Agenda and minutes

Apologies from the following board members: Vanessa Andreae, Councillor Larry Culhane, Dr Nicola Lang, Lisa Redfern, Councillor Lucy Richardson, Sue Roostan and Glendine Shepherd.

If a Member of the Board, or any other member present in the meeting has a disclosable pecuniary interest in a particular item, whether or not it is entered in the Authority’s register of interests, or any other significant interest which they consider should be declared in the public interest, they should declare the existence and, unless it is a sensitive interest as defined in the Member Code of Conduct, the nature of the interest at the commencement of the consideration of that item or as soon as it becomes apparent.

At meetings where members of the public are allowed to be in attendance and speak, any Member with a disclosable pecuniary interest or other significant interest may also make representations, give evidence or answer questions about the matter.  The Member must then withdraw immediately from the meeting before the matter is discussed and any vote taken.

Where members of the public are not allowed to be in attendance and speak, then the Member with a disclosable pecuniary interest should withdraw from the meeting whilst the matter is under consideration. Members who have declared other significant interests should also withdraw from the meeting if they consider their continued participation in the matter would not be reasonable in the circumstances and may give rise to a perception of a conflict of interest.

Members are not obliged to withdraw from the meeting where a dispensation to that effect has been obtained from the Audit, Pensions and Standards Committee. 

None.

(a)   To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health & Wellbeing Board held on Monday, 13 December 2022; and

(b)   To note the outstanding actions.

It was noted that Jacqui McShannon had attended the previous meeting.  Sue Roostan reported that paragraph 5.4, should state “non-essential CCG work”, that in paragraph 5.14, “intuitive” should be replaced by “initial” and that two references to “consultation” in paragraph 6.7 should state “engagement”.

RESOLVED

The minutes of the previous meeting held on 13 December 2021 were noted as an accurate record, as amended.

Vaccine reluctance has shone a stark spotlight on the long-standing problem of lack of trust in our health services by many Black and minority ethnic residents (whether general public or NHS employees) as a result of their lived experience over the years of worse access, treatment and outcomes.  An essential component relates to addressing health inequalities and this item is an introduction to the work that the borough is undertaking to address this.

4.1           Councillor Ben Coleman introduced the term “health inequality” within the context of people who receive poorer health treatment because of biased, racist perceptions and behaviours. The recently published report “Ethnic Inequalities in Healthcare: A Rapid Evidence Review” (February 2022) produced by the NHS Race and Health Observatory, and led by its director, Dr Habib Naqvi, evidenced stark and overwhelming racial inequity within the UK’s healthcare system. The NHS Race and Health Observatory had engaged nationally which was a positive step. Locally, H&F had recently received a significant funding award to look at the root causes of health inequalities within the borough.  Linda Jackson prefaced the discussion by describing the borough’s collaborative approach with Dr Bob Klaber, Consultant in Paediatrics, Imperial College Healthcare NHS Trust. A reluctance to come forward for vaccination in some ethnic communities stemmed from a lack of trust.  The Council was working with partners including the NHS and police to address this.

4.2           Dr Naqvi’s provided an overview of the work of the Observatory, which was set up to be a semi-independent unit scrutinising the NHS and UK Healthcare system. Details were provided on the Observatory’s form and function. Observatory’s work focused on 5 main areas. These were: maternal and foetal mortality in ethnic communities; disproportionate mental health illness in ethnic communities and access to mental healthcare; empowering vulnerable communities; and digital health. Councillor Ben Coleman commended Dr Naqvi for his work and an insightful, that to achieve meaningful and sustained progress it was necessary to get “comfortable with the uncomfortable in order meet the needs of diverse communities”.

A Zoom recording of Dr Naqvi’s complete presentation from can be accessed at H&F Health & Wellbeing Board | 14 March 2022 - YouTube, 13:42.

4.3           Bevin Powell referenced historic reports which highlighted the impact of health inequalities and cultural misrepresentation in the NHS which impeded building trust and confidence. He asked how improved cultural competencies could help address institutional and structural racism.  Assistive technology and digital innovations were helpful, but this would not necessarily avoid cultural bias due to an absence of systemic planning. Ensuring cultural competency at every level from commissioning to service delivery required that the right questions be asked throughout.  

4.4           Dr Naqvi agreed and outlined a piece of work that the Observatory was currently engaged in that identified new innovations in the NHS to ensure that an equalities impact assessment was factored in at the start.  The review of racial bias in pulse oximeters illustrated that the design of the device did not recognise differences in skin pigmentation and needed to be addressed. This led to a decision to have a wider review of medical devices. Dr Naqvi focused on leadership and how dealing with this challenge should not be a burden for those most affected by it.  There should be an equal burden of commitment for everyone and if it worked for the most vulnerable in the community then it would work for the majority.   Councillor Coleman endorsed the  ...  view the full minutes text for item 4.

This report presents the program of work required to undertake a Pharmaceutical Needs Assessment (PNA) for the London Borough of Hammersmith & Fulham to ensure that the Health and Wellbeing Board meets its statutory requirement to publish a PNA by October 2022.

5.1           Nicola Ashton outlined the requirements of the Pharmaceutical Needs Assessment (PNA) and how the Board would have to deliver this.  Required every three years, an extended grace period of 6 months had been permitted and the PNA would be required by October 2022.  Health Dialogues Limited was the appointed provider that would help support and deliver the PNA process.  With reference to the slide deck Ashlee Mulimba explained that the PNA captured local views and assessed the current pharmacy provision to see if this met existing local needs.  This was achieved through a process of engagement, communication using tools such as social print mediums to channel the views of seldom heard voices.  This ensured that the views of those furthest from decision making such as addicts, the homeless, sex workers, Black and Asian Minority Ethnic groups were included.  The intention was to complete stakeholder engagement by the end of March 2022, using a broad approach with multiple channels to generate wide ranging perspectives. Dr Lang clarified that consultation, and a survey would be conducted over the summer period.  The suggestion to include organisations such as Nubian Life as part of the engagement was welcomed.

5.2           Councillor Coleman commented that given the earlier discussions around minority ethnic groups that were “poorly reached”, pharmacies had a critical role to engage and meet the needs of these communities.  Nicola Ashton reported that previous surveys had indicated that there had been minor variation in the level of use except in the timing of access.  Bevan Powell enquired about what collective measures were being taken to work with grass roots communities.  Dr Lang confirmed that engagement would be undertaken through local faith forums in the borough.  She was keen to ensure that those without a voice should be included, together with data and feedback obtained from other co-produced sessions.  Yvonne Okiyo recommended that an equalities impact assessment be undertaken to ensure that there was range of suitable methods to facilitate consultation with different communities of interest. It would also assist consultation with groups with protected characteristics or those most likely to be impacted.

RESOLVED 

That Health and Wellbeing Board commented on and noted the statutory requirement to develop and publish an updated Pharmaceutical Needs Assessment (PNA) by October 2022.

This verbal report from the Director of Public Health and the Director of Covid-19, provides an update on the council’s Covid-19 response.

6.1           Dr Niki Lang reported that Covid rates were rising and that the Secretary of State for Health had mentioned that our local rate was 550 per 100,000 population, and that in H&F there had been 40 cases reported in the previous 7 days.  There had been a London level discussion about what could have caused this, but it was likely to be because of increased social interaction and low false testing rates, given that people had begun testing again.  The BA2 variant of Omicron was found to be more easily spread compared to the original Omicron variant, wanning vaccine immunity and reduced mitigation measures with fewer people distancing or wearing face masks.

6.2           Dr Lang also reported that they were supporting local service providers with advice regarding the most recently implemented changes issued on 24 February 2022.  Sue Roostan confirmed that a spring booster vaccination plan was about to be implemented and delivered through community pharmacies with some pop up.  It was unlikely that large, primary care network hubs would be used although this might change depending on the view of the Joint Committee for Vaccination and Immunisation.  Given the 40% increase in the number of cases Sue Roostan confirmed that hospitalisations were low in number, both in terms of intake and the intensive care units.

6.3           Jacqui Mc Shannon reported that schools continued to implement the advice of the Director of Public Health in terms of testing provision for children and staff in vulnerable settings, including the guidance on self-isolation.  Dr Lang confirmed that refreshed guidance had been issued to schools and the requirement for schools to test twice weekly had been removed.  The BA2 variant was a concern and schools had been supported in continuing to follow the advice.  Commenting on the possibility that lateral flow test kits would be charged for in future, Dr Lang acknowledged that this was a concern as it might inhibit testing.  There was a consensus that contrary to the government view, Covid was very much present.

RESOLVED

That the verbal report was noted.

The Board is requested to consider the items for future meetings.

To be followed up.

None.

The Board is asked to note the date of the next meeting on Thursday, 16^th March 2022.

Wednesday, 29 June 2022.