Race Against TB: Halting TB surge requires centralised commissioning

13 October 2010

Specialised commissioning for tuberculosis services should be introduced to reverse the increase in cases over the past 20 years, according to the Race Against TB report, published today by TB Alert and Race for Health.

The recommendations follow a summit of 100 NHS leaders and senior figures in social care in June, which heard that, if current trends continue, TB cases in Britain will soon exceed those in the US, which has five times this country’s population.

The Race Against Tuberculosis report also calls for retraining of clinicians who fail to spot cases of TB. It recommends that most patients should receive Directly Observed Therapy (DOT) – where a health worker is present when people take their medication – to increase compliance and tackle drug resistant TB, which threatens to make treatment ineffective. The controversial measure was key to success in cutting rates in New York, where a TB epidemic threatened in the 1990s.

Mike Mandelbaum, Chief Executive of TB Alert, said:
‘TB is a crucial public health issue, and one that the UK has struggled to address successfully over recent decades.  Most TB patients are not diagnosed as a result of visiting their local surgery, and GPs will not have the expertise to effectively commission TB services. That is why London’s TB commissioners recently called for TB services to be commissioned at a regional level, and this advice this should be reflected in all parts of the country.’ (CSL, 2010)

Today’s report, which will go to Andrew Lansley, Secretary of State for Health, warns that long-term underfunding for TB services must be tackled and says that London, which is in the World Health Organisation’s top incidence band for TB cases, should have centralised commissioning, which requires firm backing from Boris Johnson, the Mayor of London and London’s Director of Public Health.
The Summit which led to today’s report was a partnership between Race for Health, a DH-sponsored programme to improve health in BME communities, and TB Alert, the key partner of the DH in raising awareness about TB, and was supported by London TB Commissioning and the Department of Health. 

Professor Helen Hally, National Director of Race for Health, said:
‘The incidence of tuberculosis in Britain and its steady increase over the last 20 years - with the impact experienced disproportionately by black and minority ethnic (BME) communities – is unacceptable. Tackling TB properly needs firm commitment to challenging race inequality. This report demonstrates how dealing with inequality can be the most cost effective way of improving health for everyone. This is a mainstream, not a side, issue.’

The Government has acknowledged that tuberculosis can be a costly public health and economic issue if not effectively managed (DH, 2007).  The majority of new cases, in London and elsewhere, arise in socially and economically disadvantaged communities and those from newly arrived racial minorities.   Over the past 20 years there has been a steady increase in new cases in the UK, with 9,153 provisionally reported in 2009, a 5.5% increase compared with 2008 (HPA, 2010); 72% of cases were non-UK-born people and 78% were from non-white ethnic groups (HPA, 2010).

Nick Relph, Chair of the London TB Commissioning and Chief Executive, Hounslow PCT, and a contributor to the report, said: ‘TB is curable, but a lack of awareness is preventing many people from accessing treatment. A joined-up approach between local stakeholders and a more focused approach by the NHS could dramatically reduce rates of the condition.’

Notes for Editors:
TB Alert is a recipient of a Third Sector Investment Partnership grant from the Department of Health for raising awareness about TB. In February 2010, TB Alert launched ‘The Truth About TB’ programme. The programme brings together PCTs, local government, the voluntary sector and communities affected with TB, to encourage and support a partnership approach to raising awareness locally: www.thetruthabouttb.org. For more information contact: Helen Clegg Helen.clegg@tbalert.org  01273 234030, 07949 675033.

Race for Health, sponsored by the Department of Health, is at the cutting edge of good practice around race equality and health. TB is one of seven condition groups against which member PCTs measure their performance. www.raceforhealth.org.  For more information contact: Jack O’Sullivan jack@think-osullivan.com 07779 655585 

References:
1. Department of Health (2007) Tuberculosis prevention and treatment: a toolkit for planning, commissioning and delivering high-quality services in England.  London: Department of Health.
2. Health Protection Agency (2010) Tuberculosis Update, March 2010. London: Health Protection Agency and NHS London.
3. Commissioning Support for London (2010) London TB Service Review and Health Needs Assessment. London: Commissioning Support for London. (Calling for the establishment of a London TB Board of Control with full responsibility and accountability for the design, commissioning and delivery of TB services across the capital.)