Cynulliad Cenedlaethol Cymru

National Assembly for Wales

Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon

Health, Social Care and Sport Committee

Ymchwiliad i Hepatitis C

Inquiry into Hepatitis C

HSCS(5) H09

Ymateb gan Goleg Nyrsio Brenhinol Cymru

Evidence from Royal College of Nursing


Response from the Royal College of Nursing Wales to the Health, Social Care & Sport Committee’s inquiry into Hepatitis C


The Royal College of Nursing Wales is grateful for the opportunity to respond to this consultation and would like to raise a number of points in relation to the inquiry:

The action being taken to meet the requirements of the Welsh Health Circular and the target set by the World Health Organisation to eliminate Hepatitis B and Hepatitis C as significant public health threats by 2030

There are several initiatives operating in Wales which are helping to meet this aim:

The Wales Liver Disease Delivery Plan through which Health Boards aim to improve and review their liver services using six themes:

·         Preventing liver disease & promoting liver health

·         Timely detection of liver disease

·         Fast & effective care

·         Living with liver disease

·         Improving information

·         Targeting research

There are highly functional blood-borne viruses (BBV) networks across Wales which have a clear national vision.

Routine opt-out BBV screening operates across Wales. A systematic approach is also taken to BBV testing across ‘at risk’ population, and re-engagement for those previously diagnosed. Further investment is required in BBV teams however to ensure equitable and transparent access.

Rates of sustained virological response (SVR) are high, with effective treatment available in tablet form – these have minimal side-effects and above a 97% chance of eradicating the disease.

How the knowledge & awareness of the public and health professionals of Hepatitis C can be increased

Education, across the public sphere and within the health profession, is needed to help overturn negative messaging and dispel some of the myths about testing and treatment. Better education and awareness raising is also important in helping to reach those most at risk, especially the vulnerable groups such as the homeless and rough sleepers, who do not always engage with any healthcare sectors.

Increased collaboration with a number of different services/agencies would help increase knowledge and awareness. Some of these include; correctional services, substances misuse units, asylum seeker services, community pharmacies, primary care (GP surgeries), specialist secondary care (e.g. Haemophilia unit) and tier 3 services - for example, charitable organisations.

Health Boards should engage with and promote initiatives such as ‘World Hepatitis Day’ in conjunction with the World Hepatitis Alliance’s annual themes.

It is essential, in order to increase knowledge of health care professionals to have BBV training included in their pre & post graduate syllabus and induction for all new staff starting in all Welsh health boards.

Other examples of good practice which could be further invested and/or replicated across Wales:

·         Cardiff Hepatitis Support Network was launched in July 2017, providing an online information hub, along with an e-form for self-referral.

·         The Annual All Wales Hepatology Nurse Forum (AWHNF) testing and awareness raising roadshow which operates across Wales.

·         BBV training days held on a monthly basis and open to all staff across all sectors of health & social care who want to be involved in BBV testing in Cardiff & Vale.

·         All Wales Hepatology Nurse Forum annual conference, which is aimed at health professionals across wales.

·         The Cardiff & Vale UHB Hepatitis C social media campaign #GetTestedGetCured which has been effectively supported by the Health Board’s communications and media team. This is a long-term campaign which involves infographics being displayed on media screens across Cardiff & Vale UHB.

Increased awareness raising of BBVs amongst younger people is needed, for instance in schools, colleges and universities. This is vitally important as understanding the risks before embarking on risky behaviours may prevent the spread of infection.

The scope to increase community-based activity

There are many positive aspects relating to existing community-based activity such as:

            A complete map of community pharmacies across Wales that carry out needle exchange and ‘Opiate Substitute Therapy’ (OST) has been established. A BBV Pharmacist lead for Wales has been recruited to oversee and coordinate the national pharmacy projects in BBV screening & treatment. Cardiff have already performed some pilot projects in some community pharmacies with some positive outcomes.

The Harm Reduction Database developed by Public Health Wales as part of their Substance Misuse Programme captures Hepatitis (BBV) activity and risks in the community. Substance misuse services are required to complete these online database forms each time a client/individual is screened for BBVs. This is an ongoing project with progress still to be made but improvements have been seen following biannual Wales network meetings.

The scope to increase community-based activity includes:

Increasing access to portable fibroscanners; one fibroscanner is used and shared by the specialist nursing team across all the community services in Cardiff and Vale for instance. Having access to additional fibroscanners would enable more community clinics to use the technology in patient assessments.

‘Point of care testing’ (for example via Oraquick mouth swab) can enable teams to provide Hepatitis C antibody results within 30 minutes and initiate diagnosis or further testing and treatment options where required. A virology point of care testing lead based at University Hospital Wales has been able to oversee the roll-out of the scheme across Cardiff & Vale.

Working with homeless people, rough sleepers and other vulnerable groups such as the pilot project run in Cardiff in 2017 in conjunction with the Salvation Army & Cardiff Council night bus. A double-decker bus provided temporary shelter as well as equipment and volunteers to enable screening for BBVs and fibroscans with a view to improving liver health. Having specialist nursing teams with a presence in homeless shelters and hostels, drug and alcohol units, and prisons is also worthwhile.

Harm reduction advice is key to the prevention of acquiring BBVs and individuals at risk should be aware that following eradication, they can be re- infected with the virus if exposed to further risks.

The long-term viability of treatment programmes

Treatment has evolved hugely over recent years and is considered to be highly effective in the eradication of the Hepatitis C virus. There are many treatment options with Directly Acting Anti-viral (DAA) treatments all having an efficacy exceeding 97%.

The long-term viability of treatment programmes is dependent on several factors:

Cross-party political support in working towards eradication 2030 must be maintained, and Welsh Government funding for BBV services, medication and awareness raising programmes are essential if the eradication target is to be met.

Adherence to the DAAs is imperative as the risk of treatment failure and/or developing resistance may rise in the future. This can be a challenge in small groups of patients who are already vulnerable.

Annual All Wales Hepatology Nurse Forum (AWHNF) to continue to provide a link between the BBV services across the health boards in order to efficiently liaise when patients geographically move between treatment centres.

About the Royal College of Nursing

The RCN is the world’s largest professional union of nurses, representing over 430,000 nurses, midwives, health visitors and nursing students, including over 25,000 members in Wales. The majority of RCN members work in the NHS with around a quarter working in the independent sector. The RCN works locally, nationally and internationally to promote standards of care and the interests of patients and nurses, and of nursing as a profession. The RCN is a UK-wide organisation, with its own National Boards for Wales, Scotland and Northern Ireland. The RCN is a major contributor to nursing practice, standards of care, and public policy as it affects health and nursing. The RCN represents nurses and nursing, promotes excellence in practice and shapes health policies.