Public Health Wales and Hywel Dda University Health Board response to independent review into Llwynhendy TB outbreak
/ Ymateb Iechyd Cyhoeddus Cymru a Bwrdd Iechyd Prifysgol Hywel Dda i adolygiad annibynnol o’r achosion o TB yn Llwynhendy
Mae Iechyd Cyhoeddus Cymru a Bwrdd Iechyd Prifysgol Hywel Dda (BIP) wedi croesawu cyhoeddi’r adolygiad annibynnol o’r achosion hirsefydlog o dwbercwlosis (TB) Llwynhendy, ac wedi ymrwymo i ddysgu gwersi i adeiladu ar y gwelliannau sydd eisoes wedi’u gwneud ac wedi’u cydnabod gan yr adroddiad.
Er bod yr adroddiad wedi canfod bod gwelliannau i reolaeth yr achosion a’r ddarpariaeth gofal iechyd lleol yn “sylweddol”, dywedodd hefyd fod y rhannau o reolaeth cyfnodau cynnar yr achosion yn annigonol. Roedd hyn yn cynnwys oedi cyn gwneud diagnosis o TB ysgyfeiniol yr achos cyntaf a oedd yn golygu ei fod yn hynod heintus am gyfnod hir o amser, nid oedd yr ymateb cychwynnol yn ymestyn olrhain cyswllt yn ddigonol. Er ei bod yn cael ei hystyried yn foddhaol, nid oedd rheolaeth glinigol cleifion unigol â TB ar ddechrau'r achos wedi'i chydgysylltu oherwydd diffyg gwasanaeth TB penodedig a chlinigydd arweiniol.
Yn ogystal, canfu'r adolygiad fod angen mwy o fanylion penodol ar y protocol ar gyfer rheoli digwyddiadau ac achosion o TB ynghylch monitro'r achosion a chofnodi canlyniad y cysylltiadau dilynol.
Nododd yr adroddiad hefyd nad oes gan Gymru strategaeth genedlaethol ar gyfer TB. Er bod un wedi’i gynnig gan Grŵp Gweithredu Iechyd Resbiradol, hyd yma nid yw wedi’i fabwysiadu gan Iechyd Cyhoeddus Cymru na Llywodraeth Cymru. Yr wythnos diwethaf, cyhoeddodd Llywodraeth Cymru ystod newydd o gamau gweithredu i helpu i atal a rheoli TB yng Nghymru.
Roedd yr adroddiad yn cydnabod, yn ystod cyfnodau mwy diweddar yr achosion, fod y rheolaeth wedi gwella “yn sylweddol”, a bod y problemau gyda’r ddarpariaeth gofal iechyd lleol wedi cael sylw i raddau helaeth.
Yr Athro Meng Khaw, Cyfarwyddwr Cenedlaethol Diogelu Iechyd a Gwasanaethau Sgrinio, a Chyfarwyddwr Meddygol Gweithredol Iechyd Cyhoeddus Cymru:
“Mae Iechyd Cyhoeddus Cymru yn estyn ein cydymdeimlad diffuant i bawb sydd wedi’u heffeithio gan yr achosion o dwbercwlosis (TB) yng nghymuned Llwynhendy, Sir Gaerfyrddin ers 2010.
“Fel sefydliad GIG, rydym yn cymryd ein cyfrifoldeb i ddiogelu iechyd pobl Cymru o ddifrif, a dyna pam y comisiynwyd yr adolygiad annibynnol allanol hwn, i sicrhau ein bod yn dysgu o’r digwyddiad hwn ac yn cymryd camau i sicrhau ein bod yn gwneud newidiadau a gwelliannau. Rydym yn derbyn argymhellion yr adolygiad hwn yn llawn.
“Er i’r adolygiad ganfod bod rheolaeth iechyd y cyhoedd wedi gwella’n sylweddol yng nghamau diweddarach yr achosion, mae’n amlwg nad oedd yr ymateb cychwynnol yn foddhaol ac y gallai ein holrhain cyswllt a’n rheolaeth o’r Tîm Rheoli Achosion fod wedi bod yn well. Mae'n wir ddrwg gennym i unrhyw un a allai fod wedi cael ei effeithio.
“Mae rheoli achos mor gymhleth o TB yn heriol oherwydd y rhwydweithiau cymdeithasol cywrain a’r amserlenni estynedig yn aml ond rydym am sicrhau’r cyhoedd ein bod eisoes wedi ystyried y gwersi a amlygwyd yn yr adolygiad, ac wedi gwneud gwelliannau sylweddol yn y ffordd yr ydym yn ymdrin ag achosion o'r fath.
“Mae Iechyd Cyhoeddus Cymru a Bwrdd Iechyd Prifysgol Hywel Dda yn dymuno sicrhau’r cyhoedd bod gwersi wedi’u dysgu a’n bod ni wedi cyhoeddi cynllun gweithredu llawn i fynd i’r afael ag argymhellion yr adolygiad. Mae hyn yn cynnwys ymrwymiad i weithredu i godi ymwybyddiaeth ymhlith y cyhoedd a gweithwyr gofal iechyd proffesiynol, er mwyn lleihau'r risg o unrhyw achosion yn y dyfodol; rhoi prosesau penodol ar gyfer TB ar waith i sicrhau bod cysylltiadau rhwng achosion yn cael eu datgelu'n gyflym; a chytuno â Llywodraeth Cymru ar strategaeth TB a chynllun cyflawni i leihau nifer yr achosion o dwbercwlosis yng Nghymru.
“Rydym hefyd yn atgoffa pobl nad yw’r achos hwn ar ben. Rydym yn annog y 470 o bobl yr ysgrifennwyd atynt a’u gwahodd i gael eu sgrinio, ond nad ydynt wedi ymateb i’w gwahoddiad eto, i ddod ymlaen.”
Dywedodd yr Athro Philip Kloer, Cyfarwyddwr Meddygol a Dirprwy Brif Weithredwr Bwrdd Iechyd Prifysgol Hywel Dda:
“Rydym yn cydnabod yr effaith y mae’r achos hwn wedi’i gael ar gymuned Llwynhendy ac ar ran Bwrdd Iechyd Prifysgol Hywel Dda, rwy’n cydymdeimlo â phawb sydd wedi’u heffeithio.
“Mae Bwrdd Iechyd Prifysgol Hywel Dda yn derbyn argymhellion yr adolygiad yn llwyr ac wedi ymrwymo i gyflawni ein cynllun gweithredu i ddatblygu ein gwasanaeth TB lleol ar gyfer yr achosion parhaus hyn ac unrhyw achosion yn y dyfodol.
“Hoffwn ddiolch i’r Athro Mike Morgan a’i banel am eu gwaith ar yr adroddiad hwn sy’n darparu argymhellion pwysig ac annibynnol i sicrhau gwelliannau o ran rheoli unrhyw achosion o TB yn y dyfodol.
“Mae buddsoddiad a gwelliannau eisoes wedi’u gwneud i’r gwasanaeth TB o fewn y bwrdd iechyd a bydd hyn yn cael ei adolygu ymhellach i ddiwallu anghenion y boblogaeth leol.
“Nid yw’r achos hwn wedi dod i ben, ac rydym yn ailadrodd yr alwad i’r rhai sydd wedi’u gwahodd i gael eu sgrinio ond nad ydynt eto wedi dod ymlaen i wneud hynny cyn gynted â phosibl ac annog ymwybyddiaeth barhaus o fewn y gymuned o TB a’i symptomau.”
Gellir gweld yr adroddiad yn https://biphdd.gig.cymru/adolygiadTB
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
Donna Reed
Uwch Swyddog Cyfathrebu | Senior Communications Officer
Bwrdd Iechyd Prifysgol Hywel Dda | Hywel Dda University Health Board
donna.reed@wales.nhs.uk