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