The Committee received an update on children's oral health in Barnet from Emma Waters, Public Health Consultant at Barnet Council. Ms Waters began by highlighting the impact of tooth decay on children in Barnet. She stated that the most recent data, from 2022, suggests that a significant number of children in Barnet experience dental cavities, with rates being higher than the England average.

Children's Oral Health

The committee raised various issues and questions about children's oral health in Barnet. These included:

• The impact of the Covid-19 pandemic on children being able to access NHS dentists. It was noted that the proportion of children accessing NHS dentists reduced significantly during the pandemic and that even before the pandemic, access to NHS dentists was limited in Barnet. Ms Waters confirmed that there has been an increase in the number of children being seen by NHS dentists in Barnet but that this is still lower than pre-pandemic levels and that those pre-pandemic levels were not adequate with only around 50% of children being seen by an NHS dentist. She also stated that even when children can access dentists, this is dependent on family resources to travel to the dentist.
• Safeguarding issues around children's dental health were raised. This included the point that dental neglect is a safeguarding issue and that dental professionals should receive regular safeguarding training. Ms Waters confirmed that dental professionals do receive safeguarding training, as it is a requirement of their registration. She also stated that, in her experience, dental professionals rarely witness instances of dental neglect and that this is partly due to the fact that parents do not have to register children with dentists so the children seen are those who are being taken to see a dentist.
• A point was made that the data in the report suggests that the proportion of looked after children in Barnet who have seen a dentist in the last year is 69%, which was considered to be unacceptably low. Ms Waters agreed that this figure should be higher and committed to seeking more up-to-date data on this, as the council has been working with the looked after children's nurses on dental health since the oral health needs assessment was published in 2022.
• A suggestion was made that the current Children and Young People Oral Health Action plan should be expanded to include adult oral health as this may support improvements in children's oral health as families share the same behaviours and habits. Ms Waters agreed with this point, noting that there is currently no funding to support an Adult Oral Health Action plan. She confirmed that the council would consider how information about adult oral health could be included in communications and publicity about children's oral health.
• The lack of mobile dental vans in the borough was raised. Ms Waters confirmed that there are currently no mobile dental vans in Barnet, but that some boroughs do offer fluoride varnishing in vans. She stated that the council does not commission dental services, these are commissioned by the North Central London Integrated Care Board. She agreed that the council should discuss with the ICB whether a mobile dental van could be commissioned in Barnet.
• The potential to provide funding to help parents travel with children to NHS dentists that are outside of their immediate area was also raised. Ms Waters agreed to investigate whether any such funding exists, noting that she was not aware of any such schemes.
• The lack of funding for a borough-wide fluoride varnishing scheme was raised by the committee, in particular as the committee had been informed that this was an effective measure to protect children's teeth and that other boroughs offer this intervention. Ms Waters confirmed that fluoride varnishing is an effective intervention and stated that she supported the measure, but that there was currently no funding available to implement it.
• The issue of private dental care for children was raised with Ms Waters being asked to confirm whether any data was available on the proportion of Barnet children who access private dental care. Ms Waters stated that no such data was available but agreed that it was likely that some children were accessing private dental care.
• A question was asked about whether there had been a decline in the number of dentists working in Barnet. Ms Waters committed to obtain data from the local dental committee to clarify the position on this.
• The committee questioned what work was currently underway in the five most deprived wards in Barnet in relation to the Oral Health Action plan. Ms Waters confirmed that, currently, the work was focused on promoting a supervised toothbrushing scheme in early years settings in those wards. She stated that, in addition, the council would target those wards with communications and publicity about oral health and would also be working with health ambassadors in those areas.
• Concerns were raised about the accuracy of the online tool that is used to signpost parents to NHS dentists who are accepting new patients. Sarah Campbell, Manager of Healthwatch Barnet, confirmed that her organisation had received feedback from residents that the online tool was not always accurate, as some dentists who were listed as accepting new patients were not actually doing so. She agreed to share a link to the tool with the committee and to encourage residents who are having trouble finding a dentist to contact Healthwatch Barnet.

The Committee then moved on to an update on the proposed relocation of the Mount Vernon Cancer Centre, provided by Jessamy Kinghorn from NHS England.

Mount Vernon Cancer Centre

Ms Kinghorn explained that this was a strategic review of non-surgical cancer care provided by the Mount Vernon Cancer Centre and that a proposal had been developed to relocate the cancer centre to Watford General Hospital.

The key points raised by the committee included:

• The low number of Barnet patients who attended Mount Vernon Cancer Centre. The committee was informed that in 2023/2024 only 106 Barnet residents used the service. This was considered low in the context of the overall number of cancer patients in Barnet and Ms Kinghorn was asked to confirm where Barnet residents typically receive cancer care. Ms Kinghorn confirmed that some Barnet residents access cancer care at University College London Hospitals NHS Foundation Trust (UCLH). She also explained that the location of cancer care is often determined by factors such as the type of cancer and where the specialist service for that type of cancer is located. She stated that Mount Vernon Cancer Centre only offers non-surgical treatment and that this also impacted on where patients are referred for care.
• The cost of the relocation was questioned. Ms Kinghorn confirmed that no funding was in place at present to support the relocation. She stated that permission to move to public consultation had been given and this was the next stage of the process, but that capital funding was not yet available and that this posed a risk to the proposals.
• The impact of the relocation on services and waiting lists. Ms Kinghorn stated that the proposal was to move the service in its entirety to a new purpose built facility and therefore there should be no impact on the number of patients who could access the service and that waiting lists should not be affected by the move.
• Committee members were particularly interested to understand how the proposed move to Watford might affect access to services for Barnet residents. Ms Kinghorn explained that this should reduce travel times for Barnet residents but that this was dependent on the mode of transport. She also stated that the proposed location at Watford had good public transport links.
• The plans to close the Mount Vernon Cancer Centre site at Northwood were questioned. Ms Kinghorn explained that all of the cancer services at the Northwood site would relocate to Watford as part of the proposal, but that other services such as the day hospital run by Hillingdon Hospital would remain at the site. She stated that Hillingdon Hospital was also in the process of decanting some of its services to the Northwood site as part of its plans to build a new hospital at Hillingdon.
  
• The facilities available at Watford for patients attending the new cancer centre were also questioned. Ms Kinghorn stated that the new cancer centre would be located in its own building and that there would be a link bridge to Watford General Hospital which would enable patients to access services such as critical care, cardiology and diabetes treatment if needed. She confirmed that there were good public transport links to the proposed site at Watford. She stated that car parking was a consideration that was being discussed with West Hertfordshire Hospitals NHS Trust, but that the Trust had recently added a multi-storey car park which had improved parking capacity at the Watford site.

The committee was asked to consider whether they wished to be formally involved in scrutiny of the proposals and the decision was made to receive formal communication about the relocation plans but to not participate on the Joint Health Overview and Scrutiny Committee (JHOSC). The committee stated that they wished to receive the dates and agendas for the JHOSC meetings and may opt to send a representative to specific meetings where issues relating to Barnet are being discussed.

Councillor Dawn Wakely then provided an update from Cabinet and the Health and Wellbeing Board, focusing on the development of the next Joint Health and Wellbeing strategy.

Joint Health and Wellbeing Strategy

The key points raised during this item included:

• The use of the Joint Strategic Needs Assessment to inform the development of the next Joint Health and Wellbeing Strategy. The committee were informed that a Member training session on the Joint Strategic Needs Assessment was planned for the following week.
• The need to develop a comprehensive plan for mental health. Cllr Wakely confirmed that there is a strand on mental health in the current Joint Health and Wellbeing Strategy but that the mental health needs of Barnet residents would be included in the new strategy.
• The training and support provided to Barnet's Health Champions and Health Ambassadors. The committee was particularly interested to understand how information about health initiatives was shared with the community. Cllr Wakely explained the differences between the Health Champions and Health Ambassadors, noting that the Health Champions role was developed during the Covid-19 pandemic and had continued since then, whereas the Health Ambassadors were a more targeted group who received some payment for their work. She stated that both groups were trained and provided with information and resources by Groundwork London.
• The committee expressed concern about the short-term nature of contracts with the voluntary sector and how this impacted on their ability to plan for the future. Cllr Wakely explained that many of the projects were dependent on grant funding, which often came with a short timescale, but agreed that it was important to provide as much stability as possible for voluntary sector organisations.

Cllr Wakely confirmed that she looked forward to continued discussions with the committee during the development of the Joint Health and Wellbeing Strategy.

The Committee then reviewed the final report of the Primary Care (GP) Access Task and Finish group which had been set up to investigate concerns about access to GP services in Barnet.

GP Access Task and Finish Group

The following points were raised:

• The report contained an extensive list of recommendations. Cllr Mearing-Smith, presenting the report on behalf of Cllr Caroline Stock who was unable to attend the meeting, noted that the recommendations were directed towards the ICB and not towards Barnet Council, as the council was not in a position to resolve issues around access to GP services. She stated that the recommendations focused on three key areas; improvements in communication with residents about how to access GP services, a request for additional funding for GP services to take account of population growth and the increasing number of older people in Barnet and better communication between primary and secondary care to ensure that patients received the right care at the right time.
  
• Cllr Sergeant confirmed that one of the key issues to emerge from the task and finish group was a dire shortage of GPs in Barnet and that several GPs who had been interviewed for the report had expressed serious concerns about this, which she considered to be a tribute to their work.
• The committee was also informed that there were fewer GPs working in Barnet now than there had been in the past and that this was particularly concerning as Barnet's population was continuing to grow.
• The report also recommended that the ICB undertake a communications campaign to inform patients about changes in primary care but committee members expressed concern about the effectiveness of this as the root cause of the problem was a lack of GPs.
• The committee was informed that there had been difficulties in obtaining data from the ICB about the funding formula that was used to allocate funding to Barnet's GPs. Cllr Mearing-Smith confirmed that the task and finish group had been provided with data that was not disaggregated and that it had been impossible to understand from this data how the ICB was taking into account factors such as the increasing number of older people in Barnet.
• Ms Campbell from Healthwatch Barnet confirmed that her organisation was also working on improvements to primary care. She stated that Healthwatch Barnet were working on a joint project with Healthwatch Enfield to improve access to GP services across North Central London. This project was funded by the ICB and involved improving GP websites, mystery shopping GP phone lines and developing a guide for residents on how to access GP services. She also informed the committee that Islington GP Federation had been awarded a contract by the ICB to undertake a piece of work on improving access to GPs in Barnet.

The committee agreed to formally adopt the final report and to send it to Cabinet with their approval. It was agreed that the committee would follow up on the response from the ICB in future work programmes.

The committee then received a presentation from Ms Campbell about the work of Healthwatch Barnet over the past year.

Healthwatch Barnet

The key points raised by the committee included:

• The high number of blood pressure checks undertaken by the Community Connectors project. It was noted that over 960 blood pressure checks had been carried out and that many of those people who had been identified as having high blood pressure at the events had subsequently made changes to their lifestyle, including increasing the amount of exercise they do, changing their diet and arranging to see their GP.
• The work of the Healthy Heart project to support people from Barnet's African, Caribbean and South Asian communities was highlighted. The committee were informed that the Healthy Heart project had been awarded funding for a third year.
• The support provided by Healthwatch Barnet to the committee's enquiries. It was noted that Healthwatch Barnet had provided detailed written and oral evidence to the committee's enquiry into hospital discharge.
• The work that Healthwatch Barnet were undertaking to investigate residents’ views on cancer screening was discussed. Ms Campbell confirmed that the project was focusing on gathering evidence from global majority residents about their experience of accessing cancer screening.
• The committee were particularly interested to understand what the most effective methods of communication were in terms of reaching people in the community, given the high number of events that Healthwatch Barnet had delivered over the past year. Ms Campbell confirmed that Healthwatch Barnet used a combination of methods, including social media and publicity on their website, but noted that face-to-face events were particularly important when trying to reach people from communities who experience health inequalities. She stated that this required close partnership working with other organisations such as the Somali Centre of Excellence and the Barnet Asian Women’s Association.
• The committee was informed that Healthwatch Barnet were planning to undertake a project to investigate care home residents’ experience of mealtimes and questioned how this would be done. Ms Campbell confirmed that the project would involve visiting care homes, speaking to residents and staff and undertaking observations. She stated that the project would focus on ensuring that residents were receiving nutritious meals in a supportive environment and that the project would champion best practice.
• The importance of making sure that residents were aware of Healthwatch Barnet's work was raised, in particular as the organisation's role was not always well understood. Ms Campbell confirmed that Healthwatch Barnet did not act as an advocate but that they did gather evidence about people's experiences of services, which was then shared with organisations who could make improvements to services. She confirmed that the organisation was working with Barnet Mencap on joint publicity and would also approach Barnet Council about how Healthwatch Barnet could be included in the council's publicity and communications about health services.
• The committee questioned the involvement of Islington GP Federation in a project about access to GP services in Barnet. Ms Campbell explained that this project was funded by the ICB and that the ICB had invited bids to undertake the work, which had been awarded to Islington GP Federation. She confirmed that the project was particularly focused on improving access to GP services in Barnet, as the data suggests that there were higher levels of dissatisfaction with GP services in Barnet when compared to other areas in North Central London.

The committee thanked Ms Campbell for her presentation and the meeting moved on to a review of the Task and Finish groups.

Task and Finish Group Updates

The committee were informed about the progress of the various Task and Finish Groups.

• The Primary Care (GP) Access Task and Finish group had completed its work and the final report would be presented to the next meeting of the committee. It was noted that this work had been undertaken in partnership with Cllr Stock and the other committee members, in particular Cllr Sergeant, Cllr Perlberg and Cllr Bonds, and that Tracy Scollin from the Governance Team had done a lot of work to support the group.
  
• The Home Education Task and Finish group had met twice and had been joined by colleagues from the Children’s Education Overview and Scrutiny Sub-Committee. It was noted that this group had been working closely with Cllr Barnes and the group were in the process of developing a set of recommendations.
• The Youth Homelessness Task and Finish group had met three times and were working closely with Cllr Coakley-Webb and officers from the Housing team. The group were in the process of analysing data and developing a survey to gather feedback from young people with experience of homelessness.
• The Committee were informed that two Task and Finish groups were planned for the next municipal year. These included a review of the Drug and Alcohol Strategy and a review of the council's suicide prevention work.

The committee received a copy of the Cabinet Forward Plan and the Work Programme for the Health and Wellbeing Board and were asked to consider whether there were any items that they wished to request for pre-decision scrutiny. The Committee agreed that their next meeting should be themed around public health and would consider this further when developing their work programme.