The Health Scrutiny Committee met on Tuesday 12 March 2024 to discuss updates on the Waltham Forest Health and Care Partnership, access to dental services, and the draft Sexual and Reproductive Health strategy for North East London. The committee noted progress on the Health and Care Partnership, heard about ongoing challenges and recovery plans for dental services, and reviewed the proposed SRH strategy, making several recommendations across these areas.

Update on the Waltham Forest Health and Care Partnership

Sue Boon, Director of Place, Impact and Delivery, provided an overview of the Waltham Forest Health and Care Partnership (WFHCP), highlighting its role in bringing together the NHS, local government, and other health and social care providers. The committee heard about the WFHCP's strategy and its achievements over the past year, with a focus on transforming integrated care and providing proactive, local support to residents. Ms Boon explained that proactive care involves early intervention and comprehensive care plans to identify and meet residents' needs. The committee discussed the challenges of accessing GP appointments and the transition in primary care to improve accessibility through various workforces, including pharmacists. Regarding discharge targets, Waltham Forest is reportedly achieving over 70% of the national target for having care packages in place within 24 hours.

The committee raised concerns about community engagement, remuneration for the supported internship programme, and the process for health-funded continuing care. Ms Boon stated that while there isn't a specific target for community engagement, there is ongoing work to address specific areas and demographics. Information on the internship programme's remuneration and accreditation was requested. The committee also discussed the discharge process for patients awaiting continuing healthcare assessments, noting that placement availability remains a challenge.

Discussions also covered outreach and engagement with the homeless community, with Ms Boon describing work with night shelters, foodbanks, and hostels, and the appointment of a homelessness clinical lead. The availability of phlebotomy services in GP surgeries was also discussed, with Dr Ken Aswani confirming that it is expected to become more routine. Terry Day from Age UK Waltham Forest highlighted difficulties with telephone access to GP surgeries for older people and the increased pressure on community services due to social prescribers.

The committee recommended that officers inform members about remuneration and accreditation for the supported internship programme, investigate the funding needed to support increased referrals to VCSE organisations via social prescribers, and clarify how services are advertised to homeless individuals. They also suggested a standing item on future joint Adult Social Care and Health Scrutiny Committee agendas to review the work of the WF Health and Care Partnership.

Dental Services Access in Waltham Forest

Jeremy Wallman, Head of Primary Care Commissioning for Dentistry, Optometry and Pharmacy, presented an overview of dental services in Waltham Forest, detailing the mix of General Dental Services (GDS) and Personal Dental Services (PDS) agreements. He discussed budget allocations, the ongoing impact of the COVID-19 pandemic on dental access, and the roadmap for recovery, including new measures and investments.

The committee received an update on the Healthy Smiles pilot for looked-after children, which had experienced low attendance. Mr Wallman acknowledged the pilot's challenges and the need for greater awareness and a rethink of its delivery. He was unsure of direct links between dental commissioning and children's centres but noted engagement with family hubs for community dentistry promotion. Dr Ken Aswani added that there would be a significant increase in phlebotomy capacity in the future.

Regarding endodontic provision, Mr Wallman explained the complexity of root canal treatments and the challenges in persuading private providers to offer them on the NHS due to costs. He noted that while provision has improved, resources remain an issue. The committee discussed the disparity in the number of dentists compared to GP surgeries and the historical nature of NHS dentistry contracts. Mr Wallman confirmed that there isn't specific targeting of dental services in areas of high deprivation, but community services do work with specific demographics. He acknowledged that cost is a barrier to dental access and expressed concerns about the potential for missed early diagnoses of oral cancers. The committee also discussed the lack of formal patient registration with specific dental surgeries since 2006, with dentists' obligations limited to a course of treatment.

The committee noted the report.

Draft Sexual and Reproductive Health (SRH) strategy for North East London (NEL)

Joe McDonnell, Director of Public Health, presented the draft Sexual and Reproductive Health (SRH) strategy for North East London (NEL). He outlined the statutory provision of specialist sexual health services, including STI testing and treatment, HIV testing and PrEP, and contraception services. The strategy has four priority areas: healthy and fulfilling sexual relationships, good reproductive health across the life course, high-quality and innovative STI screening and treatment, and HIV: Towards Zero. Mr McDonnell discussed Waltham Forest's specific context and needs, noting a higher proportion of LGB+ residents and higher rates of STIs compared to national averages, particularly among men, young people, and those of Black and Mixed ethnicity.

The committee inquired about the increase in gonorrhoea and syphilis rates and the education provided to young people regarding contraception to prevent repeat abortions. Mr McDonnell explained that the UK Health Security Agency is investigating the rise in gonorrhoea and syphilis, potentially linked to changes in safe sex behaviour due to increased PrEP availability. He highlighted prevention efforts and sex education in schools, emphasizing the importance of emergency contraception and support for those who have had abortions.

Discussions also covered early HIV diagnosis, the role of the SRH strategy steering group, and the potential for integrating services like cervical screening and IUD removal. Mr McDonnell stated that addressing stigma is key to improving screening uptake in certain communities and that while a women's only service isn't specifically part of the strategy, there is work with the Integrated Care Board (ICB) on a women's health model. The committee asked about support for immigrants regarding HIV and STI testing, and Mr McDonnell mentioned the Borough of Sanctuary work. Information on the low numbers of people starting antiretroviral therapy (ART) promptly after diagnosis was requested.

The committee suggested appointing a dedicated staff member in schools for young people's sexual health queries and highlighted the importance of messaging to young men about their responsibility in sexual health. Mr McDonnell discussed the C-Card initiative and the broader conversation with schools about roles like school nurses.

The committee recommended that officers provide demographic data for those receiving ART, borough-level data for gonorrhoea viral strains, and that schools consider appointing a 'Sexual Health Advice Officer'.