Press release: New figures show larger proportion of strokes in the middle aged

Public Health England (PHE) today launches the Act FAST stroke campaign which urges the public to call 999 if they notice even one of the signs of a stroke in themselves, or in others:

• Face – has their face fallen on one side? Can they smile?
• Arms – can they raise both their arms and keep them there?
• Speech – is their speech slurred?
• Time – to call 999

In England, one in six people will have a stroke in their lifetime, and new statistics released by PHE show that 57,000 people had their first-time stroke in 2016. It is estimated that around 30% of people who have a stroke will go on to experience another stroke.

Stroke is the third most common cause of premature death, and a leading cause of disability in the UK. There are around 32,000 stroke-related deaths in England each year. Deaths related to stroke have declined by 49% in the past 15 years. This has been accredited to a combination of better prevention, earlier treatment and more advanced treatment. Getting an NHS Health Check, for those aged 40 to 74 years, can identify early if you are at risk of a stroke.

While the majority (59%) of strokes occur in the older generation, PHE’s figures also found that over a third (38%) of first time strokes happen in middle-aged adults (between the ages of 40 to 69). More first-time strokes are now occurring at an earlier age compared to a decade ago. The average age for males having a stroke fell from 71 to 68 years and for females, 75 to 73 years between 2007 and 2016.

Awareness is crucial, so the campaign reaches out to people of all ages to highlight the risk of stroke and reiterates the signs and how vital it is that people call 999 and get to hospital as soon as possible. Around 1.9 million nerve cells in the brain are lost every minute that a stroke is left untreated, which can result in slurred speech and paralysis. If left untreated, a stroke can result in permanent disability or death.

The Stroke Association’s latest State of the Nation report reveals that in the UK almost two thirds (65%) of stroke survivors leave hospital with a disability. Around three quarters of stroke survivors have arm or leg weakness, around 60% have visual problems and around a half have difficulty swallowing and loss of bladder control. Communication is also affected in around a third of stroke survivors.

Professor Julia Verne, Public Health England Director, said:

Stroke is still one of the leading causes of death in England. While it’s often associated with older people, the latest research shows that people are having strokes at a younger age. Everyone needs to be aware of the signs.

Calling 999 as soon as you see even one of the symptoms develop – in the face, arms and speech – is essential. Speedy treatment will help prevent deaths and disability.

Tony Rudd, National Clinical Director for Stroke with NHS England and stroke physician at Guy’s and St Thomas’ NHS Foundation Trust, comments:

Thanks to improved NHS care, stroke survival is now at record high levels. Urgent treatment for strokes is essential, so friends and family can play a key part in making sure their loved ones receive care as quickly as possible.

Every minute counts and knowing when to call 999 - if you see any one of the signs of stroke - will make a significant difference to someone’s recovery and rehabilitation.

Steve Brine MP, Parliamentary Under Secretary of State for Public Health and Primary Care, said:

Strokes still claim thousands of lives each year, so the message of this Act FAST campaign remains as relevant as ever. The faster you act, the greater the chance of a good recovery. That’s why I’m urging everybody, and we must remember stroke can hit at any age, to familiarise themselves with the signs of a stroke and be ready to act fast.

Martin Flaherty OBE, Managing Director of the Association of Ambulance Chief Executives said:

We fully support Public Health England’s Act FAST stroke campaign. This is an important message and we urge people to call 999 immediately if they notice the signs or symptoms of a stroke in themselves or in others. Even if it is not a stroke, it is likely to be something that needs medical advice and attention, so calling the ambulance service is the right thing to do.

Juliet Bouverie, CEO of the Stroke Association, said:

As the UK’s leading stroke charity, we have said time and again that stroke devastates lives in an instant. Almost two thirds of stroke survivors leave hospital with a disability, but it doesn’t have to be this way. The faster you seek and receive emergency specialist treatment for stroke, the better your chances of making a good recovery. Knowing the signs of stroke and being able to Act FAST could save a life – your life.

The FAST (face, arms, speech, time) acronym has featured in the advertising for a number of years and is a simple test to help people identify the most common signs of a stroke.

Background

1. The Act FAST campaign videos and pictures can be found on Dropbox.
2. Interview opportunities with PHE, healthcare professionals and case studies are available upon request

3. The Act FAST campaign will run nationally from 1 February. The campaign includes advertising on TV, press, radio, bus interior posters and digital, supporting PR and a social media drive. Some activity will specifically target black and minority ethnic audiences because African, African-Caribbean and South Asian communities have a higher incidence of stroke. Twitter: @ActFAST999, Facebook: www.facebook.com/ActFAST999

4. A stroke is a brain attack that happens when the blood supply to the brain is cut off, caused by a clot or bleeding in the brain. A mini stroke is also known as a transient ischaemic attack (TIA). It is caused by a temporary disruption in the blood supply to part of the brain.

5. The Stroke Association is a charity that believes in life after stroke and together we can conquer stroke. It works directly with stroke survivors and their families and carers, with health and social care professionals and with scientists and researchers. They campaign to improve stroke care and support people to make the best recovery they can. They fund research to develop new treatments and ways of preventing stroke. The Stroke Helpline (0303 303 3100) provides information and support on stroke.

6. The One You campaign is a nationwide programme that supports adults in making simple changes that can have a huge influence on their health. Changes that could help prevent diseases such as type 2 diabetes, cancer and heart disease and reduce risk of suffering a stroke or living with dementia, disability and frailty in later life

7. People aged over-30 are being encouraged to take Public Health England’s online ‘Heart Age Test’ to find out their ‘heart age’ which will show their potential risk of having a heart attack or stroke and gives them the opportunity to take action. To calculate someone’s heart age, they will need to share some lifestyle information, including weight, height and smoking habits. They will then be able to see how their real age compares to their heart age and find out how many years they can expect to live without developing cardiovascular disease

8. Adults aged 40 to 74 are eligible for a free NHS Health Check which is designed to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes or dementia. As we get older, we have a higher risk of developing one of these conditions. An NHS Health Check helps find ways to lower this risk. Those in the age group can expect to receive a letter from your GP or local authority inviting you for a free NHS Health Check every 5 years.

9. Additional symptoms of stroke and mini stroke can include sudden:

• loss of vision or blurred vision in one or both eyes
• weakness or numbness on one side of the body
• memory loss or confusion
• dizziness, unsteadiness or a sudden fall, especially with any of the other symptoms

Celebrity campaign supporters

Celebrity supporters of this campaign include Shelley King, Gloria Hunniford, Marcus Birdman and Alastair Stewart. Quotes from the celebrities are included below and interviews are available upon request.

Shelley King, actress who plays Yazmeen Nazir on Coronation Street and supporter of the Stroke Association, said:

Both my mother and grandmother have been affected by a stroke so it’s something incredibly close to my heart and I want to do anything I can to encourage people to be aware of the signs of a stroke and to act quickly if you notice them, either in yourself or in other people around you. Back in the 90s when my mother had a stroke, there was very little awareness – many people wouldn’t have spotted the signs or known what to do, delaying action that could have saved lives. But today, with campaigns like Act FAST, we can be empowered to do more. A stroke can strike at any time – it might be someone just walking down the street who needs your help – so it’s crucial that all of us take notice of the FAST acronym and know to call 999 immediately if we see any single one of the signs.

Gloria Hunniford, television and radio presenter and supporter of the Stroke Association, said:

I know first-hand the importance of recognising signs of stroke and acting fast, having had to do so for my husband, Stephen. I was about to head out of our home to work, when Stephen stumbled into the house from the garden saying his left arm felt like cotton wool. My dad had suffered a series of strokes, so recognising the warning bells, I knew I had to act fast. Not many of us realise how quickly the clock is ticking for someone who is suffering stroke – thankfully Stephen got to the hospital in time to receive clot-busting treatment within the crucial 3-hour time window. Whether it’s just one symptom or more, and no matter how subtle, it’s absolutely essential to call 999 at the first signs of a stroke. I dread to think what could have happened if Stephen was too late – his outlook could have been much worse. Fortunately, he fully recovered.

Alastair Stewart OBE, journalist and newscaster and supporter of the Stroke Association, said:

My father had a stroke and it was devastating for my family. He was my hero and to see him struggling with disabilities afterwards was heart-breaking. I’d encourage everyone to familiarise themselves with the Act FAST acronym so they can act quickly when they see a stroke happening and hopefully avoid someone experiencing the same difficulties as my father.

Markus Birdman, stand-up comedian and supporter of the Stroke Association, said:

I considered myself to be fit and healthy, so when I was 40 and had a stroke it was a shock. I woke up one morning and found it really hard to see; I had absolutely no idea what was going on. You never think it’s going to happen to you, especially not when you’re young, but strokes can happen at any age so it’s important that people know the signs to look out of so they can act quickly. The faster you act, the less damage that is done and the better the person’s chance of a good recovery.”

Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Twitter: @PHE_uk, Facebook: www.facebook.com/PublicHealthEngland.

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Out of hours 020 8200 4400

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Research and analysis: First stroke estimates in England: 2007 to 2016

These estimates of the incidence of first-ever strokes in England between 2007 and 2016 used data from the Health Improvement Network’s general practice database to make the calculations.

The briefing document reports on:

• the estimated total number of first strokes in England in 2016
• trends in incidence
• differences in stroke incidence by age, gender, ethnicity and deprivation.

The technical document explains how the estimates were created.

This work supports and was released to coincide with the launch of the 2018 ActFast stroke awareness campaign.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/publications/first-stroke-estimates-in-england-2007-to-2016
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News story: Prescribed medicines that may cause dependence or withdrawal

The Parliamentary Under Secretary of State for Public Health and Primary Care has commissioned Public Health England (PHE) to review the evidence for dependence on, and withdrawal from, prescribed medicines. Withdrawal is more accurately defined as discontinuation syndrome in relation to anti-depressants.

The review was launched on 24 January 2018 and is due to report in early 2019.

PHE will carry out a public-health focused review of commonly prescribed medicines, authorised for adults who have non-cancer pain, anxiety, insomnia or depression.

The review will bring together the best available evidence on:

• prevalence and prescribing patterns
• the nature and likely causes of dependence or discontinuation syndrome among some people who take these medicines
• effective prevention and treatment of dependence and discontinuation syndrome for each drug category

Included within the scope of the review are:

• adults (age 18 and over)
• dependence and discontinuation syndrome
• benzodiazepines, Z-drugs, GABA-ergic medicines, opioid pain medications, antidepressants
• medicines above that are prescribed to treat anxiety, insomnia, chronic non-cancer pain and depression
• community prescribing

The review will exclude or will not cover:

• cancer and terminal pain
• over-the-counter medicines
• prescribing in hospitals and prisons
• other medicines, such as anti-psychotics, stimulants, ‘smart drugs’, anti-obesity drugs

Methods for the review will include:

• mapping of medicine categories, conditions and guidance to inform scoping, data analysis and literature review
• analysing all prescription and some GP patient data to understand prevalence and detail of prescribing patterns, patients and conditions
• an expert group to inform our approach, interpret findings and propose recommendations
• broader stakeholder engagement to ensure relevance, appropriateness and support
• a call for papers and evidence including unpublished research and reports collating personal experiences
• a literature review to summarise the evidence on causes, harms and effective prevention and treatment responses
• a report of the evidence review and recommendations, which will be peer reviewed

If you have any concerns about medicines prescribed to you, you should talk to your doctor. Do not stop taking any prescribed medicine without medical advice.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/news/prescribed-medicines-that-may-cause-dependence-or-withdrawal
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Research and analysis: Health visitor service delivery metrics: 2017 to 2018

Local authority commissioners and health professionals can use these resources to track how many pregnant women, children and families in their local area have received health promoting reviews at particular points during pregnancy and childhood. The data and commentaries also show variation at a local, regional and national level. This can help with planning, commissioning and improving local services.

The metrics cover health reviews for pregnant women, children and their families at several stages:

• antenatal contact
• new birth visit
• 6 to 8 week review
• 12 month review
• 2 to 2 and a half year review

Public Health England (PHE) collects the data, which is submitted by local authorities on a voluntary basis.

Annual health visitor metrics for 2017 to 2018 will be published on 24 October 2018.

See health visitor service delivery metrics in the child and maternal health statistics collection to access data for previous years.

Find guidance on using these statistics and other intelligence resources to help you make decisions about the planning and provision of child and maternal health services.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/publications/health-visitor-service-delivery-metrics-2017-to-2018
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Research and analysis: Child development outcomes at 2 to 2 and a half years metrics: 2017 to 2018

Local authority commissioners and health professionals can use these resources to track to what extent children aged 2 to and a half years in their local area are achieving the expected levels of development.

The data is collected from the health visitor reviews completed at 2 to 2 and a half years using the Ages and Stages Questionnaire 3 (ASQ-3). Public Health England (PHE) collects the data, which is submitted by local authorities on a voluntary basis.

The metrics presented are ‘the percentage of children who were at or above the expected level’ in these areas of development:

• communication skills
• gross motor skills
• fine motor skills
• problem solving skills
• personal-social skills
• all five areas of development

These data and commentaries also show variation at a local, regional and national level. This can help with planning, commissioning and improving local services.

Find guidance on using these statistics and other intelligence resources to help you make decisions about the planning and provision of child and maternal health services.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/publications/child-development-outcomes-at-2-to-2-and-a-half-years-metrics-2017-to-2018
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Official Statistics: Breastfeeding at 6 to 8 weeks after birth: 2017 to 2018 quarterly data

Quarterly experimental statistics on breastfeeding prevalence at 6 to 8 weeks after birth for the financial year, 2017 to 2018. Information is presented at local authority of residence, PHE Centre and England level.

The latest January 2018 release includes data for both quarter 1 and quarter 2 of 2017 to 2018.

Public Health England collects the data through an interim reporting system set up to collect health visiting activity data at a local authority resident level. Data is submitted by local authorities on a voluntary basis.

Annual experimental statistics for 2017 to 2018 will be published on 24 October 2018.

See the breastfeeding statistics collection to access data for previous years.

Find guidance on using these statistics and other intelligence resources to help you make decisions about the planning and provision of child and maternal health services.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/statistics/breastfeeding-at-6-to-8-weeks-after-birth-2017-to-2018-quarterly-data
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Guidance: Flu vaccination: supporting data for adult vaccines

PHE have received a number of enquiries about re-calling eligible patients and health care workers who have already received trivalent influenza vaccine (TIV) to additionally give them quadrivalent influenza vaccine (QIV). This is unlikely to be of benefit and recall of such vaccinated individuals is not recommended.

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Correspondence: Vaccine update: issue 274, January 2018

The January 2018 issue features:

• annual 2018 national survey of parental attitudes to immunisation
• vaccine coverage for pertussis vaccination programme for pregnant women update
• latest school leaver MenACWY vaccine coverage estimates published
• immunisation of pregnant women and newborn infants training slides
• training: fundamentals of immunisations
• national immunisation meeting 2018: key note speaker and booking opens soon
• best practices around ordering, receipt and storage of vaccines
• keep your vaccines healthy poster now available to order
• change to MMRVaxPro and PPD2TU packs
• flu vaccine information and availability 2017/18 for the children’s national immunisation programme
• flu vaccines for the 2017 to 2018 influenza season

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/publications/vaccine-update-issue-274-january-2018
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Research and analysis: Public health outcomes framework: 2016 user survey report

We carry out a regular user engagement activities to make sure the PHOF continues to meet the the changing needs of stakeholders.

This report summarises the results and planned actions following the latest 2016 survey of PHOF users. The survey was available from the main PHOF webpage on GOV.UK from 1 November 2016 to 16 December 2016.

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Guidance: Sexual and reproductive health: Spend and Outcome Tool (SPOT)

This guidance is a step by step guide on how to use Spend and Outcome Tool (SPOT) for Local Authorities (LAs) to compare spend data on sexual and reproductive health with sexual and reproductive health outcomes.

The information provides an overview of spend and outcomes across key areas of business for LAs, including:

• the potential breadth of issues hindering comparisons between outcomes and spend
• how to identify if the spend or outcomes data, or both, for their LA is suitable for drawing comparisons from
• next steps for interpretation where data comparisons can be made
• how to prevent misinterpretation

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National Statistics: Cancer registration statistics, England: first release, 2016

Official statistics are produced impartially and free from political influence.

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Guidance: Using the NHS Health Check programme to prevent CVD

This professional resource explores how the NHS Health Check is playing an important role in the prevention and early detection of cardiovascular disease (CVD) in England. We will also examine options for increasing the coverage and uptake of evidenced-based interventions following the NHS Health check to ensure that we are optimising the benefits of this world-leading prevention programme.

Download the infographics, references and a shorter version of this publication, print documents.

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Case study: Preventing diabetes by improving NHS Health Checks in Bromley

Summary

A comprehensive baseline audit was conducted by the Public Health Vascular Team in Bromley to identify areas of good practice with regards to assessing and managing patients at high risk of developing diabetes, as well as areas requiring improvement.

Background

With the continuing increase in diabetes prevalence, it is essential we maximise prevention opportunities, ensuring the effectiveness of the NHS Health Check (NHSHC) programme in identifying people at high risk of developing diabetes and people with undiagnosed diabetes.

In Bromley, an estimated 29,872 people (11.5%) of the population are at high risk of diabetes, and an estimated 5,000 adults have undiagnosed diabetes.

The NHSHC programme has a diabetes filter, to aid identification of those at high risk:

• body mass index greater than or equal to 30 or greater than or equal to 27.5 in South Asian and Chinese population
• blood pressure greater than or equal to 140mmHg Systolic and/or greater than or equal to 90mmHg Diastolic

People captured by this filter then require further assessment through blood testing of glycated haemoglobin (HbA1c) or fasting plasma glucose (FPG).

People identified as meeting the diabetes filter should be managed according to the South London Diabetes Filter Pathway, which was launched in 2010 (and updated in 2015) to support the implementation of the diabetes assessment component of the NHSHC in general practice locally.

There is strong evidence that providing intensive lifestyle interventions for patients at increased risk of developing diabetes can prevent or slow its progress. Once identified, support can be put in place, either through means of referral to Bromley’s diabetes prevention programme, advice around diet and physical activity or referral to a structured education programme.

This report assesses the follow up and outcomes of those people at risk of premature vascular morbidity, who had a NHSHC over the period 1 April 2014 to 31 March 2015. This time delay between the NHSHC and the audit, allows for the time taken to perform investigation, follow up, diagnosis and review. It follows on from an initial audit carried out in 2011 to 2013.

What was involved?

Computer searches

Computer searches were developed in order to examine relevant data for patients who received a NHSHC from 1 April 2014 to 31 March 2015. Each of the GP practices performed the computer search in their clinical system and exported the search results to Excel worksheets and securely emailed to Public Health.

Audit standards for the project were developed to measure recommendations in national and local guidelines with consideration to the local lifestyle services available at that time. Computer searches were designed to report on features from clinical records that would help inform measurement of the following audit standards:

• blood test
• repeat blood test
• coding
• intensive lifestyle intervention
• risk factor profiles

For this re-audit, data collection only used computer searches, and did not include a comprehensive notes review as in the original audit. A notes review was considered unnecessary for the small additional benefits that would be obtained as the majority of data is linked to READ codes which can be searched on. The additional workload to general practice and cost involved in writing to patients to obtain their consent was not warranted in this re-audit.

Initial findings from computer searches

44 out of 45 GP practices participated in the audit. Results of computer searches from the participating practices produced the following initial findings:

• 8,726 patients underwent a NHSHC in 2014 to 2015
• 2,770 (32%) of this population met the diabetes filter as described above
• 2,232 (81%) of these patients underwent blood sampling for HbA1c and or FPG
• 1,725 (77%) of these patients who had a blood test were found not to be at high risk of diabetes mellitus according to their blood test result and not included in further analysis
• 507 (23%) patients who had received a blood test had a result indicating high risk of diabetes.
• however not all the 507 patients were included in further analysis because:
  • 62 (12%) of these patients who had a blood test, were tested more than 1 year after the NHSHC, so were not included in further analysis as that blood test was assumed not to have been as a result of the NHSHC
  • 8 (2%) patients had been coded with a diagnosis of type 2 diabetes prior to having a NHSHC so were not eligible
  • 38 (7% patients were coded with a diagnosis of type 2 diabetes following their NHSHC; this is a good outcome that patients with undiagnosed diabetes are being identified as part of the NHSHC but it is assumed they will receive appropriate follow up which is not the subject of this audit project
  • therefore 399 (79%) of patients who had a blood test less than 1 year after the NHSHC and were found to be at high risk of diabetes mellitus were included in further analysis

What works well?

When comparing this re-audit with the original audit in 2011 to 2013 there have been demonstrable improvements in the identification process and outcomes of people at high risk of diabetes. In particular, a far greater proportion of patients who met the diabetes filter then went on to have an HbA1c and (or) FPG test in 2014 to 2015 (81%) compared to 2011 to 2013 (39%).

The recommendations made in the previous audit have undoubtedly contributed to this, from the increased support and education, the improvement of the template and identification of blood test requesting and the commissioning strategies of non-payment for people who are not documented to have been offered a blood test.

Next steps

Further improvements are still required for the recommended 1 year follow up reassessment of risk factors. Significant gaps exist in this area. Following discussion with colleagues it was felt the best way to make improvements in the follow up, is for it to be incorporated in the service specification GP practices have with the diabetes service.

It is proposed we introduce key performance indicators into the GP contract to ensure patients with NDH are correctly coded and reassessed annually. It is possible there is some reluctance to ‘label’ people with a READ code on their medical records, with consideration to health insurance. However although there have been some improvements in percentage coded, it is still low at 17%. Improved levels of READ coding is likely to improve the numbers of patients who are appropriately followed up.

The re-audit flags up the need for further investigation into patients that are at high risk of diabetes but are not responding to health advice of lifestyle interventions. For example, are the patients with improvements in blood results also the patients who are recording weight loss or other lifestyle improvement markers? If the patients who are showing a worse blood level at the repeat test, what sort of lifestyle interventions were they offered and are they receiving the appropriate level of support? This group might require a higher level of support, for example a more intensive intervention programme or a greater level of motivational support.

Questions around use of resource and targeting patients in most need of intervention advice. For example, the re-audit showed that 56 patients with a good physical activity score were given exercise advice (65% of the total patients for this category) compared to 77% in the inactive range. It might be a worthwhile trade off to aim for 100% activity advice in the inactive range at the expense of less advice to the already active.

Further collaborative working is continuing between Public Health, CCG, Diabetes service, GP practices and the Diabetes Prevention Interventions ( Walking away from Diabetes and the NHS Diabetes Prevention Programme), with the aim of building on the improvements made, addressing gaps and continuing to link the NHS Health Check with the identification and appropriate management of people with NDH in Bromley.

Further information:

Gillian Fiumicelli, Head of Vascular Disease Prevention Programme, Public Health, London Borough of Bromley.

Acknowledgements: Cathy Aiken, former Public Health Vascular Disease Nurse Specialist, Public Health, London Borough of Bromley.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/case-studies/preventing-diabetes-by-improving-nhs-health-checks-in-bromley
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Case study: Bradford’s Healthy Hearts: better management of CVD patients

Summary

The Bradford’s Healthy Hearts programme is dealing with the higher-than-average rate of cardiovascular disease (CVD) prevalence and deaths in Bradford. This involves multiple interventions to:

• optimise statin therapy
• address atrial fibrillation
• establish prevalence of hypertension
• improve the care of patients known to have hypertension

Background

Bradford Districts CCG includes 41 GP practices caring for a population of approximately 350,000 people. The area has a higher-than-average rate of CVD and consequently, a high rate of CVD death. Findings show:

• 14% of people have hypertension
• 21,000 people have total cholesterol (TC) of over 4.00 mmol/l
• approximately 28% of all deaths are due to CVD

The Bradford’s Healthy Hearts programme aims to reduce CVD-related deaths by at least 10% and prevent 150 strokes and 350 myocardial infarctions by 2020.

What was involved?

Statins

One of the main features of the programme is optimal use of interventions to focus strongly on large-scale improvements, while minimising the workload and resource impact on front-line staff.

As part of this, 1 of the 3 features focused on optimising statin therapy, based on the recognition that the scale of the problem was far beyond the capacity of primary care to challenge using traditional systems and methods. The local statin treatment protocol was streamlined to:

• atorvastatin 40mg daily for all primary prevention patients
• atorvastatin 80mg daily for all secondary prevention patients

IT searches identified patients who could be swapped from generic simvastatin to atorvastatin, and over 3 months, 6,000 patients switched their treatment. The use of atorvastatin is in line with NICE guidelines, however the dosage for primary prevention patients with no routine planned up-titration was a local decision to minimise the impact on primary care workload.

Hypertension

Another intervention for the first 2 years of the programme was to improve the care of patients already known to have hypertension. The aim was to increase the number of patients, aged under 80 years, achieving a blood pressure (BP) target of <140/90 mmHg.

The programme also included a multifaceted approach for atrial fibrillation (AF).

What works well?

In the first 2 and a half years following the launch of the programme in February 2015, there were treatment changes for nearly 22,000 patients and residents of the Bradford Districts CCG are now more aware of what is needed for a healthy heart.

Statins

The statin switch was well received by patients and practices. For the 6,000 patients who swapped from simvastatin to atorvastatin, there were significant indicative reductions in mean LDL-C of 0.9 mmol/l and in TC of 0.5 mmol/l.

As a result of this success, the programme moved on to patients at increased risk of CVD with a QRISK2 score greater than 10% and not on a statin. Over 5 months, 7,000 patients took up the offer of statins and in a sample of 2,136 of these patients there was a mean reduction in TC of 0.39 mmol/l.

Hypertension

The feedback from clinicians was that ease of implementation was crucial. Taking cues from the very successful, evidence-based Canadian hypertension programme and Million Hearts, a simplified treatment protocol was agreed upon after extensive consultation with local consultants across a wide range of specialties.

At baseline, 63% of patients with uncomplicated hypertension achieved a BP of less than 140/90 mmHg. Over a planned 2-year programme, a benchmark target of 76% was set, which was nearly achieved at just over 1 year.

At 16 months, 5,200 patients were newly identified to target, equating to 76%, despite increases in hypertension prevalence occurring at the same time.

Next steps

The Healthy Hearts programme is now embarking on a hypertension screening programme supported by the British Heart Foundation. It aims to screen 10,000 people, especially targeting those who are less likely to access healthcare.

Further information

Dr Youssef Beaini, GP and CVD Lead for Yorkshire and Humber Clinical Network

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/case-studies/bradfords-healthy-hearts-better-management-of-cvd-patients
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Case study: A comprehensive review of NHS Health Checks in Leeds

Summary

A review of outcomes in Leeds from the NHS Health Check was conducted for the period 2011 to 2016. The review focused on outcomes such as diagnosis of cardiovascular disease (CVD) and identification of behavioural risk factors. Recommendations for improving the uptake of the NHS Health Check (NHSHC) and reaching vulnerable groups are made.

Background

CVD mortality rates in Leeds vary. A breakdown of the life expectancy gap between the most deprived quintile (MDQ) of Leeds City Council and the England average by cause of death has shown that circulatory diseases make up 29% of the life expectancy gap between Leeds and England for males and 24% of the life expectancy gap for females.

Linked to the Department of Health’s ‘Living Well for Longer’, a call to action on avoiding premature mortality and the CVD outcomes strategy was launched in 2009.

The initial implementation of NHSHC in Leeds in 2009 was through a staged roll out, focusing on the GP practices within the most deprived parts of the city. In 2013 the responsibility for NHSHC was transferred to the Local Authority and is now 1 of 5 mandated services.

The Leeds implementation approach focused on:

• the outcomes - to reduce health inequalities for the poorest fastest
• being systematic
• primary care record as the corner stone
• patient at the centre - to provide continuous insight gathered from people and evaluation of our approach
• clinical engagement
• a staged roll out implementation plan based on level of deprivation and estimated highest risk
• all 103 GP practices implementing the NHSHC in Leeds

What works well?

A review of outcomes from the NHSHC was conducted for the period 2011 to 2016.

Analysis showed that over the period of 2011 to 2016, 114,339 NHS Health Checks were completed, resulting in 16,054 (14%) new diagnoses or high risk people being identified. This includes:

• 721 diabetes diagnoses
• 96 chronic kidney disease
• 207 atrial fibrillation
• 2,371 individuals at high risk of developing diabetes
• 4,101 diagnoses of hypertension
• 8,558 with a greater than 20% 10 year CVD Risk

A review of referrals following NHSHCs in 2015 to 2016 showed:

• 5,139 smokers identified, with the majority offered advice and 343 referred to smoking service
• 5,098 individuals with a BMI over 30, with 1,474 offered advice and 161 referred to weight management services
• 7,185 individuals were inactive or moderately inactive and completed a Global Physical Activity questionnaire (GPAQ) -10,494 were offered advice and 348 referred to an exercise programme.
• 1,242 completed the Audit C alcohol screening tool, with 5,392 offered advice (no referral data available)

What could be better?

Several challenges in implementing the NHSHC in Leeds have been identified. These include:

• invitations to the NHSHC have declined over recent years
• the percentage of people attending from the most deprived communities has decreased from 18% to 13%
• uptake is higher in the over-50s age range
• only between 9% and 11% are from Black, Minority Ethnic (BME) communities
• men have consistently had the lowest uptake but are more likely to be found to be high risk
• there is under-representation from people with learning disabilities
• people with severe mental illness are not accessing NHSHCs

Recommendations for the future

More marketing and promotion

Feedback from current providers, wider stakeholders and the public highlighted the need for awareness raising of the service to ensure the eligible population know of its existence and their eligibility. Promotional material should be tailored rather than a one size fits all approach.

More flexibility

The service should ensure that all eligible individuals can access an appointment that suits them with relative ease, at a time and location that fits in with their work and life demands

Improved engagement

The provider should demonstrate their ability to increase uptake among main groups, in particular:

• males
• people from the 40 to 49 age group
• people with learning disabilities and/or severe mental illness

Improved patient communication

Patients wanted to receive more information on what their completed NHSHC means to them. This could be in the form of a paper handout or an online platform.

Assured quality standards

The quality and consistency of the NHSHC being offered to the patient should be assured, by accessing relevant training. A quality assurance or audit tool completed by the provider should also be built into the specification irrespective of the delivery location.  

Next steps

The model for lead providers should involve:

• increased flexibility in terms of time and location for eligible people
• a focus on males, those living in the most deprived quintile, people working full-time and those with a learning disability or severe mental illness

There needs to be continued GP involvement in the delivery of the programme as their strengths as providers of the NHSHC are acknowledged and should be considered as part of any future delivery model. But this should be linked in with wider services, engaging with community leaders and targeting communities with a credible plan for outreach activities.

Marketing and communication should be simple, understandable and relevant to target service users and be targeted to specific groups rather than being a one size fits all approach.

Digital providers should be able to demonstrate how they can use online platforms to support the promotion and/or delivery of the NHSHC.

Finally arrangements for implementing the NHSHC should fit with the new health and care landscape of accountable care systems and the relevant primary care engagement schemes for the prevention of CVD.

Further information:

Lucy Jackson, Consultant in Public Health, Leeds City Council.

Melanie Earlam, Health Improvement Manager, Public Health England

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/case-studies/a-comprehensive-review-of-nhs-health-checks-in-leeds
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Guidance: NHS Health Check: stocktake and action plan

This stocktake and action plan sets out the main areas for development by Public Health England (PHE), local authorities and the NHS to ensure we continue to get the most from the NHS Health Check programme in the next 5 years.

This set of slides reviews the programme as the first 5-year cycle ends and outlines an action plan for the next cycle focusing on:

• delivering a high-quality programme
• encouraging the development of evidence and research
• providing strong leadership
• maximising access to and utility of intelligence

Download the Powerpoint version of the slideset.

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Corporate report: NDA and PHE Epidemiology Governance Group Annual Report 2016 to 2017

Significant epidemiological and radiobiological research involving nuclear industry workers was previously sponsored by parts of the UK nuclear industry.

Nuclear Decommissioning Authority (NDA) now own and manage this work and its assets. Public Health England (PHE) are contracted by NDA to maintain and carry out research on these assets.

The NDA-PHE Epidemiology Governance Group provides Independent governance and oversight of this work.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/publications/nda-and-phe-epidemiology-governance-group-annual-report-2016-to-2017
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Open consultation: UK SMI B 29: Investigation of specimens for screening for MRSA

Public Health England has opened a consultation this week in joint partnership with professional organisations.

This consultation asks for feedback in relation to the Standards for Microbiology Investigations B 29: Investigation of specimens for screening for MRSA.

We have refined the process so that UK SMI users can comment more easily if they see no requirement for amendments to the document out for consultation.

This information is as important to the consultation process as comments.

Use this form to provide comments or amendments for B 29

Use this form if you have no amendments for B 29

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/consultations/uk-smi-b-29-investigation-of-specimens-for-screening-for-mrsa
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National Statistics: Geographic patterns of cancer survival in England: Adults diagnosed 2011 to 2015 and followed up to 2016

Official statistics are produced impartially and free from political influence.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/statistics/geographic-patterns-of-cancer-survival-in-england-adults-diagnosed-2011-to-2015-and-followed-up-to-2016
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News story: Bird flu prevention zone extended to cover whole of England

A bird flu prevention zone has been declared across the whole of England, Chief Veterinary Officer Nigel Gibbens has confirmed today.

This means it is a legal requirement for all bird keepers to follow strict biosecurity measures. It comes as 13 dead wild birds were confirmed to have the virus in Warwickshire.

Last week 17 wild birds tested positive in Dorset and a total of 31 infected birds have now been identified at that site. Defra took swift action to put a local prevention zone in the area on Friday (12 January). However, as these latest results show the disease is not isolated to a single site the decision has been taken to extend the prevention zone across the country on a precautionary basis.

Testing of the birds found in Warwickshire is ongoing, however, it is highly expected that this will be the same H5N6 strain of the virus which has been circulating in wild birds across Europe in recent months. Public Health England have advised the risk to public health remains very low and the Food Standards Agency have said that bird flu does not pose a food safety risk for UK consumers.

Chief Veterinary Officer Nigel Gibbens said:

Following the latest finding of bird flu in wild birds in Warwickshire, we are extending our action to help prevent the virus spreading to poultry and other domestic birds.

Whether you keep just a few birds or thousands, you are now legally required to meet enhanced biosecurity requirements and this is in your interests to do, to protect your birds from this highly infectious virus.

Biosecurity measures

The prevention zone means bird keepers across the country must:

• Ensure the areas where birds are kept are unattractive to wild birds, for example by netting ponds, and by removing wild bird food sources;

• Feed and water your birds in enclosed areas to discourage wild birds;

• Minimise movement in and out of bird enclosures;

• Clean and disinfect footwear and keep areas where birds live clean and tidy;

• Reduce any existing contamination by cleansing and disinfecting concrete areas, and fencing off wet or boggy areas.

Keepers with more than 500 birds will also be required to take some extra biosecurity measures including restricting access to non-essential people, changing clothing and footwear before entering bird enclosures and cleaning and disinfecting vehicles.

The prevention zone will be in place until further notice and will be kept under regular review as part of our work to monitor the threat of bird flu.

Poultry keepers and members of the public should report dead wild birds to the Defra helpline on 03459 33 55 77 and keepers should report suspicion of disease to APHA on 03000 200 301. Keepers should familiarise themselves with our avian flu advice.

There are no plans to carry out any culls or put movement restrictions in place.

Background

• Trade should not be affected following the findings in wild birds, according to the rules of the World Animal Health Organisation (OIE).

• The risk to poultry and other captive birds depends, amongst other things, on the level of biosecurity on the premises and the likely contact between kept birds and wild birds, which is why it is now mandatory that all keepers ensure they practice the highest standards of biosecurity.

• Keep up to date with the latest avian influenza situation

• There are currently no findings of bird flu in Scotland, Wales or Northern Ireland and the prevention zone is for England only

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/news/bird-flu-prevention-zone-extended-to-cover-whole-of-england
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Official Statistics: Substance misuse treatment in secure settings: statistics 2016 to 2017

Healthcare professionals can use these resources to understand:

• outcomes of alcohol and drug treatment services in secure settings in England
• the profile of adults and young people accessing alcohol and drug treatment services in secure settings

The data will help with planning, commissioning and improving services in prisons and other secure settings.

The report and accompanying tables present statistical analysis of treatment data from 1 April 2016 to 31 March 2017. Treatment centres in prisons and secure settings across England submitted the data to Public Health England (PHE).

These secure settings include:

• prisons
• immigration removal centres
• young offender institutions for 18- to 21-year-olds
• young offender institutions for under 18-year-olds
• secure training centres
• secure children’s homes
• welfare only homes

PHE collects data on patients receiving treatment, details of their treatment and the outcomes.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/statistics/substance-misuse-treatment-in-secure-settings-statistics-2016-to-2017
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Guidance: Gloucestershire: breast screening programme

Quality assurance (QA) aims to maintain national standards and promote continuous improvement in screening. This is to ensure that all eligible people have access to a consistent high quality service wherever they live.

QA visits are carried out by the Public Health England screening quality assurance service (SQAS). The evidence for this report comes from:

• routine monitoring of data collected by the NHS screening programmes

• evidence submitted by the provider(s), commissioner(s) and external organisations

• information shared with SQAS London as part of the visit process

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/publications/gloucestershire-breast-screening-programme
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Guidance: North East London: bowel cancer screening programme

Quality assurance (QA) aims to maintain national standards and promote continuous improvement in screening. This is to ensure that all eligible people have access to a consistent high quality service wherever they live.

QA visits are carried out by the Public Health England screening quality assurance service (SQAS).

The evidence for this report comes from:

• routine monitoring data collected by the NHS screening programmes

• evidence submitted by the provider(s), commissioner and external organisations

• information collected during the pre-visits to the bowel screening programme on 30 May 2017

• information shared with the Screening Quality Assurance Centre (London)

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/publications/north-east-london-bowel-cancer-screening-programme
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Research and analysis: Healthy High Streets: good place making in an urban setting

Details:

PHE commissioned the UCL Institute of Health Equity to synthesise the latest and most relevant evidence for local decision makers, built environment professionals (eg planners, urban designers, landscape architects), town managers, public health professionals, and others involved in implementing street design principles on the health and wellbeing benefits of making high streets more inclusive, safe and healthier, particularly in areas of high deprivation.

This review provides a rapid assessment of evidence relating to pedestrian friendly, healthy high streets in urban settings, with specific reference to design interventions and street furniture. Evidence relating to both children and adults is considered, alongside groups who may have specific needs or preferences such as older people, younger people, disabled people (considering specific impairments where relevant) and different ethnic groups.

The review illustrates how, across a broad range of local stakeholders, a greater understanding of how place and people interact could help realise the potential of our high streets, and contribute to health and economic gains of our local communities.

To learn more about the Healthy Places work please join our [Healthy People Healthy Places Knowledge Hub(https://khub.net/group/healthypeoplehealthyplaces)

Related links

Spatial Planning for Health: An evidence resource for planning and designing healthier places

Homes for health: Strategies, plans, advice, and guidance about the relationship between health and the home

Active travel: a briefing for local authorities)

Everybody active, every day: a framework to embed physical activity into daily life

Obesity and the environment briefing: increasing physical activity and active travel and regulating the growth of fast food

Local action on health inequalities: Improving access to green space

Sustainability and public health: a guide to good practice

Health and wellbeing: a guide to community-centred approaches

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/publications/healthy-high-streets-good-place-making-in-an-urban-setting
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Press release: World leading cancer dataset shows improvements in diagnosis

Routes to Diagnosis now includes 10 years’ worth of data, covering more than 3 million cancer cases, making it the most comprehensive diagnosis of its kind in the world.

The data shows a dramatic improvement in the way some cancers are being diagnosed across England, but also pinpoints areas where improvements could still be made.

Key findings from the latest Routes to Diagnosis data include:

• diagnoses from emergency presentations, where outcomes are the worst, have improved falling from 24% to 20% between 2006 to 2016
• diagnoses through urgent GP referrals - 2 week waits - have increased significantly from 25% in 2005 to 37% in 2015, meaning that around 110,000 cases are now diagnosed this way
• diagnoses of pancreatic cancer through emergency presentation - with the very worst outcomes - has fallen by 6%, a significant drop
• diagnoses of colorectal cancers through the national bowel screening programme - the route with the best survival rate - remain under 10%
• the number of cancer cases diagnosed in Accident and Emergency varies across the country , ranging from 8% of all cases in the Peninsular Cancer Alliance to 20% of all cases in the London Cancer Alliance – this is despite similar cancer incidence levels

This latest update includes a new interactive tool which, for the first time, shows trends in cancer diagnosis for 53 different types of cancer. By using the tool doctors and managers will be able to quickly and easily see the differences between cancers and understand where survival rates are improving.

Dr Jem Rashbass, Cancer Lead at Public Health England said:

Diagnosing cancer earlier is one of the most important ways to improve cancer survival and we know that those patients who have their cancer diagnosed as an emergency have poorer outcomes. In England we have pioneered the analysis of routes to diagnosis data which allows us to highlight where we are making an impact and where challenges still remain.

Health Minister Steve Brine said:

With cancer survival rates at a record high it’s imperative that we continue to see a greater awareness of the signs and symptoms of cancer.

These figures demonstrate that our healthcare professionals are making a real difference by giving patients quicker referrals so they can access the best treatment available.

Sir Harpal Kumar, Cancer Research UK’s chief executive, said:

The earlier cancer is detected, the greater the chance that treatment will be successful. This Routes to Diagnosis data is an invaluable tool to see how we can diagnose cancer earlier.

We’re pleased to see that the proportion of people who are diagnosed as an emergency has fallen, but with 40,000 cancers still diagnosed in A&E each year in England we know that more improvement is needed.

The main reason the number of cancer diagnoses are increasing is because people are living longer and risk is of developing cancer increases with age. Lifestyle factors, such as the increase in obesity over the last few decades have also contributed to the rise in cases.

Case study

Earlier diagnosis leads to more successful treatment, so this data also highlights the importance of our cancer screening programmes in detecting cancer early.

Julia was diagnosed with stage 2a cervical cancer after her GP quickly referred her as a 2 week wait following post-coital bleeding; however she knows that it would have been detected earlier if she had attended her routine cervical screening appointments.

Julia Tugwell, cervical cancer survivor said:

I believe that if a GP or other healthcare professional had questioned me directly about my lack of screening attendance, over many years, I would have been more likely to have attended.

The new data shows that 3-year survival for cervical cancer following a screening diagnosis is 95%, compared to 65% when picked up through the 2 week wait – when symptoms might indicate a later stage cancer.

Background

1. National Cancer Registration and Analysis Service (NCRAS) is part of Public Health England and works to drive improvements in standards of cancer care and clinical outcomes by improving and using the information collected about cancer patients for analysis, publication and research.
2. Routes to Diagnosis groups patients into 1 of 8 routes:

• screen detected
• emergency presentation
• 2 week wait
• GP referral
• other outpatient
• inpatient elective
• death certificate only
• unknown

Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Twitter: @PHE_uk, Facebook: www.facebook.com/PublicHealthEngland.

Public Health England press office

Email phe-pressoffice@phe.gov.uk

Telephone 020 7654 8400

Out of hours telephone 020 8200 4400

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/news/world-leading-cancer-dataset-shows-improvements-in-diagnosis
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Guidance: Sexually transmitted infections: Yorkshire and Humber data

Sexually transmitted infections (STIs) represent an important public health problem in Yorkshire and Humber. Out of all the Public Health England centres, it has the third highest rate of new STIs in England.

More than 36,300 new STIs were diagnosed in Yorkshire and Humber residents in 2016, representing a rate of 674 diagnoses per 100,000 adults. Rates by upper tier local authority ranged from 458 new STI diagnoses per 100,000 population in North Yorkshire to 1,043 new STI diagnoses per 100,000 population in Hull.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/publications/sexually-transmitted-infections-yorkshire-and-humber-data
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Guidance: The wellbeing of 15-year-olds: analysis of the What About YOUth? survey

The 2014 What About YOUth? (WAY) survey included measures of wellbeing which can be analysed to examine the relationships between health behaviours and attitudes on the wellbeing of 15-year-olds.

This report highlights 4 main findings:

1. Young people who engaged in behaviour which might harm their health such as drinking and smoking, having poor diet or exercising rarely, or who had negative feelings towards their body size reported lower wellbeing than those who did not.
2. Self-reported wellbeing varied depending on the relative affluence or deprivation of the family, with those whose families were in more affluent groups and living in the least deprived areas reporting higher average wellbeing.
3. Young people who stated that they had a disability, long-term illness or medical condition reported lower wellbeing than those who did not.
4. Young people who described their sexual orientation as gay, lesbian, bisexual or ‘other’ were more likely to have lower wellbeing than those who declared themselves heterosexual. On average these young people also reported lower life satisfaction and happiness, and higher anxiety.

Commissioners and providers of health, social care and education can use this information to target local resources where they are likely to have most impact in terms of improving the wellbeing of young people.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/publications/the-wellbeing-of-15-year-olds-analysis-of-the-what-about-youth-survey
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Research and analysis: Notifiable diseases: causative agents report for 2018

Updated: Added report for week 2, 2018.

This report compares the current week’s data on statutory notifications of causative agents to that of the previous 5 weeks.

Older weekly NOIDS causative agents reports are also available:

• 2017
• 2016
• 2015
• 2014

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/publications/notifiable-diseases-causative-agents-report-for-2018
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Collection: Health equity

These resources can help local authorities, commissioners and decision makers make plans to reduce inequalities in health.

If you have any queries or comments on the Health Equity collection page, please contact the Health Equity team at health.equity@phe.gov.uk.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/collections/health-equity
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Collection: Teenage pregnancy

The teenage pregnancy prevention framework and the framework for supporting teenage mothers and young fathers are designed to:

• help local areas assess their local programmes to see what’s working well
• identify any gaps in services
• strengthen the prevention and support pathways for all young people, young parents and their children

Both frameworks provide an evidence-based structure for a collaborative whole system approach to prevent teenage pregnancies and support teenage parents.

The teenage pregnancy narrative reports bring together key data and information for local authorities to help inform commissioning decisions to reduce unplanned teenage conceptions and improve outcomes for young parents.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/collections/teenage-pregnancy
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Guidance: Teenage pregnancy prevention framework

This framework aims to help local areas assess their teenage pregnancy prevention programmes to:

• see what’s working well
• identify any gaps
• take a multi-agency whole-system approach

to prevent unplanned pregnancies and support young people to develop healthy relationships.

A Powerpoint version of the teenage pregnancy prevention framework is also available to download.

The teenage pregnancy narrative reports bring together key data and information for local authorities to help inform commissioning decisions to reduce unplanned teenage conceptions and improve outcomes for young parents.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/publications/teenage-pregnancy-prevention-framework
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News story: Avian flu found in wild birds in Dorset

Bird flu has been detected in 17 wild birds in Dorset, the Department of Environment, Food and Rural Affairs has confirmed today, with more expected over the coming days.

This is the first confirmed finding of the virus in the UK this winter and tests have shown it is closely related to the H5N6 strain that has been circulating in wild birds across Europe in recent months. This is different to the strains which affected people in China last year and Public Health England have advised the risk to public health is very low. The Food Standards Agency have said that bird flu does not pose a food safety risk for UK consumers.

UK Chief Veterinary Officer, Nigel Gibbens, said:

This is the first time avian flu has been identified in the UK this winter and while the disease does not represent a threat to the public, it is highly infectious and deadly to birds.

As the virus has been circulating across Europe, this finding has not come as a surprise. But it is vital that anyone who keeps birds - whether a few in a back garden or thousands on a farm - is vigilant for any signs of disease, reports suspect disease to APHA and maintains good biosecurity to reduce the risk of their birds becoming infected.

While there is no legislative requirement to put restrictions in place when this strain of virus is found in wild birds, the Chief Veterinary Officer has confirmed local measures will be introduced to help manage the potential threat.

A local ‘avian influenza prevention zone’ will be introduced in the area of Dorset where the diseased birds were found. This means it will be mandatory for all captive bird keepers to put enhanced biosecurity measures in place such as feeding and watering birds indoors to minimise mixing with wild birds, minimising movement in and out of bird enclosures, cleaning and disinfecting footwear and keeping areas where birds live clean and tidy. This will be in place until further notice and will be kept under regular review as part of our work to monitor the threat of bird flu.

There are no plans to carry out any culls or put movement restrictions in place.

The risk to domestic poultry nationally remains low, however good biosecurity is essential and bird keepers across the country are reminded to follow our biosecurity advice which includes specific advice for keepers of backyard flocks.

Poultry keepers and members of the public should report dead wild birds to the Defra helpline on 03459 33 55 77 and keepers should report suspicion of disease to APHA on 03000 200 301.

Trade should not be affected following the findings in wild birds, according to the rules of the World Animal Health Organisation (OIE).

Background

1. The risk to poultry and other captive birds depends, amongst other things, on the level of biosecurity on the premises and the likely contact between kept birds and wild birds, which is why it is essential that all keepers remain vigilant and ensure they practice the highest standards of biosecurity.
2. Find out if you are in the local ‘avian influenza prevention zone’ by typing in your postcode
3. Keep up to date with the latest Avian Influenza situation
4. For media queries contact Defra press office on 020 8225 7618 or out of hours on 0345 051 8486.

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Research and analysis: Cancer in the South East

These reports give care providers and policy makers an insight into the burden of cancer - measured in terms of the number of people affected, deaths and survival - for the 4 Cancer Alliance regions in South East England:

• Kent and Medway
• Surrey and Sussex
• Thames Valley
• Wessex

The reports also comment on some identified risk factors and screening.

They are aimed at Cancer Alliances to support commissioners of health services to provide more timely diagnoses and improve treatment pathways. As well as local authority commissioners looking at the wider prevention agenda.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/publications/cancer-in-the-south-east
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News story: UK flu levels continue to increase according to PHE statistics

The latest Public health England (PHE) statistics published at 14.00 today show that seasonal flu levels have continued to increase in the last week across the UK.

The statistics show over the last week there has been a 78% increase in the GP consultation rate with flu like illness, a 50% increase in the flu hospitalisation rate, and a 65% increase in the flu intensive care admission rate. The main strains circulating continue to be flu A(H3N2), A(H1N1) and Flu B.

PHE and the Department for Health this morning launched the ‘Catch It, Bin It, Kill It’ campaign. The campaign includes radio, press and digital advertising to inform the public about the steps they can take to protect themselves and reduce spread of the virus by practising good respiratory hand hygiene. Dr Paul Cosford, Medical Director of PHE, Sir Bruce Keogh, Medical Director of NHS England and the Chief Medical Officer Dame Sally Davies have also written to all frontline healthcare workers to encourage them to take up the offer of the vaccine if they haven’t already.

The flu virus can live for many hours on hard surfaces and therefore practising good hand hygiene can limit the spread of germs and transmission of flu. People are advised to catch coughs and sneezes in a tissue, bin it, and then wash their hands afterwards to kill the germs. Practising good hand hygiene and giving eligible people the flu vaccine is the best defence against the virus.

Professor Paul Cosford, Medical Director, Public Health England said:

Our data shows that more people are visiting GPs with flu symptoms and we are seeing more people admitted to hospital with flu.

We are currently seeing a mix of flu types, including the A(H3N2) strain that circulated last winter in the UK and then in Australia. The A(H3N2) strain particularly affects older, more vulnerable age groups.

We encourage anyone who is eligible to take up their offer of the flu vaccine – it is not too late. People suffering with flu-like symptoms should catch coughs or sneezes in tissues and bin them immediately, wash their hands regularly with soap and warm water and frequently clean regularly used surfaces to stop the spread of flu. Avoid having unnecessary contact with other people if you or they have symptoms of flu.

Seasonal flu usually circulates for several weeks each year. The intensity of circulation depends upon the underlying population immunity, the circulating viruses and external factors such as the weather. It is an unpredictable virus and it is not possible to anticipate how flu levels will progress.

Amongst other diseases like norovirus that normally increase during winter, seasonal flu puts extra pressure on the NHS every year.

The latest data is available online. Currently, 71.3% of adults over 65, 46.9% of adults with a long-term health condition, 45.5% of pregnant women, 40.8% of 3-year-olds and 42% of 2-year-olds have received the vaccine.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/news/uk-flu-levels-continue-to-increase-according-to-phe-statistics
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Research and analysis: Remote health advice: weekly bulletins for 2018

Monitoring patterns in phone calls to the NHS 111 service each day across England, to track the spread of infectious diseases like flu and norovirus. These data provide early warning of community based infectious diseases.

Weekly bulletins are also available for:

• 2017
• 2016
• 2015
• 2014

Past reports are available from the HPA archive.

from Public Health England - Activity on GOV.UK https://www.gov.uk/government/publications/remote-health-advice-weekly-bulletins-for-2018
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