North Manchester General Hospital’s specialist team secures Hep C ‘micro-elimination status’ for three UK prisons
A specialist health team from North Manchester General Hospital has secured hepatitis C ‘micro-elimination status’ for three prisons where they provide an ‘in-reach’ service.
Micro-elimination status means that above 95% of the prison population have been tested and treated and a robust support package is in place for those people who declined.
At HMP Haverigg, in the South Cumbria, 99% of prisoners have been tested for the blood borne virus, hepatitis C. HMP Lancaster Farms outside of Lancaster and HMP Buckley Hall in Rochdale borough have also achieved this result with 99% and 98%, respectively.
The specialist team based at North Manchester General Hospital is part of the Northern Care Alliance NHS Group, which brings together Salford Royal and Pennine Acute Trusts under a group arrangement.
Hepatitis C is a blood borne virus that, if not treated, affects the liver. Injecting drug use is the highest risk factor associated with hepatitis C. As figures show, up to around 60% of people going into prisons are former or current drug users, it makes the prison population a high-risk group.
Progression of the disease varies according to different factors, for example, alcoholism can make the disease advance faster. There are also different strains of hepatitis C which determine which therapy can be prescribed. Some people will be unaware they have it and therein lies the risk of it being inadvertently transmitted to a wider population.
Jayne Bennett, Hepatitis Specialist Nurse NMP for Prisons at North Manchester General Hospital, explained the impact of testing on prisoners’ lives. She said: “It is life changing. There are not many areas of medicine where we can say from the outset ‘we’ve got a 97% chance of a cure here’.
“For some prisoners, they’ve never completed anything, so when they complete this and when you see them three months after treatment and you tell them they are cured it has a powerful impact. These are grown men and they cry because they then think ‘right, I can move on, I can get out of here and start looking after my kids’. It’s huge. I find it incredibly rewarding, all the team does.”
HMP Haverigg prison is among the first sites to hold this status in England, with credit going to the hepatitis C team at North Manchester General Hospital in leading implementation of testing events.
HMP Haverigg was officially given the status from NHS England and NHS Improvement (NHSEI), which is now one body, earlier in September 2019 which is evidence that the ‘In-reach Manchester model’, as it is known, is delivering results.
HMP Haverigg, HMP Lancaster Farms and HMP Buckley Hall, HMP Manchester, HMP Forrest Bank and HMP Styal, all come under North Manchester’s care. HMP Hindley in Wigan is also supported by the secondary care service at North Manchester for testing events to supplement their mandatory testing requirements.
Talking about the benefits of an ‘in reach’ service, Jayne added: “Historically, prisoners had to come out of the prison to have their hepatitis C treated and managed. They would have to come out handcuffed to officers, sitting in our outpatients department - the patient experience wasn’t right.
“I came into post and started going into prisons through an in-reach service and found the numbers being treated increased.
“We were recognised nationally by the World Health Organisation and the Hepatitis C Trust and basically became known as the ‘In-reach Manchester Model’ which influenced the way others now set up their own services.”
NHSEI, the National Offender Management Service (NOMS) and Public Health England (PHE) published their National Partnership Agreement in 2013. Included in this was a commitment to deliver an opt-out testing model for blood borne viruses.
Having three micro-elimination sites is the result of a team effort. While Jayne’s focus is prisons treatment management, Marie White, is their testing lead and Sandra Bell, Clinical Assistant and Clinical Justice Liaison, spends her time within the prison walls holding awareness events and carrying out their thorough testing programme.
Sandra’s influence can often be the difference between a prisoner choosing to be tested or not. It is a role that gives her an enormous sense of pride.
“I’m passionate that everyone should be treated the same regardless of what they have done in terms of criminality,” Sandra said. “For some, being clear of hepatitis C gives a purpose for them being in prison - that they’ve achieved at least one thing.”
The team is aiming to gain elimination status in all its prisons and want to test and treat 100% of prisoners in all 6 of sites. Currently 3 sites have achieved and maintained 99% elimination status. 1 site is at 92% and the remaining 2 are above 80%.
Pictured: Meet the North Manchester nurses who are giving prisoners hope for a virus free future L-R Marie White, hepatitis testing lead, Sandra Bell, senior clinical assistant and Jayne Bennett, hepatitis specialist nurse