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Plea to retain TB nurse expertise as diagnoses hit record low

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The skills of specialist tuberculosis nurses must not be cast aside as headway is made on eradicating the disease in England, a leader in the field has warned.

TB nurse specialist Stacey Farrow issued the plea as latest official figures released today showed that new cases in the country have hit a record low.

“That will only continue to happen while we have dedicated, experienced TB nurses in place”

Stacey Farrow

Data from Public Health England reveals a 44% drop in new diagnoses from a peak in 2011 of 8,280 to 4,672 in 2018 – the lowest since tracking began in 1960.

Ms Farrow told Nursing Times the expertise of TB nurses needed to be retained to ensure progress continued and to also support the wider workforce who may become “deskilled” in dealing with the condition as patient numbers decreased.

“It’s really, really key at this point when we really are starting to win the battle and numbers are going down that we keep the emphasis on the workforce out there,” said Ms Farrow, who heads up the TB team at Northern Care Alliance in Manchester.

However, she said the decommissioning of TB nurses was “definitely a worry” and highlighted how in some areas these specialists were already being asked to step into different roles. 

“I know locally that in one service TB nurses are being asked to work in other clinics,” said Ms Farrow, who has spoken to Nursing Times ahead of World TB Day on Sunday. 

stacey farrow

stacey farrow

Stacey Farrow

“A lot of TB nurses may come from a respiratory nurse background or an infection control background, and I know already that some TB nurses are being asked to re-step into that role and that’s something we are trying to prevent,” she added.

She highlighted how many of those with TB now would be described as “hard to reach” or “underserved” and were in need of enhanced support. These include people who are homeless, those in the prison community, substance misusers and migrants.

Figures show the most deprived 10% of the population have a rate of TB more than seven times higher than the least deprived 10%, and people born outside the UK have a rate 13 times higher than those born in the UK.

TB is treatable but requires a six-month course of antibiotics and Ms Farrow described how the role of the TB nurse specialist often crossed over with social work as they sought to keep track of their patients.

If treatment is not completed correctly, the risk of the disease returning and becoming drug-resistant and harder to combat is heightened.

“If you think of that demographic of people, they are quite moveable so they can move around areas,” Ms Farrow told Nursing Times.

“It’s not unusual if someone is not taking the treatment for us to be out and about trying to find them,” she added.

Ms Farrow said nurses also faced “denial” from some patients about having the TB because they believed it was a disease of the past.

The other difficulty was getting the patient to disclose the names and contact details of those they had been in contact with and may have passed the disease on to, Ms Farrow said.

“It takes quite a lot of hard work working with people to encourage them to give us the contacts that need screening as well so that’s quite hard work in this group of people because they are very reluctant sometimes and sometimes they don’t know the names of the people they hang out with,” she said.

While TB nurses were usually based in a hospital setting, Ms Farrow told how they would work closely with outside organisations including homeless hostels and housing associations in their jobs.

Ms Farrow credits the success in bringing down the numbers on PHE and NHS England’s five-year TB strategy for England, which was published in 2015.

She said this “helped focus TB control” and also introduced new measures to tackle the disease including systematic screening of all new entrants into England from areas with high incidence rates.

The strategy also established regional TB control boards to co-ordinate and oversee work in this area, and Ms Farrow is the lead nurse for the North West committee.

England is working towards the World Health Organization’s goal to halve TB incidence by 2025 and ultimately eliminate the disease.

Looking ahead, Ms Farrow said there would be a case for reassessing the skill mix in the TB nursing team.

She highlighted how some areas already had social workers and drug and alcohol professionals linked with their service and to carry out some of the non-clinical duties - and she believes this should become more routine. 

However, she stressed: “I certainly wouldn’t like to see the number of TB nurses going any less than it is and I think that’s definitely a skill that we need to keep.”

“It is hugely encouraging to see a continued decline in TB cases in England”

Sarah Anderson

As the number of active TB cases dropped, Ms Farrow said the role of the TB nurse needed to shift to also focus on latent – or sleeping – TB. Around 10% of latent TB cases will turn active and therefore infectious to others.

She said it would a “shame” if commissioners and trusts assessed their workforce need only on the number of active cases of TB in their population.

“The emphasis for the UK has got to be on latent TB treatment and managing our active case appropriately and that will only continue to happen while we have dedicated, experienced TB nurses in place,” she told Nursing Times.

Ms Farrow said the quest also needed to continue to find a better TB vaccine. The current one in use by the NHS – the BCG – is no longer given routinely and is not thought to be very effective in adults.

“TB numbers across the world may continue to go down but going forward vaccination has got to be the way forward,” Ms Farrow said.

“There are lots of trials across the world at the moment going on, I’m sure in the future we will see an effective vaccine – I would like to think,” she added.

Dr Sarah Anderson, head of TB strategy at PHE, welcomed the decline in cases but said the push needed to continue.

“It is hugely encouraging to see a continued decline in TB cases in England which shows that the interventions we are putting in place are having an impact,” she said.

“However, TB still affects nearly 5,000 people a year in the UK and many people are simply unaware of the symptoms and impact of the disease,” said Dr Anderson.

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