Health and Social Care Committee

Inquiry into the measles outbreak 2013 - Written Evidence from Neath Port Talbot County Borough Council

 

Background

On Wednesday, 27th March, 2013, the Authority, along with Swansea and Bridgend Council’s received an urgent invitation to send representatives to a joint agency meeting as concern was escalating regarding the number of reported Measles cases in the Swansea, Neath and Port Talbot region.

 

The Director of Education of Neath Port Talbot Council took the decision that given the concern being expressed by health professionals a representative needed to attend.  I attended all meetings throughout the campaign to represent the County Borough Council.

 

The meeting was given Silver Group status under the ABMU emergency planning/response procedures.  It became evident fairly soon of the seriousness and severity of the problem being faced by health colleagues.

 

Figures presented to us outlined how there were 7,500 susceptible children in the ABMU health region, 139 schools reporting at least one case, 500 people confirmed as having Measles and 51 people in hospital.  Members of the Silver Group were informed that whilst the media were reporting the increase in confirmed Measles cases it was not having a significant enough impact with additional people coming forward to be vaccinated.

 

Concern was shared amongst the group that with the onset of the Easter holiday period children for one school/community would be mixing with children from others and this posed a real threat of the outbreak spreading further afield.

 

The action agreed at the first Silver Group meeting was:

  1. To create three dedicated locality teams covering the main geographical areas of ABMU whose role it would be to co-ordinate a response for each area;
  2. Launch a major new publicity campaign using all available means of communication possible highlighting the message to parents and children of the dangers of the disease and the need for vaccination;
  3. Set-up weekend drop-in sessions at the four main hospitals across the region;
  4. To organise an intense schools’ immunisation programme targeting all secondary age and special school pupils immediately upon return following the Easter break.

 

In regards to points 1-3, I am sure these will have been covered elsewhere in the inquiry by ABMU health colleagues, therefore, I shall concentrate my evidence based upon point 4: the Schools Immunisation Programme.

 

Factors that led to the current measles outbreak

ABMU health colleagues are best placed to provide evidence regarding the issues that led to the outbreak; however, factors that possibly compounded the problem at the time were the lack of general understanding of the seriousness of Measles by the public, or merely the lack of acknowledgement of the scale of the problem (or both).  This rather simplistic personal thought is supported by a discussion with a Headteacher whose school participated in an earlier round of the immunisation programme prior to Easter, and prior to the increased awareness raising media campaign.  Parents at that school were written to highlighting the increasing number of Measles cases in the area and offering vaccinations at school, however, the take-up was extremely low.  The Headteacher explained that when enquiries were made with parents regarding the reasons for the low take-up, parental apathy appeared to be the main cause.  The susceptibility coverage rate following this school vaccination session was just 80% of pupils; this is very much below the outcome of the other Neath Port Talbot secondary schools that took part in the School’s Immunisation Programme that achieved 95% and above.  Further communications and work with the parents of this secondary school have subsequently raised the susceptibility coverage rate to now slightly over 90%.

 

Actions taken by public health professionals, in partnership with other agencies, in response to the outbreak

Immediately from the inception of the Silver Response Group it was evident that there was true meaning to a partnership approach and not merely “lip service” being paid to the involvement of other agencies.  The engagement and participation of local authorities and third sector representatives was fundamental with the direction agreed to reach a mass target audience.  Each had a role to play and each contributed effectively bringing their own professional experiences to the table.

 

Dr. Sara Hayes, ABMU Director of Public Health, chaired the group supported by Mrs. Karen Jones, Emergency Planning Officer for ABMU.  Standing items were included on each agenda relating to the schools programme and local authority response.  The local authority was given an equal voice and there was a feeling of mutual respect.  Copies of minutes, reports, updates, fact-sheets were electronically forwarded to all partners at the same time as being circulated to all internal ABMU officers.  This ensured that whilst a very steep learning curve was required of non-health professionals, all Silver Group participants were equally aware of the key issues and response that was taking place as it unfolded in real-time.

 

Having the right people in place within Silver Group quickly developed a “can do” attitude from within with no reference to structures, hierarchy or jostling for position.  Every organisation within the group was of equal value and standing.  Partners/agencies with very different backgrounds worked extremely well together for a single purpose.

 

Neath Port Talbot Council’s Communications Team worked together with the ABMU Communications Team in promoting the weekend hospital drop-in sessions, individual school immunisation programmes and general message encouraging the citizens of Neath Port Talbot to receive the MMR.  Both teams ensured there was a continuous supply of press releases providing updates and constantly promoting the need for vaccination in the press in order to keep the issue at the forefront of people’s minds. 

 

Neath Port Talbot Council’s role

The Leadership and Chief Executive of the Council and Senior Management of the Education Department were continuously briefed and updated throughout this intense period.  The support from the Chief Executive was particularly encouraging with a very clear early steer that the Council was to participate fully and provide whatever support it could to ABMU to undertake the enormous challenges ahead.  Such support the Council gave to the Health Board included:

  

Neath Port Talbot School’s Immunisation Programme

It was agreed at the first Silver Group that given the main epicentre had been located as being in the Swansea region, the School’s Immunisation Programme should commence in Swansea as well as those Neath Port Talbot schools that attracted pupils’ cross-border.  The target age range was agreed to be all secondary aged pupils and those that were vulnerable, such as special school pupils.

 

Silver Group met several times throughout the Easter holiday period planning and preparing a timetable programme of schools to ensure as many pupils were targeted as possible in a short a period as possible.

 

Headteachers of those schools identified as being included in week 1 of the campaign were contacted at home during half-term to seek approval for their school’s involvement and to commence the logistics required to ensure a success of the programme and a high vaccination rate.  Credit must be given to Headteachers whose response was most supportive.  Other Headteachers were contacted on a rolling programme basis whilst co-ordinating those schools involved in week 2 and subsequently week 3 of the campaign. 

 

In addition to communicating with those Headteachers involved in the schools programme, other Headteachers, Chairs and Vice-chairs of Governors from Neath Port Talbot Schools were communicated with frequently updating those to the latest position regarding the outbreak, disseminating advice, fact-sheets, newsletters and frequently asked questions.

 

Schools were asked to provide copies of their logos and a photograph of the Headteacher in order for dedicated webpage’s to be created per school to personalise the campaign for parents and pupils.  School’s arranged for the specific details of their involvement with the programme along with additional information about Measles to be uploaded to their own website as well as texting parents via the school’s text system.

 

Individual personalised letters were sent to each parent by the local authority which included a consent form.  The forms were tracked for responses as whether consent had been provided, denied, notification that pupils had been vaccinated elsewhere, or that the pupil had left the school.  This information was fed through to ABMU for distribution to various services including the Lead School Nurse, Medicines Management Team and Child Health Data Unit to calculate the number of nurses and vaccines required at each session.  Where no forms were returned, staff made direct contact with individual parents to enquire whether letters had been received and whether they were planning to give consent.  In the majority of cases consent was forthcoming.

 

The local authority co-ordinated with each of its schools on behalf of ABMU to ensure there was the use of suitable rooms for the vaccinations to take place, the delivery and connection of refrigeration equipment, the pupil flow throughout the day to ensure maximum take-up, the offer to members of staff that wish to receive the MMR and that reminder text messages and notifications were being sent to parents.

 

With an increased interest from the national press and the commencement of the school’s immunisation programme the media requested access on several occasions to Neath Port Talbot schools to report upon the campaign.  National coverage was provided at both Cwmtawe Comprehensive School in Pontardawe and Dwr-Y-Felin Comprehensive School in Neath.  Articles appeared in the Times, Telegraph and several other mainstream daily national papers; filming took place for BBC Wales, BBC News, SKY, ITV and Newsnight and radio coverage both locally and nationally including Radio 5 Live.  The authority’s Communications Team co-ordinated this response alongside ABMU’s Communications Team.

 

Neath Port Talbot’s Communications Team proactively identified former Welsh rugby international player, Christian Loader, a sports teacher at Dwr-Y-Felin, who was receiving his vaccination at school and used the opportunity to further enhance the coverage.  From this Mr. Loader volunteered the information that he had lost some of his hearing as a child because of Measles which led to even further UK national coverage to endorse the need for the MMR vaccination.

 

In total, 13 Neath Port Talbot secondary and special schools participated in the immunisation programme in little over a two-week period.  Almost 1600 pupils were targeted as being susceptible with over 700 pupils and staff being immunised.  When the data was calculated taking into consideration the school’s programme, those pupils that attended either the hospital drop-in sessions or GP surgery, only one special school in the County Borough had a lower immunisation rate than 95%.  One school achieved a 100% immunisation rate and a second achieved 99%.  As a partnership response, this was a fantastic uptake.

 

In addition to the School’s Immunisation Programme, council officers made direct contact with all electively home educated families passing information to them regarding the outbreak and encouraging those that were unvaccinated to take-up the MMR.  Colleagues in the Youth Service, Children’s Services and Libraries were also passed information for public display.

 

Lessons that could be learned in order to prevent future outbreaks

Local Authorities serving local communities clearly have a key role to play alongside Health Boards in an attempt to eradicate some of these diseases that should with modern vaccinations be diseases of yesterday.  All those involved with the Silver Response Group agree that direct and effective communication has been the success of this campaign and, if new modern medicines and vaccines are effectively sitting in cold storage under used, then hard hitting communication has to be one of the major drivers in preventing future outbreaks.

 

Issues that went well and some of the key lessons learnt from this current outbreak:

 

The challenge remains for all organisations, regardless of sector or tier, national or local delivery to keep people interested enough in health issues so not only MMR, but other similar dangerous diseases, continue to remain at the forefront of people’s minds.

 

 

 

John Burge

Principal School’s Governance Officer

Neath Port Talbot County Borough Council