The Health and Adults Scrutiny Subcommittee of Tower Hamlets Council met on Monday 13 February 2023 to discuss critical issues affecting residents' health and well-being. Key topics included the significant challenges in accessing NHS dental services, particularly for residents of Tower Hamlets, and a comprehensive review of mental health services, with a focus on improving outcomes for Black, Asian, and Minority Ethnic (BAME) communities.

Access to NHS Dental Services

The subcommittee received an update on the pressing issue of accessing NHS dental care in Tower Hamlets, which has been ranked as the second worst in the country for adult dental appointments. Mohammad Chowdhury, Cabinet Member for Health, Well-being and Social Care, highlighted that while there are 36 full NHS fee-paying contracts in Tower Hamlets, the pandemic has exacerbated existing problems. Treatments are taking longer, leading to limited capacity for new patients. He explained that the cessation of formal dental registration in 2006 means practices are not obligated to see patients beyond their current course of treatment, contributing to difficulties in accessing routine care.

Matthew Adrien, Service Director at Healthwatch Tower Hamlets, elaborated on the England-wide issues affecting dental access, including recruitment and retention of dentists and nurses. He reassured attendees that London offers a universal 24/7 urgent dental care service, accessible by calling 111, which diverts to a dental triage service. This service can provide advice or direct patients to urgent care dental centres. Adrien also noted that while dental contracts are being re-procured, this often does not fully solve the access problem, as oral health is a broader public health issue. He mentioned pilot programmes for specific groups like looked-after children and rough sleepers, and the ongoing work to strengthen intermediate-level dental services, such as Tier 2 restorative care and minor oral surgery.

Councillor Amy Lee raised concerns about the impact on residents, particularly in Tower Hamlets, and questioned if dentists were terminating NHS contracts due to costs. It was confirmed that some contract terminations have occurred due to staffing shortages, a legacy of the pandemic, making it difficult for practices to meet contractual obligations. The council is looking to re-procure practices in areas of high need, though this process can take time. The discussion also touched upon the upcoming delegation of dental commissioning to Integrated Care Boards (ICBs) from April 1st, which is hoped to bring a more localised approach.

Mental Health Services and BAME Communities

Richard Fragley, Director of Integrated Care and Deputy Chief Executive at ELFT (East London NHS Foundation Trust), and Angela Burns, Public Health Programme Manager at the council, presented an overview of mental health services in Tower Hamlets, with a particular focus on improving outcomes for BAME communities. They acknowledged national evidence indicating poorer outcomes for these communities in mental health services, often due to a lack of trust and fear of discrimination.

Key initiatives discussed include the Let's Talk report, which made recommendations for increased cultural awareness, staff training, workforce diversity, and accountability. The Trust is also a pilot site for the National Patient Race Equality Framework, aiming to improve interactions with diverse communities and address racial bias.

Specific programmes highlighted include the Community Connector role, where individuals employed by local voluntary sector organisations work within multidisciplinary teams to connect residents with community support. The Trust has also increased the number of Clinical Associates in Psychology, with a significant proportion from BAME backgrounds. Peer support workers are also being employed, offering routes into the workforce for individuals with lived experience. The Recovery College is developing psychoeducation programmes in Somali and Soleti, and a Pursuing Equity Quality Improvement Programme has increased access to talking therapies for the local Bangladeshi community.

Angela Burns added that public health is working on improving culturally competent communication and tailoring mental health and well-being support. The Health and Well-being Ambassadors, initially focused on COVID-19, are now also communicating messages about mental health.

Councillor Ahmodul Kabir asked about local awareness, early identification, and diagnosis of mental illness. Richard Fragley stated there is room for improvement in all areas, but initiatives like the Recovery College and work with the voluntary sector are helping to raise awareness. He also noted the importance of accessible information about services and building trust through a diverse and culturally competent workforce. Angela Burns added that while there is demand for existing services, stigma surrounding mental illness, particularly more severe conditions, remains a significant challenge.

Councillor Muna inquired about culturally appropriate communications and targeted groups. Fragley explained that materials are available in various languages, and interpreters are used for in-depth contact. The Community Connector posts and Recovery College programmes are examples of tailored outreach. Evaluation work is ongoing, with promising initial results from patient-reported outcome measures.

Councillor Amy Lee raised concerns about people experiencing mental illness crises and asked about specific work to raise awareness of mental illness, beyond general mental health and well-being. Fragley detailed the extensive secondary care services available, including a crisis line, crisis house, crisis resolution home treatment team, inpatient wards, and community mental health teams. He emphasised the significant involvement of service users and carers in planning and improving services, including a large people participation team and working groups. He confirmed the Trust is not involved in the Serenity Integrated Monitoring programme.

Councillor Kabir asked about engagement with community leaders, such as imams and the Muslim community. Fragley mentioned that work on the Patient Carer Race Equality Framework has involved engaging with mosques and faith groups. He also highlighted past work with imams to develop cultural competence and the running of a dementia cafe from the London Mosque. Angela Burns added that a workshop on managing mental health during Ramadan was held with the Bangladeshi Mental Health Forum.

The committee also discussed how interventions like the Health and Well-being Ambassadors and the talking therapies project will be measured, with a focus on qualitative themes from conversations and tracking recovery rates using standardised measures. The project investigating why recovery rates were under target for the Bangladeshi community engaging with talking therapists is in its initial stages.

The meeting concluded with a reminder from the Chair, Councillor Ahmodur Khan, about the importance of investing in mental health alongside physical health and the need to convey this message to residents. The next Health and Adults Scrutiny meeting is scheduled for Wednesday 13 April 2023.