Topic Summary on Tuberculosis

This JSNA focuses on issues in respect of Tuberculosis (TB) in the city of Manchester. It provides a summary of the disease itself, what we know about the health issues that affect Manchester residents who are at risk of becoming infected with TB and describes what Manchester City Council and other organisations working in the city are doing to support the city in addressing the TB agenda. The JSNA closes with a list of several opportunities for action that exist to mitigate the risks and challenges created by TB.

The JSNA provides an overview of national evidence and data regarding the number of TB cases in different population groups and areas. The work to prevent, detect and treat tuberculosis will mitigate against health-related harms across the life course. Individuals belonging to high-risk groups or who are experiencing high risk factors are more likely than the general population to be at risk of becoming infection and acquiring more complicated treatment outcomes. Work to address these inequalities and ensure that disadvantaged communities can reach their full potential and live independently without fear of falling will contribute to the wider strategies aiming to tackle health inequalities in the city.

• The number of TB cases reported in England increased by 7.5% in Quarter 1, 2024 compared to the same quarter in 2023.
• There was an 11.2% rise in TB notifications in the updated 2023 figures compared with 2022, rebounding to above the pre-COVID-19 pandemic numbers in 2019.
• TB is a marker of health inequality and disproportionately affects the most marginalised populations of society. For example, 15% of people in England diagnosed with TB have at least one social risk factor (SRF).
• Addressing the social and economic determinants of TB is essential to achieving the goal of national elimination.
• In 2021, Manchester had a higher rate of TB cases per 100,000 population than the North West region). Manchester also has the highest rate of TB in Greater Manchester.
• Currently, there are currently around 18,000 people In Manchester on the waiting list for new entrant latent TB screening. The workforce across Manchester’s TB wards, clinics and laboratories do not have the capacity to carry out such an extensive screening exercise and process the blood samples that this will create.
• The lack of both funding and capacity puts severe pressure on existing services working to address and mitigate the risks of TB. However, more specifically, there is a notable lack of funding available to manage the numbers of latent TB screening in the city currently.

There are a range of local services in place across Greater Manchester (GM) and Manchester to help mitigate the risks of TB and bring down infections. Each locality within GM has health professionals and TB consultants who can care and treat people with latent or active TB. Some areas have full-time dedicated TB nurses. Other areas have a part time TB nurse who works in other areas of respiratory medicine or infectious diseases. Any cases of multi drug resistant TB are cared for by a specialist centre. In Manchester, these are located within the North Manchester General Hospital Infectious Diseases Unit and the Manchester Royal Infirmary.

There are also several cross-sectoral groups working to address the TB agenda. The GM TB Collaborative is leading the development of a multi-agency TB Control Strategy for GM. In Manchester, the Health Protection Board, chaired by the Director of Public Health, is responsible for overseeing TB work at a local level. The No Recourse to Public Funds (NRPF) team at Manchester City Council works to provide wrap around support for residents who have been diagnosed with TB and have a NRPF status attached to their visa.

BHA for Equality, a national charity commissioned by Manchester City Council, also plays a major role in the community in delivering Public Health campaigns. They have worked closely with asylum seeker hotels to increase understanding and dangers surrounding TB for residents living in these settings and are embedded within the community to spread important messages. A cross-sector and multi-agency approach is proven to be both effective and essential to address and mitigate the risks of TB for residents living in Manchester.

The JSNA contains a series of opportunities for action to further strengthen Manchester’s commitment to the TB agenda and should be considered as part of the TB programme work. These opportunities for action have been aligned with both NICE guidelines and Local Government guidelines.

In summary they are:

1. Use World TB on 24 March as the basis for campaigns and awareness raising activities around TB.
2. Advocate to increase the funding available for latent tuberculosis screening programmes in order to screen new entrants to the UK who have arrived from high-risk countries.
3. Further strengthen collaborative working to make certain that we continue to build on positive relationships whilst also creating new and innovative connections to support vulnerable population groups in the city.
4. Introduce a holistic approach to health and social care through creating a ‘one stop shop’ to provide a cascade of care through direct intervention in one place.
5. Improve the understanding of lived experience by conducting qualitative research to understand better the lived experiences of high-risk groups and those who experienced Multi Drug Resistant-TB.
6. Contribute to local health intelligence in order to build a deeper understanding of gaps in knowledge through comprehensive data collection.

This JSNA was completed in May 2024 and was presented to the Health and Wellbeing Board on the 5 June. A full copy of the JSNA can be accessed as part of the papers for that meeting.