Agenda item

Matthew Cole, Director of Public Health, presented the report on the Quarter 2 performance and drew the Board’s attention to a number of issues including smoking cessation, A&E treatment and ambulance wait times, the cancer pathway and emergency admissions for ambulatory care sensitive conditions. 

The Board were advised by BHRUT that the recruitment issues in A&E could take five years to improve because of the high demand across the area.

Councillor Carpenter was concerned that the conception rate per 1,000 to women aged 15 to 17 was still above the national average.  Matthew Cole responded that the rate had reduced by 19% since its highest quarter reported, which had seen 38.2 conceptions per 1,000 teenage women, and was reducing steadily, however, a study would be commissioned in the New Year to find out why the Borough was lagging behind the national average and to consider the effect of the two year programme to reduce teenage pregnancies.  Marie Kearns commented that the teenage pregnancy rate had been an issue for the Borough for years, if not decades, and we needed to find out why that was still the case as there had been a number of campaigns aimed at reducing the rate.

There was discussion about the feedback from the BAD Youth Forum / Young Inspectors in regards to the alleged refusal of pharmacies to issue condoms or emergency contraception and insisting on age identification.  Matthew Cole advised that when problems about a specific pharmacy are reported to Public Health they would make contact with the Pharmacy concerned to make sure they fully understand and were complying with their contracts, including any staff training that may be required in the Pharmacy.  Matthew Cole advised that there would be a new and different way of providing condoms as part of the new Public Health contract provision for sexual health.  The provision of a card to enable young people to ask discreetly for contraception provision was also being looked into. 

Councillor Butt asked about other contraception provision in the area.  Matthew Cole advised that the services were commissioned from GPs and other specialist centres, there were a large number of emergency contraception provider, which were widespread across the Borough.  Councillor Butt gave an example of an inaccurate website and advised that she was also aware of two month waiting lists for contraception services appointments and felt these were unacceptable.  The Chair suggested that this type of information was passed to Matthew Cole so that effort could be given to resolving such problems.

Comments were made in regard to the Health and Adult Services Select Committee looking at sexual health services as an issue for in-depth scrutiny, due to the long standing teenage pregnancy rates and problems being reported with the provision of sexual health services in the Borough, but this would be dependent on its future scrutiny programme.

The Chair said that there had been a number of occasions where initiatives that worked well in other areas, with similar communities to LBBD, for some reason do not always work in LBBD and we need to consider how we do things differently or look at why they are less effective and she would be discussing with officers in the New Year a possible piece of work around this problem.  Dr John, Barking and Dagenham Clinical Commissioning Group, said he welcomed the Chair’s view of trying to triangulate why programmes had less success here than in similar areas.  Dr John indicated that it may be opportune to look at cross / joint provision, for example could GPs work with schools in regards to obese children.

In response to a question from Councillor Carpenter in regards to the increase in childhood obesity levels Matthew Cole said that they had remained roughly static, based on the recent data releases for London and England.  There was then discussion in regards to the phenomenon whereby children who are not overweight become so when they go to primary school, this was a national trend and was unclear why it was occurring.  A sustained focus would be needed to reduce the later in life problems that would occur for those children.

Councillor Carpenter was concerned about the potential closure of the Birthing Centre and the loss of midwifery led births at Barking Hospital.  Sharon Morrow, Chief Operating Officer, Barking and Dagenham Clinical Commissioning Group, advised that Conor Burke had given assurances that the services will not stop whilst negotiations continue with Barts Health NHS Trust and that should the Barts Health negotiations fail other service providers would be sought and negotiations started.  Councillor Keller said that the Birthing Centre had been provided after a long and hard campaign led by the Council and she would wish to record her support for its retention.  Councillor Turner commented that should there be any proposed closure of the Birthing Centre this needs a higher profile with much greater public engagement.  Councillor Turner added that likewise the GP Practices that could be at risk following the CQC report also would require public engagement and local discussion.  Sharon Morrow said there was no proposal to close the Birthing Centre service and it was not something being suggested from the commissioners, however, it was being reported so that the Board was aware of the risk due to the potential need to change partners.

Dr John said he welcomed the imminent discussion with CQC to explore a number of issues and stated that he was concerned that the CQC had not been to many of the GP practices and CQC had not discussed their findings with the GPs or taken into account mitigating circumstances.  Dr John gave the example of his own practice showing a high rate of antibiotic prescription but he had the highest rate of registered sickle cell patients in London.  Dr John confirmed that none of the six practices which CQC showed as being of high concern were single handed practices and only one GP had been visited by the CQC.

The Chair asked for comments in regards to the high London Ambulance Service (LAS) conveyance rates from three practices in Barking and Dagenham.  Sharon Morrow responded that the CCG had commissioned an enhanced GP service for nursing homes in the Borough, including Alexander Court and Chase View.  An interim evaluation had shown a reduction in LAS conveyances across all homes (although not Alexander Court).  The CCG will review LAS conveyances from the Ripple Road practice.

Anne Bristow, Corporate Director of Adult and Community Services, advised that how well we share performance trends amongst partners will be picked up in the work on the revised Health and Wellbeing Strategy in the New Year.

The Board:

(i)  Reviewed the overarching dashboard;

(ii)  Noted the further detail provided on specific indicators and responses to the questions raised and that further updates would be provided in due course; and,

(iii)  Welcomed the assurance given by Conor Burke that the Barking Community Hospital Birthing Centre would not close and the issue had only been raised as a risk because negotiations were being held with Barts Health NHS Trust, however should these not be successful other service providers would be approached.

(iv)  Noted that further to Minute 59, 28 October 2014, the London Ambulance Service had been asked by the CCG to provide a formal response in regards to Infant Deaths and this was currently awaited.

(v)  Noted that Sharon Morrow would circulate statistics on the Birthing Centre clientele to the Board members.

(vi)  Noted Matthew Cole would arrange for information on sickle cell to be passed to Councillor Turner.

(v)  Noted a sustained focus would be needed on childhood obesity to reduce the later in life problems and medical interventions that were more likely to occur in adults that had been obese as children.

(vi)  Board Members who found issues of service provision concern for Public Health should inform Matthew Cole of the details in order that an investigation could be undertaken and if necessary action taken.