The report identified several areas and these are listed below:
- There was a delay in the diagnosis of the first person who contracted TB meant that they were highly infectious for a long period of time.
- The initial response – that is, starting an Outbreak Control Team (OCT)*, and undertaking contact tracing (identifying people who may have come into contact with the disease) was inadequate, and did not extend contact tracing sufficiently. Some people who had TB were not identified, and went on to infect others.
- The initial OCT in phase 1 of the response was closed down too early, and was re-opened three times as more cases appeared.
- Following the first two phases of the TB outbreak, public health management improved substantially.
- Though deemed satisfactory, the clinical management of individual patients with TB at the beginning of the outbreak was uncoordinated because of the lack of a dedicated TB service and a lead clinician.
- Local respiratory healthcare provision was inadequate, now largely addressed with appointment of a lead Consultant (Doctor) and TB Specialist Nurse, but some improvements are still needed to make this even better.
- Although Hywel Dda UHB had the statutory responsibility for outbreak control, it should have been subject to oversight from Public Health Wales.
- A Public Health Wales review recommendation which was that outbreaks require a more structured approach is yet to happen.
- Wales does not have a National Strategy for Tuberculosis (TB). Although one has been proposed by the Welsh Respiratory Delivery Group, so far it has not been adopted by either Public Health Wales or the Welsh Government. Last week, the Welsh Government published a new range of actions to help prevent and control TB in Wales. You can see this announcement here.
*An Outbreak Control Team is a team of people from different agencies, such as Public Health Wales, the local health board, the local authority and any other relevant organisations. They are in charge of managing an outbreak of an infectious disease and are responsible for bringing it under control. The OCT works with the Communicable Disease Outbreak Control Plan for Wales.
- What is the Communicable Disease Outbreak Plan for Wales?
This plan is used to manage all outbreaks of communicable disease in Wales. It forms part of the Framework for Managing Major Infectious Disease Emergencies and links with Wales Resilience Emergency Civil Contingency plans and structures.
The Communicable Disease Outbreak Plan for Wales facilitates the establishment of an Outbreak Control Team (OCT). The OCT is a collaborative arrangement between organisations operating to the processes set out in this plan.
The Communicable Disease Outbreak Control Plan defines the roles and responsibilities of the OCT and all of the organisations involved (See Part 2 and Part 3). A Chair of the OCT is appointed at the first meeting. The plan is subject to regular review and improvement. The most recent review was completed in 2022, following lessons learnt from the Covid-19 pandemic response across Wales. A further detailed review is scheduled for 2023.