Agenda and minutes

• Agenda Item 9 Page 3 - The Chairman noted that the numbering of the questions to Dr Greenberg should read 1, 2, 3 and 4.

Matters arising from the Minutes of the meeting held on 3 December 2020:

• Agenda Item 8 Page 3 - The Chairman informed the Committee that Ms Slater-Robbins, Senior Children and Young People’s Commissioner, London Borough of Barnet, had requested an update on the review of the Maternity Services’ links to breastfeeding support on the Royal Free London NHS Foundation Trust’s website. The review had still not been completed, due to the Trust’s focus on the Coronavirus pandemic, but she would inform the Committee when it was.
• Agenda Item 8 Page 3 - A Member requested if the Committee could receive further information regarding the demographic and geographic spread and how the Council might best target information to those communities not having taken up breastfeeding, given that the breastfeeding rate in Barnet has now improved to 63% which is well above the England average of 48.15%.
• Agenda Item 9 Page 5 - The Chairman reported that both she and Cllr Stock had tested the system again for outpatient blood tests, having previously experienced delays of up to four weeks, and timely access to appointments was now greatly improved. Dr Greenberg had also informed her that Outpatient Blood Services at Barnet, Chase Farm, the Royal Free and Edgware Community Hospital are now all open for both routine and urgent blood tests.
• Agenda Item 10 Page 7 - The Chairman reported that Outpatient Blood Services at Finchley Memorial Hospital were also now open for both routine and urgent blood tests. Central London Community Healthcare (CLCH), who run the service, had reviewed the phone booking system after her comments. Capacity had been increased and calls were no longer being automatically disconnected.
• Agenda Item 10 Page 8 - Nicholas Ince, Senior Primary Care Transformation Manager, NCL CCG (Barnet Directorate), had forwarded the link on pharmacy vaccination availability, as agreed. This had been emailed to the Committee on 29 October 2020.
• Agenda Item 11 Page 10 - The Chairman confirmed that the Seminar on Mental Health and Housing, as requested in relation to Cllr Moore’s Member’s Item, was held on 1 December.  She expressed her thanks on behalf of the Health Overview and Scrutiny Committee (HOSC) to Dawn Wakeling and everyone involved. Cllr Moore commended officers, adding that the event was well attended and reflected how seriously Members take these issues. She noted that there remains a concern about the interface between Housing Associations and private landlords, who are not obliged to engage with the Council, so she hoped the Council would continue to work on its influential role.

RESOLVED that the Committee approve the Minutes of the meeting held on 3 December 2020 as an accurate record, subject to the one amendment.

None.

Cllr Cooke declared a non-pecuniary interest under Item 9 as his daughter works at University College London Hospital (UCLH).

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the Minutes of the JHOSC meeting held on 25 September were received.

Agenda Item 8 Page 6 - Cllr Hutton expressed concern about Public Health England (PHE) being abolished and replaced by the National Institute of Health Protection, especially as this happened during a pandemic and without consultation. Dr Tamara Djuretic, Director of Public Health, London Borough of Barnet, responded that she and other Directors of Public Health had been part of previous discussions nationally about the future of the public health system but she had not been informed prior to the announcement. Directors of Public Health are appointed by the Secretary of State delegating to PHE and local members but are not part of PHE. She added that she had been reassured that public health functions would stay at a local level and that during the pandemic the Coronavirus Response Cell at the London level, led by PHE, has been and would continue to provide support for Barnet. Any future changes might take place in 2021 but will possibly be delayed from 1 April 2021.

RESOLVED that the Minutes of the JHOSC meeting held on 25 September 2020 were noted.

The Chairman invited the following to the meeting:

·       Dr Tamara Djuretic, Director of Public Health, London Borough of Barnet

·       Dawn Wakeling, Executive Director, Adults and Health, London Barnet of Borough

Dr Djuretic reported that Coronavirus cases in Barnet have been decreasing, standing currently at 140 per 100,000 population. We are out of lockdown and in Tier 2 but there are still certain social distancing measures in place and these need to be exercised and followed, especially if there are up to three households in a Christmas bubble.

Dr Djuretic continued that the current average hospital admission of patients with Covid in Barnet is ten patients per day. The latest data as at 17 November shows 69 Covid patients in general beds and 22 on mechanical ventilation across the whole Royal Free Group. Approximately one third of these patients are Barnet residents.

Barnet has good access to PCR Covid tests, with two local sites as well as mobile testing units. The Government has introduced ‘Lateral Flow’ testing initiatives across five national programmes. One is for Care Settings including residents, care workers, and visitors, one programme is for university students, one is for work places although it is not exactly defined which ones, another is for hospital staff and the last one is for Directors of Public Health to utilise Lateral Flow Tests (LFTs) as and when they are needed. The LFT is a new technology producing results in 30 minutes although its specificity is high sensitivity is not as good, resulting in a few false positives but there are more false negatives. At the moment, there are two large Care Homes in Barnet which have received the tests in the first wave. Barnet has ordered 8000 tests and will use them initially in places of worship, schools and day centres. As the results cannot be guaranteed with LFTs, protective measures still need to be in place and Barnet has communicated this to Middlesex University and Care Homes.

Dr Djuretic reported that Barnet has recruited around 100 champions from a variety of communities to help to disseminate messages around Covid, including building trust in the vaccine as well as social distancing.  In addition, Barnet will begin contact tracing to support NHS Test and Trace on 4 December. Preparations are underway for a vaccination programme to be run by the NHS. Barnet is supporting North Central London (NCL) to identify sites for mass vaccination. Vaccination will also be carried out in Primary Care and mobile sites. The Pfizer BioNtech vaccine has been approved with Astra Zeneca/Oxford next in the queue and the third will be Moderna. Two doses of each of these vaccines will be needed and there will be priority tiers starting with Care Homes.

A Member asked whether Care Home residents who have been treated in hospital with Covid, but have recovered, would be given the Lateral Flow Test so that they can return to Care Home. She also expressed concern that it may not be in  ...  view the full minutes text for item 8.

• Flu vaccination update/lessons learnt and potential future Covid-19 vaccination
• Alternative Provider Medical Services (APMS)
• Further update on services at Finchley Memorial Hospital (FMH)
• GP Federation at FMH and services they provide

The Chairman invited the following to the meeting:

·       Colette Wood, Director of Primary Care Transformation, NCL CCG

·       Kelly Poole, Deputy Director of Primary Care Transformation, NCL CCG

·       Carol Kumar, Deputy Director of Primary Care Transformation, NCL CCG

·       Mr Michael Whitworth, Chief Executive, Barnet GP Federation

·       Cllr Anne Clarke, London Borough of Barnet

·       Cllr Peter Zinkin, London Borough of Barnet

Flu vaccination update/lessons learnt and potential future Covid-19 Vaccine distribution

Dr Stephens presented the report written by Nicholas Ince, Senior Primary Care Transformation Manager, NCL CCG.

Dr Stephens noted that flu vaccination providers have for some months been delivering the flu vaccine to those in groups at higher risk and from December they have been offering the vaccine to 50-64-year olds who are not at risk. She reported that the latest data for over 65s vaccinated as of 23 November 2020 was 69.7% in Barnet, which has already surpassed the final 2019 achievement of 65.9%. For the cohort of under 65s at risk, the percentage was 37.3% which has nearly surpassed the final 2019 figure of 40.3% and for the 2-3 year old cohort the percentage was 44.2% which has already surpassed the 2019 achievement of 31.1%. She confirmed that where there were initially problems with supplies of the vaccine, this has been remedied. Feedback from patients on the safety of environments for receiving the vaccine has been positive.

Dr Stephens reported that the programme was supported by a comprehensive communication and engagement plan to help to spread the word on the benefits of vaccination using social media, contacts with patients in acute trusts and the voluntary and community sector. Community outreach is also ongoing with Care Homes and the homeless.

The Chairman asked whether the Mutual Aid Strategy is up and running whereby GPs and pharmacies can give unused supplies of vaccines to surgeries and pharmacies which have run out. This was mentioned by Nicholas Ince at the last meeting. Dr Stephens confirmed that it is.

A member enquired about the three Covid vaccines: what the differences are and which would be used. Dr Stephens responded that only the Pfizer vaccine has been approved so far and the Oxford/Astra Zeneca vaccine is currently in the process of being approved by the MHRA, followed by the Moderna vaccine. It is not yet known how long the vaccines will protect patients. The Pfizer vaccine presents more problems as it requires storage at a temperature of -70C, can only be moved four times and is produced in large amounts so must be used as soon as it is defrosted. Each of these vaccines require two doses.

A Member asked what is being done to encourage flu vaccine take-up as there may be some communities which may be missed who are also more vulnerable to Covid and whether it was known where the deficits are. Dr Stephens responded that there is data on vaccine take-up and demographics and this does help to direct the focus of the CCG. She also mentioned that there  ...  view the full minutes text for item 9.

·       Royal Free London NHS Foundation Trust

·       Central London Community Healthcare

·       North London Hospice

The Committee received the mid-year updates to the Quality Accounts for the Royal Free London NHS Foundation Trust, Central London Community Healthcare (CLCH) and the North London Hospice (NLH). The Chairman noted that no supplementary questions had been asked by the HOSC when the updates had been circulated to the Committee in advance of the meeting.

The Chairman reported that Dr Greenberg had apologised and notified her of an error on Page 10, Item 17 of the RFL NHS Foundation Trust’s Mid-Year Quality Account update. The answer provided stated that “all ‘Must Do’ actions are now complete”. This was not correct and should read “81% of the ’Must Do’ actions are now complete’.

RESOLVED that the Committee noted the updates on all three Mid-Year Quality Accounts.

A paper was received and the amendment mentioned in relation to the mid-year update on the Quality Account that “81% of the ‘Must Do’ actions were now complete” was reiterated by the Chairman. 

RESOLVED that the Committee noted the report.

To follow

The Chairman invited the following to the meeting:

·       Dr Janet Djomba, Public Health Consultant, London Borough of Barnet.

·       Dr Tamara Djuretic, Director of Public Health, London Borough of Barnet

·       Dr Clare Stephens, Clinical Representative, NCL CCG Governing Body

The Committee received the report and Dr Djomba presented her slides. 

Dr Djomba reported that the last presentation on measles and childhood inoculations to HOSC was a year ago and at that time the team had been preparing to implement the Action Plan when the pandemic began and disrupted this. 

Dr Djomba reported that GPs had fed back that some parents were anxious to bring their children for vaccination during the pandemic but many had not received sufficient information that the NHS vaccination programme should continue during this time. 

Dr Djomba continued that the vaccination programme had also been disrupted because most stakeholders were in ‘business continuity mode’ concentrating on the pandemic response. Barnet Council and the CCG had monitored this and provided support and information to GP Practices on how to continue with childhood immunisation safely, whilst maintaining infection control. GPs had also sent information and appointment reminders to parents. Barnet Council is returning to its routine business so is looking to improve the uptake in immunisation and had increased its communications to parents mainly via health visitors and early years settings, but also using social media.

Dr Djomba reported that there had also been delays in the registration of births during the pandemic but this this is being prioritised. 

Full data on immunisation uptake for Quarters 1 and 2 in 2020 is not yet publicly available but Quarter 1 showed a good uptake of the first dose at two years old of the MMR vaccine in Barnet at 83.5%. Dr Djomba reported that she had been informed that there had been no decrease in uptake for Quarter 2 due to the pandemic. London has an historically low uptake and Barnet’s is comparable to London’s, though better than its neighbouring Boroughs. However, the uptake is below the 95% that is needed for herd immunity. Dr Djomba continued that for the second dose of the MMR vaccine, uptake in Quarter 1 was 77.5% and Quarter 2 doesn’t show a significant decrease. Uptake of the ‘6 in 1’ vaccine which is given to babies at an earlier stage before 12 months was at 90% for Barnet, which is below the national average but better than across London and neighbouring Boroughs.

Dr Djomba reported that the uptake of the pre-school booster vaccine for children of five years of age was 75.8% in Quarter 1. This was lower than the uptake across NCL and something that the team will be focussing on. 

A Member enquired whether there was a reason for the significant dip in some vaccines in Quarter 1 of 2018/19 and whether this had been a data reporting issue. Dr Djomba responded that such strong deviations are usually related to data capture or reporting, although it could represent a lower uptake. However, she  ...  view the full minutes text for item 12.

22 February 2021

·       Coronavirus and Covid 19 Vaccination Update

·       Alternative Provider Medical Services (APMS) in Cricklewood Update (CCG)

·       Children and Young People’s Oral Health in Barnet

·       Written Update on Birth Registrations

10 May 2021

·       Quality Accounts: Royal Free London NHS Foundation Trust, Central London Community Healthcare and the North London Hospice

·       Childhood Inoculations Update and Crown Coronation Trial Results.

RESOLVED that the Committee note the Forward Work Programme.

None.