Testing, Treatment, Care and Support Revised Actions for Phase II

Action 1: Each NHS Board will have, or be affiliated to, a Managed Care Network (MCN) for Hepatitis C; this Network should comprise representatives of all stakeholder groups including those for the prison service, local authority social work, the voluntary sector, addictions/mental health, and people living with and affected by Hepatitis C. The Network should be guided in its practice through the use of “care” guidelines, prepared by the Hepatitis C Action Plan’s Testing, Treatment, Care and Support Working Group and SIGN Guidelines on Hepatitis C. Outcome (Desired): MCNs for all NHS Boards established and accredited. Responsibility: Lead Organisation: NHS Boards. Partners:

Performance Indicators: MCN accreditation. Timescale: MCNs established by May 2008 (first meeting) and accredited by Funding: Requirement: Hepatitis C MCN Co-ordinators (7 WTE each AfC band 6, July March 2011). 2008/09: £181, /10: £241, /11: £241,562 Total Costs: £664,296

Action 2: NHS Quality Improvement Scotland (QIS) will develop standards for Hepatitis C testing and the treatment, care and social support of persons with Hepatitis C infection. Outcome (Desired): NHS QIS standards developed. Responsibility: Lead Organisation: NHS QIS. Partners:

Performance Indicators: Auditing against the published Standards. Timescale: NHS QIS standards developed by Funding: Requirement: Funding to be sourced separately from NHS QIS Core Budget:

Action 6: Testing, Treatment, Care and Support services within each NHS Board will be developed to increase the numbers of persons undergoing therapy (currently 450/year). Outcome (Desired): 500 treated in 2008/2009, 1,000 in 2009/2010, 1,500 in 2010/2011, and at least 2,000/year thereafter. Responsibility: Lead Organisation: NHS Boards. Partners:

Performance Indicators: Number of persons offered therapy. Number of persons commenced on antiviral therapy. Proportion of those having received antiviral therapy who achieved a sustained viral response Timescale: Targets for as indicated. Funding: Requirement: Increased provision of testing, treatment, care and support (see attached spreadsheets for detail on costs). 2008/09: £2,700, /10: £9,500, /11: £15, Total costs:£27,700,000

Action 7: Service Level Agreements/Memorandums of Understanding, between NHS Boards and the Scottish Prison Service (SPS), to promote the management of Hepatitis C treated persons in medium and long-stay prisons, should be developed taking into account the SPS BBV strategy. Outcome (Desired): The establishment of SLAs/MOUs between SPS and NHS Boards. Approximately 10% of all Hepatitis C treated persons in Scotland (as above) should be prison inmates. Responsibility: Lead Organisation: SPS. Partners:

Performance Indicators: Number of persons offered therapy (prisons only). Number of persons commenced on antiviral therapy (prisons only). Proportion of those having received antiviral therapy who achieved a sustained viral response (prisons only). Timescale: SLAs/MoUs by Nov Targets for as indicated above. Funding: Requirement: Increased provision of testing, treatment, care & support included above (see Action 6).

Action 8: For each NHS Board a formal plan, indicating how it has integrated/will integrate appropriate elements of Hepatitis C specialist treatment and care services into those for addiction/mental health including both primary and secondary care, will be developed and implemented Outcome (Desired): Development and implementation of plan. Responsibility: Lead Organisation: NHS Boards. Partners:

Performance Indicators: Through MCN accreditation. Timescale: Plan developed by March 2009 with implementation thereafter. Funding: Requirement: Funding for MCN Co-ordination included above (see Action 1).

Action 9: Each Local Authority will identify a Strategic and Operational Lead for Hepatitis C infection. Outcome (Desired): Local Authority Leads established. Responsibility: Lead Organisation: Local Authorities. Partners:

Performance Indicators: Local Authority Lead identified. Timescale: Leads identified by July Funding: Requirement: Funding for increased provision of care and support included above (see Action 6).

Action 10: NHS Boards will work in partnership with General Practitioners (GPs) to develop and implement a plan, incorporating innovative approaches, to improve Hepatitis C testing and referral activities. Outcome (Desired): A plan to increase testing, diagnosis and referral by GPs. Responsibility: Lead Organisation: NHS Boards. Partners:

Performance Indicators: Numbers of persons Hepatitis C tested, Hepatitis C diagnosed and referred to specialist care services by GPs. Timescale: Development of plan by March 2009 with implementation thereafter. Funding: Requirement: Funding for MCN Co-ordination included above (see Action 1) and funding for increased provision of testing included above (see Action 6).

Action 12: A programme of work to evaluate different approaches to Hepatitis C testing/ Hepatitis C test sampling (e.g. near patient testing/use of saliva and dried blood spots) will be undertaken. Outcome (Desired): Programme of Hepatitis C testing/sampling work undertaken. Responsibility: Lead Organisation: Hepatitis C Specialist Laboratories. Partners:

Performance Indicators: Timescale: Funding: Requirement: Sheila Cameron and Sheila Burns to provide costed proposal. Year 1:£200,000 Year 2: £200,000 Year 3: £0 Total costs:£400,000

Prevention Revised Actions for Phase II

Action 13: Each NHS Board will have, or be affiliated to, a Network covering the prevention of Hepatitis C and comprising representatives of all stakeholder sectors. Each NHS Board will identify a Hepatitis C Prevention Lead. Guidance regarding Network membership and Terms of Reference for the Hepatitis C component will be established. Outcome (Desired): Hepatitis C requirements for the Network established and Prevention Leads (Hepatitis C) appointed. Responsibility: Lead Organisation: NHS Boards. Partners:

Performance Indicators: Audit against the guidelines (Action 14). Timescale: Hepatitis C requirements for Prevention Network agreed and implemented by September Prevention Leads appointed by May Funding: Requirement: National Hepatitis C Prevention Network Co-ordinator (1 AfC band 7, July 2008-March 2011). 2008/09: £30, /10: £41, /11: £41,207 Total costs:£

Action 14: Guidelines for services providing injection equipment to IDUs will be developed. Outcome (Desired): Guidelines developed. Responsibility: Lead Organisation: Scottish Government. Partners:

Performance Indicators: Audit against the Guidelines. Timescale: Interim Guidelines developed by November Final Guidelines by July Funding: Requirement: Production, printing and dissemination of Guidelines. 2008/09: £100, /10: £02010/11: £0 Total costs:£100,000

Action 15: Services providing injection equipment will be improved in accordance with Guidelines (Action 14). Outcome (Desired): Increased uptake of injection equipment. Reduction in reported sharing of injecting equipment among IDUs. Reduction in the incidence of Hepatitis C infection among IDUs. Responsibility: Lead Organisation: NHS Boards. Partners:

Performance Indicators: Proportion of injection episodes undertaken with sterile injecting equipment (needles and syringes and other injecting paraphernalia). Proportion of IDUs sharing injecting equipment during a specified period. Hepatitis C prevalence/incidence among recent onset injectors. Baseline data will be available in 2008 and, thereafter, targets will be set. Timescale: Each Network to provide a plan of action by March Implementation in Funding: Requirement: Increased provision of injecting equipment (funding in 2008/2009 based on NHS Boards report of spending £565,023 in 2007/2008 on improving services to prevent Hepatitis C; funding for 2009/2010 and 2010/2011 based on Scottish Government allocation in spending review). 2008/09: £600, /10: £3,000, /11: £3,000,000 Total costs:£6,600,000

Action 17: A research initiative to provide injection equipment through vending machines will be evaluated. Outcome (Desired): Implementation and evaluation of research initiative. Responsibility: Lead Organisation: HPS. Partners:

Performance Indicators: Measures of use and acceptability. Timescale: Design 2008/2009. Evaluation 2009/2010. Report Funding: Requirement: Funding to be sourced from that allocated to Action 15.

Action 18: An in-prison needle/syringe exchange initiative will be piloted as one of a range of harm reduction measures to reduce the transmission of Hepatitis C. Outcome (Desired): The implementation and external evaluation of the initiative. Responsibility: Lead Organisation: SPS Partners:

Performance Indicators: Measures of use and acceptability. Timescale: The implementation and external evaluation of the initiative by Funding: Requirement: Evaluation of an in-prison pilot needle exchange initiative. 2008/09: £50, /10: £100, /11: £50,000 Total costs:£200,000

Education, Training and Awareness-raising Revised Actions for Phase II

Action 3: A national Hepatitis C Learning and Workforce Development Framework will be developed. Outcome (Desired): A knowledgeable, skilled and confident Hepatitis C workforce. Responsibility: Lead Organisation: NHS Education for Scotland Partners:

Performance Indicators: MCN accreditation (see Action 4). Timescale: Framework to be developed and published by December 2008, implemented throughout 2009/2011. Funding: Requirement: National Hepatitis C Workforce Development Co-ordinator (1 WTE each AfC band 7, April 2008-March 2011). 2008/09: £41, /10: £41, /11: £41,207 Total costs:£123,621

Action 4: NHS Boards, working with their partners, such as local government, the voluntary sector and the Scottish Prison Service (SPS), will review the learning and development needs of the Hepatitis C workforce and implement a co- ordinated approach to Hepatitis C workforce development consistent with the national Hepatitis C Learning and Workforce Development Framework. NHS Boards will appoint an Hepatitis C workforce development co-ordinator to support the implementation of a co-ordinated local approach to Hepatitis C workforce development. Outcome (Desired): A knowledgeable, skilled and confident Hepatitis C workforce. A co-ordinated local approach to Hepatitis C workforce development. Responsibility: Lead Organisation: NHS Boards. Partners:

Performance Indicators: MCN accreditation (Staff Training element) and Review against NHS QIS Standards. Timescale: NHS Board Workforce Development Leads to be identified by September NHS Boards to assess the learning and development needs of their HCV workforce by December NHS Boards to implement a co-ordinated approach to Hepatitis C workforce development throughout 2009/11. Funding: Requirement: Local Hepatitis C Workforce Development Co-ordinators (7 AfC band 6, Dec March 2011). Year 1:£80,521 Year 2: £241,562 Year 3: £241,562 Total costs:£563,645

Action 5: Awareness-raising campaigns and communications activity will continue to be developed to meet the information and educations needs of a range of professional audiences. Outcome (Desired): Increased awareness and knowledge of Hepatitis C and its management among professional audiences. Responsibility: Lead Organisation: Scottish Government. Partners:

Performance Indicators: Awareness of communications activity and messages tracked by national tracking surveys/activity. Timescale: Communications activities to be undertaken throughout Funding: Requirement: Funding to be sourced separately from the Scottish Government Core Communications Budget.

Action 11: An awareness campaign, to promote Hepatitis C testing among those at risk of being infected will be implemented and evaluated. Outcome (Desired): Improved awareness levels of Hepatitis C among target audiences. Increased numbers presenting for a Hepatitis C test. Responsibility: Lead Organisation: Scottish Government. Partners:

Performance Indicators: Awareness of communications activities and messages tracked by national tracking surveys/activity. Numbers of persons Hepatitis C tested. Timescale: Campaign to be implemented by September 2009 with evaluation by March Funding: Requirement: Funding to be sourced separately from the Scottish Government Core Communications Budget.

Action 16: Educational interventions aimed at vulnerable individuals, IDUs and those at risk of starting to inject will be designed and undertaken to highlight how Hepatitis C transmission can be prevented. These include: prevention programmes, approaches to family support, peer education and other relevant interventions. Outcome (Desired): Increased awareness of Hepatitis C among IDUs and those at risk of injecting. Responsibility: Lead Organisation: NHS Health Scotland. Partners:

Performance Indicator: Proportion of injection episodes undertaken with sterile injecting equipment (needles and syringes and other injecting paraphernalia). Proportion of IDUs sharing injecting equipment during a specified period. Hepatitis C prevalence/incidence among recent onset injectors. Baseline data will be available in 2008 and, thereafter, targets will be set. Timescale: A range of interventions to be implemented throughout Funding: Requirement: Hepatitis C Education and Awareness-raising Co-ordinator (1 AfC band 7, July 2008-March 2011). 2008/09: £30, /10: £41, /11: £41,207 Total costs: £113,319 Local implementation of NHS Boards educational interventions. 2008/09: £0 2009/10: £500, /11: £500,000 Total costs: £1,000,000

Action 19: Blood Borne Viruses (including Hepatitis C) Guidance and educational support materials will be developed and disseminated to raise awareness of the health and social impact of Blood Borne Viruses and support the education of young people in primary, secondary and further education settings and settings supporting vulnerable young people. Outcome (Desired): Increased awareness and knowledge of BBV (including Hepatitis C) among young people in schools, further education settings and settings supporting vulnerable young people. Increased confidence of key staff to support BBV related education. Uptake of educational materials. Responsibility: Lead Organisation: Learning and Teaching Scotland. Partners:

Performance Indicator: Levels of BBV (including Hepatitis C) education in schools, further education settings and settings supporting vulnerable young people. Knowledge of BBV (including Hepatitis C) among young people and young adults. Timescale: Educational support materials to be published by June Funding: Requirement: Production, piloting, printing and dissemination of materials. 2008/09: £70, /10: £30, /11: £0 Total costs: £100,000

Monitoring and Surveillance Actions for Phase II

Action 20 The further development of the National Hepatitis C Clinical Database, including the establishment of a Generic Clinical System for Hepatitis C. Outcome (desired): The establishment of a Generic Clinical System for Hepatitis C, reporting annually on the performance indicators for Actions 6-7. Responsibility: Lead Organisation: HPS Partners: Hepatitis C Clinical Database Monitoring Committee, NHS Boards, (others to include)

Performance Indicator: (See Outcome) Timescale: Establishment of a Generic Clinical System for Hepatitis C by December Progress and available NHS Board data published in Annual Report by May 2009, and all NHS Board data published in Annual Report by May Funding: Requirement: Continued development of the National Hepatitis C Clinical Database (Includes funding for: data-entry at HCV Clinics, Generic Clinical System Development, National HCV Clinical Database Manager, Epidemiologist/Information Analyst and Travel). 2008/09: £182, /10: £347, /11: £202,000 Total costs: £731,000

Action 21 Development of a surveillance system to monitor Hepatitis C testing practice in Scotland. Outcome (desired): The establishment of a Hepatitis C Test Database, reporting annually on the performance indicators for Actions 10 and 11. Responsibility: Lead Organisation: HPS Partners: BBV Specialist Laboratories, NHS Boards, (others to include)

Performance Indicator: (See Outcome) Timescale: Establishment of a Hepatitis C Test Database relating to all NHS Boards by December Progress and available NHS Board data published in Annual Report by May 2009, and all NHS Board data published in Annual Report by May Funding: Requirement: Development of a Hepatitis C Test Database (Includes funding for: Epidemiologist; IT Support; Travel) 2008/09: £79, /10: £79, /10: £79,000 Total costs: £237,000

Action 22 Development of a surveillance system to monitor the provision of injecting equipment in Scotland. Outcome (desired) The establishment of a Database on Injecting Equipment Provision reporting annually on the performance indicator for Action 14. Responsibility: Lead Organisation: ISD Partners: HPS, NHS Boards, ADATs, (others to include)

Performance Indicator: (see Outcome) Timescale: Establishment of a Database on Injection Equipment Provision by June Data published annually in relevant reports such as Drug Misuse Statistics Scotland by December Funding: Requirement: Development of a Database on Injection Equipment Provision. 2008/09: £150, /10: £150, /11: £150,000 Total costs: £450,000

Action 23 Annual surveys of Hepatitis C prevalence and incidence among injecting drug users across Scotland will be undertaken. Outcome (desired): The implementation of surveys, reporting annually on the performance indicators for Actions 15 and 16. Responsibility: Lead Organisation: HPS Partners: University of the West of Scotland, Hepatitis C Specialist Laboratories, NHS Boards, (others to include)

Performance Indicator: (see Outcome) Timescale: Surveys undertaken annually and data published in Annual Report by May Funding: Requirement: Annual surveys of Hepatitis C prevalence/incidence and associated behaviours/service use among IDUs in Scotland. 2008/09: £306, /10: £450, /11: £417,000 Total costs: £1,173,000

Action 24 A survey of Hepatitis C prevalence among prisoners in Scotland will be undertaken. Outcome (desired): The implementation of, and report on, the survey. Responsibility: Lead Organisation: HPS Partners: SPS, (others to include)

Performance Indicator: (see Outcome) Timescale: Survey undertaken and data published in report by March Funding: Requirement: Survey of Hepatitis C prevalence among Prisoners in Scotland. 2008/09: £42, /10: £252, /11: £95,000 Total costs: £389,000

Action 25 Surveys to estimate the prevalence of Hepatitis C among i) people in Scotland who have lived in Pakistan and ii) children in Scotland will be undertaken. Outcome (desired): The implementation of, and report on, surveys. Responsibility: Lead Organisation: HPS Partners: GG & C NHS Board, University of Glasgow Dental School, (others to include)

Performance Indicator: (see Outcome) Timescale: Surveys undertaken and data published in reports by March Funding: Requirement: Surveys of Hepatitis C prevalence among i) people in Scotland who have lived in Pakistan and ii) children in Scotland. 2008/09: £50, /10: £150, /11: £50,000 Total costs: £250,000

Co-ordination (governance, communications and project management) Actions for Phase II

Action General The establishment of new groups, the modification of existing groups, the implementation of a new accountability and reporting structure, the further development of communication arrangements and the project management approach.

Action 26 Establishment of new groups, including: (i) A National Managed Care Network Leads Group (see Action 1), (ii) A National Prevention Leads Group (see Action 13), and (iii) An NGOs/Voluntary Sector Group. Outcome (desired): Reshaped governance arrangements Responsibility: Lead Organisation: HPS Partners: Performance Indicator: Delivery of Actions within agreed costs and timescales.Timescale: Implemented by June 2008.

Action 27 Review and modification of existing Groups (including Membership and Terms of Reference): (i) The Action Plan Co-ordinating Group, (ii) The Hepatitis C Executive Leads Group, (iii) The Action Plan Project (now Programme) Implementation Group, (iv) The Education, Training and Awareness-raising Group. Outcome (desired): Reshaped governance arrangements Responsibility: Lead Organisation: HPS Partners: Performance Indicator: Delivery of Actions within agreed costs and timescales. Timescale: Implemented by June 2008.

Action 28 The Implementation and development of a new accountability and reporting structure. Outcome (desired): Reshaped governance arrangements Responsibility: Lead Organisation: HPS Partners: Performance Indicator: Delivery of all Actions within agreed costs and timescales. Timescale: Implemented by June 2008.

Action 29 Actions to enable Hepatitis C Stakeholders to keep abreast of Action Plan progress and outputs, and to provide feedback on these; including: (i) The development of the existing Hepatitis C Scotland website, including a stakeholder forum, (ii) The production of a Scottish Hepatitis C Action Plan Annual Report, (iii) A Scotland contribution to a UK Annual Report on Hepatitis C (with HPA), and (iv) The holding of an annual Stakeholder meeting. Outcome (desired): Further development of the Project Communications Plan. Responsibility: Lead Organisation: HPS Partners: Performance Indicator: Delivery of all Actions within agreed costs and timescales. Timescale: Preliminary website development May 2008, full development by Dec Annual Report by May UK Annual Report by Nov Annual Stakeholder meeting in May 2009.

Action 30 Further development of the programme management approach, including: (i) The establishment of a new project management team, and (ii) The development of a project management plan. Outcome (desired): Further development of the Project Plan. Responsibility: Lead Organisation: HPS Partners: Performance Indicator: Delivery of all Actions within agreed costs and timescales. Timescale: Implemented by June 2008.

Funding RequirementTotal Costs ( ) a) Meetings including an annual stakeholder conference, APCG, Exec Lead, MCN Lead and Prevention Lead meetings £49,500 b) Admin Support (2 Band 4)£140,072 c) Hepatitis C Action Plan Communications & Website Manager (1 Band 7) £123,621 d) IT/Web/Graphics Technical Support (0.4 AfC Band 5 £33,547 e) Annual Report Production£15,000 f) Hepatitis C Action Plan Portfolio Manager (0.4 AfC Band 8a) £60,979 g) Hepatitis C Action Plan Project Manager (1 AfC Band 7) £123,621 h) Computing, Licences and Recruitment Costs£80,000 i) HCV Executive Lead Support Officers (7 AfC Band 6, April 2008 – March 2011 £724,686 a)– h) : HPS i) : NHS Boards