Public Health Wales and Hywel Dda University Health Board response to independent review into Llwynhendy TB outbreak

Public Health Wales and Hywel Dda University Health Board (UHB) have welcomed the publication of the independent review into the longstanding Llwynhendy tuberculosis (TB) outbreak, and have committed to learning lessons to build on the improvements that have already been made and acknowledged by the report.

While the report found that improvements to both the outbreak management and the local healthcare provision were “considerable”, it also said that the parts of the management of the early phases of the outbreak were inadequate. This included a delay in the diagnosis of the index case’s pulmonary TB meaning he was highly infectious for a prolonged period of time, the initial response did not extend contact tracing sufficiently. Though deemed satisfactory, the clinical management of individual patients with TB at the beginning of the outbreak was uncoordinated because of the lack of a dedicated TB service and a lead clinician.

In addition, the review found that the protocol for the management of incidents and outbreaks of TB needed more specific detail on the monitoring of the outbreak and recording of the outcome of the follow-up of contacts.

The report also noted that Wales has no national strategy for TB. Although one has been proposed by the Welsh Respiratory Delivery Group, so far it has not been adopted by either Public Health Wales or the Welsh Government. Last week, Welsh Government published a new range of actions to take forward to help prevent and control TB in Wales.

The report recognised that during the more recent phases of the outbreak, that the management has improved “considerably”, and that the issues with the local healthcare provision have largely been addressed.

Professor Fu-Meng Khaw, National Director for Health Protection and Screening Services, and Executive Medical Director for Public Health Wales, said:

“Public Health Wales extends our sincere sympathies to all those who have been affected by the outbreak of Tuberculosis (TB) within the community of Llwynhendy, Carmarthenshire since 2010.

“As an NHS organisation, we take our responsibility to protect the health of people in Wales very seriously, which is why this external independent review was commissioned, to ensure that we learn from this outbreak event and take steps to ensure that we make changes and improvements. We accept the recommendations of this review in full.

“Whilst the review found that public health management improved considerably in the later stages of the outbreak, it is clear that the initial response was not satisfactory and that our contact tracing and management of the Outbreak Control Team could have been better. We are sincerely sorry to anyone who may have been impacted.

“Managing such a complex TB outbreak is challenging due to the elaborate social networks and often extended timescales involved but we want to reassure the public that we have already taken on board the lessons highlighted in the review, and have made substantial improvements in the way we handle such outbreaks.

“Public Health Wales and Hywel Dda University Health Board wish to reassure the public that lessons have been learnt and that we have published a full action plan to address the review’s recommendations. This includes a commitment to action to raise awareness amongst the public and healthcare professionals, to reduce the risks of any future outbreaks; to put in place TB specific processes to ensure that links between cases are uncovered quickly; and to agree with the Welsh Government a TB strategy and delivery plan to reduce the incidence of tuberculosis in Wales.

“We are also reminding people that this outbreak is not over. We urge the 470 people who have been written to and invited for screening, but who have not yet responded to their invitation, to come forward.”

Professor Philip Kloer, Medical Director and Deputy Chief Executive for Hywel Dda University Health Board, said:

“We recognise the impact this outbreak has had on the Llwynhendy community and on behalf of Hywel Dda University Health Board, I offer my sympathies to all who have been affected.

“Hywel Dda University Health Board fully accepts the recommendations of the review and is committed to delivering on our action plan to develop our local TB service for both this ongoing outbreak and any future outbreaks.

“I would like to thank Professor Mike Morgan and his panel for their work on this report that provides important and independent recommendations to ensure improvements in the management of any future TB outbreaks.

“Investment and improvements have already been made to the TB service within the health board and this will be further reviewed to meet the needs of the local population.

“This outbreak has not ended, and we reiterate the call for those who have been invited for screening but have not yet come forward to do so as soon as possible and encourage ongoing awareness within the community of TB and its symptoms.”

The report can be viewed at https://hduhb.nhs.wales/TBreview