PHE North West Bulletin

Issue 03, January 2016

In this issue Welcome 1

Goodbye to 2015 and hello to the New Year 1

PHE’s role in flooding 2

Dental Consultant for PHE North West awarded an MBE 4

Dry January 4

North West Alcohol Conference 5

New Alcohol Guidelines 6

Protect yourself from Norovirus 7

The next generation take over PHE 8

Ebola screening scaled down 8

Experts recognised for their work in West Africa to stop the spread of Ebola 9

Save the date for NHS Health Check Conference in March 10

Ageing Well in Work: A Call to Action 11

Antimicrobial Resistance Strategy Relaunch events 12

Developing a Sustainability and Health Network 13

Change4LifeSchool Zone now live – promoting healthy pupils 14

Suzan picks up top award at international conference 15

Jane Rossini, Deputy Centre Director, PHE North West

Contact us: PHE North West Centre, 5th Floor, 3 Piccadilly Place, London Road, Manchester, M1 3BN

Tel: 0344 225 0562 Email: PHENWBulletin@phe.gov.uk Twitter: @PHE_NorthWest

Welcome Goodbye to 2015 and hello to the New Year As we prepared to say goodbye to 2015 and welcomed 2016, storms Desmond, Eva and Frank held much of our area in their grip – impacting across the North West and sadly ruining the festive season for many. Families and communities across our area dealt with the aftermath of the flooding whilst the response from local communities and emergency services was heroic. The kindness of communities and the huge number of people who volunteered from across the country was fantastic. You can read more about the co-ordinated multi-agency response to the floods, included PHE North West’s role on page two.

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It would be great to have a crystal ball to predict just what we will face this year – 2015 was unbelievably busy, unpredictable and exciting. We welcomed the launch of PHE North West, bringing our three centres together for the first time. We dealt with an array of health protection issues from Avian Flu and TB to Hepatitis, and the massive challenge of cryptosporidium in parts of Lancashire’s water supply. Last year also saw the launch of the memorandum of understanding on Greater Manchester Devolution, the launch of the North West TB Control Board, innovative work to tackle Antimicrobial Resistance, the first survey of dental special needs in the North West and the shortlisting of the collaborative blood pressure work in Cheshire and Merseyside for funding from the NHS England test bed team. Whatever this year holds I am confident that together we can meet the challenges and reap the rewards of our partnership work. Here’s to another 12 months. Dr Jane Rossini, North West Deputy Centre Director/Director of North Health Equity Programmes

PHE’s role in flooding The devastation suffered by communities across the North West during December demonstrated why flooding remains one of our highest civil emergency risks.

Photograph – Warwick Road, Carlisle, courtesy of Cumbria Police

Flooding presents a number of risks to health. PHE’s role is to advise the public, homeowners and front line responders and enable them to clean up safely. PHE’s role begins long before severe flood warnings are issued. Emergency planners

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represent PHE at local resilience fora, to assess the risk and contribute to drawing up county wide multi agency flood plans. Staff from our health protection teams attend flood training and exercise events, the most recent of these being in November 2015 in Kendal. In the run up to potential flooding events, PHE will dial in to local flood advisory service teleconferences where the Environment Agency will share its opinion on what is likely to occur. A lot can happen in this period, and the principle is to begin early preparations and give communities as much warning as possible. Where matters escalate, the multi-agency flood plans are activated, with local strategic co-ordinating groups convened to manage the situation. These are chaired by the police with representation from emergency services, local authorities, NHS England, together with colleagues from the Environment Agency, utility companies and the military. During the December floods, PHE was represented at meetings of Strategic Coordinating Groups, some of which took place at the same time. For our on call staff, this meant attendance at police headquarters on a Saturday night and dialling in to teleconferences during the early hours of the morning. Local communications teams also joined media advisory cells to work on the messages going out to the public. The focus has since turned to recovery. PHE is advising the local recovery co-ordinating groups as the clean-up operation begins, roads are reopened and health and social services strive to get back to normal. Recovery is led by our local authorities, and given the scale of the disruption, will become the day job for many for some time to come.

Photograph – Carlisle United Football Club, courtesy of Cumbria Police

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PHE advice on flooding is available at: www.gov.uk/government/collections/flooding-health-guidance-and-advice Contributor – Dyfan Jones, Emergency Preparedness Manager, PHE North West

Dental Consultant for PHE North West awarded an MBE

Eric Rooney, a Public Health England Dental Consultant, based at PHE North West’s Cumbria and Lancashire office, has been awarded an MBE for his services to dentistry on the New Year’s honours list. Eric has a dual role, and is also the Deputy Chief Dental Officer for NHS England. He has had a distinguished career developing dental policy throughout England, however he has been North West-based for his entire career. Eric began his career with Liverpool Health Authority in 1983 and moved to Cumbria in 2002 to work for health authorities and

primary care trusts before joining Public Health England in 2013. In addition, Eric has developed policy with the British Dental Association, the Department of Health and Public Health England. His biggest accomplishments include leading the successful negotiation of a new national contract for salaried dentists for NHS employers, and an independent review of NHS dental services in 2008-09. This review has set a vision for the future of NHS primary dental care with a focus on prevention. There are now 100 pilot “clinical pathways” throughout England with this focus. Eric says it is the friendly, supportive people of the North West that has kept him here. He also says that while he is honoured to receive the award; it couldn’t have been achieved without the many people and groups that he has collaborated with over the years.

Dry January In partnership with Alcohol Concern, this month we are again encouraging everyone to take a break from alcohol in the New Year. As we all refocus on healthy habits after the indulgences of the holiday season, January is a key time for changing drinking behaviour.

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This year’s campaign focuses on all adult drinkers who consume above the guidelines on a regular basis, but particularly increasing and high-risk drinkers (Men who regularly drink more than a pint and a half of 4% beer a day and women who regularly drink more than a 175ml glass of 13% wine a day) who are aged 40 to 60 from lower socio-economic groups and who are likely to have wider health concerns. The objectives of the campaign are straightforward: promote the benefits of taking time off from alcohol and temporary abstinence as a proven trigger to reducing alcohol consumption over the longer term. And although New Year’s Day may now seem a distant memory we are still encouraging people to take the 31 day dry challenge and reap the benefits of a break from alcohol. To find out more visit http://www.dryjanuary.org.uk/ Contributor – Paul Duffy, Health and Wellbeing Manager

North West Alcohol Conference Alcohol consumption in the North West is amongst the highest in the country, and our area also has the highest number of months of life lost due to alcohol. In November we were happy to be involved for the first time in the long standing annual North West Alcohol Conference. The conference in Liverpool focused on the need for further research into addressing alcohol harm; mainstreaming treatment for alcohol harm; and changing behaviours by adapting our environments. Presentation highlights included an outline of the techniques used by the alcohol industry to influence young people and what needs to be done to address this. It also considered the importance of primary care in prevention, identification and reducing harm, and the absence of alcohol treatment funding available from CCGs. Partners learned that small changes such as glass and bottle shapes can have a big impact on reducing consumption amongst the functioning and increasing-risk drinker, as well as those with more severe dependencies. Steve Morton, PHE North West’s Health and Wellbeing Manager, said: “By working in partnership with Aintree Hospital we were able to bring more of a public health perspective to this already successful event. One of the key attractions of this event

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is that it brings clinicians, practitioners and commissioners together to discuss a shared issue.”

Mel Sirotkin, Centre Director, PHE North West, facilitates a panel discussion at the North West Alcohol Conference

New Alcohol Guidelines On Friday 8 January the Chief Medical Officer, Dame Sally Davies announced new Alcohol Guidelines. These will take effect immediately, although the wording of the guidelines will be issued for consultation, with an opportunity to respond until 1 April 2016. PHE will, in due course, update any public information that relates to the UK alcohol guidelines. In brief they state that:

There should be a single guideline for men and women: This will now be 14 units a week for both men and women

There is an additional recommendation not to ‘save up’ 14 units for one or two days - but instead to spread them over 3 or more days

A ‘protective effect’ is less significant than it was - i.e. - one or two glasses of red wine does not prevent you from getting heart disease, as is often reported

The previous line about ‘If pregnant women choose to drink they should limit their drinking to one or two units once or twice a week’ has been removed to remove the current ambiguity around drinking in pregnancy

The new guidelines also present new evidence about the clear links between alcohol consumption and cancer

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Protect yourself from Norovirus Norovirus is a common source of gastro-enteritis, and it is often known as ‘winter vomiting disease’. Although it is true that there is an increase in winter months, cases do occur in all seasons. Once a person has been exposed to the virus, it usually takes between 12 and 48 hours for them to become ill. The illness characteristically starts with the sudden onset of severe and dramatic vomiting. This can occur with such force that it is termed ‘projectile’. Some people also develop diarrhoea. In general the symptoms usually last for about 24 – 48 hours after which the person feels ’washed out’ for a day or so. There are no long-term effects of norovirus infection and, even in the frail or elderly, most people will make a full recovery within 48 hours. Since the causative organism is a virus (Norwalk-like virus - NLV), antibiotic treatment has no effect upon norovirus infection. Norovirus is highly infectious and may be caught:

by direct contact with an infected person especially their vomit or diarrhoea (e.g. being close to a person when they vomit or when cleaning up after them, or even by breathing in and swallowing the virus that is in the air around someone who has just vomited, or from a person who is incubating norovirus infection)

from food (that has been prepared by someone with the virus, or was contaminated by virus from someone with symptoms e.g. fruit at a bedside, or else that was contaminated at source, such as oysters, from sewage polluted sea);

via flat surfaces that have been contaminated with the virus after someone has vomited in the vicinity, as the virus can survive in the environment for some time, possibly days;

Norovirus is not caught from animals. To control the spread of the virus, good hand hygiene, cleanliness of the environment and good food hygiene are essential. Contributor Dr Nicola Schinaia Consultant in Communicable Disease Control (Cumbria and Lancashire)

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The next generation take over PHE In November PHE North West was at the forefront of social media messages - helping to promote a national initiative through our Twitter account. Dubbed the Takeover Challenge, a national event from the Children’s Commissioner, children and young people were given the chance to be involved in decision-making. PHE used the opportunity to focus on “Children and Young People’s Emotional Health and Wellbeing” to grow our understanding of the issues and topics affecting young people. PHE North West staff were asked to share messages that they would tell their younger self to help them succeed. What would your message be? Here are a few of our messages:

Paul Duffy, Health and Wellbeing Manager (Alcohol and Drugs), PHE North West – Cheshire and Merseyside

Lea Madgwick, PA/Administrator, PHE North West – Cumbria and Lancashire

Ebola screening scaled down In December the decision was made by PHE to scale down screening arrangements following a sustained decline in the Ebola outbreak in West Africa.

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Other factors influencing the decision included the introduction of new control methods such as a highly-effective Ebola vaccination, the WHO declaring Sierra Leone Ebola transmission free and the continued low risk presented to the UK by the disease.

Under the scaled back operations, screening will stop for travellers from Sierra Leone, Guinea and Liberia. PHE will maintain its monitoring system for high-risk returning workers until the outbreak has been declared over in the affected countries. More information about the changes is available here.

Experts recognised for their work in West Africa to stop the spread of Ebola Thomas Inns, Epidemiology and Surveillance Scientist, and Suzan Trienekens, Field Epidemiology Training Programme Fellow, from PHE North West’s Field Epidemiology Service, recently received the Ebola Medal for Service in West Africa. This is a special medal approved by the Queen to recognise service by civilian and military personnel involved in the Ebola response. Both Thomas and Suzan separately spent around six weeks on the ground in Sierra Leone, lending their expertise in infectious disease field epidemiology to address the Ebola crisis. Their work helped to identify and monitor contacts of cases, and strengthen the surveillance of new cases.

West Africa faced field epidemiology challenges that made even basic contact tracing complicated: lack of data and missing lab results, and even finding possible contacts, with sometimes only names of people and villages to go from. Both Thomas and Suzan thought the experience was an invaluable opportunity. They were also grateful for the PHE North West team to cover their responsibilities here so they could make the trip. Thomas says it was one of the biggest, most serious infectious disease outbreaks in his lifetime so he was glad to make a contribution as an epidemiologist. Suzan felt an epidemiologist’s skills were greatly needed to strengthen Sierra Leone’s public health response. She says the work was challenging and interesting, and they encountered situations that would simply never exist in the UK.

Dr Ken Lamden, former Consultant in Communicable Disease Control

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Dr Ken Lamden, former Consultant in Communicable Disease Control with the Cumbria and Lancashire Health Protection Team was also recognised with the medal for his work in Sierra Leone.

Save the date for NHS Health Check Conference in March Getting Serious about Prevention, NHS Health Check’s 2016 conference in London on 1 March 2016, is aimed at professionals involved with commissioning, providing, evaluating and supporting the NHS Health Check programme. It will be an opportunity to hear from Duncan Selbie, PHE’s Chief Executive, and Sir Bruce Keogh, NHS England’s Medical Director. It will share learning and innovative work from across the country through a series of workshops that will look at the findings from national and local evaluations as well as explore different dimensions of the programme. These dimensions include delivery in the workplace, the dementia component, behaviour insights, clinical management, the NHS Diabetes Prevention Programme and more. The NHS Health Check systematically targets the top seven causes of preventable mortality: high blood pressure, smoking, cholesterol, obesity, poor diet, physical inactivity and alcohol consumption. It is primarily a health improvement programme offering a genuine opportunity to engage people aged 40-74 in discussions about healthy lifestyles before they get sick. It goes on to help them take control of their health and avoid, reduce or manage their risk of developing future health problems.

Thomas Inns and Suzan Trienekens, from PHE North West’s Field Epidemiology Service, received an Ebola Medal for Service in West Africa

The Ebola Medal for Service in West Africa

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To register, visit this link: https://www.phe-events.org.uk/hpa/frontend/reg/tOtherPage.csp?pageID=199744&ef_sel_menu=1710&eventID=511&eventID=511

Ageing Well in Work: A Call to Action Late last year Manchester was the venue for an international conference to present the findings of a major project undertaken by Greater Manchester Public Health Network and Public Health England.

Professor Martyn Regan addressing the conference

Ageing Well in Work sets out to ensure older people realise the health benefits of remaining active in later life through employment, volunteering and other forms of civic participation. The focus of the Ageing Well in Work project has been on the actions required to help individuals flourish in work, delay retirement and remain active in their local communities. This call to action is timely since the devolution agenda within Greater Manchester stresses reform priorities, which are aligned to opportunities for economic growth, which will include getting people into and keeping individuals in good quality employment and thereby reducing dependency amongst working age populations and promoting independence in later living. An executive summary on the Ageing Well initiative can be found here: Ageing Well in Work: A Call to Action Executive Summary Contributor – Emma Cunningham, Ageing Well Project Officer, PHE North West

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Antimicrobial Resistance Strategy Relaunch events The Cheshire and Merseyside Antimicrobial Resistance (AMR) Strategy relaunch event took place in December in Halton. The event aimed to reinvigorate the Cheshire and Merseyside Antimicrobial Resistance Strategy by bringing together various stakeholders and providing them with the opportunity to shape the future direction of the strategy. It was well received, and attended by over 50 professionals from different disciplines, including GPs, pharmacists, CCG representatives, a microbiologist, and dental and veterinarian colleagues. The day included presentations from the five steering groups whose multidisciplinary membership provided updates on their work to date in areas including back-up prescribing; education, awareness and training; near patient/point-of-care testing; antibiotic stewardship and data and intelligence. Additionally, examples of local good practise were showcased by Cheshire West’s Medicines Management and Infection Prevention and Control Team, and representatives from Dental Public Health. Some good practices discussed included the provision of individualised primary care prescriber data to aid in benchmarking, and the launch of a local dental AMR work plan. Cheshire and Merseyside’s AMR strategy co-ordinates the various approaches that are available to tackle AMR. Attendees were able to comment on the current AMR strategy to influence an updated action plan. Based on comments from attendees, Cheshire and

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Merseyside will continue to fight to slow the development of antimicrobial resistance. Meanwhile, also in December the first stakeholder workshop on tackling AMR in Greater Manchester took place. The workshop drew together 40 participants from across medicines management, public health, microbiology, emergency planning and academia, representing acute trusts, local authorities, CCGs among others.

A series of talks outlined both current activity and the future challenge. Workshops sessions mapped current activity, as well as identifying potential areas for collaboration and development across Greater Manchester. The evidence collected at the workshop will be used by the AMR steering group to develop a strategy and associated work streams to

make further progress on AMR. Contributor – Sarah Reeves, Junior Specialty Doctor (Health Protection)

Developing a Sustainability and Health Network Climate change is one of the most prominent environmental issues of our time and has been identified as the greatest threat to global health of the 21st century. The Paris Agreement highlighted that health professionals and health systems have an unprecedented opportunity and mandate to build mitigation and adaptation actions into the core business plans of their organisations. Public Health England is currently working on a number of initiatives, including the implementation of the PHE and NHS England Sustainable Development Strategy for the Health and Social Care System 2014-2020. This strategy outlines an approach to building a sustainable health and care system that works within the available environmental and social resources to protect and improve health now and for future generations. To support the implementation of this strategy, PHE North West is working with NHS, other PHE centres and local authority colleagues from across the north to build a sustainability network. The network would see opportunities for training/education, sharing of best practices/demonstration projects, and supporting and encouraging local action. The network is supported by the NHSE/PHE Sustainable Development Unit (www.sduhealth.org.uk), which is a national unit based in Cambridge working on behalf of the health and care system in England.

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In the North West, we are developing a sustainability working group that will support the network and help co-ordinate sustainability initiatives within PHE. We would be pleased to hear from you if you are interested in knowing more, or would like to become involved. Local PHE North West sustainability contacts are: Mark Brown, Dyfan Jones, Richard Jarvis and Darryl Quantz. Contributor – Darryl Quantz, Public Health Registrar, Co-ordinator of the Northern Sustainability and Health Network

Change4LifeSchool Zone now live – promoting healthy pupils A new Change4Life School Zone online resource has been created for primary teachers and provides curriculum-linked materials and inspiration to help them teach pupils about healthy eating and being active. The School Zone features lesson ideas, homework tasks and whole school activities for teachers to use with Key stage one and two pupils. You can find the School Zone at www.nhs.uk/c4lschools or by searching Change4Life/schools.

As part of the next Change4Life campaign we will also be sending out healthy eating teaching resources to primary schools via the School Fruit and Veg Scheme (SFVS). This will support the January Change4Life Sugar Smart consumer campaign and schools will receive these teaching packs in January or early February, depending on when their SFVS delivery arrives. Developed by educational experts, these curriculum-linked resources encourage pupils to become Food Detectives and to learn about sugar and five a day. Each school that is part of the SFVS will receive packs containing a lesson plan, extension activities, homework plans and reward stickers.

Annika Harwood and Caroline Holtom, Workplace Wellbeing

Champions for PHE North West testing the Sugar Smart app

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They will also get parent packs to put in pupils’ book bags containing a leaflet and some stickers. The leaflet encourages downloads of our Sugar Smart app to find the amount of sugar lurking in food and drinks. Any schools interested in finding out more can subscribe to the School Zone mailing list by emailing partnerships@phe.gov.uk Contributor – Claire Troughton, Social Marketing Manager (North)

Suzan picks up top award at international conference In September, Suzan Trienekens, a UK-FETP (Field Epidemiology Training Programme) fellow, from PHE North West’s Field Epidemiology Service attended the biennial Global TEPHINET (Training Programs in Epidemiology and Public Health Interventions Network) conference held in Mexico City. TEPHINET is a professional network of field epidemiology training programmes that take place across the world, and the international conference was attended by fellows from over 50 different countries. As part of the conference five scientists from Europe, including two UK-FETPs were invited to either present a poster or give an oral presentation, and Suzan was given the opportunity to give an oral presentation titled: Twenty years and counting: Epidemiology of an outbreak of isoniazid-resistant tuberculosis in England and Wales, 1995-2014. During the closing ceremony, Suzan was awarded first prize for her oral presentation, coming out on top of 100 other delegates who also presented. Suzan said “I enjoyed meeting so many different fellows with expertise in all facets of field epidemiology and disease areas. The conference gave me the opportunity to exchange experiences and ideas, catch up with colleagues and make new friends. I also had no idea that a personal highlight was waiting for me on Friday! I would like to thank all the colleagues who contributed to this work and helped prepare the presentation, both those working on TB and within FETP/EPIET, this prize is for us all.”

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Suzan pictured front row, third from left. ( Photo credited to Ioannis Karagiannis.)

Suzan’s Global TEPHINET oral presentation award: a beautiful Mayan sculpture

Follow us on Twitter @PHE_NorthWest Tel: 0344 225 0562 Email: PHENWBulletin@phe.gov.uk