All nurses, especially those in community settings, have been called on to be aware of the signs and symptoms of tuberculosis, which is making a concerning comeback in some parts of the country.
Professor Viv Bennett, director of nursing at the Department of Health, said TB was “clearly on our radar”, noting that it was one of the priority areas in the new public health nursing framework launched in July.
“It’s about all nurses… being really aware of the early signs and symptoms of TB, knowing who the vulnerable groups are, making sure they get them on to get screened – so it’s a real end to end approach,” she said.
“That’s the kind of thing we’re trying to convey through the framework,” she told Nursing Times at a recent public health nursing conference in Birmingham.
“We’re actually exporting cases of TB to Pakistan, which is a shameful position”
Earlier at the conference, which was organised by the DH and Public Health England, she explained that the framework included specific information on TB.
“For some themes and topics that are current national priorities we have got worked examples, and there is one on TB,” she said.
Meanwhile, health minister Dan Poulter told Nursing Times it was a problem in particular communities and parts of the country, especially urban areas. He said it was a “key challenge going forward” to raise awareness of the disease outside of acute settings.
“We need to move away from …dealing with TB when it’s manifest to actually saying how can we work in the community to raise awareness of TB – to talk to people as early as possible, and understand the importance of recognising where we can prevent TB in the first place,” he said. “That’s a key challenge going forward.”
Speaking to Nursing Times, Dr Poulter suggested the successful transfer of public health funding to local authorities would be vital to achieving this goal.
“It’s about raising that community awareness and getting that commissioning between local authorities and the NHS right – making sure we continue to have a community workforce and a public health workforce that has the knowledge and skills to get the engagement right and also to get the early prevention right.”
He added: “That’s something that’s very much at the heart of what’s going on – that maybe about having bespoke training courses for health visitors or it may be about continuing that investment that we’re doing in more community and district nurses.”
“It’s about all nurses… being really aware of the early signs and symptoms of TB”
Opening the conference earlier in the day, Public Health England chief executive had described the UK as being in a “shameful position” on TB.
“In the next year we will overtake the whole of the US in new cases of TB,” he said. “We’re actually exporting cases of TB to Pakistan, which is a shameful position, so we’re going to have to deal with this.”
“We know how to do this… [but] what we’ve done [before] we’ve forgotten,” he said. “We’ve not been paying attention. We need to re-remember and get on top of TB again.”
Mr Selbie suggested efforts to control the rise in TB would focus on “case finding and then case management”.
“What we’ve forgotten isn’t so much the case finding, but the case management,” he added, noting that treating a patient with typical TB took six months and up to two years for someone with the drug resistant form of the disease.
Mr Selbie said a collaborative plan on tackling TB was currently being developed and consulted on, which would be ready by October.
“It’s everybody’s business about how we get together and focus on the most important things – whether you’re in NHS secondary care, or primary care, or in local government or in a voluntary sector placement,” he said.
Sue Hartly, executive director of nursing at Birmingham and Solihull Mental Health Trust, noted that she had seen TB “coming through the mental health arena”.
“We desperately need a more effective vaccine that we could then use more widely”
She asked whether it was feasible that the NHS would return to immunising children with the BCG (Bacillus Calmette-Guérin) vaccine at the age of 14.
Sarah Murphy, a TB nurse specialist with Public Health England, told delegates that reintroducing BCG vaccination for teenagers was “definitely not the answer to our TB epidemic”.
“The problem with BCG is that it’s not as effective as most of the other vaccines we have,” she said. “It’s now given at birth because its main use is that it can prevent children from developing TB meningitis.
“They first brought it in for 14-year-olds because that was the time they left schools and went to work in factories, but obviously that’s not applicable to our education system now,” she said.
“It’s really important that people know that even if they’ve had the BCG they can still get TB,” she added. “We desperately need a more effective vaccine that we could then use more widely.”