Agenda item

To receive updates from the following: 

 

1.         Health Improvement Partnership Board

 

2.         Joint Commissioning Partnership Board

 

3.         Improving Primary Care Board

The Board received the following updates from the Sub Boards as follows:

 

8.1       Health and Improvement Partnership Update

 

Glenn Stewart, Assistant Director of Public Health highlighted the following from his report on the work of public health in the Borough. 

 

• The annual patient equalities monitoring report had been received from Barnet and Chase Farm NHS Hospital Trust.  Most of their patients come from the northern part of the borough.  People in the south are more likely to attend North Middlesex Hospital.

 

• Regeneration projects in Ponders End and Meridian Water are progressing. 

 

• Domestic Violence in Enfield is a major concern.  The definition has been widened to include those aged 16-17.  Over a third of violence reported to the police in Enfield is domestic or intimate partner violence.  

 

• Enfield was the first London borough to receive White Ribbon Status for its work with violence amongst young people, but more needed to be done. 

 

• Training in 25 GP Surgeries has begun, implementing a single point of entry system and developing protocols for routine health visitor enquiries. 

 

• The Childhood Obesity Co-ordinator should be stating work next week. 

 

• Enfield participation in the National Child Development Programme is higher than it’s ever been.

 

• Breastfeeding is being promoted throughout the borough and 30 staff recently received specialist training at Middlesex University. 

 

• No new data has been issued on life expectancy which continues to be an issue in Upper Edmonton.  A workshop will take place on 16 July 2013. 

 

• Enfield met its target for delivered health checks this year, delivering 5,503 checks.

 

• The smoking target was exceeded:  1,584 quitters against a target of 1,568. 

 

8.2       Questions/Comments

 

8.2.1   As regards transport, Lucy Saunders, had given a report to the Health Improvement Partnership Board on the bus review being carried out and there was a transport working group as part of the Barnet, Enfield and Haringey Clinical Strategy. 

 

8.2.2   The figures for domestic violence are in line with national averages and are the most up to date available.  It was acknowledged that there was a lot of under reporting in this area and not all the cases were being picked up.  Statistics are reported quarterly to the Safer Stronger Communities Board.  The recent welfare reforms may increase tensions in families and could lead to more cases.  All cases where children are involved are reported through the single point of entry database. 

 

8.2.3   It was likely that the obesity fall in reception and year 6 was either due to better reporting or increased activity. 

 

8.2.4   Councillor McGowan thought that there might be a very low threshold for what was considered obese.  It was made clear that BMI categories are agreed internationally and are not subject to local variation.  People’s perceptions of what a ‘normal’ BMI is and looks like have increased with the population increase in BMI.  

 

8.2.5   Some concerns were expressed that the new blood pressure machines were situated too publicly; consideration would be given to how they were situated, including the possibility of putting them behind curtains to allow some privacy. 

 

AGREED to note:   

 

·        That the Barnet and Chase Farm NHS Hospital Trust had presented a patient equality monitoring report to the HIP.

·        The regeneration priority areas in the North East, South West and South East of the Borough. 

·        That domestic violence is a major concern in the borough, a factsheet for this is being developed and will feed into the Health and Well-being Strategy.

·        That work is being done to promote vaccination, particularly in relation to the measles outbreak in Wales.

·        That Participation in the National Childhood Measurement Programme was the highest yet recorded in 2011-12.

·        A workshop on improving life-expectancy in Upper Edmonton has been run with a further workshop is being held on 16^th July.

·        Enfield achieved the health checks delivery target in 2012-13 but not the offer target.

 

8.3       Joint Commissioning Partnership Board

 

The Board received an update report from Bindi Nagra (Joint Chief Commissioning Officer) on the work of the Joint Commissioning Sub Board. 

 

Bindi Nagra highlighted the following from his report: 

 

• Partners including the Council, NHS and voluntary sector have agreed to form the Enfield Dementia Action Alliance with the aim of promoting the needs of those living with dementia. 

 

• In Enfield there are 2,800 people with dementia:  1,225 of them advanced.  One in three 3 over 65s will develop the disease and live with it for an average of 7-12 years.  Partners are working together sharing resources and organising training to make Enfield more dementia friendly. 

 

8.4       Questions/Comments

 

8.4.1       Litsa Worrall added that local businesses were also involved, one aspect of their involvement included alerting shop workers to the problems of dementia suffers.  The Alliance will welcome the support of the Health and Wellbeing Board.

 

8.4.2       Risk stratification involves combining information from different databases to enable easier identification of families at risk or need of interventions which will help in the development of preventative strategies. 

 

8.4.3       Questions were asked about why Enfield residents had to go to Chingford for bone density scanning.  Bindi Nagra agreed to find out and report back to the Board. 

 

8.4.4       The Section 75 agreement has been completed and is about to be signed.

 

8.4.5       HealthWatch is developing well. 

 

8.4.6       There are still some issues about some of the contracts bought over to the Council as a result of public health transition; these are worth about £400,000.  If any new cost pressures emerge Public Health England has indicated that they may adjust next year’s financial settlement. 

 

8.4.7       The NHS Social Care Grant had been notified to the council at a late stage and it had not been possible to spend all the money within the year.  The grant covers this year and next but there are no guarantees for the future thereafter.  The funds had been allocated on the basis that future funding could not be guaranteed.  Investments had been made in areas such as stroke and intermediate care which should help save money by managing preventative care and reducing the incidence of disease for the future. 

 

8.4.8       Paul Bennett, NHS England, affirmed that future funding was uncertain but he agreed that the council was acting prudently in the way that funds were being allocated. 

 

AGREED that the Board note the report. 

 

8.5       Improving Primary Care Board

 

The Board received a report updating them on the work to date carried out to implement the primary care strategy across Enfield. 

 

The report was presented by Dr Mo Abedi, (CCG Medical Director).  He highlighted the following:

 

• Eight clinical champions are working with GP Practices across the borough promoting collaborative working. 

 

• 39 out of a total of 59 practices had signed up to an enhanced access scheme which has created an extra 8,000 doctor patient appointments and telephone consultations.  The Primary Care Foundation is working with an extra 10 practices on managing capacity/demand processes.  Further work will continue. 

 

• Blood pressure and body mass index monitoring pods will be installed in 43 practices by the end of June.  Another 5 pods will be installed in strategic locations across the borough.  Two practices will have the facility for 24 hour blood pressure monitoring. 

 

• Chronic Obstructive Airways Disease (COAD), a disease which affects smokers and can result in significant numbers attending hospital unexpectedly, is being tackled through a new initiative involving training and the provision of spirometry equipment.  

 

• The Minor Aliments Scheme has resulted in about 1,200 diverted appointments and over 230 hours of GP’s time saved. 

 

• The ECCG/University College of London Joint Initiative involving the recruitment of four newly qualified GPs who will be employed in a four different practices.  They will be able to improve systems and develop networks across the borough. 

 

• Schemes to address conditions including deep vein thrombosis, anti coagulation, blood pressure monitoring and urology are also up and running. 

 

• IT equipment is being updated across all GP practices to make it easier to transfer and share information between both practices and hospitals.

 

• Practice premises are also being bought up to Care Quality Commission standards.

 

Graham Macdougall (Head of Commissioning, Integrated and Acute Care, Enfield CCG) spoke about CCG plans for the coming year: 

 

• Last year the CCG had focussed on activity and outputs, this year more emphasis would be put on preventions and impact on patients to demonstrate that the CCG is making a difference. 

 

• More work will be done to develop GP support networks to enable GP’s to work more closely together to improve services.

 

• Resources will be aligned to the different needs in the different quarters of the borough. 

 

• Further service developments are planned together with the introduction of new health checks and the use of the extra GP appointments.  There will be further investment to provide intensive support to those practices that are struggling to meet demands or with poor outcomes. 

 

• Work with the 40 patient groups, set up in most practices will continue. 

 

2.6             Questions/Comments

 

2.6.1       Councillor Orhan felt that obesity initiatives should be targeted on those areas where the problem was highest.  The pathway development review will be analysing current strategies and working out the most effective ways to manage childhood obesity. 

 

2.6.2       Ian Davis felt that the more work needed to be done to evaluate the success of the minor ailments scheme, to identify which pharmacies and which practices were making use of it and how effective it was.

 

2.6.3       The UCL doctors would be placed one in each of the four quarters of the borough and they will spend a year in a practice.

 

2.6.4       Dr Shahed Ahmad congratulated the CCG on all the initiatives started so far including the work on Chronic Obstructive Airways Disease (COPD) and improving life expectancy. 

 

2.6.5       The HiLo Initiative, a pilot project to improve the management of Coronary Heart Disease and blood pressure is being carried out in conjunction with Queen Mary University.  It is likely that it will be focussed on larger practices in Edmonton and Ponders End. 

 

2.6.6       Councillor Orhan felt that there was too much focus on adults and not enough being done for children. 

 

2.6.7       Ian Davis suggested that a set of key performance indicators including patient satisfaction should be drawn up so that it would be possible to measure improvements from year to year.  It was also suggested that a dashboard of key outcome measures be produced which could then be reported on regularly at board meetings to enable progress to be measured.  These could be linked to the JSNA.  This could be a subject for discussion at a Board development session. 

 

2.6.8       The Chair felt that the good work being done should be promoted. 

 

AGREED to note the report.