Agenda and minutes

It was noted that apologies for absence had been received from Cllr Modhwadia and Cllr Zaman.

Members will be asked to declare any interests they may have on any items to be discussed on the agenda.

The Chair asked members of the commission to declare any interests in the proceedings for which there were none.

The Minutes of the meeting held on 6 February 2024 are attached and Members will be asked to confirm them as a correct record.

The Chair noted the minutes of meeting held on 6 February 2024 were included within the agenda pack and requested outstanding information requests from the previous meeting be shared with the Commission. The Chief Operating Officer of University Hospitals of Leicester noted that he would cover outstanding actions during the update on operational issues.

AGREED:

·       Members confirmed that the minutes for the meetings on 6 February 2024 were a correct record.

The Monitoring Officer to report on any Questions, Representations or Statements of Case received.

It was noted that none had been received.

The Monitoring Officer to report on any Petitions received.

It was noted that none had been received.

The Chair updated the Commission that following the children’s mental health update earlier in the municipal year, he and Cllr Sahu had met with heath partners to further discuss concerns regarding GP referrals. It was noted that the terminology had been changed in relation to referrals being sent back to GP’s for further information. It was also highlighted that health partners agreed to undertake a number of actions to better understand why referrals were being sent back and that an update report would be provided to the Commission in the new municipal year.

It was further highlighted by the Chair that concerns had been raised regarding GP access – particularly Beaumont Ley Health Centre. It was noted that the ICB had investigated the issues with communication and an apology had been issued for the confusion. In light of concerns and the recent poll that suggested Leicester patients had the most difficulty contacting their GP surgery, the Chair suggested the Commission should continue to monitor GP access pathways and request a further update on the issue in the new municipal year.  

The Chair also noted that an item was due to be discussed on improving health equity as part of the ICB 5-year forward plan but had been deferred until a future meeting.

The Director of Public Health along with the Integrated Care Board submit a set of reports to update the Public Health and Health Integration Scrutiny Commission on:

a) Oral Health Survey Results

b) Water Fluoridation

c) Oral Cancer Action Plan

d) Access to NHS Community Dentistry.

The Director of Public Health highlighted that there were a series of reports contained within the item in which the Chair invited each report to be taken individually.

The Acting Consultant Lead for Public Health presented the report in relation to the oral health survey results in which it was noted that:

·       Oral Health Surveys are usually undertaken every two years by the Office for Health Improvement and Disparities as part of the National Dental Epidemiology Programme. The Survey includes a random sample of 5-year-old children attending mainstream schools.

·       During 2021/22, 866 children were examined as part of the survey equating to 17% of all 5-year-olds attending mainstream city schools.

·       The survey found 37.8% 5-year-old children examined had decay. This was higher than the 23% national average with Leicester ranked 9^th highest of 132 upper tier authorities and 2^nd highest amongst comparator authorities.

·       The prevalence of decay has remained consistent in 5-year-old children since 2017 but has reduced since 2012 where around 50% of examined children were found to have decay. Work is ongoing to further reduce decay in the city.

·       There was a significant decrease of dental fillings with more 5-year-old children living with untreated areas compared to the 2019 survey. This was likely to have been influenced by Covid-19 and reduced dental access.

·       Variances were identified across the city with North Evington and Wycliffe wards with significantly higher decay.

·       Activities are ongoing to reduce tooth decay in children, including supervised tooth brushing in schools and early years settings, although not all have restarted following the pandemic; providing training sessions to health professionals; and issuing oral health packs at food banks and health visits.

The Commission commended initiatives to encourage supervised toothbrushing in early years but raised concerns around the limited access to dentistry to prevent or treat tooth decay.

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

·       The oral health survey results were illustrative of 2021/22 and whilst it would inevitably take time to address issues, there is ongoing partnership work to improve oral health across different settings and there may have already been some improvement.

·       Supervised toothbrushing paused during the coronavirus pandemic and not all settings have re-engaged. There has been a good uptake in early years settings but not all children access this provision, so focus is being targeted to encourage uptake in schools. It was agreed additional information would be shared on the roll-out of the programme.

·       There are disparities of tooth decay in 5-year-old children across wards although they can also hide issues and therefore MSOA can provide more informed understanding. It was agreed that data collection areas and maps could be provided. Variances in tooth decay amongst wards and ethnicities is complex but attributing factors may be cultural, deprivation, lack of access to NHS dentistry etc.

·       The survey does not provide information to gather data regarding if a child has been to a dentist or how recently; where a cavity has been filled an inference can be made  ...  view the full minutes text for item 52.

The University Hospitals of Leicester submits a report to appraise the Public Health and Health Integration Scrutiny Commission on the current pressures faced across the urgent and emergency care pathway.

The Chair highlighted that the Commission had welcomed the improvements reported at previous meetings and that some Members attended the recent Joint Leicester, Leicestershire and Rutland Health Scrutiny meeting where the issue was discussed but made reference to two recent articles surrounding the number of patients waiting more than 24 hours in A&E and the dire state of local healthcare services.

The Chief Operating Officer at UHL presented the item and it was noted that:

·       There have been improvements to services, but some patients have waited too long for planned and urgent pathways. This was recognised to not be acceptable and continues to be a motivator to improve.

·       Waiting lists increased by the largest amount during the pandemic and UHL was placed in Tier 1 in 2023 but progress has been made and moved to Tier 2 for cancer and planned care and out of tiering for urgent emergency care.

·       There had been a 60% reduction for patients waiting over 62 days for planned cancer treatment and a 77% reduction in waiting lists for elective care. Waiting lists remain long but improvements can be seen.

·       Urgent and emergency care performance was significant improved compared with 2022 but pressures were visible with increased attendance at the emergency department. A system approach has been undertaken to alter capacity and control the flow of patients to ensure patients are being seen at the right place at the right time.

·       More patients are being discharged than in 2022 but people are waiting longer to be admitted which has impacted East Midlands Ambulance Services. The intention is to ensure ambulances can respond to calls as soon as possible but performance has been better than 2022.

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

·       Patients medically ready but awaiting care arrangements to be discharged was higher on the day of the meeting but generally in the city is between 10-20 on any given day. This often peaks where patients have complex needs.

·       Virtual wards have received positive feedback and are looking to be expanded where appropriate. It was agreed that a briefing session could be arranged to discuss the process and mitigation of risks with Members.

·       Targets are set to improve performance and progress has been made but health is central to people’s lives and the intention is to continuously improve to do better.

·       Health Care Assistants are valued for their role and clarity would be shared with the Commission regarding hold on recruitment.

·       Information would be collected and shared with the Commission regarding deaths resulting from delayed admission or hospital wards.

·       The emergency department continues to be a priority to improve performance and ensure patients are seen by the right person at the right time. 73.9% patients were treated in 4hours and the refurbished facilities enables care to be provided whilst patients are waiting to move to wards. It was agreed that a further report could be shared with the Commission on the emergency department.

AGREED:

·       The Commission noted  ...  view the full minutes text for item 53.

The Director of Public Health submits a report to update the Public Health and Health Integration Scrutiny Commission of measles and TB prevalence in the city.

The Director of Public Health presented the item, and it was noted that:

·       There had been an outbreak of measles in the City with 90 confirmed cases and a further 26 probable cases likely to be confirmed since October. Around 35 settings have been affected, mainly primary schools and places of worship - Leicester has had the highest number of cases in East Midlands.

·       The outbreak has been the result of a steady decline in vaccination rates, particularly since covid. There had been weekly meetings with the Incident Management Team and partnership working to encourage vaccine uptake including; responding to known cases; enhanced vaccination offer; and improved communications.

·       Leicester has the second highest rate of TB in the country. Rates are highest among populations who were not born in the UK, but this does not mean TB was brought into the country. Individuals can be infected with TB but not present symptoms for a year.

·       There was a conference on 21 March to raise awareness of TB and its impact, and a workshop is to be held on 25 April to develop a TB strategy for Leicester. There have been various strands of work to inform the strategy such as analysis of reasons for delaying treatment.

·       This response has been formed from the partnership working of ICB, UKHSA, National TB Unit, NHS England, local authority public health, TB services, UHL, local communities and community organisations.

The Commission noted that they were aware some GP practices had been proactively contacting patients to update them on vaccination status which was reassuring.

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

·       An individual who has received both doses of the measles vaccine are highly likely to have lifetime immunity from the infection.

·       Communications are targeted for prevalence of TB to help prevent stigma.

AGREED:

·       The Commission noted the report.

·       Item to be added to the work programme regarding the refreshed TB action plan.

The Director of Public Health will provide details of the Health and Wellbeing Survey for information.

The Principal Public Health Intelligence Analyst presented a series of slides to inform the Commission on the proposed Health and Wellbeing Survey, in which it was noted that:

·       The previous survey was completed in 2018 with the proposed survey anticipated to be undertaken for 16 weeks during summer by an independent third party.

·       The survey will be carried out face to face with a sample size of 2100 participants and attempts to replicate the demographics of the city as accurately as possible.

·       The survey consists of core questions as well as others that may change depending on emerging topics and interests, for example, the survey is proposed to include dental access as data is not available from other sources. It was noted that the pilot questionnaire could be shared with Members of the Commission if requested.

·       The primary purpose of the survey is to inform strategic and specific needs assessment and is useful to understand local communities for the council, wider partners and the voluntary and community sector for improving health and wellbeing.

·       Data collection is anticipated to be completed by September 2024 that will require analysis which can be shared with the Commission.

The Chair thanked officers for giving him sight of the survey and incorporating long covid into the survey following feedback.

AGREED:

·       The Commission noted the report.

·       The Commission requested the item remain on the work programme for an update following completion of the survey.

The Commission’s Work Programme is attached for information and comment.

The Chair noted it was the final meeting of the municipal year and thanked Members for their contributions in discussing many important topics across the council’s public health division, external health partner agencies and during joint meetings with adult social care. Thanks were also extended to youth representative for their attendance and contributions at meetings; the senior governance support officer in addition to the public health team and health partners for their continuous hard work during a period when health services have been under tremendous pressure.  

The Chair highlighted that items remaining on the work programme would be taken forward for consideration alongside other priorities that emerge.

There being no further business, the meeting closed at 19.40.