Agenda item

The Chairman invited the following to the table:

·         Dr Jeff Lake - Consultant in Public Health, LB Barnet

·         Colette Wood – Programme Lead, Care Closer to Home Integrated Networks (CHINs), Barnet CCG

Dr Lake reported that a wide range of initiatives around diabetes prevention, detection and management had been introduced in recent years in Barnet. He thanked Cllr Caroline Stock for championing a successful local campaign, including public events.

In addition, Dr Lake reported that a Pre-Diabetes Service (the National Diabetes Prevention Programme – NDPP) has been delivered in Barnet providing a nine month programme for the management of patients just below the diagnosable level of diabetes.  The NHS Long Term Plan signals an intention to expand this provision.  Locally, GPs have been incentivised to embed the annual review of patients identified at risk and assessment of motivation to change leading to brief advice and where appropriate referral to the NDPP.

A group consultation initiative is also underway in Barnet which aims to replace routine appointments with group based reviews and providing an opportunity for advice on self-care and peer support. At Millway Medical Practice, group consultations with prediabetics have demonstrated remarkable success with all patients recruited no longer demonstrating markers indicative of prediabetes after a few months.

Physical activity and healthy eating were also being promoted and Barnet has signed the Local Government Declaration on Sugar Reduction.   A ‘One You’ Self-Help website incorporating resources to support behaviour change will be launched shortly.

Dr Lake noted that his report recommended a coordinated approach to diabetes to be overseen by the Quality Improvement Support Team (QIST). He qualified this recommendation, in that whilst greater impact could be delivered by coordinating actions on prevention, detection and management of diabetes, the organisation or service to lead on co-ordination still needed to be determined.

The Chairman noted that 90% of people with Diabetes have Type 2 which is “largely preventable and manageable by lifestyle changes” (page 14, 1.2 of the report). Given the high cost of the disease, as noted in the report and which continues to increase, she asked if more up-to-date figures on cost were available as the report cited data for 2015. Dr Lake responded that a comparable breakdown of costs had not been produced since 2015 but that it is generally accepted that around 10% of NHS expenditure is attributable to Diabetes.

A Member asked what could be done about the high incidence of diabetes in South Asian and Black populations. Dr Lake noted that this was partly due to genetic predisposition but also to aspects of dietary practices in certain communities. Healthy eating messages had not been specific to those communities so it was important to address this.

A Member asked what could be done to raise awareness and to reduce the prevalence of diabetes – she referred to page 14, 1.3 of the report -  that there are likely to be over 8000 people with undiagnosed diabetes in the Borough”. Dr Lake responded that programmes were in place with Barnet schools and some workplaces in an attempt to embed healthy lifestyles and various resources and support are available to support behaviour change.  The Sugar Reduction Declaration is a positive step but more work was required to raise awareness. Childhood obesity in the UK is also a longstanding issue that needs to be tackled. He hoped that the QIST could help to start to embed prevention and detection of diabetes into Primary Care locally.

Ms Wakeling reported that Barnet had many workstreams in place involving schools and leisure services. The QIST would be working on reducing variation in detection and management of diabetes in Primary Care.

Ms Wood commented that the focus on diabetes which had been successful in the Burnt Oak CHIN, would be extended across the Borough. The CCG was looking at everything it could do from prevention to treatment to improve outcomes for patients in Barnet.

A Member mentioned that the Barnet Asian Women’s Association had been promoting the message on healthy eating for some time so it would be helpful to have more focus on such groups in the future.

A Member asked when some Key Performance Indicators (KPIs) were likely to be available so that the impact of the interventions could be measured. Dr Lake responded that historically KPIs had focused on management after diagnosis but the culture was beginning to change with more focus beginning to be made on detection and prevention, so he hoped that KPIs would be developed around this soon.

A Member said that the mobile diabetes testing in Burnt Oak had found 25% of those tested to be diabetic or pre-diabetic. Often the poorest health indicators were found in residents with limited budgets. Could there be some collective intervention to help those residents?

Dr Lake responded that there is a wider programme of work promoting healthy eating, including trying to improve people’s awareness of food options on limited budgets and their ability to cook. Ms Wakeling reported that the Public Health team had launched a Food Security Report and Action Plan for Barnet to ensure that residents have access to sufficient nutrition.  She would circulate details to the Committee.

(Note: circulated on 25.04.19)

A Member asked how the impact of the programme would be measured since prevention could be difficult to measure. Dr Lake responded that its evaluation was ongoing nationally as part of the NDPP.

A Member referred to the figure of 8000 given in the report as the number of residents estimated to be undiagnosed diabetic or pre-diabetic. Given Barnet’s population and age profile, is the true figure likely to be even higher? Dr Lake responded that the data was age adjusted so based on the best evidence to inform estimates.

A Member noted that previous work with Diabetes UK had revealed that they were aware of the Asian community in Barnet and the probable challenge for the Borough in tackling diabetes.

A Member commented that he was disappointed to see nothing in the report about child poverty since this was a major factor in poor health outcomes. Families with limited budgets were known to have diets high in white flour, potatoes, white pasta etc. leading to obesity and diabetes. The Member added that during half term the Rainbow Centre in Barnet had provided meals for 50 children daily. Poverty was a reality in Barnet and needed to be highlighted. Dr Lake responded that his report could have mentioned related pieces of work such as the Food Security Report which looked into this in greater detail.

A Member suggested that some of the information discussed be made available to the Children’s Committee to help to raise awareness. The Chairman agreed, adding that a fifth of under five-year olds was known to be overweight or obese and this same group had a higher incidence of tooth decay. This had already been reported to the Children’s Committee. She would speak with the Children’s Committee Chairman.

Action: Chairman

The Chairman congratulated Dr Shaw and Barnet Hospital (BH) on the food made available to the staff and public in the canteen at BH and the changes that had been made to encourage healthier eating. She asked Dr Shaw to provide information on meals made available to patients. Dr Shaw agreed to provide this.

Action: Dr Shaw

Resolved that the Committee note the report.