Part 2A survey results 2015
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Transcript of Part 2A survey results 2015
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PART 2A SURVEY RESULTS 2015
Presented by Amber ArnoldInfectious Diseases and Microbiology SPR
St George’s Hospital
With thanks to Daniel Philips
Graham Bickler
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Survey
• Aim: understand the use and utility of Part 2A orders since inception in 2010 to current August 2015.
• Objective: undertake a web based survey of public health consultants (PHCs) and environmental health officers (EHOs) and review results and discuss need for legislative change with participants at a half day workshop.
• Method: select survey written. Redacted part 2 A order requests used to identify PHCs and EHOs who had lead on order requests.
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Numbers and types of Applications by year
2010 2011 2012 2013 20140
5
10
15
20
25
Part 2A since introduction
PlaceThingPerson
Year
Number
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Thing-
• 23 orders (13 Blackpool, 3 Yorkshire, 7 other)
1 Piercing equipment 22 Tattoo equipment
0 re-applications
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premises
premises Infection risk aim
Petting farm
E coli 0157 Close farm
LA self-contained flat
Faecal contamination
Move out tenant for cleaning
house BBV Covert visit for seizing tattoo equipment
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Section 38 detention orders controlled by pulmonary tuberculosis notification rate and health authority response rates in England and Wales, 1994–9.
R J COKER Thorax 2001;56:818
Copyright © BMJ Publishing Group Ltd & British Thoracic Society. All rights reserved.
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29 person orders28 TB, 1 HIV Median age
38 yearsIQR 28.5-42.5
Male 93%Female 7% (n=2)
White British 41%White other 21%Black African 14%Unknown 10%Pakistani 7%Indian 7%
TB type*MDR/XDR 28%Sensitive 41%Unknown 31%
* From redacted forms
RenewedNo: 24%Yes: 62% (median 1, range 1-7)Unknown: 14%
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person
Homeless Mental health Drug/Alcohol Non-compliance Agression Prison Chaotic life0
2
4
6
8
10
12
14
16
18
20
Reason for Application
Reason
Number
More than one allowed per application
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person
undergo m
edica
l exam
ination
be tak
en to
hospital
be deta
ined in
hospital
be kep
t in iso
lation
be disin
fected
or deco
ntaminate
d
wear pro
tective
clothing
provid
e inform
ation
have h
ealth
monito
red an
d resu
lts rep
orted
atten
d train
ing
subject to
restr
ictions
absta
in from worki
ng 0
5
10
15
20
25
Powers requested
Powers
Number
More than one allowed per application N=25
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person
PHE clinician PHE+clincian PHE and EHO PHE, EHO, Clinician0
2
4
6
8
10
12
Order initiated by
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person
Home visits phone calls MDT LA legal team police psychiatric review no response0
2
4
6
8
10
12
14
Prior to application
More than one allowed per application
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Person- issues obtainingMost positive responses were positive without any difficulties
Difficulties reported were:• Transfer of patient identifiable data (PID) between parties
(LA, PHE etc)• Coordination of reports between parties- (LA no secure fax)• In court: tensions emerged between parties surrounding
requirements
No one requested extra powers
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Person - difficulties implementing
• Resources: negative pressure bed, ambulance, police• Inter agency coordination: ambulance, police, bed,
PHE physician, • Accountability and roles: Refusals by Ambulance
/police/hospital chief exec./patient, who funds bed/guard
• Patient based: missing, fear of violence from, refusal by,
• Hospital based: Drug and alcohol use and ‘cigarette breaks’, mental health needs while infectious, role of guards, retrieval on absconding
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Person- police involvement
yes59%no
21%
unknown21%
police in-volvement
• Most: Excellent support, very helpful
• PPE- wrong information, refusal due to infection risk, who is responsible for information, need for CCDC in person
• Police Time- 11 days to locate one person, repeated absconding, how many times
• Police van- unsure if patient can go in van
• Level of force- unsure what level
• Where the police can pick patient up from with the order (refused to pick up from street)
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Person-what did it hope to achieve
• Quarantine until completed RX (7 renewals)• Time to organise other services (etoh, home
etc)• Stabilise chaotic life (3 renewals)• Tell us about contacts • Detain while police preparing criminal charges• Protect specific contacts
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Person- outcomesAchieve aims: 1 no (HIV case)Protect public health: 2 no (HIV, TB Birmingham)
positive but limited • by case selection bias
• Participant
Comments quite negative:
‘These orders are only used when everything else has failed and to have an order with no sanctions is going to achieve very little as we found out.’
‘at best a temporary solution’
‘contentious from human rights perspective’
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Summary
• Major use is for person infected with TB• Use for persons stable (decreasing?)• Implementation difficult• Questions around enforcement powers