Agenda and minutes

To issue a welcome to those present, and to confirm if there are any apologies for absence.

Apologies for absence were received from Councillor Sahu.

Members will be asked to declare any interests they may have in the business to be discussed.

The Chair asked Members of the Commission to declare any interests in the proceedings. Cllr Westley declared that he is chair of a patient panel at a GP practice in the city.

The minutes of the meeting of the Public Health & Health Integration Scrutiny Commission held on 16 April 2024 have been circulated, and Members will be asked to confirm them as a correct record.

The Chair noted that the minutes of meeting held on 16 April 2024 were included within the agenda pack and asked members to confirm that they could be agreed as an accurate account. 

AGREED:

·       Members confirmed that the minutes for the meetings on 16 April 2024 were a correct record.

Members will be asked to note the membership of the Public Health and Health Integration Scrutiny Commission for 2024/25:

Councillor Pickering (Chair)

Councillor Joel (Vice Chair)

Councillor Bonham

Councillor Clarke

Councillor Zaman

Councillor Westley

Councillor Haq

Councillor Sahu

The membership of the Public Health and Health Integration Scrutiny Commission for 2024-2025 was noted.

Members are asked to note the commission meeting dates as follows:

·       Tuesday 9 July 2024

·       Tuesday 10 September 2024

·       Tuesday 5 November 2024

·       Tuesday 21 January 2025

·       Tuesday 4 March 2025

·       Tuesday 29 April 2025

The dates of the Public Health and Health Integration Scrutiny Commission were noted for 2024-2025, with the next meeting being 10 September 2024.

The Chair also reminded Members of the dates for the Leicester, Leicestershire & Rutland Joint Health Scrutiny Committee.

Members are asked to note the scrutiny terms of reference.

The Commission noted the scrutiny terms of reference.

The Chair is invited to make any announcements as they see fit.

The Chair highlighted that in discussion with the Chair of the Housing Scrutiny Commission it is intended that an informal scrutiny inquiry day will be arranged to explore homelessness and the impact on health. Members across both Commissions will be invited to participate in the task group and further details of the scope and arrangements will be circulated in due course.

The Chair further highlighted that she had attended a recent Women’s Health and Wellbeing workshop at Loros on Groby Road on the menopause and sexual health which is relevant to areas on the work programme.

It was also noted that following concerns raised by Councillor Sahu about children and young peoples GP referrals for mental health, a briefing session was scheduled to discuss progress and that the Commission would be updated on outcomes.

The Chair assured the Commission that a session on virtual wards was being arranged following concerns raised and details of this would be circulated.

Any questions, representations and statements of case submitted in accordance with the Council’s procedures will be reported.

It was noted that none had been received.

Any petitions received in accordance with Council procedures will be reported.

It was noted that none had been received.

The Director of Public Health will provide the Commission with a verbal update.

The Director of Public Health provided the Commission with an update of the latest position of health protection, and it was noted that:

·       Rates for TB had risen in Leicester in recent years and the city currently had the 2^nd highest rate in country which raised significant concerns.

·       Leicester is a complicated area due to issues of migration, travel, country of origin, poverty, homelessness, and substance misuse.

·       TB kills around a million people a year globally. It is entirely preventable; however, it requires an extremely long and hard treatment over 6 months often with side effects.

·       There had been lots of work in the city including the development of a new strategy and an action plan. A presentation was provided at Health & Wellbeing Board and discussion at the ICB clinical executive meeting enabled people to discuss how to resource and improve screening and treatment.

·       There have been some unusual strains in the county which have been more infectious and have had more severe outcomes. These strains have been around for decades but being monitored as if were to transmit to the wider community it would be concerning.

·       The outbreak of whooping cough had also raised concerns although there were more cases in the county than the city. The lower uptake of vaccinations particularly by pregnant women as newborn babies are most vulnerable was noted of particular concern. Another concern is the limited protection of the vaccine as it reduces over time and is less effective than other vaccinations.

·       Close attention to monitor the situation will continue moving forward with the incident management team, ICB and UKHSA. Partnership working is required to overcome the hesitancy amongst communities.

·       There had been a measles outbreak across East Midlands and the highest rates were in the city. There had been lots of work on this with health partners for focused efforts on communications, a roving mobile unit for vaccinations and working with communities to overcome vaccination hesitancy and this had made a real difference as there had been hundreds vaccinated since the campaign started. Rates had reduced with no new cases reported in recent weeks for the first time since the outbreak began.

·       The national issue of an e-coli outbreak associated with lettuce was highlighted. There had been only one case in the city but Public Health, the Food Standards Agency and Environmental Health were continuing to monitor.

·       The identification of a couple of salmonella cases was also highlighted which was also being monitored by Environmental Health and Regulatory Services.

·       During the pandemic there was a significant drop in the screening programme, with cervical screening rates much lower than the national average and lots of work with partners around this issue.

In response to questions and comments from Members, it was noted that:

·       The Deputy City Mayor for Social Care, Health and Community Safety is writing to the Secretary of State to request funding to tackle TB in Leicester as the city has the second highest prevalence in England. The highest prevalence area  ...  view the full minutes text for item 67.

The Director for Public Health and Health Partners submit a presentation to provide the Commission with an overview of services and systems.

The Director of Public Health provided the Commission with an overview and it was noted that:

·       Public Health is considered as both the science and art of preventing disease, prolonging life and promoting physical health through organised community efforts.

·       The understanding of ‘health’ has changed over time and encompasses mental health and wellbeing as well as physical health.

·       One of the key features of Public Health has been tackling the health inequalities and differing outcomes between communities and areas to address the stark differences in life expectancy, healthy life expectancy and disease rates etc. that are preventable and unjust.

·       There is a strong link between poverty and health outcomes. 10% of the world’s population lives in poverty. The population of an area impacts the demands and priorities of Public Health.

·       Leicester’s population is characterised by:

o   Younger population than national average.

o   Large increase of population in last few decades.

o   Ethnicity change – huge diversity and census shows that for the first time, the white population is now the minority.

o   Significant deprivation in Leicester wards compared to England. There are large disparities between different areas of the city.

·       Deprivation in the city impacts life expectancy and healthy life expectancy. This has meant people die younger and get ill earlier in Leicester which consequently has implications for health and social care and service demands.

·       Life expectancy was improving in Leicester until 10 years ago when it plateaued. Leicester’s life expectancy has been consistently below the national life expectancy. 

·       A further dip in life expectancy during the pandemic but this was sharper in Leicester than the national average due to deprivation across the city meaning people often live in crowded conditions and more likely to have underlying health conditions.

·       Public Health is based within the City Council and has followed their values, with the premise of working with partner organisations to benefit residents. The overall vision of Public Health is a fairer society where we can live with health and happiness.

·       The aim has been to prevent ill health, rather than treat. Working with partners has allowed a more targeted, cost-effective approach but required hard conversations around priorities.

·       Core 20 is an NHS initiative focused on 20% of most deprived neighbourhoods in the country. In Leicester, Leicestershire and Rutland over 90% of those in the 20% are in the city.

·       The priorities of Public Health for the next year are to be focused on primary and secondary prevention. An upcoming workshop in August will enable discussion of key priorities.

·       Wider determinants of health are influenced by the Council such as leisure centres, economic development, housing etc. all impact on health and wellbeing.

The Chief Operating Officer at the Integrated Care Board provided the Commission with an overview of health services in which it was noted that:

·       The NHS developed new organisations to replace former Clinical Commissioning Groups. The Integrated Care System (ICS) aims to bring together public sector organisations to do what is right for local people supporting social and  ...  view the full minutes text for item 68.

The LLR ICB submits a report and will provide a presentation to stimulate a discussion among members and provide a better understanding of the situation and plan for pledges 1 and 2 of the 5-year plan.  The Scrutiny Commission is invited to receive the report for information and make any comments or recommendations as appropriate. 

The Head of Population Health Management at the Integrated Care Board presented an overview of the pledges and it was noted that:

·       Pledges 1 and 2 within the ICB 5 year forward plan are centred around improving the health of the most disadvantaged and marginalised communities across the city.

·       The World Health Organisation defines health as being more than the absence of sickness. The NHS is often seen as a sickness system as opposed to a health system with a prevention agenda to keep people well and have a positive contribution in their future.

·       There is a current debate in the NHS at a national level about the structure of local ICBs and where the line should be drawn in its remit to co-operate with partners such as local authorities and the VCSE sector to address wider determinants of health, such as social and economic factors.

·       Life expectancy in Leicester is significantly lower than in Leicestershire and Rutland and has always been lower than the national average as a whole. Common illnesses and prevalence are often vaccine preventable. There are close working relationships between the ICB and Public Health to identify and address inequities and identify solutions.

·       Leicester has led in developing a model in selected GP practices for patients with chronic or complex needs to see the same GP. Around £3m discretionary funding has also been allocated to GP practices where the national formula doesn’t allocate sufficient recourse for the local population, generally in the most deprived areas.

·       Public Health have distributed around £1.1m funding to and provide support to residents in city to address fuel poverty as there is a correlation of living in cold and damp housing with poor mental health, respiratory and neurological health conditions.

·       As a deprived city, Leicester has lots of risk factors for bowel cancer. Residents are likely to have a highly processed diet and low health literacy and there is generally a poor uptake of bowel screening. There has been some innovative work across the city, particularly with the Somali community on screening, as if caught earlier there is a much higher survival rate. Work is still needed to address how to improve communication more clearly and respectfully for residents to come forward and not be embarrassed.

·       Progress has been made since the pandemic for tackling high cholesterol and improving blood pressure readings of residents in the city.

·       The life expectancy of individuals with a learning disability compared with their peers is lower by 19years, although this has improved by 3 years since 2021. Further work is required and continues to be a commitment –to further improve. 

·       Air quality is an important determinant to health and the City Mayor and his Executive have led on programmes to improve cleaner air. Work is also ongoing with the Space Centre and respiratory team at Glenfield Hospital to monitor air quality and the impact on asthma rates in children.

In response to questions and comments from Members in relation to the health overview and  ...  view the full minutes text for item 69.

Members of the Commission will be asked to consider the work programme and make suggestions for additional items as it considers necessary.

The Chair highlighted that the draft work programme was included in the agenda pack, though is a live document and topics for discussion can be reviewed throughout the municipal year to respond to emerging issues. It was further highlighted that following discussions during the evening topics including GP access and vaccinations screening could be brought forward on the work programme.

Members were invited to make suggestions for consideration in which it was noted that the Commission would like to consider A&E, hospital discharges, CQC maternity inspection and

It was further noted by the ICB that the Leicester, Leicestershire and Rutland Joint Health Scrutiny Committee would be discussing concerns around the 8am rush in GP Practice at its upcoming meeting in July for which the Chair reminded Members the Commission represents membership for the city at the Joint Committee.

It was also agreed that the ICB would circulate a briefing paper to the Commission on its priorities for 2024-2025 following discussion at its Board meeting in August.

There being no further business, the meeting closed at 20.06.