PART 2A SURVEY RESULTS 2015
Presented by Amber ArnoldInfectious Diseases and Microbiology SPR
St George’s Hospital
With thanks to Daniel Philips
Graham Bickler
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.
Numbers and types of Applications by year
2010 2011 2012 2013 20140
5
10
15
20
25
Part 2A since introduction
PlaceThingPerson
Year
Number
Thing-
• 23 orders (13 Blackpool, 3 Yorkshire, 7 other)
1 Piercing equipment 22 Tattoo equipment
0 re-applications
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
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.
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%
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
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
person
PHE clinician PHE+clincian PHE and EHO PHE, EHO, Clinician0
2
4
6
8
10
12
Order initiated by
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
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
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
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)
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
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’
Summary
• Major use is for person infected with TB• Use for persons stable (decreasing?)• Implementation difficult• Questions around enforcement powers
Recommended
