Agenda and minutes

RESOLVED:  That, in the absence of the Chair and Vice-Chair, Councillor Simon Brown be appointed as Chair for the meeting.

RESOLVED:  That the following membership changes be noted:

(1)          the appointment of Javina Sehgal  as Accountable Officer or Nominee, Harrow Clinical Commissioning Group in place of Rob Larkman;

(2)          the appointment of Varsha Dodhia as representative of the Voluntary and Community Sector in place of Carol Foyle and the appointment of Shona Duncan as Deputy.

RESOLVED:  To note the attendance at this meeting of the following duly appointed Reserve Members:-

To receive declarations of disclosable pecuniary or non pecuniary interests, arising from business to be transacted at this meeting, from:

(a)          all Members of the Board;

(b)          all other Members present.

RESOLVED:  To note that the following interests were declared:

All Agenda Items

Councillor Krishna Suresh declared a non-pecuniary interest in that his mother was in receipt of benefits.  He would remain in the room whilst the matters were considered and voted upon.

Agenda item 7 – Information Report: 0-19 PH Nursing Commissioning Update

VarshaDodhia declared a non-pecuniary interest in that she was an employee of CNWL.  She would remain in the room whilst the matter was considered and voted upon.

That the minutes of the meeting held on 7 June 2018 be taken as read and signed as a correct record.

RESOLVED:  That the minutes of the meeting held on 7 June 2018, be taken as read and signed as a correct record.

To receive any public questions received in accordance with Board Procedure Rule 14.

Questions will be asked in the order in which they were received.  There will be a time limit of 15 minutes for the asking and answering of public questions.

[The deadline for receipt of public questions is 3.00 pm, Monday 2 July 2018.  Questions should be sent to publicquestions@harrow.gov.uk  

No person may submit more than one question].

RESOLVED:  To note that no public questions, petitions or deputations were received at this meeting.

Joint report of the Director of Public Health, Harrow Council and Chief Operating Officer, Harrow Clinical Commissioning Group

The Board received a joint update report from the Director of Public Health and Chief Operating Officer on the award of the contract for the 0-19 Health Visiting and School Nursing services to CNWL with effect from 1 July 2018.  It was noted that the three main public health priorities were oral health, healthy weight and school readiness.

The Director of Public Health advised the Board that the new service had been in operation in new premises from 2 July 2018.  The first two days had been taken up with induction training.  The Director drew particular attention to the following:

·                     the key focus during the transition had been on the use of a risk register to mange and monitor risks;

·                     the new service enabled the breastfeeding service to continue and also absorb the planned £65k budget saving.  It would also enable the introduction of vision screening for all reception-aged pupils which, if funded as a stand alone service, would have cost in excess of £75k per annum;

·                     oral health was now the responsibility of all health visitors, school nurses and other staff instead of a specialist oral health promoter;

·                     additional checks, initially for the most vulnerable, would take place at age 4-5 months and at 3.5-4.5 years old.  The latter aimed to improve school readiness in those not already attending an early years setting;

·                     the new service would provide an increased school nurse presence in every school and the introduction of questionnaires for secondary aged pupils in order to identify and address areas of concern to young people and to build on the recent Young People’s Needs Assessment;

·                     the delivery model for school nursing in the two PMLD special schools would be brought in line with the statutory guidance on supporting pupils with medical conditions at school.

The CCG representative emphasised the commitment to working closely with Public Health and CNWL which had made a positive impact during the tendering process and early mobilisation.  The CCG welcomed the inclusion of additional health checks to aid early identification and intervention and hoped the increase in school nurse provision would improve multi agency collaboration.  It was however important to monitor whether  nurses withdrew as a result of the change in the delivery model for school nursing in the two PMLD schools.  She also stressed that health advice should include signposting alternatives to A&E.

The Board was informed that discussions were taking place between the CCG, Harrow Council and NWL regarding a joint specification for speech and language development, an area which had absorbed a £50k reduction in Council spending.  Although no clinical risks had been identified it was hoped that in the longer term provision to meet the rising demand, linked to the increasing numbers of Education Health and Care Plans, would be commissioned.

The CCG representative expressed the hope that the suggested change to the school nursing delivery models for PMLD special schools would not result in unreasonable cost pressures for the CCG.

A CCG clinical representative stated that it  ...  view the full minutes text for item 17.

Report of the Director of Public Health

The Board received an update report on the Harrow Integrated Sexual and Reproductive Health Service.  It was noted that Harrow’s Sexual Health Strategy had been approved by the Board in 2015.

An officer introduced the report outlining the key objectives of the strategy and the services included in the fully integrated and comprehensive system.  The Board was informed that following a procurement exercise, the Lead provider for ISRH Services across Ealing, Harrow and Brent was London North West Healthcare NHS Trust (LNWHT).

The officer reported the replacement of the previous fragmented provision by an integrated multi-agency local service.  This integrated seamlessly with the new Pan London e-service and STI Home Sampling Service.  The initial focus was to move lower risk patients from exceptionally busy clinics to enable  focus on patients with additional needs or vulnerabilities.

In response to questions the Board was informed that:

·                     branding for the new service and an official launch, including the e-service, would take place shortly.  Initial signposting would be from GP services, LNWHT ISRH or clinics;

·                     safeguarding was at the heart of the new e-service and the officer had facilitated a presentation in respect of safeguarding arrangements to Harrow LSCB Violence, Vulnerability and Exploitation sub group.  Questions from the group were submitted to the lead commissioner at the City of London and responses had been received;

·                     Harrow’s contribution to the e-service and the Pan-London Sexual Health Programme was based on the cost per appointment/test and was robustly tested.  The previous system for calculating recharges for Harrow residents who chose to be treated elsewhere had been cumbersome.  A Member commented that the e-service could reduce the number of residents attending out of borough due to confidentiality;

·                     it would be the responsibility of the LNWHT to consider any extension of the hours of the Alexandra Avenue Clinic.  Other sites across Harrow were under consideration and the Board would be informed of any developments;

·                     the distribution of condoms and  dispensing machines seven days a week was being investigated and the officer undertook to inform Board members of the current availability.  A Member suggested that the information be made available on leaflets in GP surgeries.  Pharmacies were keen to become distribution points for emergency contraception and this would increase access without incurring additional costs.

The Board endorsed the one stop approach as the way forward.  A further report including monitoring satisfaction and hours of delivery would be submitted to a future meeting.

RESOLVED:  That the report be noted.   

Report of the Chair, Enterprise Wellness

The Board received and considered the Diabetes Care Report produced by Healthwatch Harrow.  The Healthwatch Harrow representative advised that the report was based on a survey, focus groups, Healthwatch Forum and the CRISPI database (concerns, request for information, signposting and intelligence) and national and local influences.

The Healthwatch Harrow representative stated that the report set out to gain a better understanding of the experiences of local people with regard to diabetes care and service provision and set out recommendations to improve the quality of service.  She outlined the key issues and the six specific recommendations based on the workshops and survey.

Members expressed concern that Harrow had the third highest incidence of diabetes and commented that it was essential that primary care worked with GPs to promote a programme of prevention, such a programme to include encouraging people to attend for blood tests.  A Member suggested that a diabetes prevention programme be introduced in schools from an early age in the same manner as sex education.

The Director of Public Health welcomed the participation of Healthwatch Harrow in raising awareness.  She advised that the Schools National Childhood Measurement Programme indicated that Harrow was lower than the national level when started school but higher than the national level at 11.  Programmes for physical activity and healthy eating were promoted. Harrow was in the third wave of the new National Diabetes Prevention Programme.

The CCG representative informed the Board that diabetes prevention was a priority for the North West London STP and a lot of work had been undertaken with primary health and social care on a model using an outcomes based approach.  The Harrow Health app was also being actively used for raising awareness and signposting messages.

The Board discussed the initiatives being undertaken including school children walking a mile, adult walking groups in parks, patient participation groups to encourage both staff and patients to walk.  It was reported that the Harrow Parks User Group was looking at nature and ecology walks.

Discussion ensued on the needed to encourage those not already walking particularly those in the 30-50 year group.  The representative of the voluntary and community sector suggested focussing on areas where high footfall and tapping  into communities, for example having a representative for diabetes in each ward.  The Board recognised the parental influence on the amount of physical activity their children undertook.

The Director of Public Health undertook to make arrangements to reinstate the walk in the local area for Members of the Board and officers prior to Board meetings.

The Chair thanked Healthwatch Harrow for an excellent report.

RESOLVED:  That the report be noted.

Which cannot otherwise be dealt with.

CQC Inspection of Drug and Alcohol Provider

The Director of Public Health advised the Board of the excellent report by the CQC on the Council’s drug and alcohol provider WDP which outlined the four areas where it was leading the way.

Award of Gold Standard to Schools

The Chair reported that 9 Harrow schools had been awarded the gold standard at the recent London Health Schools Award ceremony at London City Hall.  Norbury School had given a presentation at the ceremony which had been well received.  The Board expressed its congratulations to all the schools involved.