Agenda and minutes

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

There were no apologies received.

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 for which there were none. Councillor Clarke declared that his wife is a social worker for the item on the Bradgate Unit.

The minutes of the meeting of the Public Health and Health Integration Scrutiny Commission held on 4^th March 2025 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 5 March 2025 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 5 March 2025 were a correct record.

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

The Chair thanked members, the executive lead and officers for their work and commitment over the municipal year ahead of a new one beginning.

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 gave a verbal update of the latest position of health protection, and it was noted that:

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

·       Discussions were ongoing with University Hospitals Leicester (UHL) on safe discharge for residents in care homes.

·       The flu vaccine uptake in schools remained poor, particularly in secondary schools, despite the aim of protecting older and vulnerable individuals via the school programme. A new procurement process was underway, due to start in September 2025.

·       Changes to Covid and flu vaccination delivery were expected from the Integrated Care Board (ICB) in the coming months. Members highlighted the importance of addressing stark inequalities in vaccination uptake within the city.

·       It was noted that funding for the roving vaccination unit had been significantly reduced, resulting in a more limited service despite a broader range of service needs and targets.

·       The new vaccine season was due to begin in April 2025.

·       Since the last meeting, additional staff had joined the service monitoring tuberculosis (TB), and a record number of tests had been carried out. An emerging strategy was in development, supported by increased attention and a new East Midlands TB board. Leicester continued to have the highest TB rates in the country.

·       Stark inequalities persisted, and future updates were expected on work with the VCSE sector to support the vaccination programme and build long-term improvements.

·       Leicester’s TB data, when compared to similar cities, remained high, and the trend had continued over the past year.

·       There had been a few suspected cases of measles in the city, however none had been confirmed. Investigations had taken place, and there were currently no concerns.

·       MMR vaccine uptake had shown a slight improvement over the last quarter. A significant amount of work was ongoing, though members agreed that a stronger grip was still needed. There were concerns about potential future resource reductions and their implications for the programme.

·       Covid rates had declined, and there were no immediate concerns.

·       Flu uptake across LLR showed significant variation, with uptake in the city reported as half the rate seen elsewhere. Members agreed this was unacceptable and needed to be addressed, particularly as many services and conditions were affected by social deprivation.

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

·       Tackling health inequalities was highly important, members raised concerns about the lack of funding. They questioned whether more honesty was needed with the public, acknowledging that without sufficient resources, change in the city would be extremely difficult.

·       Leicester had previously outperformed the national average on MMR uptake 10 years ago, suggesting that differences in system-level spending decisions played a critical role. The need to reassess how resources were prioritised and allocated across the system was important.

·       Concerns were raised on the low flu vaccination uptake in children in the city. It was noted that new staff had been appointed to work with communities and promote vaccine programmes through champions and ICB networks. The efforts already underway  ...  view the full minutes text for item 127.

The Leicestershire Partnership Trust and the Integrated Care Board submits an update and a presentation on Children and Young People’s Mental Health referrals and the services provided in Leicester.

Lead directors and professionals from the Integrated Care Board and the Leicestershire Partnership Trust presented the update on Children and Young People’s Mental Health referrals and it was noted that:

·       Children and Adolescent Mental Health Services (CAHMS) was only one part of the mental health service offering across Leicester. The aim had been that the appropriate support was available at the appropriate time. The team was really proud of the self-referral route and the triage and navigation service.

·       The latest key performance indicators demonstrated a mixed picture. There were lots of things that effected delivery against the KPIs such as the eating disorder clinic seeing small numbers of patients each month. The overall impression was that the service was performing quite strongly. Where it was not meeting targets, such as the 15-week waiting list, measures had been put in place such as follow up calls and checks.

·       The most significant challenge the team was facing was the significantly increased referrals for Autism and ADHD. They had increasingly become part of the public consciousness, and this had affected services nationally. Leicester was in the middle in terms of referrals and waiting lists. It was emphasised that treatment consisted of controlled drugs.

·       A national report was expected in spring 2026 which would provide further guidance, however the bottom line was that there was not the capacity to meet the current demand.

·       There had been success in reducing inequalities in accessing mental health services. A programme had been run in partnership with Leicester City Football Club which provided mentors for children and young people who would not usually access mental health services. The cohort was largely young black men.

·       Partnership working had also occurred with the police on topical issues such as social media and knife crime.

The Associate Director from the Integrated Care Board clarified that:

·       The triage and navigation service were the entrance point to the service for all children.

·       Emergencies could come from 111 or CAHMS crisis line.

·       There were 787 referrals between 1^st November 2023- 2024. This was a full year which was impacted by collective action.

·       The number of referrals being returned to GP’s had not changed as there was still a lack of information being included on the form. There had been a number of meetings to discuss this and the use of PRISM forms but this had been complicated by collective action.

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

·       Members expressed revelation that there had not been a review to consider the returned referrals, and how this was to be improved.

·       Concerns were expressed at GP’s writing letters for referrals as this removed the standardisation of forms and increased the risk of more complications in the referral. The most underserved demographic were black communities which would see huge disparities in how an issue could be represented by different individuals and could allow unintended discriminatory practises into the system.

·       The ICB was working with the Local Medical Committee and had explained  ...  view the full minutes text for item 128.

The Leicestershire Partnership Trust and the Integrated Care Board will provide an update on the system pressures experienced by mental health services in the Bradgate Unit through the winter period.

The lead for Mental Health Services, Adults and Older Persons for the Leicestershire Partnership Trust presented the report on system pressures at the Bradgate Mental Health Unit. It was noted that:

·       The Bradgate Unit comprised six acute Adult Mental Health Wards.

·       A detailed activity pack was developed outlining practical support provided across LLR during the winter period. A paper on this was due for release following a validation process.

·       During the winter period, an average of six patients were waiting within a 24-hour period. On some occasions, this increased to ten patients.

·       The OPEL (Operational Pressures Escalation Level) framework was used to standardise pressure levels, with four defined levels. The service operated at OPEL 3 (severe pressure) for 93% of the time.

·       OPEL 4 (critical pressure) was escalated and triggered additional support for three days over winter.

·       Activity levels and bed demand were illustrated through graphs showing pressure on flow and length of stay.

·       The average stay was 47 days, in December, the average length of stay rose to 66 days.

·       Planning for winter 2025 had already begun in line with the new financial year.

·       As part of the additional winter funding for 2024/25, the following shift patterns were made available to all core and bank staff within the Mental Health Liaison Service to enhance service coverage during peak periods:

­   06:00 – 12:00

­   18:00 – 02:00

­   16:00 – 00:00

·       In addition, the service received investment funding for the recruitment of two Link Worker posts. These roles were designed to provide dedicated support to patients within the Emergency Department and to further strengthen collaborative working with colleagues at University Hospitals of Leicester (UHL). Recruitment to these posts was successfully completed in March, with both positions scheduled to commence in June 2025.

·       The OPEL framework was reviewed prior to winter to assess robustness, supported by a national review in December.

·       Governance arrangements were strengthened and aligned with national standards, with actions identified to help de-escalate pressure levels.

·       The Psychiatric Intensive Care Unit (PICU) ward underwent extensive refurbishment work. Block purchasing arrangements with a private provider were made to minimise disruption to patients and families. Additional acute bed capacity was commissioned due to the temporary closure of the unit, including external placements when necessary. The service worked to avoid out-of-area placements where possible, though this was sometimes unavoidable.

·       Sole access to a number of beds was secured to support families in maintaining care at home.

·       There were 18 adults clinically ready for discharge per day, with 40% being city patients.

·       Some patients could not be discharged due to housing and support issues, despite not requiring hospital care.

·       Clinical discharge was managed effectively compared to other areas.

·       Multi-professional teams, including housing providers, local authorities, and practitioners, collaborated to identify support needs early and facilitate timely discharge.

·       On 13 occasions, B&Bs were used to accommodate patients, with an average stay of six days.

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

·       The OPAL scoring reflected pressure risk  ...  view the full minutes text for item 129.

The Leicestershire Partnership Trust submits a report and presentation to update the Commission on the Neighbourhood Mental Health Cafes scheme which was launched in 2021/22 to support adults in local neighbourhood settings when experiencing mental health distress.

The lead for Mental Health Improvement and Transformation and the Executive Director for Mental Health at the Leicestershire Partnership Trust presented the update on the Neighbourhood Mental Health Cafes scheme which originally launched in 2021/22. It was noted that:

·       It had been a collaborative scheme and there were nine Voluntary and Community Sector organisations (VCSE) who operated the weekly mental health cafes which were located across the city.

·       Work had taken place with Public Health to identify the areas of high need and that the diversity of the city was represented ensuring they were accessible.

·       The organisations running the cafes represented the local communities. The scheme thrived due to the organisations understanding the individuals and their needs when they walked through the door.

·       The cafes offered open access to individuals who experienced mental health distress, it provided an opportunity to discuss how they were feeling or offered a quiet place.

·       The recovery workers in the cafes had a varied skill set and had been provided with a lot of training to prepare them for what could be presented by people attending the cafes with a myriad of different issues. They were offered coping strategies, risk and safety planning, psychological self-help and coping tools.

·       3500 individuals had accessed the cafes and they were demonstrating increasing resilience.

·       Information had been gathered to understand the individual experiences. The primary concerns were anxiety and depression.

·       Most of the support offered is in-person but there is also text messaging, phone and online support. This had allowed those who were not able to travel to still be able to access the cafes support.

·       There had been varied use across localities. New Park was noted to be particularly active. Eyres Monsell had not been open long but access was increasing continuously.

·       Demographic breakdown of those who have access the cafes show:

o   More women were accessing the cafes. Work was ongoing to consider the best ways to support men.

o   Ethnicity appeared to align with the JSNA with high use from White and Asian backgrounds, however this demonstrated the need for more work to be done around Black and African populations and other ethnic groups that were not represented in the data.

o   Younger adults were not reflected in the data. There was a university offer but more work was still required, particularly to cover what the cafes could offer as young people transition from children’s services to adults. Largely older population, particularly those who had been bereaved.

o   Higher attendance from those who were retired or unemployed.

o   More work was required to understand access to the cafes for those with disabilities.

·       Although collecting data was important to the team, they were mindful that they didn’t want to overwhelm individuals visiting the cafes with a barrage of questions.

·       The main presenting needs found at the cafes were depression, anxiety, isolation, needing practical support and stress. The staff support the individual and consider other factors and challenges which may impact their presenting issues.

·       The cafes provided an  ...  view the full minutes text for item 130.

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

The Chair noted that the topics noted in the items would be added to the work programme.

There being no further business, the meeting closed at 20.01.