Research and analysis

HPR volume 9 issue 21: news (19 June)

Updated 29 December 2015

1. Public health in prisons and secure settings: annual report

PHE’s recently published Health and Justice Annual Report 2014 [1] is the first comprehensive report on prison health in England and Wales since Health Protection in Prisons 2009-10, published by the then Health Protection Agency in 2011 [2].

Since that time legislative and policy changes have significantly expanded the scope of governmental activity relating to the health and welfare of prisoners, detainees and others in contact with the criminal justice system.

In particular, the Health and Social Care Act 2012 gave NHS England new responsibilities for commissioning health services in these settings, while the Care Act 2014 gave local authorities new responsibilities (with effect from April 2015) for assessing and meeting the social care and rehabilitation needs of those groups (when they are resident within their jurisdiction).

The background to, and consequences of, these developments are described in the new report, as is the far broader remit of PHE in this area compared with that of the HPA.

PHE’s health and justice team provides guidance and tools to support NHS England in fulfilling its public health commissioning responsibilities, and to other involved agencies, such as the National Offender Management Service (NOMS). The health and justice team, which has specialists located in PHE Centres, is part of the population healthcare division of the health and wellbeing Directorate and will produce reports annually in future about its activities.

A significant component of the new health and justice report comprises national and local data on communicable disease cases and outbreaks in places of detention in England. This includes reports on tuberculosis, BBVs, hepatitis and gastrointestinal infections and also on measures to control substance misuse. The infections data is produced by the Public Health Intelligence in Prisons and Secure Settings Service (PHIPS) that was originally established in 2002 (as the Prison Infection Prevention Team) to monitor the coverage of hepatitis B vaccinations within the prison population. Now part of the national health and justice team, the scope of PHIPS surveillance activity has significantly expanded and includes supplying data to support health needs assessments and recently introduced health performance quality indicators for prisons and young offender institutions (to be followed by separate indicators for other secure settings such as police custody suites and immigration removal centres).

The great majority of infections reported to PHIPS in 2014 were blood-borne viruses (BBVs). Hepatitis C virus in the prison population is significantly higher than in the population as a whole (8% vs 2%) – accounting for by far the greatest proportion of all infections reported to PHIPS.

Improved testing for hepatitis and other BBVs has led to a doubling of the total number of reports of individual cases of infectious disease in the prison population being recorded since 2011 (1268 compared with 549). However, at the same time, evidence of progress being made in identifying and treating BBVs is presented: the first results of the phased implementation of a new policy on BBVs testing in prisons – aimed at better identifying those who would otherwise remain undiagnosed – has led to a significant increase in the numbers being tested. In 2014, 21% of new entrants to prisons were tested for hepatitis C (compared to 11% previously), and 22% for hepatitis B (compared with 12% previously), the new report notes [3].

Further information about the issues covered by the report are available via the Public Health in Prisons and Secure Settings health protection collection webpages.

1.1 References

1. PHE (June 2015). Health and Justice annual report 2014.
2. HPA (2011). Health protection in prisons 2009-10 report.
3. “Hepatitis cases responsible for 93% of prison disease reports”, PHE press release, 15 June 2015.

2. Mandatory HCAI reports quarterly trends: January to March 2015

PHE’s latest quarterly epidemiological commentary on trends in reports of Staphylococcus Aureus (MRSA and MSSA) and E. Coli bacteraemia, and of Clostridium Difficile infections, mandatorily reported by NHS acute Trusts in England up to January-March 2015, has been published on the GOV.UK website [1].

The report, including tabular and graphical information, provides data for the January-March 2015 quarter (updating the previous report published in March 2015). Some key facts are listed below.

2.1 MRSA bacteraemia

The total number of MRSA bacteraemia has increased in the current quarter (January to March 2015, n=225) when compared to the same quarter in the previous year (January to March 2014, n=206) and the immediate previous quarter (October to December 2014, n=213). Furthermore, the number of Trust assigned MRSA bacteraemia has decreased 9.4% from 106 in January to March 2014 to 96 in January to March 2015. However, in the same time period the number of CCG-assigned MRSA bacteraemia increased by 6.0% from 100 to 106.

2.2 MSSA bacteraemia

October to December 2014 saw the highest number of MSSA bacteraemia since the inception of the mandatory surveillance programme in January 2011 (n=2,571). The total number of MSSA bacteraemia has increased by 4.6% in the current quarter (January to March 2015, n=2,514) when compared to the same quarter in the previous year (January to March 2014, n=2,404). However when compared to the immediate previous quarter (October to December 2014, n=2,581) it decreased by 2.6%.

2.3 E Coli bacteraemia

A 1.0% increase has been observed in the rate of E. Coli bacteraemia reports when comparing the current quarter (January to March 2015) with the same quarter of the previous year (January to March 2014) from 63.09 to 63.75 reports per 100,000 population, with an overall increase of 5.4% since October to December 2011 (from 60.50 to 63.75 reports per 100,000 population).

2.4 C. Difficile infection (CDI)

From January to March 2014 and January to March 2015 there was a 12.7% increase in the counts of CDI from 3,006 to 3,388. This is now the fourth consecutive observed increase in all reported C. Difficile infections, when comparing to the same quarters in the previous years.

2.5 Reference

1. PHE (11 June 2015). Quarterly Epidemiological Commentary: Mandatory MRSA, MSSA and E. coli bacteraemia, and C. difficile infection data (up to January-March 2015).