The Health and Wellbeing Board of Merton Council met on Tuesday 12 November 2024 to discuss a range of public health matters. Key decisions included the endorsement of the approach for The Merton Story 2024/25 Joint Strategic Needs Assessment and agreement to proceed with a collaborative approach to refresh the Pharmaceutical Needs Assessment. The Board also received updates on the SWLSTG annual report, the Brazil Model Community Engagement pilot, and the smoking, vaping, and tobacco control strategy.

The Merton Story 2024/25 – Joint Strategic Needs Assessment

The Board reviewed and endorsed the approach for The Merton Story 2024/25, an annual assessment of Merton's population health and care needs. This assessment is a statutory requirement and forms part of the Joint Strategic Needs Assessment (JSNA), which informs the Health and Wellbeing Board's strategy and commissioning intentions. The report now includes a more visual presentation of data, allowing users to explore specific areas in greater detail. Discussions highlighted concerns regarding childhood obesity and oral health, with plans to address these through the developing Health and Wellbeing Board Strategy and existing initiatives like the Borough of Sport and free swimming programmes. The Board also noted the importance of linking data from the Integrated Care System (ICS) dashboard and exploring the creation of a dedicated dashboard for children's oral health. The JSNA is expected to be published in February 2025.

SWLSTG Annual Report 2024

Vanessa Ford, Chief Executive of South West London and St George's Mental Health NHS Trust (SWLSTG), presented the Trust's annual report. The report highlighted the Trust's commitment to improving health outcomes, reducing inequalities, and ensuring sustainability. Key achievements included a strong Care Quality Commission (CQC) rating, a 20% reduction in staff vacancy rates, and the development of the Springfield site, which includes social housing. The Trust broke even financially despite receiving a lower proportion of the health budget than the average.

Discussions focused on addressing health inequalities, particularly the 20-year mortality gap for individuals with mental health conditions. While access rates for Black and Mixed ethnic groups were higher, this did not always translate to improved treatment and experience, an area the Trust is committed to rectifying. The Asian population had the lowest access rates, and there was an overrepresentation of Black and Brown individuals in inpatient settings. The report also detailed progress on the disaggregation of Section 75 arrangements and the launch of the Merton Integrated Hub, which brings together over 22 organisations.

Challenges remain, particularly with long waiting times for ADHD services, which have seen a threefold increase in referrals over the last four years without a corresponding increase in workforce or funding. The Trust is working on national reviews and interim measures, including recruiting non-medical prescribing nurses and introducing post-diagnostic support groups. The report also touched upon the transformation of environments in Richmond, Barnes, and Tolworth, with Merton residents set to benefit from the site in Tolworth.

Brazil Model Community Engagement Pilot

Tony Molloy, Chief Executive of Merton Connected, introduced a pilot project based on the Brazil Model of Community Health and Wellbeing Workers (CHWWs), known as Chewies. These workers visit households to build trusted relationships and provide holistic support, aiming to reduce hospitalisations and improve health outcomes. The model, which has seen significant success in Brazil, focuses on education, navigation of health services, support, and research.

The pilot in Merton is being delivered by Merton Connected and focuses on the Pollards Hill and Phipps Bridge Estate areas, chosen due to high levels of health inequality. Two CHWWs have been recruited and are visiting households, engaging with residents on various issues including housing, access to talking therapies, and activities for children. The project is funded by the Integrated Care Board (ICB) and aims to demonstrate preventative health outcomes. Discussions highlighted the importance of building trust, the time required to see immediate health impacts, and the broader social benefits of the model.

Smoking, Vaping & Tobacco Control Update

Julie Kalsi presented an update on the smoking, vaping, and tobacco control strategy in Merton. The report indicated that Merton's smoking prevalence in 2023 was 14.7%, slightly higher than the London and England averages. Higher prevalence rates were noted among those in manual roles, individuals with long-term mental health conditions, and those with anxiety or depression.

The One You Merton service provides tiered support for smoking cessation, with services undergoing procurement for an April 2025 start. In 2023/24, approximately 1,500 residents set a quit date, with 557 successfully stopping smoking. The national Swap to Stop scheme, which offers vape starter kits to smokers, has seen 90 redemption codes issued in Merton. Forthcoming initiatives include a national scheme to support pregnant women and an NHS long-term plan for inpatients. Clarion Housing is also involved in linking smoking cessation with cost-of-living support.

Discussions also covered the upcoming Tobacco and Vapes Bill, which aims to prevent young people from legally buying cigarettes and regulate vaping products. A ban on single-use vapes in England is set to come into effect in June 2025. Merton has received £270,000 in grant funding over five years to expand stop smoking services, with targets for increased quit rates. Trading Standards has been active in inspecting shops for illegal vapes, removing over 4,000 in Merton, and has prosecuted retailers for selling to underage individuals. The Board agreed to recommendations to discuss approaches for increasing capacity and awareness of stop smoking services, actively promote these services, and support the workforce in quitting smoking.

Joint Pharmaceutical Needs Assessment

Barry Causer introduced the report on the Joint Pharmaceutical Needs Assessment (PNA). A PNA is a statutory requirement that must be published every three years, with Merton's current assessment due by October 2025. To achieve cost-effectiveness and economies of scale, Merton is collaborating with other local authorities across Southwest London, including Sutton, Wandsworth, Richmond, and Croydon, to jointly commission a provider for the PNA refresh.

A steering group, comprising public health leads from each borough, representatives from the SWL ICB, the Local Pharmaceutical Committee, the Local Medical Committee, and Healthwatch, will guide the development of the PNA. This collaborative approach is expected to identify pharmaceutical needs, including those that may be met by cross-border provision, and ensure that pharmacy services meet community needs. The Board agreed to receive the completed PNA at a later meeting in 2025 for adoption.