Agenda and minutes

RESOLVED that the minutes of the meeting held on 11 May 2023 be agreed as a correct record.

Apologies were received from Colette Wood – substituted by Kelly Poole (North Central London ICB)

Apologies were also received from Chris Munday (Executive Director Children’s & Family Services - London Borough of Barnet) and Sarah Campbell - Barnet Healthwatch.

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RESOLVED – that the Board noted the standing item on the agenda which lists the frequently used acronyms in Health and Wellbeing Board (HWBB) reports.

K Isaac – Director of Operations, Central London Community Healthcare NHS Trust (CLCH) presented the report and explained that the report focused on providing an overview and update on the progress of the mental health and community service reviews and delivery of the “core offer”. It provided an update on Barnet improvements and how these would benefit citizens in Barnet and furthermore, highlighted actions taken to address local Barnet challenges across community and mental health services.

It was explained that since the last update to the Barnet Health and Wellbeing Board, investment areas for Year 1 had been signed off by both the programme board and relevant system and ICB governance. Provider-led delivery plans for the first year of investments (2022-23) were mobilised from September 2022, alongside a process to track and monitor their impact. There had been a series of system conversations from January 2023 to agree the investment priorities for the second year of the programme (2023-24) and plans for these were being worked up by providers and were in the process of being signed off by the end of August 2023, with implementation expected to commence from September 2023.

CLCH had improved the coverage of some services to be 7 days a week, as well as wound care clinics and the Silverline triage service. The impact of the changes were to reduce pressures on other parts of the health service. CLCH will be seeking investment this year to expand Speech and Language Therapy, catheter provision, and rehabilitation services.

Carol Mayo - Managing Director, Barnet, Enfield and Haringey Mental Health Trust explained that a key focus was to address and improve staff shortage in the coming year. Access to psychological therapies has been improved. It was reported that a series of quality improvement initiatives were underway to improve patient flow and discharge processes, for example in Adult Crisis Care, Community Mental Health, and physical health checks for people with Severe Mental Illness. Crisis cafes have continued to expand, but she recognised that there was more work to do in this area. There is also a continued focus on embedding transformed adult community secondary care services in collaboration with primary care, social care and VCS organisations.

Kate Bayley- Barnet Mobilisation Manager, Whittington Healthcare NHS Trust reported that the ICB had invested £150k into the therapies accelerator programme to address waits in therapy services across NCL. In addition, in 2023-24 the ICB would be investing a further £323k recurrently in Barnet. Whittington Health took on responsibility for the therapies services from February 2022, and is the provider of children’s therapies for Camden, Islington and Haringey boroughs, as well as Barnet. Since the transfer staff vacancies had more than halved from 31% to 11% and waiting lists for first appointments had reduced by 80% (from 3,964 to 761), and average wait times were currently 11 weeks for Occupational Therapy, 5.5 weeks for Physiotherapy, and 15.5 weeks for Speech and Language Therapy. This is against a backdrop of increased demand nationally, and  ...  view the full minutes text for item 7.

The Chair resumed the meeting.

Louisa Songer – Senior Public Health Strategist presented her report and explained that the national drug strategy, ‘From Harm to Hope’, was published in December 2021 setting out the government’s 10-year plan to tackle harm caused by illegal drug use and related crime.

In keeping with previous drug strategies, From Harm to Hope sets out three strategic priorities:

i)             Break drug supply chains

ii)            Deliver a world-class treatment and recovery system

iii)           Achieve a generational shift in the demand for drugs.

In June 2022, the Joint Combating Drugs Unit (JCDU) published guidance on setting up and operating Combating Drug Partnership. Local areas were tasked to come together to address all three strands of the governments drug strategy, by bringing together partners to assess needs, develop an action plan, and deliver locally relevant ambitions.

Barnet’s needs assessment was published and Louisa Songer highlighted a few key points from the assessment. It was reported that the general rate of drug crime in Barnet remained relatively low but with pockets of activity in specific areas. There was an aging cohort of drug users, specifically opiate drug use, in those over 50 whilst the number of younger age groups using opiates had decreased; opiates (specifically heroin) and alcohol were the most reported substances used by adults in treatment. It was noted that there continued to be a substantial unmet need across Barnet, including a number of parents who were not accessing support for their substance misuse and a falling number of young people in treatment. It was considered that better partnership working was required with local GP’s to improve identification of people misusing alcohol and address physical health problems for people misusing substances.

In response to comments and questions raised by the Board, the following information was noted:

·       GPs were caught in a perpetual vicious circle as when they referred people to drug/alcohol services, it was often a requirement for that individual to be in a period of abstinence for them to engage with the services which was not always a viable option for a person suffering from addiction issues.

·       People with mental health issues and drug-related problems were often being turned away from services due to their lack of abstinence. There needed to be a more joined up approach in breaking down barriers and for the provision of services providing an holistic approach to support and recovery. Barnet had invested in joint roles in the Mental Health and homelessness services to break down these barriers, and its substance misuse services have knowledge to help service users to navigate the Mental Health landscape.

·       Some schools offered information in personal, social, health and economic (PSHE) education classes to educate on drugs/alcohol and the associated risks and it was suggested that these be expanded and delivered to more schools preferably by those with ‘lived experience’. The Board noted that an audit of PHSE provision on substance misuse was part of the delivery plan for the partnership, which will capture this,  ...  view the full minutes text for item 8.

Dr Calisha Allen, Barnet Public Health presented her report which provided an overview and update on key findings of the Directorate of Public Health recently completed Population Sexual Health Needs Assessment. The Barnet 2023 Sexual Health Needs Assessment looked at data from the last 5 years and used 2021 census demographic data to help better understand the needs of the Barnet population. The last 5 years have seen unprecedented pressures and changes to sexual health provision and healthcare more broadly both regionally and nationally, due to the COVID-19 pandemic and monkey pox.

The following information was reported:

·         57.8% of women choose user dependent contraception.

·         70.6% of STI tests were completed through online self-sample kits.

·         STI testing levels have not yet returned to pre-pandemic levels.

·         HIV rates in Barnet are classified as high but remain below regional levels.

·         Gonorrhoea rates are above pre-pandemic levels and syphilis rates continue to rise including throughout the pandemic.

·         41.1% of abortions in Barnet were repeat abortions.

·         In the reporting period 2021 chlamydia detection rates in females aged 15 to 24 are below the national recommendation, at 1502 per 100,000.

The rates of HIV in Barnet are still relatively high. However, the Council is striving to reach the Government’s target of no new HIV cases by 2030. There was continued commitment to accessing those hard-to-reach groups such as those suffering from homelessness, migrants and under-represented groups who were less likely to access sexual health services.

The Board commented that there were some issues with the accessibility of Pre-Exposure Prophylaxis (PrEP). It was explained that efforts were being made to create clearer pathways for patients and sharing information with GPs and main points of contact for the public. Work was also being undertaken to improve the accessibility of the web pages across the system to help residents understand where and how to access consultations for PrEP. An offer for self-testing kits to be available at GP receptions was made, which will be taken up outside of the meeting. It was noted that specialist services and pathways existed for those who have been a victim with a range of services provided by the council, Central North West London NHS Trust and the voluntary and community sector for those who had suffered from sexual abuse and/or FGM.

The Chair thanked the officers for their report.

Resolved that:

i)        the Health and Wellbeing Board note and approve recommendations from this needs assessment that will go on to inform the writing and implementation of the Barnet Sexual Health strategy.

ii)      the Health and Wellbeing Board further to note that all recommendations from the sexual health needs assessment were agreed by the steering committee which was comprised of a range of professionals working in sexual health including members from the council, professionals and healthcare professionals within NHS services and the charity sector.

Dr Deborah Jenkins – Public Health Consultant, elaborated on her report and explained that the Board has a statutory duty to publish a Pharmaceutical Needs Assessment (PNA) and update it at least every three years. If there were changes to pharmaceutical provision since the last published statement (in 2022), the Board is required to review the impact of the change and assess whether a supplementary statement is required. Since the last assessment was published, two pharmacies closed in April 2023, which were the Lloyds pharmacies in Sainsburys stores in New Barnet and Hendon, and a third pharmacy closed due to consolidation with another premises in North Finchley in September 2022. The impacts of these changes on pharmacy provision in the borough have been assessed and it was considered that these two closures and one consolidation would not lead to a gap or poor provision in pharmacy services Barnet.

The Board discussed the report.

Resolved that:

a)    the Board note the closures of the two Lloyds pharmacies in two Sainsburys stores and the consolidation of one pharmacy into another premises.

b)   the Board agrees that an updated supplementary statement is not required for the two pharmacy closures.

c)    the Board agrees that an updated supplementary statement (Appendix B) will be published for the pharmacy consolidation (as required by statutory guidance), and that an updated map of pharmacy provision in Barnet (Appendix A) is published alongside the statement.

Dawn Wakeling, Executive Director – Communities, Adults and Health gave a verbal update to the Board and highlighted that the borough partnership had been to the Royal Free and Middlesex Population Health Committee and presented an update on the work of the borough Partnership relating to the Aging Well Pathway Aging Well MDT and the Council support for Care Homes. The feedback received had been extremely positive; they had described Barnet’s frailty pathway and support for care homes as exemplary and suggested it be rolled out nationally. There had been a North Central London wide bid for cancer screening and to raise awareness for early signs of cancer which hopefully should result in a circa £400k investment.

The Board noted the verbal update.

Dr Tamara Djuretic – Director of Public Health and Prevention gave a verbal update to the Board and highlighted the following:

·         The rate of measles cases in London was at the highest level in a decade, with the number of new cases continuing to rise. There had been various campaigns launched recently, encouraging people to get themselves and their children vaccinated with those born between 1998-2004 the most at risk.

·         Recent data suggests the growth of the outbreak of monkeypox has slowed and a vaccine was now available.

·         There had been an increase in the number of cases of whooping cough reported.

The Board noted the verbal update.

The Board noted the items due to be reported to future HWBB meetings.

RESOLVED that the Board noted the Forward Work Programme.

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