The Health Scrutiny Committee of Waltham Forest Council met on Tuesday 16 January 2024 to discuss protecting communities from drug and alcohol-related harm and to review services at Whipps Cross Maternity. The committee recommended that officers consider appointing people with lived experience to advisory boards for the Combating Drugs Partnership and that schools consider appointing a 'Drug Support Champion'. They also recommended that officers ensure there are no unexplained acronyms in reports and provide comparative data for maternity services within Barts Trust.

Protecting Communities from Drug and Alcohol Related Harm

The committee reviewed the framework for the Combating Drugs Partnership, which aims to address drug and alcohol-related harm through three pillars: prevention, supply, and treatment. Joe McDonnell, Director of Public Health, and Dan Greaves, Corporate Director of Community Safety & Resilience, explained that the partnership was established to meet national requirements and to develop a coordinated approach to tackling drug issues.

Concerns were raised about the lack of direct community and lived experience representation on the partnership's advisory boards. Mr McDonnell acknowledged this as a challenge and stated that there would be a rethink on community involvement now that the framework was in place. He also noted that a sub-board focused on treatment had a standing item on lived experience, though this had not yet involved specific individuals.

Discussions also touched upon the impact of policing on certain communities, with Mr Greaves agreeing that policing disproportionately affects some communities. He highlighted the existence of a stop and search monitoring group and a police encounter panel to ensure lawful and dignified interactions, but acknowledged that further work was needed to scrutinise these powers for fairness.

The committee heard about the Safe Streets pilot, which Councillor Afzal Akram asked about, and Mr Greaves responded that lessons learned from this data-driven, multi-agency approach had been applied to drug challenges in the borough, fostering positive relationships and enabling quick responses. The evaluation of the pilot is ongoing.

Councillor Kastriot Berberi inquired about the partnership's engagement with housing associations. Mr Greaves confirmed that operational partnerships with housing providers were crucial, citing examples of estate walks to identify areas for physical improvement and work to support vulnerable residents at risk of cuckooing.

Dianne Barham from Healthwatch raised concerns about individuals with co-occurring mental health and substance misuse issues, querying access to mental health treatment and the potential for dependency on prescribed drugs. Mr McDonnell stated that dual diagnosis pathways were a focus and had improved, though capacity remained a challenge. He noted that dependency on prescribed opiates was an area of growing awareness and would be explored further.

Monwara Ali, Chair of the Voluntary and Community Sector Leadership Group, suggested involving young people from an early age through the education system and tapping into the existing youth network for information and engagement.

Councillor Jennifer Whilby asked for more details on Project Adder, a government-funded pilot aimed at a whole-system approach to tackling drug issues. Mr Greaves explained its effectiveness in coordinating partners and increasing capacity, seeing it as a genesis for the government's drug strategy.

Councillor Whilby also enquired about resilience-building in primary schools. Mr McDonnell stated that while much of this was school-funded, the framework included auditing local provision and highlighted the Botvin life skills training and the expansion of family hubs.

Councillor Richard Sweden raised questions about the most prevalent drugs beyond opiates, the issue of prescription drug use, actions targeting more affluent drug users, and the availability of inpatient treatment. Officers agreed to provide written responses to these questions.

Decisions:

• The Committee noted the report.
• The Committee recommended that officers consider appointing people with lived experience to the boards which advise the Combating Drugs Partnership.
• The Committee recommended that schools be encouraged to consider appointing a 'Drug Support Champion' for young people.

Whipps Cross Maternity

The committee received a report on maternity services at Whipps Cross Hospital, presented by Mary Olusile, Associate Director of Midwifery, Dr Sujatha Thamban, Divisional Director for Women and Children, and Dr Amanjit Jhund, CEO of Whipps Cross Hospital.

The Chair expressed concern about the high maternal mortality rates among Black and Asian women. Dr Jhund explained that these patterns were seen nationally and internationally, with confounding factors such as higher rates of diabetes and high blood pressure in some populations contributing to disparities, even after adjustments. He assured the committee that collaborative work was ongoing to understand the root causes and that incidents at Whipps Cross would be investigated with lessons learned implemented. Dr Thamban added that socio-economic status also played a role, and each case would be reviewed by a committee.

Joe McDonnell, Director of Public Health, emphasised that many differences in mortality rates were due to underlying health inequalities such as deprivation, rather than variations in care. He noted that the maternal mortality data was national, as there were insufficient local deaths to draw conclusions, and there had been no maternal deaths in Waltham Forest in the last year.

Councillor Akram sought more detail on actions being taken to address the issues and anomalies in the report. Ms Olusile outlined various support services for different groups, including a vulnerable team, a diabetic team, and a maternal medicine team. She also discussed efforts to improve parent education and community access to services, as well as a birth reflections clinic for women with previous complicated births. Dr Thamban mentioned the availability of a language service and multilingual information leaflets.

Regarding data comparison, Ms Olusile explained that local figures for neonatal deaths could not be directly compared to national data due to adjustments for factors like congenital abnormalities. However, she stated that Whipps Cross's stillbirth rate was within national figures. The committee requested comparative data for maternity services within the Barts Health Trust.

Dianne Barham from Healthwatch congratulated Whipps Cross staff on their response to equity and equality recommendations. She highlighted ongoing issues with access to GP services, which impacted antenatal care and trust in the healthcare system, particularly for ethnic minority and vulnerable communities. She also raised concerns about access for neurodivergent individuals and people with disabilities.

Councillor Whilby inquired about international recruitment of midwives. Ms Olusile explained recruitment through the Capital Midwife Programme from an approved list of countries, avoiding those with significant midwife shortages. She also detailed UK-based training, apprenticeship routes, and efforts to retain staff.

Mr McDonnell asked about midwives identifying wider determinants of health such as poverty and housing issues, and referral pathways. Ms Olusile confirmed that these were often picked up during booking assessments and referred to relevant support services, with the vulnerable team being a key resource.

Dr Jhund expressed pride in the hospital's good CQC rating but acknowledged infrastructure limitations and ongoing work with the Barts Charity for funding. Dr Amanda Joy, ICS Clinical Lead for Maternity and Early Years Waltham Forest, highlighted the role of health visiting teams and the Family Nurse Partnership for young mothers.

Councillor Whilby asked about access for pregnant refugee women. Ms Olusile stated that maternity services were provided to all regardless of status, with the vulnerable team offering one-to-one support. Councillor Berberi further enquired about access for refugees, asylum seekers, and those without valid leave to remain, and whether any had been refused care. Ms Olusile reiterated that maternity services would be provided to all who needed them.

Decisions:

• The Committee noted the report.
• The Committee recommended that officers ensure there are no unexplained acronyms in reports ahead of publication.
• The Committee recommended that officers provide comparative data for maternity services within Barts Trust.