Download December 2016 - Salford City Partnership

Part 1 - Open to the Public
ITEM NO.
REPORT OF
Director of Public Health
TO
Joint Lead Member Briefing for Adult Services, Health & Wellbeing
ON
Wednesday 8 December 2016
Public Health Monthly Briefing
RECOMMENDATIONS:
Strategic Executive Lead Members are asked to note the contents of this report.
EXECUTIVE SUMMARY: This briefing offers an update on the strategy, process, and
performance coming through the Health and Wellbeing programmes for the period running
up to Tuesday 22 November 2016.
BACKGROUND DOCUMENTS: Not required
KEY DECISION:
NO
Effects of smoking tobacco on DNA at the cellular level
A team at King’s College London have shown the devastating impact of cigarette smoke on
the body’s DNA. While chemicals in tobacco smoke have long been known to raise the risk
of at least 17 forms of cancer, the precise molecular mechanisms through which they mutate
DNA and give rise to tumours in different tissues has never been clear.
More than 70 of the 4,000 chemicals found in tobacco smoke are known to cause cancer.
Some damage DNA directly, but others ramp up mutations in more subtle ways, often by
disrupting the way cells function. The more mutations a cell acquires, the more likely it is to
turn cancerous.
The reason why some people can smoke
develop the disease, is down to the way
chemicals they inhale create mutations at
changes will be harmless, but others are
exposed to, the greater the chance that the
the DNA that turn cells cancerous.
for years without getting cancer, while others
mutations arise. When a person smokes, the
random points in the genome. Many of these
not so benign. The more smoke a person is
accumulating mutations will hit specific spots in
The study revealed that people who smoke a pack of cigarettes each day for a year develop
on average 150 extra mutations in every lung cell, and nearly 100 more mutations than usual
in each cell of the voice box. More still build up in the mouth, bladder, liver and other organs.
Smoking is the most preventable cause of cancer in the world and accounts for more than 1
in 4 UK cancer deaths.
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Action on Cardio Vascular Disease: Getting serious about prevention
Report from Public Health England (PHE) September 2016
Although there has been a significant reduction in deaths from cardio vascular disease
(CVD) in England over the past 20 years, CVD still remains the second highest cause of
death (many of which are premature deaths).
In 2014 CVD caused 25% of premature deaths in men and 17% in women (premature
means before the age of 75). Within each local authority CVD will account for 1 in 4
premature deaths.
Cardio vascular disease is a family of diseases with a common set of risk factors that result
from atherosclerosis (furring or stiffening of artery walls); coronary heart disease, stroke and
peripheral arterial disease. It also covers other conditions such as vascular dementia,
chronic kidney disease, cardiac arrhythmias, type 2 diabetes, sudden cardiac death and
heart failure.
CVD is one of the conditions most strongly associated with health inequalities. Risk factors
such as smoking, physical inactivity and obesity are greater in lower socio-economic groups
and the burden of disease and death is disproportionately shouldered by the most deprived.
The public health approach to prevention of CVD includes:
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Primary prevention: designed to reduce the instances of an illness in a population and to
reduce their duration
Secondary prevention: aimed at detecting and treating pre-symptomatic disease
Tertiary prevention: activities aimed at reducing the incidence or recurrences of chronic
incapacity among those with symptomatic CVD
With activity at all three levels of prevention PHE takes a population health systems
approach with a care pathway. The report lists:
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The key risk factors in terms of behavioural risks + social and environmental factors
The key interventions for CVD with risk detection and management in Primary Care
The existing leadership, resources and support from PHE
PHE has a central role to play in influencing evidence-based national policies, providing
guidance and tools to support effective intervention and implementation as well as help to
measure progress at both national and local levels.
The report provides a list of internet based tools, information, and learning resources that are
available for each level of prevention.
Local authorities have a critical role to improve the health and wellbeing of all communities
through CVD prevention in relation to; promoting NHS Health Checks, tackling obesity,
encouraging physical activity, reducing diabetes and hypertension, reducing harm from
tobacco, alcohol and drugs as well as supporting people to make healthier eating choices.
The priorities for action for PHE to tackle CVD in 2016-17 are listed and include:
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An action plan setting out organisation-wide commitments to CVD prevention
Mechanisms to measure PHE’s impact on CVD prevention
A national network of primary care leaders in CVD
Strategic partnership building
Enhancement of the Heart Age tool for self assessment of risk
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Intelligence and data provision
An annual review of PHE’s work on CVD for the next 4 years
An online blood pressure tool to help people understand what blood pressure means (in
collaboration with NHS Choices)
PHE plan to strengthen joint working between internal teams to address CVD outcomes.
With external partners they want to collaborate to develop work programmes,
recommendations and guidance for risk factors where there are currently gaps.
Department of Health Community Pharmacy Savings Proposals in 2016/17
Background
In the Spending Review, the Government re-affirmed the need for greater efficiency and
productivity, and the need for the NHS to deliver £22 billion efficiency savings by 2020/21, as
set out in the NHS’s own plan, the Five Year Forward View. Community pharmacy will need
to play its part in delivering those efficiencies. Given the potential impact of the proposals the
Department also announced it would consult with other stakeholder organisations, including
patient and public groups. The consultation regarding the new pharmacy contract has now
closed and a summary of the proposals are available here and are summarised below:

Funding settlement
o 2016/17 £2.687 billion (4% reduction)
o 2017/18 £2.592 billion (3.4% reduction)
o 2018/19 and beyond will be the subject of future consultation

Fees and services
o Changes to fees and allowances, consolidating a range of fees into a single
activity fee
o Phasing out establishment payments
o Introducing a Pharmacy Access Scheme (PhAS)
o Introducing a Quality payments Scheme
o Changes to drug reimbursement

Changes to market entry to facilitate the consolidation of pharmacies
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Modernising the service - Improve the prescription ordering journey to maximise
patient choice and convenience

Urgent medicines supply pilot scheme
Funded from the Pharmacy Integration Fund (Not from overall funding) NHS England
will be responsible for this allocation. This will be piloting a national urgent medicines
supply service where people calling NHS 111 requiring urgent repeat medicines will
be referred directly to community pharmacies.

Pharmacy Access Scheme (PhAS )
Funded through the Community Pharmacy Contractual Framework, to support access
where pharmacies are sparsely spread and patients depend on the most. 1356
pharmacies will receive funding and it will run from 1st December 2016 to 31st March
2018. Criteria will be:
1. The pharmacy is more than a mile away from its nearest pharmacy by road
2. The pharmacy is on the pharmaceutical list as at 1st September 2016
3. The pharmacy is not in the top quartile by dispensing volume
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Quality Payments Scheme - £75 million funded through the overall funding for
2017/18 of £2.592 billion. To qualify for payments, pharmacies will have to meet four
gateway criteria
1.
2.
3.
4.
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Provision of at least one specified advanced service
NHS entries choices up to date
Ability of staff to send and receive NHS mail
Ongoing utilisation of Electronic Prescription Service
Implementing any specific new measures with regards to prescription duration
are not being pursued.
Proposed changes
Community pharmacy already play a vital role in dispensing medicines, advising on medicine
use, promoting good health and supporting the prevention agenda and supporting people to
look after themselves. However it could play an even greater role as part of more integrated
local care models in optimising medicine usage, supporting people with long term conditions,
treating minor illness and injuries, taking referrals from other care providers, preventing ill
health and supporting good health.

Pharmacy at the heart of the NHS
To integrate Pharmacies with the wider health and social care system to help relieve
pressure on GPs and Accident and Emergency Departments, ensure optimal use of
medicines, and will mean better value and patient outcomes.

NHS funding for community pharmacy
The average pharmacy receives £220,000 a year in NHS fees and allowances and in
the context of the NHS needing to deliver £22 billion in efficiency savings by 2020/21;
the government has said it wants to examine community pharmacy and the
contribution it can make to this challenge.

Efficiency in community pharmacy
It is suggested that there are approximately 3000 too many pharmacies in England
and many of them are grouped together, with 40% located in clusters of three or more
within a 10-minute walk of each other and thus between 1,000 and 3,000, out of
11,674 should or could close overall.
Pharmaceutical Services Negotiating Committee (PSNC) has rejected the Department of
Health’s proposed funding package for 2016/17 stating the proposed package includes
reckless cuts to pharmacy funding that will, if implemented, see patients suffer as services
are withdrawn.
Community Pharmacy in Salford
Salford City Council has a strong working relationship with Salford and Trafford Local
Pharmaceutical Committee (LPC), which is now part of Greater Manchester Local
Pharmaceutical Committee (LPC), and the 55 pharmacies it represents. The Council works
in partnership with pharmacies to deliver a needle exchange service, observed consumption
treatment, emergency contraception, Chlamydia treatment and stop smoking interventions.
The Public Health Department works in partnership with local pharmacies to deliver a
national pharmacy contract requirement to hold 6 annual public health campaigns and
contributes funding and is aiming to develop the Healthy Living Pharmacy (HLP) framework
in Salford. The HLP scheme will ensure that all those pharmacies that sign up to the scheme
are trained and prepared to offer advice and practical interventions to help people manage
minor illness, to prevent illness through self-care and give healthy lifestyle advice to
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maximise good health and wellbeing, improve quality of life. It is hoped that training of an
initial small cohort of Pharmacies will begin in 2017/18, that will then be able to provide brief
health and wellbeing interventions to the Salford population that visit their Pharmacies. This
new model will support them to work towards the suggested proposal of community
pharmacy playing a greater role as part of more integrated care models. The proposals may
encourage more pharmacies to become members of the scheme providing an extended
service to prevent ill health and support good health.
84% of adults visit a pharmacy each year making them the most visited healthcare setting.
Pharmacists are very accessible healthcare professionals, generally well placed within the
different areas of Salford and have good contact with the local population who place a huge
amount of trust in them regarding their health. The change in funding is likely to reduce the
number of pharmacies therefore reducing access to the public. These changes are likely to
have greater impact on the smaller pharmacies dispensing less than 5000 prescriptions per
month and many of these pharmacies are in the areas of highest deprivation and greatest
need.
We will continue to monitor developments with these savings proposals and the findings of
the consultation.
Tuberculosis (TB)
Tuberculosis (TB) is a vaccine-preventable bacterial disease spread by airborne droplets and
characterised by the formation of nodules in the lungs. Public Health England’s Annual TB in
England report 2016 shows a consistent year-on-year reduction in the incidence of TB in
England from 2011 to 2015, with a 2015 rate of 10.5 cases per 100,000 people. TB is
declining in both UK born and non-UK born population groups across all regions. In the North
West, the rate has declined to 7.9 cases per 100,000, but Salford had a (non-significant)
increase in its 3-year rolling average rate to 12 cases per 100,000. The Salford rate is now
significantly worse than the North West rate. Most TB cases occur in non-UK born groups
and reduced migration from high incidence countries explains some of the nationwide
reduction, with some of this improvement attributed to efforts to address TB under the
Collaborative TB Strategy for England 2015-2020. Latent TB screening for those arriving
from high TB incidence countries is an important element of this strategy, and has been
implemented in GP practices in Salford as part of the Salford Standard.
For more information see https://www.gov.uk/government/publications/tuberculosis-inengland-annual-report and https://fingertips.phe.org.uk/profile/tb-monitoring
National HIV Testing Week (NHTW) commenced 19 November 2016
National HIV Testing Week (NHTW) which was held 19 November 2016 is a national effort to
increase HIV testing among England’s key populations most affected by HIV. Last year
hundreds of organisations participated by raising awareness, providing extra testing
opportunities and promoting services. The aims of NHTW are:
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To increase testing among key populations in England;
To increase awareness and acceptability of HIV testing among key populations;
To increase access to HIV testing for these key populations (in both statutory and
community settings).
Gay and other men who have sex with men (MSM) and black African people are the two
groups that continue to carry a disproportionate burden of the HIV epidemic in England. In
the lead up to and throughout NHTW, HIV Prevention England (HPE) will deliver a targeted,
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high profile, national campaign to reach people who do not normally test and encourage
them to take an HIV test.
Why is it important in Salford?
 Nearly 5 in every 1,000 residents (aged 15-59) have the disease. This is more than twice
the national average (2.1 in every thousand) and equals approximately 700 people in
Salford (aged 15-59) known to be living with HIV.
 According to the national estimates, as many as 200 people were living with
undiagnosed HIV in Salford in 2014. As well as the risks to the individual concerned,
undiagnosed HIV has an impact on the wider public health; people who don’t know they
are HIV positive are at greater risk of passing the virus on to others.
 In 2014, 747 adult residents (aged 15 years and older) in Salford received HIV-related
care: 590 (number rounded up to nearest 5) men and 160 (number rounded up to
nearest 5) women. Among these, 70.2% were white, 23.2% black African and 0.7%
black Caribbean. With regards to exposure, 64.2% probably acquired their infection
through sex between men and 30.6% through sex between men and women.
 It supports the aims of the Halve It campaign that Salford City Council and Salford
Health and Wellbeing Board have signed up to which are to work with partners to halve
late diagnosis and halve the people living with undiagnosed HIV in Salford.
Salford City Council will inviting key sexual health clinical and third sector services along with
GPs and Pharmacies to participate in NHTW by:
 Ensuring that access to testing is available to all who wish to test during the event.
 Displaying free posters or using the other free resources from HPE
Free HIV tests are available at Salford sexual Health clinics, the details of which can be
found here:
http://www.boltonft.nhs.uk/services/sexual-health/information/clinics-and-opening-times/.
Salford City Council is also a partner of the Public Health England’s National HIV Home
Sampling Scheme (https://www.test.hiv/). This is a home sampling (not testing) service which
means that advice and guidance is given if a positive result is found after the sample has
been tested which makes this different from a home testing service. The service is targeted
at the two most at risk groups (men who have sex with men and black African men and
women). In the first year of this programme (November 2015 to October 2016), there have
been 7 diagnoses found from a total of 795 kits ordered of which 422 have been returned.
There were 32 residents of Salford diagnosed with HIV in 2014 so the results of the HIV
Sampling Service already represent a 22% increase in diagnoses which helps to improve our
target around late diagnosis of HIV; We estimate that we need to diagnose 5 more case early
and 62 more Salfordians earlier per year to meet the council’s ‘Halve-It 2020’ pledge.
In addition, the LGBT Foundation and BHA Equalities launched Salford HIV clinics providing
a safe and confidential space for Gay, Bisexual MSM men and black African communities to
get tested at:
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Langworthy Cornerstone Health centre - Tuesday's from 12-5pm
Salford university - Tuesday's and Thursday's from 12-5pm
Revive at the Spiritan Centre Salford - Wednesdays 10am-3pm
Salford City Council’s City Mayor has also agreed to have HIV test to promote this HIV pilot
and to raise awareness of national HIV testing week and World AIDS day.
St John’s Wort ‘stops emergency contraceptive pill working’
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“Women taking an emergency contraceptive pill containing levonorgestrel are being advised
to check the ingredients of other medicines they are taking because they could stop the pill
working.
The Medicines and Healthcare products Regulatory Agency said women taking some
medicines, and remedies containing St John's Wort are affected. These women should take
a double dose of the contraceptive pill, it said.”
What is Emergency Hormonal Contraception?
Emergency Hormonal Contraception (EHC) can prevent pregnancy after unprotected sex or
if a contraceptive method has failed for example, a condom has split or the woman has not
taken their oral contraception (“the pill”). There are two types of EHC:
 the emergency contraceptive pill (sometimes called the morning after pill)
 the IUD (intrauterine device, or coil)
There are two kinds of emergency contraceptive pill. Levonelle (drug name Levonorgestrel)
has to be taken within 72 hours (three days) of sex, and EllaOne has to be taken within 120
hours (five days) of sex. Both pills work by preventing or delaying ovulation (release of an
egg). In Salford we currently only commission the free prescription of Levonelle in certain
Salford Pharmacies but we are currently reviewing both the cost and clinical effectiveness of
including EllaOne as an emergency contraceptive choice.
The IUD can be inserted into the uterus up to five days after unprotected sex, or up to five
days after the earliest time the woman could have ovulated. It may stop an egg from being
fertilised or implanting in the womb.
Emergency contraception does not protect against sexually transmitted infections (STIs).
What does this announcement mean?
The Medicines and Healthcare products Regulatory Agency (MHRA) have released an
update on emergency contraception that states:
“Medicines or herbal remedies that induce cytochrome P450 3A4 enzymes reduce blood
levels of levonorgestrel, which may affect emergency contraceptive efficacy. Women seeking
emergency contraception who have used CYP3A4 enzyme inducers within the last 4 weeks,
should preferably use a non-hormonal emergency contraceptive—ie, a copper intrauterine
device. If this is not an option, these women should take double the usual dose of
levonorgestrel; increasing from 1.5 milligrams to 3 milligrams”
This means that any woman taking certain herbal supplements (including St John’s Wort)
may be compromising the efficacy of Levonorgetsrel if the two medications are taken
together.
Impact in Salford
EHC is supplied by several Pharmacies across Salford. The recommendations from the
Medicines and Healthcare products Regulatory Agency has been sent to all Pharmacies and
GPs in Salford along with the Local Pharmaceutical Committee (LPC) and Local Medical
Committee (LMC) to ensure future prescribing takes account of this issue. We have also
sought advice from our Medicines Optimisation commissioning support service at Salford
CCG to establish if any further action should be undertaken. They have confirmed that
enzyme inducers are already mentioned in the Patient Group Directive (written instructions to
standardise the supply of medicines to patients) and that no further action is necessary.
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Proton Beam Therapy comes to Manchester
What is Proton Beam Therapy?
Proton beam therapy is a relatively new form of radiotherapy. It uses beams of protons (sub
atomic particles) to destroy cancerous cells. Protons are speeded up using a particle
accelerator and then beamed into cancerous cells.
Approved in 2014, the first Proton beam therapy centre outside London is currently under
construction at Christies Hospital, Greater Manchester (see picture right), expected to open
in 2018.
What it treats?
It can be used to treat types of cancer in critical areas such as to treat brain tumours in
young children whose brains are still developing.
The technology can be used to treat adult cancers where the cancer has developed near a
place in the body where damage would cause serious complications to sensitive organs such
as the optic nerve, spinal cord, or brain.
Photography: Chiaolin Gunn-Russell
What is the benefit for Salford?
Providing local facilities means patients can receive cancer treatment in the UK without
having to travel overseas, thus reducing associated stress/inconvenience and additional
strain on possible existing poor health, as well as saving on travel and accommodation costs.
It also allows medical specialists to monitor success in the UK under the NHS.
Proton beam therapy is also better than conventional radiotherapy for treating certain types
of cancer, although the technology is still new and long term benefits are unknown. Unlike
conventional therapy, in proton beam therapy the beam of protons stops once it ‘hits’ the
cancerous cells, which means it results in less damage to surrounding tissue.
This development can also help to jump start cancer research with clinical trials and it will
take time to assess the success of proton beam therapy.
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Useful weblinks:
The Christie Proton Beam Therapy Centre
http://www.christie.nhs.uk/services/i-to-q/proton-beam-therapy/plans-for-the-christie-protonbeam-therapy-centre/
What is proton beam therapy?
http://www.nhs.uk/news/2014/09September/Pages/what-is-proton-beam-therapy.aspx
Proton beam therapy: where are we now?
http://scienceblog.cancerresearchuk.org/2015/07/16/proton-beam-therapy-where-are-wenow/
Proton Therapy Center
http://www.proton-cancer-treatment.com/
KEY COUNCIL POLICIES: Not required
EQUALITY IMPACT ASSESSMENT AND IMPLICATIONS: Not required
ASSESSMENT OF RISK: Not required
LEGAL / FINANCIAL / PROCUREMENT / HR IMPLICATIONS: Not required
OTHER DIRECTORATES CONSULTED: Not required
CONTACT OFFICER: David Herne
TEL NO: 0161 793 3518
WARDS TO WHICH REPORT RELATES: Not applicable
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