Luton And Dunstable Find And Treat Team

The TB Find & Treat programme in Luton

Tackling TB and other key infections in under-served and hard to reach populations in the East of England

Thursday, December 19, 2019

Syed M Tariq, Consultant Respiratory Physician, Luton & Dunstable University Hospital NHS Foundation Trust and Sultan Salimee, Consultant in Communicable Disease Control, Public Health England, East of England, tell us about their integrated approach to bring care in their local community.

Our local authority, Luton, was ranked as 59th out of 326 most deprived local authorities in 2010 and the decline is ongoing. Some areas within Luton are reported to be in the top 10% most deprived areas in the country.

As the incidence of tuberculosis (TB) is closely linked to marked inequalities in the geographical and socio-economic distribution, it is not surprising to find that TB rates in Luton are much higher than the national average.

Between 2005 and October 2017, we linked 54 TB cases to a large cluster (in Luton) via strain typing and/or epidemiological links: this was found to be the second largest in England after one that was previously observed in London. We identified patients aged between 22 and 90 years, most of whom had pulmonary TB (83%), were born in the UK (72%) and were of white ethnic background (74%). We also noticed that these patients frequently presented with several social risk factors including alcohol or drug use/misuse, homelessness and joblessness.

Between 2009 and 2012, the University College London (UCL) ‘Find and Treat’ service was commissioned to carry out TB screening in Luton with their mobile x-ray unit (MXU). This was agreed to run on an annual/one-off basis and focussed on individuals from vulnerable groups. During this period, the mobile unit screened 440 individuals in central Luton and identified four cases of active TB. However, between 2013 and 2017, no mass screening took place. During this period, on average, one case of active TB belonging to the same strain of the original cluster was recorded every quarter, suggesting that the ongoing transmission of the bacteria had not been interrupted.

A change in approach

Following a review of the TB cluster in May 2017, and noting that ongoing transmission had not been interrupted, the PHE East of England Health Protection Team (EofE HPT) and Luton Borough Council Public Health Department jointly agreed that a new approach was required to manage this cluster.

Designing a new intervention gave us a chance to build more integration at the onset. It was clear that no organisation could deliver any plan to tackle TB in isolation, so we involved many partners into the design and delivery of the service. We were aware that a one-off intervention would not stop transmission, that we needed to think longer term, including regular interventions.

One of the outcomes of this process was that we took a holistic approach with the new service rather than just focussing on TB as we realised we had a chance to significantly reduce morbidity and mortality in an under-served population with one single programme.

Eventually, in November 2017, the new “Find & Treat” service was launched, with funding for three years. The service consists of a twice-yearly mobile screening clinic for Luton’s vulnerable individuals, covering not just Chest X-Ray for TB, but also additional services for this vulnerable population, including screenings for blood borne viruses (BBVs), fibroscans for evidence of liver fibrosis, seasonal flu vaccination and access to general health and social care support.

It has become a true one-stop screening, with the local authority providing transport from the screening location to ensure prompt access to specialist secondary care services, and we hope that we will be able to obtain more funds or take different approaches and extend the service into the future.

Results so far and lessons learnt

Since November 2017, we have run four Find & Treat sessions in Luton, the last two in 2019. We have performed 376 Chest X-Rays, and found 37 cases of TB (4 active). In addition, we have performed 193 tests for blood borne viruses, which found 2 cases of HIV, 1 of HBV and 6 cases of HCV. The 211 liver scans performed revealed 41 with abnormal findings.

The programme is proving to be very successful, and in particular, we are seeing good compliance when treatment is advised following screening. This was achieved thanks to the skills and knowledge of the community workers involved in the programme, who were very successful in interacting with these ‘harder to reach’ groups: a good example of integration at work.

If we had to sum up the key lessons we learned from this experience, for someone embarking in a similar process, they would definitely be:

  • Relationship building is crucial. Building a strong working partnership however takes time, so start in good time.
  • Do not underestimate the impact of organisational and staff changes. The constant NHS and Local government reorganisation across the country has often led to staff leaving the organisations, changes in structure, process and lack of continuity of services.
  • Cross-organisational work can have a significant and positive impact on service delivery.
  • To improve their health and well-being, bring the service to hard-to-reach groups via those that regularly engage with them.
  • TB screening is cost effective when one active TB case is found among 200 people screened, but a screening programme such as this is even more cost effective as it seeks other key infections/conditions at the same time.
  • Target key health issues to get value for money from public health interventions, this makes it easier to obtain funding.

We are proud to have achieved what we did, which hopefully provides an example of best practice and excellent partnership between Local Authorities (Luton Borough Council), Public Health England, the NHS and other local and national service providers including the voluntary sector.

The success of the programme is indeed due to the commitment and participation of a wide range of local, regional and national partners. We really need to thank all the stakeholders that have been and are involved with the Find & Treat clinics, particularly colleagues in the voluntary sector, for their dedication to improve outcomes for the hard to reach groups in Luton.


Dr Tariq and Dr Salimee had key roles in the set up and running of the Find & Treat programme. Dr Salimee was particularly involved in pushing the case for a holistic approach to tackling the problem among local, regional and national partners. He led on the financial negotiations with UCL as well as in securing funding from the Luton Council Public Health Department. Dr Tariq is involved in the day-to-day delivery of the programme, by running the clinics on site, interpreting X-rays and referring patients for further investigation, following up cases and liaising with the other services. 

Stakeholders involved in Find & Treat


  • Luton Borough Council: Public Health, Drug & Alcohol Team, Housing, Transport, Social Services
  • Luton Clinical Commissioning Group
  • Luton & Dunstable University Hospital NHS Foundation Trust
  • NOAH enterprise: a charity offering help and support to people struggling due to homelessness and exclusion -

Regional (East of England)

  • PHE/East of England Health Protection
  • PHE Field Epidemiology Services East (FS/East)
  • PHE/EoE Communication
  • Cambridge Community Services – Community TB Services (Luton)