The Health Scrutiny Committee met on Wednesday 27 March 2024 to discuss updates on cancer screening programmes in Barking and Dagenham, a new strategic approach to tackling obesity, changes to health scrutiny committees, and the review of shadow governance partnership arrangements. Key decisions included noting the progress of screening programmes, supporting a new strategic approach to healthy weight, and noting changes to health scrutiny committee powers and governance arrangements.

Screening Update for Barking and Dagenham

Femi Odewale, Managing Director of the North East London Cancer Alliance, and Caroline Cook, Early Diagnosis Programme Lead, presented an update on cancer screening programmes in Barking and Dagenham. They reported improvements in bowel screening coverage and uptake, with a 3% increase in uptake over one year. Breast screening uptake also saw a significant 15% increase, and cervical screening showed positive movement in the right direction for both younger and older women. Targeted lung health checks, launched in July 2022, had achieved a 55% uptake in Barking and Dagenham, which is among the highest in the country.

However, it was noted that the data, sourced from the NHSE Futures website, has an inherent lag due to the time required for data cleaning and the six-month period for identifying non-responders. The reliability of data for specific groups, such as those with serious mental illness (SMI), learning disabilities, or who are homeless, depends heavily on accurate recording by GP systems. Breast screening data was also highlighted as potentially unreliable due to manual coding.

Several screening improvement projects were discussed, including the 'It's Not a Game' campaign targeting specific demographics, and the introduction of self-sampling kits for cervical screening. The age extension for bowel screenings was also mentioned as a measure to improve accessibility.

Members raised concerns about the low uptake of screening among homeless individuals. It was explained that while engagement with GPs is ongoing, identifying and following up with homeless patients presents challenges due to the lack of a required address. Pop-up GP clinics and support from Integrated Care System (ICS) Primary Care Networks (PCNs) were suggested as potential solutions. Hospitals also record patient details, which could aid in identification.

The rationale behind targeted screening improvement projects was explained as a means to effectively engage specific communities, using methods like social media and working with local groups and grassroots organisations. These campaigns are informed by deprivation indices to identify disengaged communities and understand the reasons for their reluctance.

Concerns were raised about the referral process and the need for GP access for sensitive matters. Self-sampling was acknowledged as an ideal solution for privacy, though not currently feasible for cervical screening due to its reliance on practice nurses. For patients with learning disabilities, a Clinical Nurse Specialist (CNS) is available for cervical screening, and efforts are being made to engage unpaid carers. Registration with a GP is a requirement for bowel and breast screening referrals. Positive uptake was noted for smoking cessation referrals linked to targeted lung health checks.

Staffing shortages, particularly for specialist roles like radiographers and radiologists required for targeted lung health checks, were highlighted as a significant issue, especially in light of NHS England's target for increased scan volumes. The Managing Director confirmed that a workforce programme is being developed, and NHSE is working with wider NHS teams to address these pressures, including financial support.

The absence of a national prostate cancer screening programme was discussed, with the explanation that such decisions are made at a national level, though free PSA test kits are available for men over 45 in North East London, showing positive results.

The Director of Public Health, Matthew Cole, noted that patients sometimes attend hospitals for diagnoses without acting on their symptoms, which, while not a misdiagnosis by the hospital, highlights the importance of early intervention. Rapid diagnostic clinics are available in Barking, Havering, and Redbridge (BHR) to identify irregular symptoms. The workload of managing incidental findings from screenings was also acknowledged as a pressure on GPs, but this route was deemed the safest for managing increased pressures.

The Committee noted the report.

A New Strategic Approach to Healthy Weight in Barking & Dagenham

Philip Williams, Head of Localities Commissioning, presented a report outlining a new strategic approach to tackling the borough's obesity crisis. He emphasised the chronic nature of the problem, with obesity rates worsening since 2016 and affecting approximately 65% of the population. The current individualistic approach, which treats less than 1% of patients annually, is deemed ineffective.

A radical shift towards a community-led, partnership approach is proposed, recognising the complex factors influencing health, including environment, poverty, food access, and time constraints. The strategy aims to gain deeper insights into diverse and marginalised communities to foster open conversations and support. Opportunities such as the Localities Programme, the Good Food Plan, and additional funding from Sport England are available to facilitate impactful, non-stigmatising change.

Members discussed the role of social prescribing, community hubs, and volunteers in supporting this new approach. It was explained that existing infrastructure would be leveraged to provide integrated support and information, with initiatives like cooking clubs and walking groups aimed at fostering social interaction and lasting impact. Community-based allotments were also supported as a means to build neighbourhood relations and promote environmental benefits.

Concerns were raised about the higher rates of obesity among children in deprived areas, with a particular focus on Year 6 children. The Head of Localities Commissioning agreed that engaging with schools is crucial for supporting children and families in adopting healthier lifestyles. This would involve collaboration with various services, including Children and Adolescent Mental Health Services (CAMHS), to address potential mental health issues contributing to overeating and obesity.

The lack of resident awareness of healthy living services, as highlighted in a Healthwatch survey, was discussed. The Head of Localities Commissioning acknowledged the need to effectively reach residents by ensuring information is relevant to their lives and not solely digital, thereby including all residents.

The Director of Public Health, Matthew Cole, also highlighted the importance of addressing underweight issues, stating that weight in general is the biggest public health challenge and requires recognition.

The Committee noted the report.

Changes to Health Scrutiny Committees

Ayesha Malik, National Management Trainee, presented a report on changes to Health Scrutiny Committees (HSCs). The most significant change, effective from 31 January 2024, grants the Secretary of State for Health and Social Care the power to intervene in proposals for changes or reconfigurations to local NHS services. This replaces the previous exclusive power of HSCs to refer such proposals. A new call-in request process is now available to anyone, without requiring an HSC referral. While the Secretary of State can intervene in complex cases causing significant public concern, HSCs retain powers regarding responsible persons, including NHS commissioners and providers. Local Authorities can review and scrutinise health services in their area, inviting comments from interested parties and considering information from local Healthwatch. HSCs will also be consulted when the Secretary of State calls in a proposal. Any proposal for change, regardless of whether it is notifiable, can be subject to a call-in request, particularly if local resolution attempts have been exhausted. NHS commissioners are expected to involve HSCs early in major changes. The report noted that these changes do not currently impact Joint Health Overview and Scrutiny Committees (JOSCs), but this may change as Integrated Care Systems (ICSs) propose changes in the future.

The Committee noted the report.

Review of the Shadow Governance Partnership Arrangements

Fiona Russell, Director for Care, Community and Health Integration, presented a review of the shadow governance arrangements for the Barking and Dagenham Place-based Partnership. Since 1 July 2023, the ICS Sub Committee and the Health and Wellbeing Board have been operating as Committees in Common (CiC). This arrangement aims to foster closer alignment, streamline governance, speed up decision-making, and improve collaboration.

The review indicated that the new arrangements have led to more collaborative working, reduced duplication, and a shared understanding of residents' needs. Partners have responded positively, valuing the consistent membership, the space for discursive discussion, and the ability to deep dive into topics. The CiC has been the first in London to adopt this model, which has been recognised in an LGA public health peer review.

Areas for further development include joint agenda planning, establishing a more systematic approach to action follow-up, and clarifying delegation to ensure the right items are brought to the appropriate meetings. There is also a tension between allowing time for discursive discussion and conducting necessary business decisions within the two-hour meeting slots.

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.