Agenda item

The appendices to this item are included in the ‘Supporting Documents’ pack.

Cllr Bright, Cabinet Member for Equalities and Cohesion, arrived during this item.

Cllr Chand, Lead Member of Health and Adult Services Select Committee, Sue Lloyd, LBBD Consultant in Public Health and Kate Kavanagh, Cancer Commissioning Manager, NEL CSU, jointly presented the report.  Cllr Chand explained that the review had been undertaken as a result of the late diagnosis and below average survival rates that appeared to be occurring in the Borough.  Those higher than average rates seemed to have a direct correlation to residents’ lifestyle choices, individuals not going for diagnosis checks, not being aware of signs and symptoms that may indicate a health issue and not then getting those signs further investigated by their GPs.  This subsequently resulted in people not getting an early diagnosis and treatment and then needing more radical interventions.  Prevention was also important to prognosis the incidence of cancer occurring in the long-term. 

Sue Lloyd and Kate Kavanagh reminded the Board that four out of ten deaths from cancer are avoidable, and as part of their presentation they also drew attention to a number of issues including, the local incidence and survival rates locally against England averages, the prevention agenda, the Cancer Taskforce Strategy priorities and ambitions, methodologies, consultations with residents, healthy lifestyle programmes, improving pathways to treatment, the health checks programme, targeting of hard to reach groups for example strategies for learning and disability carers to increase those groups uptake of screening, the need to improve the risk register of individuals, and the new breast screening unit in the Borough.

Cllr Carpenter, Cabinet Member for Educational Attainment and School Improvement, raised the issue of the healthy weight video, which when ‘clicked’ seemed to take the you to text and was concerned that the written word was not always the answer or best way to encourage individuals.  Sue Lloyd and Kate Kavanagh agreed to look into the links on the website.

In response to a question from Cllr Carpenter, Dr Mohi advised that the specialist nurse was now in place to help GPs improve their practices and encourage screening take-up.  Dr Mohi stressed that the Borough was the most improved London borough for screening checks uptake.  Education sessions were also being undertaken by GPs to improve their clinical expertise in recognising signs and symptoms earlier. 

The Chair drew attention to the ‘www.newme.london’ website as a good site to visit. 

Melody Williams, NELFT, suggested that the Healthy Workplace Charter programme could be strengthened or extended to help larger and smaller employers encourage and engage their workforce in healthy lifestyles and screening. 

In response to a question from Cllr Turner, Cabinet Member for Corporate Performance and Delivery, in relation to the 60 to 70 age range for bowel screening invitation, it was noted that those over 70 are not automatically screened and would need to opt-in and ask for a test.  Kate Kavanagh agreed to look into the take-up rate for over 70s and would provide the details to Cllr Turner direct.

The Chair raised the methods of testing and that they might prove to be why people were reticent in participating, especially in some cultures, for example the three samples packet for bowel cancer screening.  Kate advised that a single test option for bowel cancer screening had been piloted and would be rolled out soon. 

Discussion was held regarding the screening and referral processes and the analysis undertaken on what the reasons were for non-attendees or non- participation.  The Chair pointed out the significant increase in take-up rates since the mobile breast screening unit had been in the Town Centre, as opposed to the take-up rates when people had to go to King Georges Hospital.  The Chair said that she felt that gave a clear indication that the service offer and people’s wiliness to travel were clearly deciding factors. 

The Board noted that BHRUT are achieving 98% of cancer patients being seen within two weeks of referral and that the Trust were working on more rapid pathways to screening and treatment with GPs. 

Dr Jiwani, BHRUT, drew attention to people attending A&E for opportunistic tests when at a late stage of symptoms of disease, rather than attending their GPs earlier.  It was important to identify why this was occurring.  Dr Jiwani also raised the issue of the terminology used in publicity and education programmes, an example was that in two of the most common non-English languages spoken locally the word ‘lump’ does not exist, so an understanding of looking for a ‘lump’ would not make any sense as a sign to see a GP about.  In some cultures, faeces is seen as dirty and the tests could be seen as unacceptable thing to do.  In order to increase the take-up of early diagnosis tests, perhaps the cultural acceptability of the various testing options needed to be considered when inviting individuals to participate.  Kate Kavanagh advised that they were currently investigating diagnosis and visits to A&E to see if there was any learning from that data. 

Matthew Cole, LBBD Director of Public Health, drew attention to the need to target more funding to prevention to reduce the need for treatments in the long-term.  The Board discussed the need for payment mechanism to be more focussed on education and prevention at GP level and it was felt that there needed to be a mind-set shift in the next commissioning round.

Cllr Carpenter stressed the need for easily accessible, local services, of high quality. 

Cllr Turner asked if a map showing the take-up of testing due to geographical accessibility could be included in future monitoring reports.

Cllr Chand commended the Review to the Board, drew particular attention to the 12 points set out in section 3 of the report and asked the Board to support the results of the Review and the Action Plan which was set out in Appendix A to the report.

The Board having discussed the Review:

(i)  Accepted the Cancer Prevention, Awareness and Early Detection Scrutiny Review 2016/17 findings and report of the Health and Adult Services Select Committee, as set out in Appendix A to the report;

(ii)  Accepted the Action Plan as set out in Appendix A to the report;

(iii)  Agree to receive six-monthly progress reports on the delivery of the action plan; and

(iv)   Suggested that that it would wish to see:

(a)  Other local employers being encouraged to take up the Healthy Workforce Programme, for example through the local Chamber of Commerce.

(b)  A higher percentage of funding being directed towards educating the public of signs and symptoms that need to be checked and why attending and participating in testing is vital. 

(c)  The language used in the publication materials and interactions with partnership staff to be looked at critically to ensure that they make sense to hard to reach communities and are culturally acceptable.

(d)  The cultural acceptability of testing options is considered in order to increase the take-up of early diagnosis tests.

(e)  The local provision for testing to be continued to encourage attendance and that the quality of those testing resource needs to be maintained to a high standard. 

(d)  Requested that a map of the Borough showing the take-up of testing due to geographical accessibility be included in future monitoring reports.