The Health Scrutiny Committee met on Wednesday 27 March 2024 to discuss a range of health-related issues affecting Barking and Dagenham residents. Key topics included an update on cancer screening programmes, a proposed new strategic approach to tackling unhealthy weight, and changes to the legislative framework for Health Scrutiny Committees.

Screening Update for Barking and Dagenham

The committee received an update on cancer screening performance across Barking and Dagenham. Since August 2022, there have been improvements in bowel screening coverage and uptake, with a 3% increase in one year. Breast screening uptake has also seen progress, although it remains a service impacted by the pandemic. Cervical screening rates are moving in a positive direction for both older and younger women. Targeted lung health checks, introduced in July 2022, have achieved a 55% uptake in Barking and Dagenham, which is among the highest nationally.

Members raised concerns about the low uptake of screening among homeless patients, with officers explaining the difficulties in identifying and following up with this demographic. Suggestions included utilising GP pop-ups and support from Primary Care Networks (PCNs). The effectiveness of targeted screening improvement projects, such as the 'It's Not a Game' campaign, was discussed, with the rationale being to encourage attendance from specific groups through tailored messaging and engagement with local organisations. The committee also noted the challenges related to staffing shortages for specialist roles, such as radiographers and radiologists, required for lung health checks, and the impact of financial support pressures. The unavailability of prostate screening was also raised, with officers explaining that decisions on such programmes are made at a national level, though free PSA test kits are available for men over 45 in North East London. The Director of Public Health highlighted the importance of patients acting on symptoms and the role of rapid diagnostic clinics in identifying irregular symptoms for specialist review.

A New Strategic Approach to Healthy Weight in Barking & Dagenham

A significant portion of the meeting was dedicated to discussing a proposed new strategic approach to tackling the borough's obesity crisis. The Head of Localities Commissioning (HLC) presented a report highlighting that approximately 65% of the population is affected by obesity, a situation that has been worsening since 2016. The current individualistic approach, which only reaches a small fraction of patients annually, was deemed insufficient.

The proposed strategy advocates for a radical shift towards a community-led, partnership approach that recognises the complex factors influencing health, including environment, poverty, food access, and time constraints. This communities-up approach aims to gain deeper insights into diverse and marginalised communities, fostering conversations and support networks. Opportunities such as the Localities programme, the Good Food Plan, and Sport England funding were identified as potential avenues for impactful, non-stigmatising, long-term change, requiring active community engagement.

Members inquired about the integration of social prescribing, community hubs, and volunteers into the new strategy. The HLC explained that existing infrastructure would be leveraged to provide support and information, with initiatives like cooking clubs and walking groups fostering social interaction and lasting impact. The importance of community-based allotments was also supported as a means to build neighbourhood relations and promote environmental benefits. Concerns were raised regarding the high rates of childhood obesity, particularly in deprived areas, with the HLC emphasising the crucial role of engaging with schools and collaborating with services like Children and Adolescent Mental Health Services (CAMHS) to support children and families. The lack of awareness of existing healthy living services was also acknowledged, with a commitment to finding effective ways to reach residents who may not engage with current offerings, ensuring information is accessible beyond digital platforms. The Director of Public Health also drew attention to the significance of underweight issues as part of the broader public health challenge of weight management. The committee noted the report, indicating support for the proposed strategic shift.

Changes to Health Scrutiny Committees

The Principal Governance Officer (PGO) presented a report detailing changes to Health Scrutiny Committees (HSCs) stemming from new legislation that came into effect on 31 January 2024. The most significant change grants the Secretary of State for Health and Social Care the power to intervene in proposals for changes or reconfigurations of local NHS services. This replaces the previous exclusive power of HSCs to refer such proposals to the Secretary of State. A new call-in request process is now available to anyone, not just HSCs. While the Secretary of State can make decisions on reconfiguration proposals, these powers are intended for complex cases causing significant public concern. HSCs will continue to hold powers regarding responsible persons, including NHS commissioners and providers, allowing them to review and scrutinise health service planning, provision, and operation. Local Authorities are expected to consult interested parties and consider information from local Healthwatch. Under the new arrangements, HSCs will also be consulted when the Secretary of State decides to call in a proposal. Any proposal for change can be subject to call-in, regardless of whether it is notifiable, and there is no specific timeframe for such requests once local resolution attempts have been exhausted. NHS commissioners are expected to involve HSCs early in major change processes. The committee noted the report.

Review of the Shadow Governance Partnership Arrangements

The Director for Care, Community and Health Integration (DCCHI) provided an update on the shadow governance arrangements for the Barking and Dagenham Place-based Partnership, established in July 2023. The integration of the ICB Sub-Committee and Health & Wellbeing Board into Committees in Common (CiC) has led to positive changes, including closer alignment, increased collaboration, and streamlined governance. The arrangements have facilitated development sessions, improved attendance, and more efficient decision-making within an environment conducive to healthy debate.

Partners have provided positive feedback, highlighting strong partnership working and opportunities for residents to communicate directly with members. The committee expressed anticipation for more joint agenda planning and the development of an integrated partnership programme management unit to further enhance collaboration. In response to questions about resident engagement, the DCCHI cited the healthy weight programme, where residents could directly engage with members in open meetings to facilitate co-production. The committee noted the report.

Health & Wellbeing Board and ICB Sub-Committee (Committees in Common) - 16th January 2024

The minutes of the Health & Wellbeing Board and ICB Sub-Committee (Committees in Common) meeting held on 16 January 2024 were noted by the committee. Key discussions from that meeting included an update on Barking and Dagenham's winter planning, the NEL Joint Forward Plan Refresh 2024/25, an ICB finance overview, the draft Annual Report of the Director of Public Health 2022/23, the Barking and Dagenham Partnership Risk Register, and proposals for the procurement of integrated adult and young people substance misuse services.