Agenda item

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 current item, it was noted that:

·       Developing the ICB 5-year forward plan included the input of Local Authorities and communities to ensure the identified pledges were associated to need and also aligned to NHS and adult social care frameworks. Targets and metrics are monitored and reported at a national and local level with a more focussed performance dashboard established locally to provide assurance and identify improvements where there are gaps. It was agreed that a session could be arranged to showcase the dashboard to Members of the Commission if desired.

·       Health profiles are available although are generally focussed at a MSOA level as opposed to wards to ensure the data is illustrative at a more neighbourhood level and does not mask what is going on due to size and variances across wards. For example, western ward includes neighbourhoods such as New Parks, Braunstone Frith and Western Park, all of which may experience different health needs.

·       A system approach is taken to address healthy food provision with a renewed action plan currently being developed that could be discussed in more depth at a future meeting. It was further highlighted by the Deputy City Mayor for Social Care, Health and Community Safety that where the Authority has direct responsibility, for example pop-up pantries, balanced food is offered to provide healthier choices alongside other public health initiatives such as free toothbrush and toothpaste. A holiday activity programme has also been delivered across the city for eleven years which includes a variety of fruit and vegetables as lunch provision but often find children may not initially choose to eat until they see those they trust modelling eating healthier options.

·       71% of patients are seen by clinical staff in GP practices, such as a GP, nurse or medic. Webinars have been run to share best practise between GPs about the use of multidisciplinary teams to ensure patients are seen by the right person although there is not one size fits all for different community needs. It was agreed a further breakdown could be shared if requested.

·       Additional support has been put in to register refugees and asylum seekers although many remain unregistered. Promotion is ongoing to raise awareness that documents are not required to be produced at GP but may deter individuals where secondary provision is needed. Members were encouraged to directly raise cases with the ICB and Deputy City Mayor where individuals are being asked to provide documentation to register with a GP and Cllr Russell agreed to write to all Members.

·       There is a home first ethos across the city that is evidently successful with working alongside adult social care to ensure patients are able to safely return home and receive the support needed. Sometimes this may not be possible and patients may be discharged to alternative locations but will be return home or be relocated to provision nearer as soon as possible.

·       Primary care appointments are available but an issue has been identified with missed appointments impacting effective use of resource and consultations. Work is ongoing to determine why patients may book and not attend appointments, including barriers to improve attendance.

·       It would be transformative to move to a flag system in primary care so that when vulnerable patients, those with complex needs or require continuity with the clinician they see make contact with a GP surgery it is automatically flagged even if the receptionist doesn’t know them. Work is underway locally and regionally to identify the resources that would be required to implement this and it was agreed that options could be shared with the Commission when further developed.

·       An extensive review of GP data since 2019 has been completed regarding GP funding under the national model where practices are underfunded. Data illustrated there are 10% more appointments available but the population has increased by around 15% and therefore not aligned, particularly as the population appear to be sicker and require more appointments since the pandemic. 

·       36 Health Inequity Champions from a range of primary and secondary care settings as well as adult social care have completed NHS England training.  Funding was also secured to enable work with Sharma Womens Centre to inform VCSE on health inequities such as cancer, high blood pressure and respiratory disease. The Local Authority also deliver a Community Wellbeing Champion programme with over 190 organisations and 400 individuals designated to deliver outreach work to communities.

·       Severe mental health conditions are such as psychosis and delusional schizophrenia are considered as much harder to treat and lead to larger cognitive issues that can be impacted by stigmas and beliefs. Mental health services have received increased funding over recent years with Leicestershire Partnership Trust recognised as a mature partner to deliver services to support residents.

·       Caroline Trevithick is the Chief Executive Officer for the ICB and an Acting Chair of the ICS has been appointed with NHS England recruiting for the substantive post.

The Chair invited the Healthwatch representative to participate in the discussion in which it was noted in response to questions that:

·       A GP practice is required to temporarily register a patient if they attend and require an appointment. It was reiterated that any known cases where patients are asked to provide documentation to register at a GP practice should be shared with the ICB.

·       Primary Care Networks are very successful in some areas and others could work better. Generally, PCNs offer more appointments and access to specialist roles as part of multi-disciplinary teams. 

·       E-consult is an additional mechanism for patients to contact GP practices and provide flexibility to address the 8am rush and should not be the only provision. Reaching people are training people to access e consults and using cascade model to get those trained to help others understand. Assurance was provided that the ICB will intervene where it is known if GP practices are using e-consult as the only option.

·       650k appointments include telephone and face-to-face consultation, with the latter now back up to 70% of appointments following the pandemic, and is increasing each month.

·       The cloud-based telephony system has only just been implemented so is too early to determine effectiveness but an update can be provided to the Commission in future.

AGREED:

·       The Commission noted the report.

·       Food action plan to be added to the work programme.

·       The Deputy City Mayor for Social Care, Health and Community Safety to contact all Members regarding access to register with a GP and to directly raise cases where individuals are requested to provide documentation.

·       A separate briefing session to be arranged on the dashboard to monitor pledges.