Healthwatch Essex is launching a unique report which reveals the experiences of young people in a secure inpatient mental health unit.

The study, named SWEET!3, is believed to be the first of its kind in the county. The report has been written by our Research and Engagement Associate, Hannah Fletcher, who spent six months visiting Poplar Adolescent Unit Education Centre based in Rochford Community Hospital, working to understand young people’s experience of being treated in a secure unit of this nature.

The report had a number of key findings:

• Young people often felt ignored or powerless in their journey through mental health services. Their diagnosis was, at times, disclosed to their families but not to them. This caused them to feel excluded from conclusions made about their health and not consulted on their personal experience of living with their illness. Acronyms and terminology also caused them difficulty in being able to understand and discuss their care.
  
  
• Delays in care often caused a deterioration in mental health to the point of crisis. This was common and ranged from being because of waiting times through to the young person not seeking support because of fear of stigmatisation. A number of participants in the study discussed how they had been struggling with their mental health for a long time prior to getting a referral and, even after referral, continued to wait for long periods.
  
  
• A number of patients who had initially entered the health system via A&E after experiencing mental health crisis, were discharged from A&E after receiving no treatment or only treatment for physical injuries - even though it was obvious that their injuries had been self-inflicted.
  
  
• Inconsistent care and high staff turnover often caused young people to disengage or struggle to build a relationship of trust through which they could discuss their experiences. Changes between services and professionals also meant that they found themselves having to re-tell these experiences over and over which left them with a sense that they were ‘starting from scratch’ and making no real progress.

David Sollis, Chief Executive of Healthwatch Essex, said:

“This report undoubtedly makes for difficult reading at times but we hope that, in hearing these voices which are not commonly heard, the whole of the health and social care system in Essex can come to understand the needs of these young people more clearly.

“We are very grateful to the Poplar Adolescent Unit who facilitated our engagement with their patients and staff. Their hard work and devotion clearly makes a lasting impression on the lives of the young people they work with.

“We are hugely thankful to the young people whose voices are central to this report. We appreciate that it can be difficult to talk about such personal and sometimes painful experiences but we are very grateful that they did, because it offers an opportunity for their experiences to shape the way that services are designed and delivered in Essex in the future.”

To hear Hannah talking about her findings click here.

Latest update - 16  July 2019

As of July 16, there have been no further cases of iGAS within the mid Essex area.

NHS Mid Essex Clinical Commissioning Group continues to lead the incident management team comprised of Public Health England, Provide Community Interest Company (who provide the majority of our out of hospital services), NHS England and NHS Improvement, to monitor and investigate the existing iGAS outbreak.

As we have mentioned in our previous briefing, the total number of cases is 32* and sadly, 12 of those patients have died. The number of cases reflects Public Health England’s Whole Genome Sequencing Work of the GAS bacteria found in patients within the outbreak. The work found that the iGAS case in Basildon in 2018 and the iGAS case in Southend in February 2019, are not part of the outbreak in mid Essex.

Whole Genome Sequencing is used within a Public Health laboratory setting to investigate differences and similarities in the DNA sequence of bacteria. This method allows Public Health England to check which iGAS cases are genetically linked and which are not. This is done by analysing the DNA sequence of each bacterial sample collected from patients within this outbreak. Any further information from the Whole Genome Sequencing work will be shared in future updates.

*Of the 32 patients affected by the iGAS outbreak in mid Essex, 30 are confirmed cases and two are probable.

Background (Updated on 16 July):

Those affected within the iGAS outbreak are older people in Braintree District, Chelmsford City and Maldon District. The majority of patients were receiving treatment for wounds, with some in care homes but most in their own homes.

It was previously thought that the single case of iGAS in Basildon in 2018 and single case of iGAS in Southend in February 2019 could be part of the outbreak in mid Essex. Whole Genome Sequencing of all cases of iGAS identified as part of the outbreak has provided confirmation that the cases in Basildon and Southend are not part of the mid Essex outbreak. These two cases appear to be isolated cases of iGAS that can arise in the community, and have now been removed from the outbreak investigation.

Incident management team and control measures

The incident management team continues to monitor the control measures already in place to limit the spread of this infection. These include:

• A programme of preventative antibiotics for the community nursing staff in mid Essex
  
  
• Community nursing teams who usually work within the CM7 postcode area in Braintree are working only in that area for the time being to minimise the risk of the infection spreading. This is because the majority of cases have been within this area of Braintree.
  
  
• A deep clean of all community nurse bases in mid Essex has been completed. The reinforcement of standard infection control measures including hand hygiene and use of personal protective equipment among staff continues.
  
  
• Swabs are being taken from adult patients being treated by mid Essex community nursing teams to check for the bacteria.

Advice for the public and helpline

The NHS understands this is a worrying time for people and wants to reassure members of the public that the risk of contracting iGAS is very low. Treatment with antibiotics is usually very effective when started early.

The local Freephone helpline number, 03000 032124, is open Monday to Friday, 9am to 5pm, for anyone with concerns about iGAS infection. Updates will continue to be available at midessexccg.nhs.uk.

Latest update - 9 July 2019

NHS Mid Essex Clinical Commissioning Group, along with partners at Public Health England, Provide Community Interest Company (who provide the majority of our out of hospital services), NHS England and NHS Improvement, are continuing to monitor, assess and investigate the outbreak of invasive Group A Streptococcus (iGAS) infection in mid Essex.

As part of the investigation, Public Health England has undertaken Whole Genome Sequencing of the GAS bacteria found in patients within the outbreak. This work has demonstrated that the iGAS case in Basildon in 2018 and the iGAS case in Southend in February 2019, are not part of the outbreak in mid Essex. Therefore the rest of the cases are linked to the iGAS outbreak in mid Essex. The total number of patients affected is now 32* and sadly, 12 of those patients have died.

Whole Genome Sequencing is used within a Public Health laboratory setting to investigate differences and similarities in the DNA sequence of bacteria. This method allows Public Health England to check which iGAS cases are genetically linked and which are not. This is done by analysing the DNA sequence of each bacterial sample collected from patients within this outbreak. Any further information from the Whole Genome Sequencing work will be shared in future updates.

*Of the 32 patients affected by the iGAS outbreak in mid Essex, 30 are confirmed cases and two are probable.

Background (updated on 9 July):

Those affected within the iGAS outbreak are older people in Braintree District, Chelmsford City and Maldon District. The majority of patients were receiving treatment for wounds, with some in care homes but most in their own homes.

It was previously thought that the single case of iGAS in Basildon in 2018 and single case of iGAS in Southend in February 2019 could be part of the outbreak in mid Essex. Whole Genome Sequencing of all cases of iGAS identified as part of the outbreak has provided confirmation that the cases in Basildon and Southend are not part of the mid Essex outbreak. These two cases appear to be isolated cases of iGAS that can arise in the community, and have now been removed from the outbreak investigation.

Incident management team and control measures

NHS Mid Essex Clinical Commissioning Group is leading an incident management team and is working hard with colleagues to manage the situation. These colleagues include Public Health England, Provide Community Interest Company, who provide the majority of mid Essex community health services, NHS England and NHS Improvement.

The control measures put in place to limit the spread of this infection include:

• A programme of preventative antibiotics for the community nursing staff in mid Essex
• Community nursing teams who usually work within the CM7 postcode area in Braintree are working only in that area for the time being to minimise the risk of the infection spreading. This is because the majority of cases have been within this area of Braintree.
• A deep clean of all community nurse bases in mid Essex and reinforcing standard infection control measures including hand hygiene and use of personal protective equipment among staff continue.
• Swabs are being taken from adult patients being treated by mid Essex community nursing teams to check for the bacteria.

Advice for the public and helpline

The NHS understands this is a worrying time for people and wants to reassure members of the public that the risk of contracting iGAS is very low. Treatment with antibiotics is usually very effective when started early.

The local Freephone helpline number, 03000 032124, is open Monday to Friday, 9am to 5pm, for anyone with concerns about iGAS infection. Updates will continue to be available at midessexccg.nhs.uk.

Frequently asked questions:

What is Group A Streptococcus (GAS)?
GAS is a bacterium, full name Streptococcus pyogenes, it is sometimes found in the throat or on the skin and usually causes no symptoms.
How are GAS infections spread?

GAS is spread by contact or by droplets from the respiratory tract, when sneezing or coughing. People may carry GAS in their throat or on their skin, which would make them a carrier, also referred to as colonised. Carriers often have no symptoms of illness.

What infections are caused by GAS?
Most GAS infections result in illnesses such as a sore throat (this can be called ’strep throat’) or a skin infection such as impetigo or scarlet fever. On rare occasions, these bacteria can cause other more severe diseases, for example blood stream infections (septicaemia).

What is invasive group A streptococcal (iGAS)?
iGAS is rare but serious. It can occur when bacteria gets into parts of the body where bacteria usually are not found, such as the blood, muscle, or the lungs. These infections are called invasive GAS. In the current outbreak patients with iGAS have suffered septicaemia (blood stream) infection.

What are the signs and symptoms of invasive Group A Streptococcal?

• High fever
• Severe muscle aches
• Pain in one area of the body
• Redness at the site of a wound
• Vomiting or diarrhoea

What should I do if I think I have any of the symptoms of iGAS?
If you develop any of the symptoms of iGAS contact your GP or seek medical advice immediately. Tell your GP that you have been in contact with someone with invasive GAS and that you have developed some symptoms that you are worried about.

It is very likely that your GP will ask you to come into the surgery so you can be examined. If you are too unwell to visit the surgery or it is closed, do not delay seeking medical advice and contact NHS111 or visit https://111.nhs.uk

Update on 3 July 2019

As part of the ongoing iGAS outbreak in mid Essex, NHS Mid Essex Clinical Commissioning Group can confirm that a further patient has been diagnosed with iGAS and is currently being treated.

In addition, as part of the monitoring and risk assessments of this outbreak, Public Health England (PHE) have further reviewed how cases are defined in this outbreak to ensure that all appropriate cases are captured and investigated. As a result, an additional case has been added to the total outbreak count. This patient passed away with sepsis earlier this year. The case was previously not included in the iGAS count. Therefore, the total number of patients affected by the iGAS outbreak is 34 and 13 of those patients have sadly died.

Update 27 June 2019

Mid Essex streptococcus outbreak – statement by Dr Anna Davey, CCG Chair, at Board today

At the CCG's Board meeting in public held at Spring Lodge Community Centre in Witham this afternoon (Thursday 27 June), our Chair, Dr Anna Davey, gave the following update on the invasive Group A Streptococcus (iGAS) outbreak in mid Essex.

I want to give you all an update on the ongoing incident here in mid Essex. Twelve people have sadly died and I want to start by expressing our sincere condolences to their families.

We have established an incident management team and are working hard with colleagues from Public Health England, Provide Community Interest Company, who provide the majority of our out of hospital services, NHS England and NHS Improvement, to understand why this has happened and to prevent any more cases from occurring.

There have been 32 cases of iGAS in Essex. Those affected are elderly people in Braintree District, Chelmsford City and Maldon District. The vast majority of patients were receiving treatment for wounds, some in care homes but most in their own homes. A single case was found in Basildon in 2018 and a single case in Southend in February 2019. There does not appear to be a direct link between the cases in south Essex and mid Essex.

To give you a brief overview, Group A streptococcus, or GAS bacteria, can be found in the throat and on the skin and will not cause any illness for most people. Most Group A streptococcus infections can cause mild illnesses such as a sore throat, also known as strep throat, scarlet fever or a skin infection. For most healthy people this will cause no more than a mild illness.

On rare occasions, this bacteria can enter the body and cause severe, and sometimes life-threatening conditions. This is called Invasive Group A Streptococcal disease – iGAS. While this infection is rare, it is not new and has been seen in the UK before.

We have put in place measures to prevent the spread of this infection, including giving all community nursing staff who treat patients with chronic wounds antibiotic prophylaxis.

A deep cleaning of all community nurse bases has been conducted on all premises and to ensure the infection does not spread out of the locality, district nurse teams working within the CM7 Braintree area are only working within this postcode for the time being. This is because the majority of cases have been within this area.

We are taking wound swabs from all patients who are being treated for wounds in the area to check for the bacteria, and increasing opportunities for hand hygiene and use of personal protective equipment among staff.

We understand this is a worrying time for people, and know how frustrating it is that we don’t have answers to lots of the questions you may have. But we want to reassure members of the public that the risk of contracting iGAS is very low for most people. Treatment with antibiotics is very effective if started early.

We are continuing to work with Public Health England to stop the spread of this outbreak and ensure our local community is protected.

Our Freephone helpline number, 03000 032124, is open Monday to Friday, 9am to 5pm, for anyone with concerns about iGAS infection. We will also continue to keep our website updated as and when we have more information on the outbreak or investigation.