Agenda item

To receive and note updates from the following sub boards:

 

1.       Health Improvement Partnership Board

 

2.       Joint Commissioning Partnership Board

 

3.       Improving Primary Care Board (To Follow)

 

1.               Health Improvement Partnership Sub Group Update

 

The Board received an update report from Shahed Ahmed, Director of Public Health, on the work of the Health Improvement Partnership and the Public Health Department. 

 

Glenn Stewart, Assistant Director of Public Health, highlighted the following from the report: 

 

·       Work with the CCG is continuing to increase HIV testing.

·       Immunisation records are not up to date but withstanding recent threats such as the recent measles outbreak indicate that levels are higher than recorded.  Work on improving record keeping continues. 

·       Health Check assessments are going well.  At the end of Quarter 2 4001 checks had taken place: 45% over the trajectory. 

·       A conference on reducing the prevalence and stopping people starting smoking had taken place in October.  Smoking prevalence in Enfield is 18.5% of adults compared with the England average of 20%. 

·       The healthy weight co-ordinator is doing good work and has set up 7 sub-groups across the borough. 

·       The Council has applied for funding from the Greater London Authority (GLA) as part of the mini Holland bid to help increase physical activity through cycling in the Borough. 

·       Enfield has high levels of tooth decay; the rate of decayed missing and filled teeth among 5 year olds is the highest in London.  Work on improving this is taking place. 

·       Public Health is co-ordinating the Council’s bid to become accredited under the GLA Healthy Workplace Charter. 

·       Work on the domestic violence and anti-social behaviour is continuing. 

·       Uptake of maternity services by 12 weeks and 6 days of pregnancy is increasing.

·       Breastfeeding is above the London and England averages. 

·       Infant mortality is still high: an average of 28 babies die every year in Enfield.  This is also concerning as infant mortality is an indicator of population health. 

·       A conference was held in July to develop a plan to improve female life expectancy in Edmonton. 

·       Work is continuing to improve employment opportunities at North Middlesex Hospital for Edmonton residents. 

·       All Cabinet reports now have a section to complete on public health implications.

·       Vacancies in the public health team and difficulties in recruitment have caused some delays in the development of programmes, but all vacancies are now covered, some with agency staff. 

 

2.       Discussion of the Health Improvement Partnership Update Report

 

The following points were raised during the discussion: 

 

2.1     Late diagnosis of HIV infection not only means that the disease is not dealt with at an early stage, but also increases the likelihood that individuals will infect more people.  HIV testing needs to be more routine and regular.  This is cost effective as treating the disease at a later stage is very expensive.

 

2.2     Voluntary sector representation on groups is welcome. 

 

2.3     Interventions such as “brushing for life” are being planned to help prevent tooth decay. 

 

2.4     Tooth decay and high infant mortality rates are symptoms of poverty. 

 

2.5     Fluoridation of the water supply has been considered but in order for it to be implemented all the London Boroughs would have to agree to it.  Some thought that the water in Enfield naturally had good levels of fluoride.  Some dentists in the South are encouraging their patients to use fluoride toothpastes. 

 

2.6     It was questioned whether infant mortality is still a reliable predictor of access to healthcare services in Enfield.  Infant mortality can also be high in affluent areas due to mothers having babies later in life. 

 

2.7     Averages can mask problems as rates can be high in some areas and low in others.  In some areas smoking prevalence can be as high as 70%.  It is helpful to consider outliers and to consider carrying out surveys in specific local areas.  Obesity in eastern Enfield is higher than the in the west.  Although the west is also higher than it should be. 

 

2.8     More work was needed to tackle HIV infections particularly among some African and other communities living along the North Circular Road. 

 

2.9     The Over 50’s Forum was keen to get involved in helping to improve public health.

 

2.10    In significant parts of Edmonton a significant group of people are putting sugar into babies’ bottles.

 

2.11    The Over 50’s Forum felt that the public health and CCG Budget was not high enough and were planning to present a petition to NHS England to this effect. 

 

AGREED to note the content of the report. 

 

3.       Joint Commissioning Sub Group Update

 

The Board received a report updating the Board on the work of the joint commissioning across health and social care in Enfield. 

 

3.1     Discussion of the Report

 

The following points were raised during the discussion: 

 

3.1.1   Paragraph 4.3 should state that the Enfield CCG had served notice on the community health services element of the Mental Health Trust Contract, not on the whole contract.  The CCG and the Council were working together to work out how the services should be reshaped. 

 

3.1.2   The Older People’s Assessment Unit is not being well used, but rates have improved since the report was written and it would take time for it to become established.  More GPs are now referring patients.  Updated use figures would be presented to the next meeting.  There had been problems with the ambulance service which were being resolved.  Most of the referrals would however be from GPs or the Urgent Care Centre.  Reports from those who have used it were positive. 

 

3.1.3   The review of the Winterbourne View investigation was due to be published that week which is likely to make recommendations for Health and Wellbeing Boards. 

 

AGREED to note the report. 

 

4.       Improving Primary Care Update Report

 

Mo Abedi, Medical Director for Enfield CCG and Jenny Mazerelo, Programme Manager Primary Care, provided a verbal update to the Board. 

 

The key points of the presentation were as follows: 

 

·       Improving access to GP’s, a major priority, has resulted in an extra 2,750 GP appointments per month.  39 practices have signed up to the scheme covering 82% of the Enfield population.  More work with the 20 worst practices is also taking place to improve their patient access.

 

·       Public satisfaction with the Minor Ailments Scheme is high and they have indicated that they would like it to continue.  It has therefore been agreed that it will continue indefinitely. 

 

·       The University College London Scheme for 4 new GPs which is projected to bring in 17,000 extra appointments per year is almost ready to begin recruitment.  This scheme will raise the profile of Enfield and hopefully encourage more newly qualified GPs to the area. 

 

·       The newly installed health kiosks for measuring blood pressure, height and weight were recently advertised in Our Enfield Magazine. 

 

·       Initial results from the childhood obesity camp are encouraging. 

 

·       The Patient Experience Tracker will enable practices to better assess and respond to issues.  Thirty four practices have expressed an interest in this service.

 

·       The pilot HiLo Initiative is to operate in two of the larger practices in conjunction with Queen Mary University helping to manage Coronary Heart Disease and high blood pressure.

 

·       Health trainers have been recruited to promote the benefits of cancer screening to the community. 

 

·       Enfield Carers Strategy has enabled the recruitment of a GP Liaison Worker and Carers nurse who are working on early identification of carers, health promotion and other carer issues.

 

·       The IT in most GP practices has been upgraded.  The new text messaging service has saved 3,976 appointments and 615 clinical hours. The possibility of extending the texting service to include health promotion messages was being considered. 

 

·       Future planning includes focussing on the development of the GP networks to encourage collaborative working between practices, setting up an innovation fund to enable practices to bid for funding.  A great deal of work has taken place over the past 18 months. 

 

5.       Discussion of the Report

 

The following points were raised during the discussion of the report: 

 

5.1     Concern was expressed that not all GPs had the necessary IT to enable them to offer on line appointments from 1 April 2014.  The requirements were that they should be able to do this during the 2014/15 year, which was what the CCG were working to achieve. 

 

5.2     Concern was expressed about the availability of overnight urgent care.  Board Members were assured that a doctor and a nurse would be available through the night at Chase Farm Hospital. 

 

5.3     Some patient forums had felt that the questions in the patient survey were leading.  Questions had been developed in consultation with voluntary groups including the Over 50’s Forum and Healthwatch and had been commented on by the Local Medical Council.  The questions will be subject to evaluation at a later date.  It was hoped that the questionnaire will provide good intelligence about the patient experience. 

 

5.4     The University College London investment was welcome and should provide a catalyst to make Enfield a beacon of excellence.  Good communication was key. 

 

5.5     The outcomes of the patient survey will be reported back to the next meeting of the Board. 

 

AGREED to note the report.