Agenda and draft minutes

Cllr James Hockney, Chair, welcomed all attendees.

Apologies for absence were received from Cllr Elif Erbil and Cllr Doris Jiagge. Apologies for lateness were received from Cllr Andy Milne.

Members of the Council are invited to identify any disclosable pecuniary, other pecuniary or non-pecuniary interests relevant to the items on the agenda.

There were no declarations of interest registered in respect of any items on the agenda.

To approve the minutes of the meeting held on 28 November 2023.

The minutes of the previous meeting held on 28 November 2023 were AGREED.

To receive the report of the Executive Director – People, providing an overview of primary care dental care and oral health promotion provision for Enfield residents; understanding about residents’ oral health needs; and highlighting how the Local Authority, North Central London Integrated Care System and NHS England are working together to improve oral health.

Cllr Alev Cazimoglu (Cabinet Member for Health and Social Care) and Dudu Sher-Arami (Director of Public Health) introduced the report of the Executive Director – People, identifying the dental care needs in Enfield and oral health promotion activity in the borough.

A detailed presentation was received from:

• Dr Rakhee Patel (Public Health and Primary Care / Lead for Ageing Well and Dental Public Health, NHS England London Office)

• Kelly Nizzer (representative of the London Dentistry, Optometry and Pharmacy Commissioning hub)

• Mark Eaton (Director of Strategic Commissioning & Procurement, NHS NCL ICB)

Enfield was near the London average of one in four children having some untreated dental decay and in hospital admissions for dental caries. However, Enfield had the highest average number of extracted teeth and third highest average number of filled teeth in five-year-olds in London: this was noted as a positive indication of access to dental care.

The ICB inherited dentistry from NHS England in 2023 and had been proactive and supportive, with additional investment and encouraging dentists to do more activity. The dental services available in Enfield, including community, urgent, and secondary services were highlighted.

The effects of the Covid-19 pandemic and backlog of dental patients was noted. A dental recovery plan had been put in place in London, including a financial uplift to practices for a unit of dental activity and a patient premium incentive scheme in respect of a new patient appointment.

Oral health promotion service colleagues added information about their work, which was mainly related to children and young people, visiting settings for under-fives and schools, and providing training to staff. The fluoride varnish programme for 22 schools in Enfield was highlighted as an evidence-based preventative treatment and targeted within the borough to wards with the highest levels of obesity and percentage of disease.

Questions were invited from Members.

The Chair asked about children’s access to dental care, parents’ behaviour and need for oral health promotion. It was confirmed that there was evidence from the data as set out in the report and that promotion and intervention in respect of children’s oral health should be constant, integrating with wider issues such as healthy eating. An example of that was the collaboration with Tottenham Hotspur Foundation to reduce consumption of sugary drinks by raising awareness with children. Whittington NHS Foundation Trust provided oral health promotion across North Central London and included targeted promotion at early years settings and supervised tooth brushing.

Members raised the concern of advertisement of sugary drinks linked to TV football coverage. It was advised that the work with the charitable arm of Tottenham Hotspur Foundation would be subject to evaluation by the ICB.

In response to further queries regarding prioritising of interventions, it was confirmed that there were many common factors around oral health and obesity mainly due to sugar intake, and this informed the approach. All children of the right age groups in the prioritised schools were offered fluoride varnish treatment. The most effective intervention was to younger school  ...  view the full minutes text for item 4.

To receive the report of the Executive Director – People, providing an update to the panel on the current landscape and work undertaken to tackle substance misuse in Enfield following the introduction of the national drug strategy, ‘From Harm to Hope’.

Cllr Alev Cazimoglu (Cabinet Member for Health and Social Care) and Dudu Sher-Arami (Director of Public Health) introduced the report of the Executive Director – People and Director of Public Health, providing an update on work undertaken to tackle substance misuse in Enfield following the introduction of the national drug strategy ‘From Harm to Hope’. There was funding related to the strategy though it was not known if any further funding would be made available beyond March 2025. Enfield’s Combating Drug and Alcohol Partnership (CDAP) was highlighted as working well: involving key partners and overseeing and driving forward delivery against the strategy. The Panel had also requested an update regarding use of nitrous oxide, and the actions taken to stop its use were set out in the report. The law had also recently been updated to classify nitrous oxide an illegal Class C drug. The report also provided an update on delivery of treatment and recovery support across Enfield.

Further details were presented by Andrew Lawrence (Head of Commissioning – CYP and Public Health).

Data on prevalence of opiate and crack use had shown a much higher increase in Enfield than neighbouring boroughs, primarily resulting from a large increase in clients being recorded on the Probation Offender Assessment System. Targets for an increase in numbers of people in treatment in Enfield had been raised.

The successes of the three sub groups of CDAP were listed in the report, and the key priorities for 2024/25. It was confirmed that the adult treatment centre would be moving from the current site at Claverings, and that the Lived Experience Representative Organisation (LERO) would be enhanced.

In respect of nitrous oxide, there were early interventions, misuse awareness workshops in schools, training, and discussion at the Headteachers’ Forum.

Questions were invited from Members.

The Chair asked about results from the national drugs and alcohol strategy and associated funding. It was advised that referrals were increasing in Enfield. Barriers around some referral pathways were recognised, and there was more work to come in relation to mental health and prison release, but progress was being made. It was confirmed there was enough capacity in the system currently, but there was the risk to funding after 2025.

In response to Members’ queries regarding working with funding uncertainty, this had affected the way that work had been planned so as to bolster treatment capability and adding referral pathways to ensure people are effectively treated. The changes in the ways of working could be done without additional funding. It was advised that Directors of Public Health across London were advocating for the funding and making sure decision-makers understood the implications of those funding decisions. Outcomes and performance were the best way to make the case. This investment in substance misuse had been greatly welcomed in Enfield and partnerships had been developed.

Members asked about increased alcohol usage, and mental health issues, since the Covid-19 pandemic. It was confirmed that alcohol use had remained at static levels since the pandemic. Mental  ...  view the full minutes text for item 5.

To note the current Health and Adult Social Care Scrutiny Panel Work Programme for 2023/24.

NOTED the Health and Adult Social Care Scrutiny Panel Work Programme for the remainder of 2023/24.

To note the dates of future meetings as follows:

The Panel’s additional date is Wednesday 24 April 2024.

All meetings will commence at 7:00pm and will be held at the Civic Centre.

NOTED that the next meeting of the Health and Adult Social Care Scrutiny Panel would be on Wednesday 24 April 2024 at 7:00pm in the Civic Centre.

This was the additional 2023/24 meeting date for the Panel.

The Panel had requested an in-depth review of Mental Health Transformation / Reforms in the borough, led by the ICS, as the substantive agenda item for discussion, as set out in the work programme.

Members also highlighted a concerning CQC inspection: that the rating of North Middlesex University Hospital Maternity Service recently went down and was rated as ‘inadequate’. The Panel requested that a copy of the CQC report be circulated to all Members of the Panel and that an agenda item be added to the 24 April meeting and appropriate representatives be invited to the meeting to discuss the issues and the actions being taken in response.

ACTION: Governance Team