates of around 0.5% in other parts of the UK.
3. Hepatitis C is spread mainly through blood-to-blood contact with an infected person. Currently, the greatest risk of acquiring the virus in the UK is through injecting drug use. In Scotland, it is estimated that over 85% of individuals who have Hepatitis C were infected in this way.
4. However, it is important to recognise that Hepatitis C is not just associated with drug misuse. Those who received coagulation factor concentrates before 1987 and recipients of blood transfusions before 1991 (before blood and blood products were routinely screened for the virus) are also at risk. Less common routes of hepatitis C infection are:
- From infected mother to baby, before or during birth
- From unprotected sex with someone who has the virus
- Through medical and dental treatment abroad where unsterile equipment may be used
- From tattooing, ear or body piercing or acupuncture with unsterile equipment
- Through sharing razors or toothbrushes or other toiletry equipment which may have been contaminated with infected blood
- Through needle-stick injuries.
5. Hepatitis C is often referred to as the 'silent epidemic.' Many who are infected are unaware of it, and often show no symptoms over a long period of time. Between 5-15% of those chronically infected with Hepatitis C will go on to develop cirrhosis of the liver within 20 years. While there is presently no vaccination for Hepatitis C, there are some very good treatments. However, the effectiveness of these treatments is dependent, at least in part, on the strain (or genotype) of the virus and stage of the disease.
6. In Scotland, only about a third of individuals who are infected with Hepatitis C are aware of it. Those who are undiagnosed will not realise that they should take steps to prevent onward transmission of the virus, and to reduce its impact in their lives. However, more importantly, only a small proportion of individuals in Scotland who could benefit from treatment are currently receiving it.
What is Scotland going to do about it?
7. The Scottish Executive has recognised the importance of tackling the Hepatitis C epidemic through the publication of its first Hepatitis C Action Plan. A draft Action Plan was published in June 2005 and followed by a three-month public consultation. The current Action Plan takes into account the responses received. One of the main messages that came out of the consultation was that there is already a great deal happening in Scotland to control and minimise the impact of Hepatitis C. This Plan will build on this existing work.
8. One of the other very strong messages that came out of the consultation was that without substantial new resources, it will not be possible to adequately address the Hepatitis C epidemic in Scotland. The Scottish Executive has heard this message, and as a first step, has allocated £4m to NHS boards over the two-year period of this Action Plan to support the actions described here. NHS boards will be required to report on their use of this funding, and the mechanisms for this are described in the section on "Co-ordination". In addition, one of the main objectives of this plan is to gather robust evidence to support a bid for further substantial new funding beyond September 2008.
9. This Action Plan will comprise Phase I of action on Hepatitis C. It covers a two-year period from September 2006 - August 2008, and will, in part, lay the foundation for further long-term action beyond September 2008 - in Phase II.
10. The Scottish Executive acknowledges that there is a limit to what can be achieved in two years. However, this Plan will put in place mechanisms to ensure better co-ordination, planning and accountability of existing services, and to raise awareness of this issue among those who are responsible for the planning and delivery of services in NHS boards, local authorities, community health partnerships and drug and alcohol action team ( DAAT) areas.
11. This Action Plan has been informed by:
- the Consensus statement issued by the Royal College of Physicians of Edinburgh at their conference on Hepatitis C held in April 2004. 1
- the most recent Shooting Up report, published in October 2005 by the Health Protection Agency (England), Health Protection Scotland, the National Public Health Service for Wales, the Communicable Disease Surveillance Centre (Northern Ireland), and the Centre for Research on Drugs & Health Behaviour at Imperial College London ( HPA et al, 2005).
- the findings of research commissioned by the Scottish Executive over the past 2-3 years, including the National Needle Exchange Survey (Griesbach et al, 2006); an Examination of the Injecting Practices of Injecting Drug Users (Taylor et al, 2004); and the Evaluation of the Lord Advocate's Guidance on Needle Exchange (Taylor et al, 2005).
- a consultation of key stakeholders undertaken by the Scottish Executive in Spring 2005 regarding Scotland's top priorities for action on Hepatitis C, and responses to the consultation on the draft Action Plan received in Summer 2005. 2
- published reports on the epidemiology of Hepatitis C in Scotland (Hutchinson et al, 2005; Hutchinson et al, 2006; Roy et al, in press).
Action Plan aims
12. In putting together an Action Plan to tackle Hepatitis C, it must be recognised that this a complex issue. Action must be taken on several fronts, and these actions must be focused and co-ordinated. The overall aims of this Action Plan are:
- To put in place mechanisms to ensure better co-ordination, planning and accountability of Hepatitis C-related services.
- To build on existing activities and interventions to reduce the number of new cases of Hepatitis C in Scotland.
- To provide professionals and service users with the information and support they need.
- To gather robust data to inform the development and expansion of testing, treatment and care services beyond 2008.
13. The Action Plan has been divided into six main sections:
- Co-ordination (Section 1)
- Prevention (Section 2)
- Testing (Section 3)
- Treatment, care and support (Section 4)
- Education, training and awareness-raising (Section 5)
- Surveillance and monitoring (Section 6).
14. To some extent, these divisions are arbitrary. Each section overlaps and is inter-connected with the other sections. This in itself is an indication of the complexity of the Hepatitis C problem. Furthermore, in taking forward action in this area, it will be important for stakeholders to take into account that different groups - for example, men and women, young people and older people, and minority ethnic groups - may have different needs and may require to have those needs met in different ways.
15. There is no easy solution to this problem. It will require commitment and co-operation from a large number of organisations, groups and individuals throughout Scotland. But it is a problem which we cannot afford to ignore any longer. The Scottish Executive expects that the publication of Scotland's first Action Plan on Hepatitis C will provide a focus and impetus to tackle this significant and growing public health concern.