Agenda and minutes

For the Board to agree the appointment of Vice-Chair for the municipal year 2022-23.

Councillor Ben Coleman reported that in previous years, an NHS health colleague had been appointed as vice-chair which offered a good opportunity to sustain a joint approach.  A recommendation would be sought and agreed at the next meeting of the Board.

For the Board to note and welcome:

Councillor Alexandra Sanderson, Cabinet Member for Children and Education

Natalia Perez, Chair of Health and Adult Social Care PAC (Nominated Deputy)

Helen Rowbottom, Chair of Children and Education PAC (Nominated Deputy)

Councillor Natalia Perez, Chair of the Health and Adult Social Care Policy and Accountability Committee (nominated deputy member), Helen Rowbottom, Chair of Children and Education Policy and Accountability Committee, and Councillor Alexandra Sanderson, Cabinet Member for Children and Education Services were welcomed to the Board.  Councillor Coleman reported that an appointment of a representative from Imperial College Healthcare NHS Trust was still sought and that he would follow up with their Chief Executive Officer Professor Tim Orchard.

(a)   To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health & Wellbeing Board held on

·       14 March 2022

·       16 March 2022 (in person, extra meeting)

(b)   To note the outstanding actions.

RESOLVED

The notes of the informal meeting were noted.

MATTERS ARISING

Councillor Coleman briefly reminded members of the Board about the newly established borough-based partnerships for each of the eight north west London local authorities, and which now collectively formed part of the Integrated Care System (ICS).  The ICS was co-chaired by Lisa Redfern and Phillipa Johnson. The clinical commissioning groups would be formally dissolved on 1July 2022, when the new ICS would come into being.  Councillor Colman highlighted the need for improved local authority representation on the board of the ICS which he intended to raise with the ICS leadership.

Apologies for absence were received from Jacqui McShannon.

None.

The Board to receive a verbal update on the Monkey Pox outbreak.

6.1           Dr Nicola provided a verbal update on monkey pox and began by thanking Adam Gray, General Manager – HIV (human immunodeficiency virus), GUM (Genito Urinary Medicine) and Dermatology at Chelsea and Westminster Hospital NHS Foundation Trust for his support and work. Dr Lang briefly described the epidemiology of the disease and the scale of the problem.  There were currently 910 cases nationally and the number was increasing, with a doubling rate of every 12 days.  About two thirds of cases were in England (873) and of these, 590 had been reported in London.  Chelsea and Westminster hospital was extremely experienced in providing sexual health treatment and services, seeing about 30-40 cases per day, the majority of whom were male and who identified as being gay or bisexual, or who had sex with men.  A robust local system had been established working with local sexual health services and the UK Health Security Agency (UKHSA, previously known as Public Health England). UKHSA had delivered all contact tracing activities and risk assessments.  The entire local NHS system was working together, with Imperial hospital forming part of the patient pathway.  After a patient was seen by Chelsea and Westminster hospital, an Imperial hospital virtual ward nurse would follow up to check on whether further medical treatment or support was needed particularly to those who were unable to self-isolate. In terms of communication, advice and information has been provided to at risk groups.  Dr Lang confirmed that despite the rate it was not as easy to catch as Coronavirus and that the Small pox vaccination offered protection.

6.2           Councillor Helen Rowbottom asked what infrastructure was in place to offer effective local support and if this was like the infrastructure established in response to Coronavirus. Dr Lang responded that similar methods were being used to track cases but acknowledged that there was an implied stigma linked to Monkey Pox. Dr Lang reported that the London Coronavirus Response Cell (renamed the London Monkey Pox Response Cell) had pivoted from Coronavirus to Monkey Pox. Dr Lang stated that it was important for people to confidentially access sexual health services and to trace any contacts an infectious person might have had.  The at-risk group was one that might feel stigma and required reassurance. A key difficulty with infectious diseases was to ensure that cases were identified, and support provided to help prevent the spread of infection. The UKHSA had confirmed that there was sufficient vaccine available but a controlled and steady roll out was required, with the priority being to vaccinate those who had been contact traced.

6.3           Councillor Natalia Perez welcomed the update and sought further information about any prevention awareness campaigns and what measures had been put in place to reach out to those communities most affected.  Dr Lang responded that much of the outreach work had been undertaken through specialist channels such as the Terrance Higgins Trust.  The local authority was not directly involved in this as communications were being led by sexual health experts.  ...  view the full minutes text for item 6.

This paper updates the Health and Wellbeing Board on the Joint Strategic Needs Assessmentin LBHF. The Joint Strategic Needs Assessment (JSNA) is a statutory requirement, and it is the way the Council is required assess the current and future health needs of the local population.

7.1           Dr Nicola Lang set out details of the Joint Strategic Needs Assessment (JSNA) for the borough and thanked Duncan Smith, Head of Business Intelligence Unit for the support provided.  The JSNA was a statutory requirement produced every five years. The new JSNA will comprised of different analytical items including factsheets, needs assessments, data profiles, area profiles, demographic reports, performance monitoring, dashboards, and infographics. It detailed the strategic, local population health needs that would be met by services delivered jointly by H&F and the NHS.  The fact sheets contained statistical information on, for example, mental health, or children’s services. This will continue to be built, adding more information and will eventually be an accessible library of factsheets and a resource for reference or to support future funding applications.  Dr Lang invited further suggestions for areas that could be added, with a view to undertaking yearly updates by factsheet authors. 

7.2           Councillor Coleman commented that the JSNA factsheet library could be a purposeful and easily accessible online resource.  Dr Lang reported that she had already found it helpful to access a homelessness factsheet for a workshop she had attended on mental health in homeless hostels (Joint Strategic Needs Assessment | LBHF).

7.3           Councillor Helen Rowbottom suggested that having sight of an executive summary or similar that highlighted outlier data would be helpful in terms of identifying policy and health and wellbeing priorities. Indexed against business intelligence data from other boroughs this could also evidence patterns and areas for analysis that could align with the work of the children’s policy and accountability committee. 

7.4           Following a question from Councillor Natalia Perez about the use of more recent census data (2021), Dr Lang confirmed that the fact sheets referenced census 2021 data which informed trend patterns demonstrating comparative change or progress. 

ACTION: Slide deck on JSNA fact sheet to be circulated to Board members

7.5           Dr Lang illustrated the application of the JSNA with an example of the demography of childhood immunisation, which indicated lower uptake among some communities.  It was recognised that the borough and ward profiles were constantly evolving through regeneration and development and Dr Lang confirmed that this progression would be reflected in updated factsheets.  Dr Lang added that herself and Duncan Smith, together with public health colleagues were awaiting the full publication of the census data which was imminent. Joanna Howe, Business Intelligence Manager (H&F) would lead the analysis, which would include details of the new wards. 

7.6           Dr Lang continued that a year after coming into her post as director of public health, she had taken on the task of addressing the borough’s low childhood immunisation take up, the fourth lowest take up in London.  The factsheets offered a source of data which enhanced the rich information already obtained through focus groups and work with community groups.   This was automatically updated each month with data released on the child health immunisation system.  Councillor Rowbottom enquired about the January 2021 date for the immunisation data  ...  view the full minutes text for item 7.

8.1           Dr Ashlee Mulimba and Nicola Ashton provided an update on the consultation currently being produced as part of the pharmaceutical needs assessment (PNA), exploring the local provision of community based pharmaceutical services delivered by trusted providers.  This was a statutory requirement to be completed by 1 October 2022 and to be agreed by the Board.  The intention was to work with pharmacies as a collective group, integral to the healthcare system, less peripheral and key providers.  Dr Mulimba outlined the work of Health Dialogues on undertaking the H&F PNA. Health and Wellbeing Boards were required to conduct a PNA to evaluate the pharmaceutical needs of the borough and review how these were currently being fulfilled by local pharmacies. 

8.2           The PNA would determine whether there were any gaps in provision and evaluate this through gathering data and engaging with residents who use pharmacy services.  Dr Mulimba reported that service user survey would be undertaken between 1 July to 31 August 2022.  This included a targeted list of local organisations ensuring that a diverse range of views could be canvassed.  This also included the use of multiple H&F media communication channels, newsletters, and a citizen’s panel.  The initial response had been welcomingly diverse with a broad range of responses from the community and 85 community pharmacies, which was very positive.  Dr Mulimba described the extensive range of local pharmacies, location and accessibility of existing sites which offered residents great choice.  In the context of childhood immunisation and vaccination Dr Mulimba welcomed the suggestion of making community-based pharmacies more integral and supported health interventions that could help improve take up. 

8.3           Speaking in the context of the move to borough-based partnerships Dr James Cavanagh commented that it was important for pharmacists and pharmacies to have a community role supporting residents and asked how providers could be encouraged to work collectively.  Dr Mulimba responded that the lead pharmacist had been part of the PNA process but acknowledged that the role of pharmacists generally could be more strategic.  How to nurture a more strategic and collective group was recognised by Councillor Ben Coleman as being a pivotal issue given that pharmacies had such potential to play a preventative role with regards to public health interventions and to achieve some uniformity of service delivery. Councillor Rowbottom suggested that a “point” person could be identified from each pharmacy, like GPs.

ACTION: The Board and borough-based partnership to explore how pharmacists could strategically and collectively help develop an integrated provision of local pharmaceutical services

8.4           Councillor Natalia Perez asked about the number of pharmacies located in the north of the borough and whether there was sufficient and equitable distribution of sites across the borough, and if these were accessible.  She also asked about the delivery of medication the experience of this during the pandemic.  Carleen Duffy enquired about the morning after pill and if this could be delivered at home.  Councillor Alexandra Sanderson commented on the decrease in the number of independent prescribers in  ...  view the full minutes text for item 8.

The Board to consider potential items and suggest topics to be included in the future.

Councillor Ben Coleman reported that he had been informed of an issue raised by a former co-opted member of the Health and Adult Social Care Policy and Accountability Committee (HASCPAC), Bryan Naylor regarding ophthalmology services and patient pathways.  There was potential to utilise pharmacists by facilitating greater collaboration with opticians.  Councillor Natalia Perez added that Bryan Naylor had also raised the issue with her potentially for consideration at HASCPAC.  Earlier diagnosis and intervention in eye treatment was critical given the degenerative nature of many eye conditions and that extensive patient wait times were a concern. Dr Nicola Lang recommended a paper should be commissioned from NHS colleagues. Councillor Alexandra Sanderson suggested childhood immunisation and dentistry services, focusing on specifically on young people.  Dr Lang added that NHS England should also be invited to contribute on these areas.  Dentistry was a growing area of concern due to the increased lack of access to NHS dental patient lists.

Suggested areas:

-        Ophthalmology services and patient pathways (HWB or HASCPAC)

-        Childhood immunisations

-        Dentistry services (specific focus on children and young people)

Better Care Fund – Formal board sign off.

The Better Care Funding (BCF) had been robustly covered in previous reports to the Board (16 March 2022), however it was recognised that   formal agreement of the formal yearend report (included in the agenda) was necessary.  Linda Jackson explained that the BCF pooled budget of £50.3 million across the borough-based health care partnership and local authority (£18.3 million from the borough).  The BCF would improve the number of avoidable admissions and discharges, with care and support provided at home, avoiding placement in residential care.  The abolition of the CCG and the establishment of integrated care services meant that the borough-based partnership would need to take ownership.  Linda Jackson reported that a conversation had been initiated about the borough-based partnership taking ownership of the BCF as there was a need to ensure that it was right for the locality.  The BCF agreement was very important both in terms of the services it funded and a way of supporting care provision outside of a clinical setting.

RESOLVED

That the Board recommend to the Integrated Care System that the borough-based partnership takes the lead in the Better Care Fund agreement going forward.

The Board is asked to note the date of the next meeting on 13 December 2022.

Wednesday, 21 September.