Transcript

Transcript

Transcript

Transcript

For us, we had a minor technical glitch to start with, but we now have contact with everybody that has had to join us online. So, we are now – we've got a quorum, so chairs – good morning. I'm Councillor Alison Moore, Chair of the Health and Wellbeing Board. Thank you for attending our meeting this morning. Please note that meetings may be recorded and broadcast by the Council or by people present. Can I remind members and officers to use the microphone when speaking by pressing the middle speaker icon? And obviously, for those of us who are online, to unmute yourself when you speak. So, moving on to the agenda properly, we have minutes of the previous meeting. Does anybody have any corrections of matters of facts to those meetings – those minutes? Okay, then I will, at the end of the meeting, sign those – the true record of the meeting. Item 2 is absence of members. We have apologies from Dawn Wakeling. She's substituted by Jess Bames-Home. We have apologies from Sarah Campbell and Deborah Sanders. We also have apologies from Louisa Songer, who, due to COVID, is joining us online. And Fiona Bateman, our Chair of the Adult Safeguarding Board, who has a clash and is joining us online today. So, welcome to online and people – members in the room. I would just ask – we all know each other, I think, well now, but when you speak the first time, it would be useful just to say who you are for the purposes of anyone who is watching us online. Do we have any declarations of interest – members' interests? I would just say – I just want to – though it's in my own declaration, I am the Council's nominee on the Governing Council of the Royal Free Trust, and I welcome that we've got a grant to do some work that's come from the Royal Free Charity. Do we have any dispensations granted by the Monitoring Officer? There are none. Public questions and comments? There are none this month. And so, we move on to our first substantive item, which is the Joint Health and Wellbeing Strategy update. And Claire O'Callaghan, Health and Wellbeing Policy Manager, will introduce the item. Claire, over to you. Lovely. Thank you very much, Chair. I'm just going to make notes. So, this report is the regular six-monthly report on the current health and wellbeing strategy. So, it gives the update on the implementation plan status that we're using to track impact of the strategy. And secondly, it also gives an update on the current – the future health and wellbeing, which I'll talk a bit about later. So, first of all, the current health and wellbeing strategy. So, most of the implementation plan is now either completed or on target to be completed by the date. There are two actions in the plan which are slightly off target. So, the transition of the Healthier High Streets program to its kind of future delivery model. That's slightly delayed from its current completion date and should be completed by the end of 2014. And then secondly, the recommissioning of smoking cessation and NHS health check services. The mobilization date for that has now been confirmed for October. That will be slightly later than advertised. In terms of indicators, roughly the same number of indicators have improved since the baseline, which was set in September 2021. Five indicators are showing a more than 5% adverse movement from the baseline. So, these are the total number of food bank beneficiaries per month, which has gone up. The proportion of babies being breastfed at six to eight weeks at the health visitor review, which has gone down. Emergency admissions from ambulatory care-sensitive physicians and life expectancy at age 65 for both males and males. So, that's the current strategy. Talking about the future strategy. So, over the summer, we've been doing some work with partner conversations looking at the updated Joint Strategic Needs Assessment, which you've seen at a previous meeting, and looking at other boroughs and the ICS population health interest. The priorities might be for Barnet in the new strategy. We are planning to take this to a meeting of health and well-being board members, an informal meeting at the table. And if you don't have it in your diary, you will do by the end of this meeting. And the intention is to have a long list of priorities to take out to wider public consultees over the next few months. We're still on track to have a draft strategy by January. So, the next time we meet, we'll have a nice draft strategy that you can comment on and approve, hopefully. And then, it will be a more formal consultation over the spring, aiming for… Thank you very much. I think there's two parts to this. Obviously, there's the current progress on the current health and well-being strategy. Does anybody have any particular comments or questions to make about that? From my perspective, perhaps you could just clarify the situation with respect to the recommissioning of the smoking cessation services and the adult health checks. And is that a contractual issue? And it's not a major change, but it's a recontracting. Yes. So, my understanding is delivery on both of those things has been continuing. So, it hasn't been a stop in service delivery. I don't know how much, because in some of the documents, that's not entirely clear. There's some crossover with our plan to ban it. And there was an odd phraseology that didn't make that quite clear. So, thank you. That's really helpful. Does anybody else have comments on any of those other areas? Any reflections from our health colleagues about the life expectancy issues and any reflections on how we might be combating that? I think… Sorry, Jess. I do apologize. So, Jess Bains-Holmes, Director of Commissioning for Adult Station Care. The question really was just to clarify. So, our emergency admissions for ambulatory care sensitive conditions have gone up, which is clearly not great. But I just wonder, the baseline is 2020 to 2021, which is the usefulness of using that as a baseline. Probably Janet. So, I'm just understanding if that's useful for us to measure it against or if we've done some other review of… Presumably, it was the baseline that was the start of the well-being strategy. So, I think a narrative around it would be appropriate. I'm assuming that… I don't know whether we are in terms of dates, whether we're in line with other statistics. But it may be important to be comparative. But we will be resetting those baselines with the new strategy, I think. But it's a really valuable point because the same is… There isn't a reflection on the change in life expectancy at 65. Some of that has been influenced by the COVID and post-COVID figures. I am assuming, but I'm not a specialist in that, but I'm assuming that that's the case. Kay. Thank you, Chair. I'm Kay, as Director of Operations. I'd be able to address this. That's a very pertinent point. And if you haven't already had an opportunity to delve into the new joint strategic needs analysis, actually, there's a huge amount of data within that and where it's been possible. Where it's possible to have it at a ward-based level, we do. Slightly, because of the new ward structures introduced in 2022, there's a little bit of transitional data there. But we've also, where we can go down below ward levels to MSOA data, we have done that. Now, that has confused some people because the names are quite colourful and do not align with wards. But actually, that gives you a tie-up through to ONS data. And so we are able to do some of that geographical analysis. And yes, there is, I'm sure there will be differences that we can unpick. And that would be a really helpful exercise to do in terms of then targeting our work and our resources into the places where we will make the most difference. Simon. Thank you, Chair. I'm Simon Wheatley, I'm the Director of Place West for the Integrated Care Board. Just to say that I think it's nationally appreciated that changes in life expectancy are multi-factorial. And certainly, what we're seeing in Barnet is disappointing, but something that's reflective of the national picture. I think you're right, Chair, that actually a recognition of the geography and also some of the specific communities would be even more important. From an ICB perspective, we're introducing a new long-term condition locally enhanced service. Nick would be able to speak to this in far more detail than me, but that is an expansion of investment in general practice to focus really significant investment that we're progressing at the moment, Chair. Thank you, Simon. And as you will know, the Adults and Health Scrutiny Committee have just completed a task and finish group on access to GP. And that will be coming to the Cabinet meeting in November, I believe. And there are recommendations both for us and actually for the ICB as well within that. And that would be really helpful. We recently had some discussions around the GP survey, and that does talk to the issue that some of our GP practices need some support in getting to where you want them to be around that continued management of older patients with those with ongoing health issues. Nick. Thanks, morning. I'm Nick Detani, GP and Clinical Director of PLACE. I think what we saw over COVID was that a lot of patients became deconditioned, and that deconditioning is now having long-term conditions impact. So, for example, we see a massive increase in patients with heart failure, for example, because they've been deconditioned and not exercising and stayed indoors for often a year. And we're seeing a big increase in pre-diabetes. And then we're also seeing a big increase in cancer diagnoses. And so what's really interesting is a lot of those are linked to not exercising, not eating well, and what people have missed out on in the year or two of COVID. So it's going to probably have a knock-on impact for the next 5, 10, 20 years. I don't know. Public health might give us an idea, but it's going to have a massive impact. And so what Simon talked about was the long-term condition locally-commissioned service that's now in North Central London. And really is exactly what Simon said, allowing general practice to focus on prevention, because actually what we've been doing is tackling acute illness, and what we're better at doing is managing people's long-term health to keep them living healthier and for longer. And one of the things I think we need to think about in our strategy is actually getting people more active and understanding their long-term condition, which is a missing feature. So if I diagnose somebody with heart failure, and I can medically optimize them, but what I can't do is get them to the gym and getting them to buy foods from the supermarket and understanding what that means for them. And that, I think, is the missing link. And actually, what we learned over COVID was that people talked to each other, and how did we get COVID vaccinations so great, because everyone talked to each other and encouraged them. It's the same thing with long-term condition. I bet most people on a neighborhood will have congestive cardiac failure or diabetes, and actually want to stick together and actually make a better lifestyle for themselves. So I think that's the things we might need to focus on. Thank you. That's really helpful, and that actually gives us a topic of conversation for the third, because it reflects some of the things that we've been – a conversation that we've been having recently with the Director of Health and Director of Adults. Claire? Yeah, just to come back on the life expectancy. So last year's annual DPA, it's got last year's data, but the factors are very much the same. Thank you, Claire. That's a sensible reminder that, of course, there is a huge amount of information in... And thank you, Nick, particularly, because I think that sense of being able to help people to build agency and understanding and control over their health and understanding that there are things that they can do to improve that situation and what they don't. I think that's a really positive way forward, and I think it's something that brings all of the partners around the table actually together around that issue, because it involves wider parts of the Council, but actually also community and acute health as well. Pauline? Maybe a various communities to try and get an increase, but I think – I mean, what I was trying to explain last night, and I'm sure in fact, was a lot of hesitancy about immunization. We are monitoring progress on immunizations. Those reports aren't public, but thank you for the reminder. We will make other relevant members to share updates on the issue of vaccination hesitancy. It's a national wide issue, unfortunately, and I'm sure a clinical colleague. Thank you. Just to add to that, there's about 5 million population in continental central London eligible for a COVID and flu chapter. I ask Councillor Edwards to speak. I would just reflect, and it's a conversation that we were having following the meeting yesterday evening and that conversation about vaccinations, particularly childhood vaccinations, and actually a reflection that there's a younger generation of parents who may not appreciate the seriousness, for example, of measles. I'm old enough to have grown up with friends who had eye problems or hearing problems or a range of other problems that resulted from having had a measles infection, and it was a relatively common place when I was a child. I don't think young parents now really always understand the real ramifications if we have a measles outbreak, and I know that an awful lot of work has gone in, both across a bonnet in terms of promotion across NCL and the wider NHS in terms of promoting vaccinations pre the school term. And there has been some work, for example, through the London Jewish Forum and other groupings to try to encourage vaccination rates within some of our communities who are most resistant. It is a really important area and it is overcoming all sorts of, I was going to say ignorance, I don't mean it that way, but lack of understanding of the impact for some communities. Yes, thanks to, excuse me for my ignorance, but I can't see anything in here, and this is not a pun, around ophthalmic or eye health in terms of wellbeing. Can you please repeat what health, I mean eye health, I'm sorry, eye health wasn't mentioned specifically on the number of outcome KPIs is limited, and whilst I absolutely agree and appreciate eye health is important sooner than in mature age. Absolutely, and there's somebody whose eye defect was picked up by that first check in school actually when I was first in reception. That's a very good point. Paul, do you want to carry on? Yeah, I also think it's important because I used to wear glasses firmly and I've had cataracts removed and it's helped my vision remarkably. What occurs to me also is the cost of it, and I'm wondering whether for some people that's prohibitive in terms of just going on a regular basis. It's the same, but I'm talking about eyes. I mean you can't go to an optician without paying some money. I discovered because there's something I'm going to have, something done on my eyes. There's even an NHS price that you can pay. So there's the private price, but there's still an NHS price. And I'm just concerned, you know, in general about particularity than somewhere else in the councils. It's a point well made, I think. Any comments from our partners? Okay. Regular eye checks for children. It's not like part of a regular health check. I know I was never offered it. Well, not for my child anyway. I think that's a question for our partners. Nick, if you could shed some light on that because clearly I'm talking about a different generation of my eye tests. There definitely is two sets of eye checks in schools for the ages now, but there definitely are. It probably has changed over the years. I don't remember what it was like when I was a child, but certainly now there is two sets before 16 that I've offered. I mean, certainly that would be something. Fiona Bateman online has made a comment that it's also true of hearing tests. And there is an expense. Thank you, Fiona. Absolutely. Absolutely right. We've got two different things going on here. We've got we've got talking about the cost of eye, dental and and and hearing checks within with people and children's testing. And there is a comment from Louisa Songer, which I'm assuming is from her current understanding. There's hearing and eye tests at school at five and six. And Claire would back that up for those who have pupils. There is there is something that replicates the sort of testing that I remember as a child. But it's not it's not wrong, actually. And the the implications for all of those elements can be quite significant. And if I understand correctly, there is some correlation between loss of hearing and developments of some forms of dementia as well, because I'm assuming because of neurological input. So I think there are that's a question we might well, very sensibly ask. And I would just be moved to comment on how Chris would appreciate you mentioning this. One of the things when we took the AUSTED, the outcomes of the Children's Services report on Tuesday at Cabinet, one of the positive comments was around the timeliness of both optical and dental checks for children looked after. And I think that is something that may not always have been the case. And so it's very pleasing to see that we at corporate parents can be assured that at least in that context, there are checks going on. Thank you. Any other comments? So. Sensory and sensory impairments can lead to social isolation, which sadly increases the risks that adults with care needs will suffer neglect and abuse. So actually, there are a range of reasons. And maybe that's something that we would want to look at in the future. It may be an appropriate subject for a scrutiny commission task and finish group. Nick. So I just checked. So you get a hearing test at birth and an eye test. And then the eye test is done again at the six to eight week check at the GP and then between the age of four and a half and five and a half to school. And then it's then not done again, but it's free for any child to have an eye test or hearing test between the age of five and 16. Hearing tests are actually the GP and the eye test done any optician free of charge for under 16 to 19. Occasionally. I just checked. That's really helpful, Nick. Thank you. So there is a program in place. There may have been disruptions during the Covid period. And it is about and it is about engagement as well as access from parents. Okay. Agree. And that is really helpful. And I suppose it's then just how do we ensure that that message is out? Because if colleagues around this table don't know that, I suspect a significant portion of our population also don't. And therefore, are they taken? How do we make sure collectively we're getting that message out to all families? Both ends of the age range. We're looking at ensuring that people understand what is available. The benefits of that and the risks if they don't. I mean, clearly eye checks for those who are older. It picks up all sorts of things like glaucoma and a range of other conditions and therefore is particularly important for older people. But actually, young people, you know, I had a friend at school who wasn't doing terribly well. And then they moved him alphabetical arrangement in the classroom with a child who joined, moved him from the back to the front of the class. He could see the board. And actually, his results then kind of climbed rather steadily. And so it's just a case in point that understanding that Councillor Coakley Webb's comment was perfectly right. You only know as a person what you see and you don't know whether that's normal or not. It's what you see. Okay. I think that's really helpful thinking about the future. One of the things that we'll want to talk about when we come around the table and discuss how we evolve the next health and wellbeing strategy is a range of those topics that might or might not form part of the strategy. Obviously, I'm really concerned that we make sure that we both for meetings and for the work that we do together, it's where we can collectively add value and make the most difference through the strategy already through these meetings. I think we've had several really insightful comments around the table today. But I look forward to having those deeper discussions in our workshop session at the beginning of October. So the formal part of item joint health and wellbeing strategy update is that the board comments on and notes the progress on the current implementation plan and the key performance indicators the board reflects on the current progress of the joint health and wellbeing strategy development. And unless anybody has anything to add at this stage, can we all agree those recommendations? I'm happy to have the comments that we've made. Are they minuted? They are indeed. And if you look at the minutes that we've taken today and that I'm signing off, PACS does a very good job in trying to capture our sometimes complex discussions around the table. Yes, they are very full minutes, so they do record what we discussed. Thank you. OK, moving on now to the next item, item seven, which is the pharmaceutical needs assessment update. And to note there are two appendices within the PAC, the map of pharmacy provision and the process for responding to applications for changes to pharmaceutical provision. The item will be led by Dr. Deborah Jenkins, consultant of public health. Thank you, Jeff. So this agenda item is to provide the board with a routine update on the pharmaceutical needs. As the board will be the last pharmaceutical needs assessment was approved, approved and published by Barnet in 2022. And since then, if there are changes to pharmaceutical provision, since the last published published statement, the board needs to review the impact of the change. The previous update to the Health and Wellbeing Board about changes to pharmacy provision was in July 2023. Since the update in July 2023, there have been several changes of ownership of various contractors in the area. Only one pharmacy. That pharmacy is Bishop's Pharmacy in Hampstead Garden suburbs. The pharmacy reduced opening hours from 6 p.m. close Monday to Friday. It was previously open until 7 p.m. It is now closed on Saturdays. It was previously open from 9 until 6 p.m. The impact of this change has been reviewed with the conclusion that it would not lead to a potential gap or poor provision of the pharmaceutical services in Barnet. But this and other changes of ownership and maintained pharmacy list has been updated, but no further actions are needed. As you can see in Appendix A, this is a screenshot of the interactive map of pharmacy provision in Barnet, which has been produced and is published on the Barnet website. The map and underlying data are refreshed and updated on a quarterly basis. I'll turn to the next appendix now, so I'll just change the screenshot. So the second area I'd like to draw your attention to is to make a process clearer, and this is the process for commenting on pharmacy change applications. When there are applications for a change in pharmacy provision in the borough, this is shared by NHS England with the Barnet public health team in order for the health and well-being board to comment. To standardize this review process, this is the chart that we've produced for the suggested actions in Appendix B. The current process is similar, but this change involves both the chair and the vice chair of the health and well-being board to review the pharmacy change application. So in brief, the flow chart describes the following steps. Barnet public health received the pharmacy change application. We then send the change application to the pharmaceutical needs assessment technical support, which is currently provided by an external consultancy organization called Soar Beyond to review the proposed change. The technical support team reviews the evidence and provides a recommendation on whether the change is significant or not. If it is significant, the evidence, suggested recommendation and draft response is sent to the chair and vice chair of the health and well-being board for comment and review. Barnet public health team then updates the draft response from the chair and vice chair as needed and sends back to NHS England. After that, if the application is granted, then the Barnet public health presents a supplementary statement or a fresh needs assessment to the health and well-being board if this is needed. Thank you. Back to the chair. Thank you very much. Does anybody have any comments on this? I mean, I would say in welcoming the tightened up procedure for responding to applications, I think it would be very helpful. I would certainly value the vice chair's comments. Clearly, I'm not a professional in this, though I bring, I hope, a community understanding to it. But it's such an important area and pharmacies are playing a larger and larger part in our spread of health and well-being services. And so I think it's really important that we understand the spread and sufficiency of those across the borough. Nick. Thank you. So I don't have any objections to this. I think it's great to have the flowchart. The only comment I make as we're, you know, we're trying to get pharmacies, community pharmacies involved more and more in patients health, more that they can offer to patients. Often patients don't realize is my fear of the opening times of convenient patients. So, for example, now I'm not a personal user of the pharmacy much, thankfully, but whenever I've needed to use it, I've had to hunt around for a supermarket pharmacy that's open to 8 p.m. There are not many and there's not many of those in Barnet, as you can probably see from the map. So thank you. I live in Hertfordshire and there's availability. But I think there's a missing link to say is that you can't predict when you're going to fall ill. And people generally fall ill on the weekend when things are shut. And so in the future, how can the farmers think about providing that provision on Saturday? In particular, Sunday is a crucial day when everything's sharp, but you want the pharmacy to minor illnesses. So how can we think about that provision in the future? Thank you, Nick. Janet? Yes, thank you very much for those comments. They will be noted, I suppose, in the minute. It will be incredibly helpful as we are just about to start the update of the pharmaceutical needs assessment. And I think it in any way, I agree with you. I just yesterday I had to rush a rush of work to catch the pharmacy during their opening times. So I think everyone can resonate with that. And it's important to consider that one more comment as well. As you know, that extended access service by General Practice is now provided on a Saturday from 9 a.m. to 5 p.m. And so I do that maybe one clinic every quarter. And I struggled. I have to print prescriptions for patients and then try and hunt down a pharmacy on a Saturday morning. So it's a challenge for patients, you know, if there's one pharmacy in the area open and you've got 20 people trying to get something on a Saturday morning. And so I understand, you know, the close and it's hard to staff it and the cost of staffing a pharmacy is not cheap. But it's just about what provision can we think about in the future because we are starting to go to a seven-day health basis. I think that's a really, really helpful point and one we should think about, particularly as a growing borough. And one of the discussions we have had recently was about a pharmacy on the west of the borough. My apologies, Jess. On the west of the borough and recognizing it's not only a rising population but perhaps a population with different behaviors and looking at how we work with those who are working lives. I think it's really important. But the reflection of marrying pharmacy timings around an expanded GP practice time is a really well-made point. Did you hear that? Did you hear that? Looking at this map where it says where all the pharmacies are and having had to, like you said, have to hunt for one that's open, how and who can we actually have information both with the addresses and the opening times of all the pharmacies that are available? And it might be, even though these are the ones that are within Barnet, if someone is living on a border, it might be that, say, that a pharmacy just over the border in Enfield is available or over the border in Haringey. And I think we've got a duty to be able to actually have that information on hand. I don't know who will be able to produce it or whether we can pull it out as council information, but for me that seems to be really important that we can plot the addresses and that we can actually tell residents what the opening times are so that when they've got an emergency, they're not, as you said, hunting around in a state of panic wondering where they can get their prescription from. I have Jess and Claire come in. Nick, if you'd like to comment? Yeah, council, so the information that you've got is on the Barnet website, but only patients probably won't use our website or use the NHS website. So the generic one I've got here, you put in your postcode, it shows you all pharmacies in any borough. But I think what Nick is saying is certainly if it is a GP led prescription, you will be able to sign post to the nearest open pharmacy. And whether that's something that we, is there a prescribed definition that is a sort of a national definition? If there is, really we want one that is a Barnet specific, what we want to encourage residents to expect of them. That's a really good point and actually there's been quite a lot of coverage on the radio, certainly on the radio over the last couple of days about pharmacies and the challenges that that changing role will present. Would you mind if I took Simon first and then? That's a very kind chair, thank you, significantly more than it perhaps meant to me three or four years or so ago. I would agree and very much think pharmacies as part of our health and wellbeing family in terms of that broader agenda that we're developing in terms of keeping people well but treating them when they are unwell. Claire? I suppose, I think my intervention for topic for discussion. Debra, do you have anything else to add in summing up the paper and the discussion? Thank you, thanks for all the comments. I think a further discussion on pharmacy provision would be really helpful. We have some links already for future agenda items. Thank you very much, and I look forward to that discussion. It feels like a very mature stage of regarding them as part of that partnership. Formerly as part of the paper, if nobody has any further comments, we are asked to note the changes in pharmacy provision in the London Borough Barnet since July 2023 and agree with the suggested and whether we agree with the suggested process for reviewing applications for the changes in pharmacy provision in the borough as outlined in Appendix B. Is that agreed? Thank you very much. Now move on to item eight. That is the suicide prevention annual suicide prevention plan annual report. To note that we have a which is the annual report itself, and the item will be led by Saher Keke, who is our public health strategist and Rachel Wells consultant in public health. Thank you very much. As part of Barnet's suicide prevention partnership, I'm pleased to present our third annual report since the publication of the strategy. Last year, the partnership created an ambitious action plan in line with the publication of the cross-government suicide prevention plan, and this report made an attempt to demonstrate how each partner contributed to preventing death by suicide in Barnet. In particular, how we collaboratively supported the groups who are known to have elevated risks, putting more emphasis on addressing the wider determinants of health. What is new about this report is the change of reporting period to align our reporting with the ONS statistics. We will continue to report statistics per calendar year as opposed to financial year. Our current suicide rate is five per hundred thousand. Although there is a slight increase in comparison to previous reporting, this is not significant. We are still amongst the five lowest suicide rate in London and probably in the country. Our innovations to reduce death by suicide and the strength of our partnership continue to put Barnet on the map last year, and I hope that you have managed to read some quotes from some of the partners involved. Finally, I want to highlight that this report proposed the renewal of the strategy and welcomed the board to feed into process.

Thanks, Chris Monday, executive director for children and families. Thanks. It was really useful and a good report. It's good to see all of the really positive pieces of work going on. I'm aware that there was a really strong cross-referencing between the findings from what used to be called serious case reviews, now called learning reviews, where the safeguarding partners have come together and undertaken reviews. I'm aware that there have been two or three in relation to suicides, and there's ongoing work in relation to some specific issues now. There's one on suicide and filicide, of which we've had two incidents where there's been a suicide of issues around children experiencing issues, both of their autism and gender. I didn't see those things coming through in the annual report, so I wonder if in the future we can make sure that there's a really strong link to the plans that come out through those multi-agency safeguarding arrangements that set out a whole range of issues. One of the issues that I don't think we're addressing fully in this is the role of private psychiatric services. Both cases that I'm aware of where there were particular challenges, both were being managed through private provision, not through state provision. I know that there were a number of recommendations made in relation to that, but that's absent in the report as far as I can see. I wonder whether we're picking up all of the intelligence that is available. It feels like this is the plan and this is what we've been doing, rather than this is what's been going on in the wider context, and these are some of the things that we found from there. To have two suicide filicides in one borough in the space of possibly less than a year, I think is something that we need to understand more and understand what we're doing about it. Indeed. Thank you, Chris, for that. Fiona Bateman is online and would like to make a comment. Just to provide some assurance, perhaps to Chris as well, all to maybe offer, because Tony and I have met to discuss the learning across the safeguarding adult reviews and the children's learning reviews. What we should do and what we could do is invite, see how to mix those meetings, particularly when we're looking at the learning that's linked to suicide prevention. So I think that would make it much easier for that to kind of connect the work. But going forward, I'm afraid I've had over the last year clashes with the suicide prevention group, so although I do always read the papers, I can't physically be in the room as I'm stuck today. So going forward, the vice chair of the safeguarding adult board will be an active member. She's already really well connected with partnerships across Barnet. So I think that learning will be more embedded in the work of the partnership going forward. But definitely, Ciara, if you'd welcome coming to those meetings that the two boards have to look at, you know, how do we join up the learning from those safeguarding reviews, that would be really helpful. I'm wondering whether, because every child's death, you know, or suicide in particular, has an after-action review, an after-death review, and it's interesting to see what the learning is from that. And I wonder where Chris has mentioned there's some private psychiatrists involved, and that may be just because of the lack of access, some of the NHS services and the long waits of 12 to 18 months is possibly a reason for that, unfortunately. But how can we learn from that? What can we change? The second thing, I say this every year, but one of the biggest things that we see now is social media. And I believe it's certainly linked to possibly death or suicide or people feeling low and depressed, actually signpost people using social media into services available, because we can put things on websites and posters and things, but young people don't use any of that. They don't use Instagram and TikTok and whatever else it is nowadays, they can't even keep track. And I also remember about five years ago, I think it was the police, I can't remember who it was, but came and gave GPs a talk on all the apps that were there, and I was astonished. I was like, never heard of half of these apps that are out there, and how do we educate parents into knowing what are the signs to look out for? Because there are a lot of rogue apps around for children, and how do we educate parents to look at what signs to look out for in their child or young one to pick up if they're going through a bad time and they're at risk of suicide and how to seek help? Because I get a lot of parents coming in who have got young children who have harmed themselves or are low, and they had no warning signs, and there probably was a warning sign, but they're not looking at their phones or looking at the right things on their phones. So I would like us to think about the generation of the future is all online, how do we read that and how do we, I don't know the answer, but just leave you to that. Thank you, it's a very thorough report. I'll take Jasmine Holmes and then Pauline. What jumps out at me is the statistics, sorry, and to echo the fact that this is clearly an excellent program of work, and what we're doing is to sort of pick out the things that we think would be even better. The national statistics around ADHD and autism diagnosis in suicides obviously assume you've had a diagnosis, and to pick up Nick's point again, the issues that we have around delays, waiting times, reduced access to diagnostics for NDD. I suppose I'd like to understand a little bit more about where we're seeing self-harm and suicide as a result of lack of diagnosis, lack of access to support, and I don't know how we can do that work with most of the diagnostics and support. But given that we know that we've got clinical restraints and financial pressures, understanding whether that is playing a significant role and that lack of diagnosis means that you struggle for longer and are likely to there. Yeah, I think to pick up on one of the points you said, I think, and Christopher confirmed that one of the things we found is that people accessing private therapies was often a cultural thing. It wasn't so much that they didn't, they just didn't want to contact NHS, it was different. One of my beliefs is that when you have these private practices, they are not, and I still think it's still the case, they're not required by law, therefore, to inform that person's general practice, therefore it goes unnoticed until the worst has happened. And when we look at the issues, well, the issues with social media and with things like self-harming that can ultimately lead to suicide or be more than one that have taken their own lives and that it's been related back to what you find on social media, they're still reporting that that still can be happening and I don't know how these social medias can be taken into account. They're talking about restricting, they can still access information and if not, they will use somebody else's phone or whatever to access it that then has got a verified aid. I think it's a really hard battle for us and how we can work with schools and parents and health professionals to try and stem this really horrible, you know, plague of social media that is actually influencing young people, whether it's to be for self-harm or their body image to what they think they should be and what they are and I'm sure that that is the root of an awful lot of problems now that would not have existed years ago. Thank you Pauline and I see Nick is nodding and I know that there is some pilot work going on with a range of schools in terms of phone access but that doesn't alter the access to phones outside of school hours. Just in the context and forgive my ignorance on this, is there any way private psychiatrists, private psychiatric health, presumably it's accredited in some way and I wonder if there is any way to lobby for a national change where they're obligated to notify. So because they're regulated by the GMC for example if they're adopted but there isn't anything that they must inform the NHSGP practice so the patient or the guardian has to consent and provide the details of the NHSGP and they can choose if what you're saying is it's cultural, they probably are not consenting to share the information. And then the law is that you don't consent, the practitioner is not allowed to share information because they'll be in GDPR breach. So I suspect it's probably more than not consenting than the clinician hypothesising and what do you do in that situation. Now the clinician can override that decision if they believe it, if that patient is actively suicidal for example. One thing they really should take into account if anything for legislation, it may be that it's just an adult but if that adult, if they know that that family has got young children, that's when the alarm bell should ring to go we need some information, we should not be holding it to ourselves and at the minute it seems that they can not do that. Just to add to that I guess if there's an adult, if thinking about what the right practice should be is that that clinician should then do a safeguarding report because they're lifting up children. Whether that's done or not is another thing but that's what we would do in general practice is do a safeguarding alert. But yeah it's probably what we've done and so I suppose there is some merit in maybe doing an after action review of the deaths that you've mentioned and thinking about what information we could share and certainly in our community I think going to legislation is one thing but in the interim we share something that the nation might be useful. And my recollection is that the same issue around disclosure and sharing has been a challenge in some of the teenage and student deaths as well, nationally not locally so I'm very conscious of that. I'm just going to read out Fiona Bateman made the comment all professionals registered with the GMC, the HCPC etc will be expected to comply with safeguarding duties so should follow local or encouraged by professional regulators. So I think that's a very helpful point, thank you Fiona. So how would you respond to those comments and both in terms of the quality and the value of the report and the work that's gone on because I think that we do need to remember after what is a very fruitful discussion that it is also there is some really good work going on and it's had national recognition, but also what we would what your reflections are on the comments that have been made. We have been working very closely with both Fiona Bateman and also Tony Lewis. And last year, some of the work we did in terms of learning from the safeguarding reviews reflected in the last year's report so I didn't repeat that this year, but that work is ongoing. In fact, in terms of the suicide case and the link with, you know, the issue around lack of communication, any with private sector. So, I have invited Tony to present the learning from the suicide review in the London community platform community of practice for all suicide prevention leads, so that we could collaboratively understand about those issues and also to see if there is any other example in London, and then maybe we can join forces together. You know if there are any good practice. So, we want to raise those issues because they are very, very challenging issues to to tackle. In terms of however I'm going to take all these comments to our start and grow well team in public health to make sure that going forward. We have a better capture of all that learning within the suicide prevention report. In terms of autism and other sort of at risk groups. I know that Jane Abbott, who is our resilience manager. She does a lot of work in schools. And there has been a new service, I believe it's commissions, working with LGBTQI children and young people. With autism, what we have in the councils, we have autism champions group running. I'm a member of that group. And we have been working with Barnet Mancub resources for autism. We have constantly raised awareness amongst the professionals, amongst staff, voluntary sector colleagues, faith organizations about the link between suicide and autism. And inviting people to take up training, which is delivered by Barnet Mancub. I think I'm working closely with family services colleagues from violence against women and girls team. I'm taking part in their reviews. We're gradually building those links. And I will make sure that they all reflect going forward, but that work is emerging and there is a lot more work to be done on that, on these areas. Thank you. Louise is joining us online, has posted, sent through a comment, drawing attention to the suicide and prevention and support after suicide link on Barnet Council's website. And she highlights the stay alive app, which is available on Google Play and other providers, for which the team had recognition and was the source of work with the Middlesex University. So the app has been a very important part of some of the work that you've done. So I don't know whether you want to comment on that, otherwise I'll finish up with some final reflections. Shall I take Pauline's question first and then allow Sahar to sum up? I'm just scrolling down under the figure two, men's lives lost to suicide in Barnet versus everywhere else. And then underneath, this really puzzling sentence. Due to small number suppression and disclosure control issues, we are unable to make accurate interpretation of female suicide rate for Barnet. About suppression of data, but Sahar, if you'd like to. Because it's not reported in the statistics, the rate, because of the small numbers. So we can't -- we don't have the data. Who does have the data? So we receive two such statistics from the Office for National Statistics. And we have the numbers for female suicides, but we don't have the rate. Because of the very low number of female suicide. I know from the safeguarding board when we get reports, we get to know what to give any figure or number in relation to that. I believe, Rachel, you'd like to comment. Could you put your mic on, Rachel? Thank you. Thank you. It was on a previous point, but I just -- I just mentioned on this one. With regards to the numbers, we have the numbers, but they are identifying if they are very small numbers. This report, we wouldn't necessarily put that in, but we do have that information. Can't form a rate on a very low number, but that's why that's there. We do have to suppress them when they're very small. I think that might be something that we can look at a way in which we can present those numbers in a way that gives you more information and appropriate. I just want -- I don't think anyone's asking for dates or times. It's just a comparison between maybe how many suicides are male and how many are female. I think that's all we're asking for. We can do that. We can do that. We can give you some information which would identify that for you. We can amend that in some way. I can quickly mention that from the real-time surveillance system. So we know that about 25% -- 75%. Just one other quick point. Just referring to something that was discussed earlier, and I know that we all know this, but I just thought it might be useful to many digital natives. And thinking about how we work with parents who are also migrating into that world with young people and children who are already in that system. I think it takes more thought across the system. It may well be that trying to engage, and I know that we have done this, but perhaps not as a board with young people around their uses. I think it would be quite an interesting discussion. Because I have a 15-year-old son, so I know what goes on, and it's incredible. And I know some of you probably will be in that situation as well. It's uncontrollable. And I think having a better understanding of how their systems work as a board may well be something worth exploring. And also ways in which their individual resilience can be improved. Chris, I don't know whether you have any comments on how we might use some of our young people's groups to have such a discussion. In fact, there's already that sort of work going on. The mental health charter was developed by a whole group of children and young people, so there's lots of dissipation in that. On the social media side, I think there's some really interesting international changes that are coming about. Very interesting to see as children and young people have the amazing ability to be able to find ways around all of the rules that are -- I'd say this purely as a father whose children seem to be able to bypass every single restriction that we put on their phones. Two of them are old enough to do it themselves now. So I think that there are some things. But I do think it's something that government need to be doing a bit more on the online harm bill. Did that go as far as it should? Is some of the work that's going on in Australia now through their administration about holding providers to account more powerfully? There's been some quite interesting work in that space. But I do think it's something that maybe as a board we should be writing to government about saying, you know, actually should we be going further on? Some of the -- you know, tick tock is supposed to be only available if you're over a certain age. Yeah, lots of children are on tick tock. Instagram is supposed to be over a certain age. You know, these days I think it's about if you're over 50, then you're allowed to be on Facebook. But, you know, there's those sorts of things that are well beyond the realm of us as parents and us as a board. I suppose it's those sorts of things that we need to be saying. What should we be doing in that space and should we be talking to parliamentarians about, you know, are there some things that they want to do more? You know, there's a new children's being act or bill coming forward. Is it something that we want to be saying that there needs to be more in that around online safety? Because I think it is genuinely -- it's a generally scary world that parents don't understand and that children do far more than us. I think the point about data that digital natives versus digital immigrants is a really important point. And Chris has just reinforced that. Nick? I'm just wondering, you know, whether in school programs there could be something around this education about online. Yeah. They had all these icons on the screen and I could recognize about three out of ten. And I thought, oh, God, I'm stupid. But, you know, what does that mean, isn't it? You know, do parents actually know what the apps children have because you just see an icon. So I think we need to -- it's not just the children. I think we need to get adults and parents involved into understanding what's on children's phones and things. And I think that's a wide -- and in reality, that's a wider issue than just around suicide prevention. It's a range of issues across young people's perception of the world and access to data and the online world in a way that maybe those of us who are a bit older just aren't grasping the breadth and depth of that. So that's a really helpful conversation. Sahar, any final comments and then I'll wind up. With regards to the research, the effectiveness of interventions in preventing suicide, suicides are still emerging. It's a relatively new field that's really developing in the last sort of 10, 20 years. In principle, anything that we do in Barnet, I work with colleagues from academia and looking to them to support with their evaluation. And I'm pleased to say that our campaign has been evaluated by Middlesex University, Professor Lisa Marzano and her team. And then they actually demonstrated statistically that the campaign may have contributed to saving 7 to 10 lives across the nine-month period. Of course, there are lots of caveats in this, but nevertheless, it's a very, very positive result and it's a contribution to campaign approach, which was later demonstrated by Dr. Alexandra Pittman from University College London and some other academics from Australia about how actually campaigns can contribute to reducing suicides. That's about it. And I think about the apps. Could I just add to that, please? We are working closely with Metropolitan Police and also Fire Service in terms of monitoring those untoward apps or emerging new methods of suicides. And we are conscious of that. And then sort of jointly in London, we're trying to find solutions if we can identify anything untoward. But these are wicked issues. And I just reflect that we are fortunate to have a university just adjacent to us where you've not only got academic contact, but actually it's a pool of students who might be useful in giving reflections. And I know that some of the work that has gone on through some student courses has been particularly around violence against women and girls, but actually there are a range of other issues that the students will be working on. So that's a possible source of news about the validity and depth in the way that we're doing. But thank you very much to her and thank you for your input. And Rachel, I would reflect that we have in former years discussed at the Health Scrutiny Committee. And I think I would reflect that we've had a really rich and thoughtful discussion this evening. Lots of potential learnings to come out of it. Recognizing the role of joining up and building on and extending relationships across a range of organization and mining the data and intelligence that others have. Taking these opportunities, working, for example, with safeguarding boards. And considering how and looking at how a suicide prevention is set against an evolving online challenge with social media. So thank you very much for all of your input. Now we have three formal recommendations that the Health and Wellbeing Board note the most recent data for the Borough of Barnet. That the Health and Wellbeing Board note the progress on implementation of the Barnet suicide prevention strategy as outlined in Appendix A. And that the Health and Wellbeing Board feed into the forthcoming suicide prevention strategy 2025 to 30 refresh. I think there's been a lot of opportunity to pick this up at some of our informal working sessions. So thank you everyone for that discussion. And we're now going to move on. I would just, because you joined us late, I just want to welcome Monique from Barnet. Good to have you at the table as our BCS representative today. Thank you very much. Very important part of our Health and Wellbeing Board. So thank you. And do pipe up if you want to feed in. Moving on now to Item 9, the Combating Drugs Partnership Board Annual Report. And this will be led by Louisa Songa, who is joining us online because she has COVID. I hope you're not feeling too unwell, Louisa. I bear with me two seconds when I sort my presentation out. Can you see a presentation up on the screen? We can, Louisa. Let me just put it into slide show mode. Thanks, chair. Yeah, forgive me, I'm fine, bit croaky, but all good, all good. But I did put some slides together just to keep me focused, because I'm probably not firing on all cylinders this morning. So hi. Hi, everyone. I'm Louisa Songa, Senior Public Health Strategist in the Public Health Team, and I lead on substance misuse strategy. And I'm here to update you on our Combating Drugs Partnership Board. A little bit of background. It's all in the paper. The board was formed off the back of the new government drug strategy a couple of years ago. We launched in November 2022, I think it was. And all areas were asked to develop Combating Drugs Partnership Boards to do three things. Really want to look at the sort of supply chains of drugs and how we could work with enforcement partners to disrupt these lines and hold offenders to account on it. The second priority was around improving our substance misuse treatment and recovery services, ensuring that they were high quality and accessible. And the third priority was around ensuring a better prevention offer, both in terms of preventing the onset of substance misuse, but also stopping, you know, supporting people from developing those sort of high risk behaviors if they're already using substances. So I put some of our achievements in the paper. There is a huge amount of data available on substance misuse. So it's really hard to try and choose which bits that we put to you. But if there's any interest in any of the areas more broadly, more specifically, we can we're happy to share further information. So the first priority, there's been a huge, I'm sure you're all aware of the work that our police and community safety colleagues have been doing around making the borough a safer place and reducing supply of substances into the community. And so address the sort of wider issues around that they bring around and social behavior and these programs that clear how build approach and some of the other operations that we've had. That certainly partnership approaches which aim to take a really multi-agency approach to the problems and look at it from a systemic point of view. And I put this graph in just to show you that, as you can see, it looks like our drug trafficking offenses in Barnet are increasing. That's a really good thing, because actually what it shows is that the police, this is police data, our police partners are able to respond to supply and, you know, the sale of substances and hold that are actually arresting people and bringing them into the criminal justice system. So it doesn't necessarily mean that there's more drugs coming into the borough, but actually that the police are doing a really good job at targeting those drug dealers. And on the flip side of that, possession, people being arrested for possession of drugs is decreasing, which is good, because actually what we can see then is that people that have substance misuse issues are being signposted into support and treatment rather than being pushed into the criminal justice system. Which can't necessarily address their issues. So in terms of delivering world class treatment service, we've been working really closely with some of our criminal justice partners to improve court pathways, prison pathways, and we've seen an increase in community sentences, lots of work on people with multiple and complex needs. So we have a substance misuse rough sleeping program, which is, I think it's in its third, fourth year of operation, and they're really sort of embedding into the community. The team have managed to build good relationships with people with multiple issues and support them into services. And through that project, we're starting to look at the wider health issues of people who are rough sleeping and also have substance misuse issues. So one of our successes is that last week we launched a dental service for rough sleepers, which is a great success. It's something we've been working on for a long time. So anyone that's rough sleeping can now access a community dentist in Hendon. I think it's one day a week that we're offering that service. It's a fast track service. And also there's oral health training sessions that are being delivered to staff through that program. And we continue to be focused on reducing drug and alcohol related deaths. I've got here rates for barnet remained lower than London, England. Apologies, that's a tie. I think we're actually similar to London and England. What we have seen is over the last few years, the numbers of people dying who are accessing treatment are largely related to alcohol. And what we are understanding from those reviews of those deaths is that there are some significant issues around people with complex physical health problems as a result of their alcohol use and people accessing treatment quite late. So we're really keen to try and change that by getting people into treatment services at an earlier stage in their substance misusing career and also ensure that they have better access to that range of physical health services to prevent those complexities. In terms of opioid related deaths, we remain quite low, which is brilliant. And we are really pushing our harm reduction strategies. So we we have a really good distribution of naloxone across the bar. I think I read yesterday that we're about 70 percent of our opioid users have access to naloxone. Naloxone is an anti overdose medication that people can administer, administer at home or in the community. And also we are now getting nitazine testing strips as well. So you may have heard in the news, there are sort of new synthetic opioid which are way more potent and more lethal than heroin. And so people can can test their drugs before they use them. We have had had one one instance we heard of locally where a chap tested his heroin, found it had nitazine in and actually gave it back to the drug dealer. And I don't want this. So we can see it works and significant engagement with partners to around training and upskilling. And one of our biggest successes that we're really, really proud of is actually the number of young people accessing treatment in Barnet for substance misuse issues has grown exponentially. I think it's at the highest. It's it's been definitely since I've worked in Barnet, but, you know, for a very, very long time. And this is this is great. This is really shows that that service is starting to to get into the right communities and work with schools and really meet that need of young people. In contrast, the numbers of treat people access in adult treatment is staying fairly similar. We really hope to see that drive up. But we it stayed quite flat over the last 12 months. We're really keen to think about how we can improve that through the next year. And again, slide on deaths. And so, obviously, a little bit on the prevention. So we need lots of work with schools around thinking about what the PSHE offer includes and ensuring that schools have access to the substance misuse service to go in and offer that that extra training and upskilling. And we have been looking at upscaling or drink coach service. And again, I think we're in about year three or four of the drink coach service. And for the first time, halfway through the year, we've exceeded the number of counseling sessions that we don't deliver. And there's a slide which just really shows you the how our campaigns have a really positive impact on the numbers of people that are going to the drink coach site and and access in that that intervention. So, yeah, really, really good to see the outcomes of our campaigns. So finally, just a point on the restructure. So we're a couple of years into CDPB now. We formed as a partnership. We've developed our work plan. And now I think we're in a really good position to look at what's working and what's not working. You know, there have been a few challenges to creating ownership and actually getting key stakeholders to drive certain areas forward. So we have reviewed some of the arrangements in other areas and made some recommendations. What we think a revised structure could look like. We presented it to the board in the last meeting in our health and sorry, my competence and drugs board in July and partners were on board with that. This is a structure. So we, if approved by the health and well board, hope to move to this structure in in the coming months. And really, you know, the first one would be very much led around our police and community safety colleagues. The treatment group would be led by public health. And we're looking at how the prevention subgroup can align with things like the only help board and some of the prevention work that's happening in adult social care. And that's it for me. Thank you. Thank you very much, Louise. And before I ask anyone to do for comments around the table, I just want to give a reflection as the chair of the Combating Drugs Partnership Board. And it's been a real it's been a real work in progress over the last two years. I've learned a huge amount. But I've also watched a range of professionals working and discussing what they do and focusing on that issue. Because for members, for counselors, the issues around drugs can be quite a challenging one out in the community. And therefore, it's been really helpful to understand the work that goes on and how the system is coming together. It's relatively unusual to have a counselor chairing the Combating Drugs Partnership Board. But I would reflect that alongside having Councillor Conway, the chair of the Safer Communities Partnership Board, with us at the CDP, I think that's given us I hope it's given us real impetus. It certainly meant that we had we have a member focus on it that I'm not sure that we would have had in other ways. It's been good growing that partner attendance. But as Louise said, it's about ownership of the work outside those meetings. And we want to maximize that that work. So I think the benefit of having a formal Combating Drugs Partnership Board meeting twice a year that's aligned with the Health and Wellbeing and Safer Communities Partnership Board meeting schedule. So that we're maximizing the time for that working group activity and the joining up that goes up on professionally outside the meeting. But also, reporting into the Health and Wellbeing Board and the CDP and the Safer Communities Partnership Board as that public, formal public expression of the work that you do. I think it's a really important the board, the Combating Drugs Partnership Board certainly saw the logic of moving to that format. And I think it would be a very positive thing to do. So I hope the board would share that. So do I have any comments or questions for Louise about the work that's going on? I think I would just reflect that actually it has been a really busy two years and we have moved a number of areas on considerably. But obviously, the work of the police in the Clearhold Build, Operation Dakota work has made a step change in what's gone on. That certainly changes for a part of the borough that I think was probably, it's fair to say, was blighted by drugs issues in that community. So if nobody else has any additional comments or questions, I think Fiona has her hand up. Thank you very much for joining us when you weren't feeling well. It was much appreciated, but really important that we note the value of the work that goes on and the amount of work that goes in to the Combating Drugs Partnership Board and the work that goes on outside that. Thank you very much. Sorry, sorry, Chair. I do apologize. I thought you were wanting to speak. Please do so before we wrap up. It's just a very quick question and taking into account what Nick said when we're looking at the pharmacy needs assessment. I wondered if there were any accessibility issues for individuals who need treatment out from pharmacies like methadone and things like that outside of usual work hours and whether or not we actually as a board should be pushing for things like from the pharmacy need assessment as well. Louisa, if I let Nick to start a comment and then you can follow up if need be. Yes, I think there is, for my understanding, we don't prescribe it anymore, it's done by CGL, but I think there is a provision to CGL based in Edgware. There's a pharmacy in Edgware that provide it on the weekend and then at Binchley Memorial Fair we pharmacy provide it out of hours as well. The majority of patients are on a weekly script, for example, and they'll come on a designated time every week. So let's say that their appointment is every Monday and they'll go every Monday and collect them and it won't be on a weekend generally that they're seen. So probably the likelihood is low, but there are two pharmacies, one in Edgware and one in Binchley and maybe more in the other part of the borough, but I'm not familiar with it. Yes, I thought there was borough coverage in that sense, but Louisa, do you have anything to add? Yeah, there's really good by the borough coverage and we review it regularly through our sort of needs assessment work to make sure that we have got access across the borough. And actually there's a really interesting new medication that's just coming on the market, which we're launching in the service, which is aimed at people who are very, very stable and might be in employment, which allows them to. Don't ask me the chemistry of it, but it's it's a very expensive medication and we will be prescribing it now anytime, actually, which allows people to have really less frequent pickups and it's a much safer medication. So it's really positive. And the service has actually now moved as well. And it's in Hendon. So that was a couple of weeks ago. So we are in the process of updating comms and communicating that out to partners. Yeah. It's a much better location. Thank you, Louisa. And I know that we've had a number of very dynamic discussions within within the partnership board about that. The interface with with housing and a range of other issues. So it's been a very active partnership, but it is about helping people to stay stable. Recover from drugs, but actually also through the education program, preventing young people from getting involved in the first place. Thank you very much for that. We have three formal we have two formal yes, two formal recommendations to make that the health and well-being board note and comment on the progress of the Combating Drugs Partnership and approve the updated structure of the CDPB outlined in section one point six of the report. The reasons for that and the the the reporting that will go on formally going forward. So we agreed on that. Thank you much to everyone. And just to note that Paul, Councillor Paul Edwards had to go at 11. He was he's judging a care home art contest. And so in his role as adults lead, he was going to have to go and do that. So but he had let us know that he was going to do that right. Finally, we're moving on to the last substantive item in the agenda, and that is the communicable disease update from Janet. Janet, Director of Public Health. Thank you very much, Chair. It is a verbal update in other forums across London already. At the moment, they are still setting up and working to sell material, a document, a pack to support them. And next week, we'll be having the annual winter preparations. Infection prevention control. Yes. That's the word. We just agreed with the chair earlier. So going forward, we are happy to bring a more. On why their health protection that work in barnet, which goes beyond the nation. Thank you. Thank you very much, Janet. Does anybody have any questions for that was a really comprehensive item. Thank you. It was my desire that we kept this on the agenda post the code reports. But I think it's really helpful, not least in the light of the discussion that went on at scrutiny. The scrutiny committee at the evening about concerns about vaccination rates and understanding the work that goes on to support that in the context of the cancer screening work. Perhaps you or Claire would like to share the news about your grant. Yeah, congratulations to the happy couple. The congratulations to us as well. So we got notification on Monday that's Barnet along with Harry gave been awarded two hundred and thirty thousand. We mentioned earlier. That's really good. Thank you very much, Claire. I think we're celebrating while it's not a communicable disease, obviously. Well, this is it's just really important that we that we make the most of grants like that, because this is tackling. As I understand it, going some way to tackle the inequalities in uptake of cancer screening across our across some of our communities. So it's really focusing on ensuring that that prevention and intervention that we all want to see is being enabled in that particular area. But there's also the issues around communicable diseases. There are some health inequality issues with that. And, Jess, you'd like to comment or ask a question. Just in terms of the grant. Fantastic news. Keen that we make sure we draw in the work that we've done post Leder. So the Learn Disability Review of Mortality to understand where screening of people with a disability or people can. It's an area that that really is important as part of that. Does anybody online have any comments or questions for us? Thank you. Fiona's made a comment. Yes, that's an AOB. So I'll pick that up under AOB. So thank you for that discussion. Janet, thank you for the report. And I hope that we'll continue to have that. And thank you for undertaking to share those those reports with us ahead of the meeting where possible, because that's a really helpful thing to do. Partners around the table will see those. There's a ghost in the chamber. The partners around the table will see those reports in different contexts, but some of us wouldn't pick those up. And it's really important so that we get that that broad picture of the work that's going on around communicable diseases and vaccination. So our recommendation is that the board notes the update. Thank you very much. We do. We do that. We have. The item 11 is the forward work program and the request is that the board notes the forward work program. Obviously, much of this year is going to be formal reporting, but actually also the development around the joint health and well-being strategy. And so that will be a pivotal meeting in January to to bring that together and send it off for wider consultation. But we will have our working session ahead of that. I hope as many people can join us on October the third as possible so that we have the richest and deepest discussion we have going forward. But a lot of what we've discussed this evening leads into that. So item 12 is always a list of the health and well-being board acronyms, which is useful for those who are not health professionals. I'm going to take item 13 as any items the chair decides is as urgent as an AOB. And I have a message from I don't know whether you'd you'd like to speak Fiona Bateman, who has joined us over the last couple of years as the chair of the adult safeguarding board. Her tenure finishes as chair. At the end of end of December and after she served for seven years. So I think that's a hugely big contribution to safeguarding in Barnet. So it's likely that this will be your last meeting. She says it's been a privilege to have been on the board and for the work of the Barnet safeguarding adults board to have been so well received by partners. Fiona, I think we have a great deal to thank you for in the input that you've had to this and to many other parts of the committee and service structure in Barnet. So thank you very much. I'm sorry this will be your last meeting, but thank you very much for all the input you have had over the years. And we look forward, obviously, to working with your successor, but we will miss your input and insight and the reflections you bring based on that seven years of experience within the board. Thank you very much for your input. Thank you. And I wish we pity in a sense, it's a pity we're not able to be. But you are always welcome to come and sit in the public gallery if you should. Should you feel so motivated in future and ask us questions and hold us to account. But thank you very much for all your input. Thank you to the members of the board who have been who joined us online and at the table today. Thank you very much for your input. And for the public gallery, I know that the former chair of the committee has joined us as well in the public gallery. So it's good to see you, Caroline, to hear our discussions and look forward to both to the next formal meeting, but more importantly, perhaps in the first instance to our working group next month. Thank you very much for your time and for the input from officers.

Transcript

For us, we had a minor technical glitch to start with, but we now have contact with everybody that has had to join us online. So, we are now – we've got a quorum, so chairs – good morning. I'm Councillor Alison Moore, Chair of the Health and Wellbeing Board. Thank you for attending our meeting this morning. Please note that meetings may be recorded and broadcast by the Council or by people present. Can I remind members and officers to use the microphone when speaking by pressing the middle speaker icon? And obviously, for those of us who are online, to unmute yourself when you speak. So, moving on to the agenda properly, we have minutes of the previous meeting. Does anybody have any corrections of matters of facts to those meetings – those minutes? Okay, then I will, at the end of the meeting, sign those – the true record of the meeting. Item 2 is absence of members. We have apologies from Dawn Wakeling. She's substituted by Jess Bames-Home. We have apologies from Sarah Campbell and Deborah Sanders. We also have apologies from Louisa Songer, who, due to COVID, is joining us online. And Fiona Bateman, our Chair of the Adult Safeguarding Board, who has a clash and is joining us online today. So, welcome to online and people – members in the room. I would just ask – we all know each other, I think, well now, but when you speak the first time, it would be useful just to say who you are for the purposes of anyone who is watching us online. Do we have any declarations of interest – members' interests? I would just say – I just want to – though it's in my own declaration, I am the Council's nominee on the Governing Council of the Royal Free Trust, and I welcome that we've got a grant to do some work that's come from the Royal Free Charity. Do we have any dispensations granted by the Monitoring Officer? There are none. Public questions and comments? There are none this month. And so, we move on to our first substantive item, which is the Joint Health and Wellbeing Strategy update. And Claire O'Callaghan, Health and Wellbeing Policy Manager, will introduce the item. Claire, over to you. Lovely. Thank you very much, Chair. I'm just going to make notes. So, this report is the regular six-monthly report on the current health and wellbeing strategy. So, it gives the update on the implementation plan status that we're using to track impact of the strategy. And secondly, it also gives an update on the current – the future health and wellbeing, which I'll talk a bit about later. So, first of all, the current health and wellbeing strategy. So, most of the implementation plan is now either completed or on target to be completed by the date. There are two actions in the plan which are slightly off target. So, the transition of the Healthier High Streets program to its kind of future delivery model. That's slightly delayed from its current completion date and should be completed by the end of 2014. And then secondly, the recommissioning of smoking cessation and NHS health check services. The mobilization date for that has now been confirmed for October. That will be slightly later than advertised. In terms of indicators, roughly the same number of indicators have improved since the baseline, which was set in September 2021. Five indicators are showing a more than 5% adverse movement from the baseline. So, these are the total number of food bank beneficiaries per month, which has gone up. The proportion of babies being breastfed at six to eight weeks at the health visitor review, which has gone down. Emergency admissions from ambulatory care-sensitive physicians and life expectancy at age 65 for both males and males. So, that's the current strategy. Talking about the future strategy. So, over the summer, we've been doing some work with partner conversations looking at the updated Joint Strategic Needs Assessment, which you've seen at a previous meeting, and looking at other boroughs and the ICS population health interest. The priorities might be for Barnet in the new strategy. We are planning to take this to a meeting of health and well-being board members, an informal meeting at the table. And if you don't have it in your diary, you will do by the end of this meeting. And the intention is to have a long list of priorities to take out to wider public consultees over the next few months. We're still on track to have a draft strategy by January. So, the next time we meet, we'll have a nice draft strategy that you can comment on and approve, hopefully. And then, it will be a more formal consultation over the spring, aiming for… Thank you very much. I think there's two parts to this. Obviously, there's the current progress on the current health and well-being strategy. Does anybody have any particular comments or questions to make about that? From my perspective, perhaps you could just clarify the situation with respect to the recommissioning of the smoking cessation services and the adult health checks. And is that a contractual issue? And it's not a major change, but it's a recontracting. Yes. So, my understanding is delivery on both of those things has been continuing. So, it hasn't been a stop in service delivery. I don't know how much, because in some of the documents, that's not entirely clear. There's some crossover with our plan to ban it. And there was an odd phraseology that didn't make that quite clear. So, thank you. That's really helpful. Does anybody else have comments on any of those other areas? Any reflections from our health colleagues about the life expectancy issues and any reflections on how we might be combating that? I think… Sorry, Jess. I do apologize. So, Jess Bains-Holmes, Director of Commissioning for Adult Station Care. The question really was just to clarify. So, our emergency admissions for ambulatory care sensitive conditions have gone up, which is clearly not great. But I just wonder, the baseline is 2020 to 2021, which is the usefulness of using that as a baseline. Probably Janet. So, I'm just understanding if that's useful for us to measure it against or if we've done some other review of… Presumably, it was the baseline that was the start of the well-being strategy. So, I think a narrative around it would be appropriate. I'm assuming that… I don't know whether we are in terms of dates, whether we're in line with other statistics. But it may be important to be comparative. But we will be resetting those baselines with the new strategy, I think. But it's a really valuable point because the same is… There isn't a reflection on the change in life expectancy at 65. Some of that has been influenced by the COVID and post-COVID figures. I am assuming, but I'm not a specialist in that, but I'm assuming that that's the case. Kay. Thank you, Chair. I'm Kay, as Director of Operations. I'd be able to address this. That's a very pertinent point. And if you haven't already had an opportunity to delve into the new joint strategic needs analysis, actually, there's a huge amount of data within that and where it's been possible. Where it's possible to have it at a ward-based level, we do. Slightly, because of the new ward structures introduced in 2022, there's a little bit of transitional data there. But we've also, where we can go down below ward levels to MSOA data, we have done that. Now, that has confused some people because the names are quite colourful and do not align with wards. But actually, that gives you a tie-up through to ONS data. And so we are able to do some of that geographical analysis. And yes, there is, I'm sure there will be differences that we can unpick. And that would be a really helpful exercise to do in terms of then targeting our work and our resources into the places where we will make the most difference. Simon. Thank you, Chair. I'm Simon Wheatley, I'm the Director of Place West for the Integrated Care Board. Just to say that I think it's nationally appreciated that changes in life expectancy are multi-factorial. And certainly, what we're seeing in Barnet is disappointing, but something that's reflective of the national picture. I think you're right, Chair, that actually a recognition of the geography and also some of the specific communities would be even more important. From an ICB perspective, we're introducing a new long-term condition locally enhanced service. Nick would be able to speak to this in far more detail than me, but that is an expansion of investment in general practice to focus really significant investment that we're progressing at the moment, Chair. Thank you, Simon. And as you will know, the Adults and Health Scrutiny Committee have just completed a task and finish group on access to GP. And that will be coming to the Cabinet meeting in November, I believe. And there are recommendations both for us and actually for the ICB as well within that. And that would be really helpful. We recently had some discussions around the GP survey, and that does talk to the issue that some of our GP practices need some support in getting to where you want them to be around that continued management of older patients with those with ongoing health issues. Nick. Thanks, morning. I'm Nick Detani, GP and Clinical Director of PLACE. I think what we saw over COVID was that a lot of patients became deconditioned, and that deconditioning is now having long-term conditions impact. So, for example, we see a massive increase in patients with heart failure, for example, because they've been deconditioned and not exercising and stayed indoors for often a year. And we're seeing a big increase in pre-diabetes. And then we're also seeing a big increase in cancer diagnoses. And so what's really interesting is a lot of those are linked to not exercising, not eating well, and what people have missed out on in the year or two of COVID. So it's going to probably have a knock-on impact for the next 5, 10, 20 years. I don't know. Public health might give us an idea, but it's going to have a massive impact. And so what Simon talked about was the long-term condition locally-commissioned service that's now in North Central London. And really is exactly what Simon said, allowing general practice to focus on prevention, because actually what we've been doing is tackling acute illness, and what we're better at doing is managing people's long-term health to keep them living healthier and for longer. And one of the things I think we need to think about in our strategy is actually getting people more active and understanding their long-term condition, which is a missing feature. So if I diagnose somebody with heart failure, and I can medically optimize them, but what I can't do is get them to the gym and getting them to buy foods from the supermarket and understanding what that means for them. And that, I think, is the missing link. And actually, what we learned over COVID was that people talked to each other, and how did we get COVID vaccinations so great, because everyone talked to each other and encouraged them. It's the same thing with long-term condition. I bet most people on a neighborhood will have congestive cardiac failure or diabetes, and actually want to stick together and actually make a better lifestyle for themselves. So I think that's the things we might need to focus on. Thank you. That's really helpful, and that actually gives us a topic of conversation for the third, because it reflects some of the things that we've been – a conversation that we've been having recently with the Director of Health and Director of Adults. Claire? Yeah, just to come back on the life expectancy. So last year's annual DPA, it's got last year's data, but the factors are very much the same. Thank you, Claire. That's a sensible reminder that, of course, there is a huge amount of information in... And thank you, Nick, particularly, because I think that sense of being able to help people to build agency and understanding and control over their health and understanding that there are things that they can do to improve that situation and what they don't. I think that's a really positive way forward, and I think it's something that brings all of the partners around the table actually together around that issue, because it involves wider parts of the Council, but actually also community and acute health as well. Pauline? Maybe a various communities to try and get an increase, but I think – I mean, what I was trying to explain last night, and I'm sure in fact, was a lot of hesitancy about immunization. We are monitoring progress on immunizations. Those reports aren't public, but thank you for the reminder. We will make other relevant members to share updates on the issue of vaccination hesitancy. It's a national wide issue, unfortunately, and I'm sure a clinical colleague. Thank you. Just to add to that, there's about 5 million population in continental central London eligible for a COVID and flu chapter. I ask Councillor Edwards to speak. I would just reflect, and it's a conversation that we were having following the meeting yesterday evening and that conversation about vaccinations, particularly childhood vaccinations, and actually a reflection that there's a younger generation of parents who may not appreciate the seriousness, for example, of measles. I'm old enough to have grown up with friends who had eye problems or hearing problems or a range of other problems that resulted from having had a measles infection, and it was a relatively common place when I was a child. I don't think young parents now really always understand the real ramifications if we have a measles outbreak, and I know that an awful lot of work has gone in, both across a bonnet in terms of promotion across NCL and the wider NHS in terms of promoting vaccinations pre the school term. And there has been some work, for example, through the London Jewish Forum and other groupings to try to encourage vaccination rates within some of our communities who are most resistant. It is a really important area and it is overcoming all sorts of, I was going to say ignorance, I don't mean it that way, but lack of understanding of the impact for some communities. Yes, thanks to, excuse me for my ignorance, but I can't see anything in here, and this is not a pun, around ophthalmic or eye health in terms of wellbeing. Can you please repeat what health, I mean eye health, I'm sorry, eye health wasn't mentioned specifically on the number of outcome KPIs is limited, and whilst I absolutely agree and appreciate eye health is important sooner than in mature age. Absolutely, and there's somebody whose eye defect was picked up by that first check in school actually when I was first in reception. That's a very good point. Paul, do you want to carry on? Yeah, I also think it's important because I used to wear glasses firmly and I've had cataracts removed and it's helped my vision remarkably. What occurs to me also is the cost of it, and I'm wondering whether for some people that's prohibitive in terms of just going on a regular basis. It's the same, but I'm talking about eyes. I mean you can't go to an optician without paying some money. I discovered because there's something I'm going to have, something done on my eyes. There's even an NHS price that you can pay. So there's the private price, but there's still an NHS price. And I'm just concerned, you know, in general about particularity than somewhere else in the councils. It's a point well made, I think. Any comments from our partners? Okay. Regular eye checks for children. It's not like part of a regular health check. I know I was never offered it. Well, not for my child anyway. I think that's a question for our partners. Nick, if you could shed some light on that because clearly I'm talking about a different generation of my eye tests. There definitely is two sets of eye checks in schools for the ages now, but there definitely are. It probably has changed over the years. I don't remember what it was like when I was a child, but certainly now there is two sets before 16 that I've offered. I mean, certainly that would be something. Fiona Bateman online has made a comment that it's also true of hearing tests. And there is an expense. Thank you, Fiona. Absolutely. Absolutely right. We've got two different things going on here. We've got we've got talking about the cost of eye, dental and and and hearing checks within with people and children's testing. And there is a comment from Louisa Songer, which I'm assuming is from her current understanding. There's hearing and eye tests at school at five and six. And Claire would back that up for those who have pupils. There is there is something that replicates the sort of testing that I remember as a child. But it's not it's not wrong, actually. And the the implications for all of those elements can be quite significant. And if I understand correctly, there is some correlation between loss of hearing and developments of some forms of dementia as well, because I'm assuming because of neurological input. So I think there are that's a question we might well, very sensibly ask. And I would just be moved to comment on how Chris would appreciate you mentioning this. One of the things when we took the AUSTED, the outcomes of the Children's Services report on Tuesday at Cabinet, one of the positive comments was around the timeliness of both optical and dental checks for children looked after. And I think that is something that may not always have been the case. And so it's very pleasing to see that we at corporate parents can be assured that at least in that context, there are checks going on. Thank you. Any other comments? So. Sensory and sensory impairments can lead to social isolation, which sadly increases the risks that adults with care needs will suffer neglect and abuse. So actually, there are a range of reasons. And maybe that's something that we would want to look at in the future. It may be an appropriate subject for a scrutiny commission task and finish group. Nick. So I just checked. So you get a hearing test at birth and an eye test. And then the eye test is done again at the six to eight week check at the GP and then between the age of four and a half and five and a half to school. And then it's then not done again, but it's free for any child to have an eye test or hearing test between the age of five and 16. Hearing tests are actually the GP and the eye test done any optician free of charge for under 16 to 19. Occasionally. I just checked. That's really helpful, Nick. Thank you. So there is a program in place. There may have been disruptions during the Covid period. And it is about and it is about engagement as well as access from parents. Okay. Agree. And that is really helpful. And I suppose it's then just how do we ensure that that message is out? Because if colleagues around this table don't know that, I suspect a significant portion of our population also don't. And therefore, are they taken? How do we make sure collectively we're getting that message out to all families? Both ends of the age range. We're looking at ensuring that people understand what is available. The benefits of that and the risks if they don't. I mean, clearly eye checks for those who are older. It picks up all sorts of things like glaucoma and a range of other conditions and therefore is particularly important for older people. But actually, young people, you know, I had a friend at school who wasn't doing terribly well. And then they moved him alphabetical arrangement in the classroom with a child who joined, moved him from the back to the front of the class. He could see the board. And actually, his results then kind of climbed rather steadily. And so it's just a case in point that understanding that Councillor Coakley Webb's comment was perfectly right. You only know as a person what you see and you don't know whether that's normal or not. It's what you see. Okay. I think that's really helpful thinking about the future. One of the things that we'll want to talk about when we come around the table and discuss how we evolve the next health and wellbeing strategy is a range of those topics that might or might not form part of the strategy. Obviously, I'm really concerned that we make sure that we both for meetings and for the work that we do together, it's where we can collectively add value and make the most difference through the strategy already through these meetings. I think we've had several really insightful comments around the table today. But I look forward to having those deeper discussions in our workshop session at the beginning of October. So the formal part of item joint health and wellbeing strategy update is that the board comments on and notes the progress on the current implementation plan and the key performance indicators the board reflects on the current progress of the joint health and wellbeing strategy development. And unless anybody has anything to add at this stage, can we all agree those recommendations? I'm happy to have the comments that we've made. Are they minuted? They are indeed. And if you look at the minutes that we've taken today and that I'm signing off, PACS does a very good job in trying to capture our sometimes complex discussions around the table. Yes, they are very full minutes, so they do record what we discussed. Thank you. OK, moving on now to the next item, item seven, which is the pharmaceutical needs assessment update. And to note there are two appendices within the PAC, the map of pharmacy provision and the process for responding to applications for changes to pharmaceutical provision. The item will be led by Dr. Deborah Jenkins, consultant of public health. Thank you, Jeff. So this agenda item is to provide the board with a routine update on the pharmaceutical needs. As the board will be the last pharmaceutical needs assessment was approved, approved and published by Barnet in 2022. And since then, if there are changes to pharmaceutical provision, since the last published published statement, the board needs to review the impact of the change. The previous update to the Health and Wellbeing Board about changes to pharmacy provision was in July 2023. Since the update in July 2023, there have been several changes of ownership of various contractors in the area. Only one pharmacy. That pharmacy is Bishop's Pharmacy in Hampstead Garden suburbs. The pharmacy reduced opening hours from 6 p.m. close Monday to Friday. It was previously open until 7 p.m. It is now closed on Saturdays. It was previously open from 9 until 6 p.m. The impact of this change has been reviewed with the conclusion that it would not lead to a potential gap or poor provision of the pharmaceutical services in Barnet. But this and other changes of ownership and maintained pharmacy list has been updated, but no further actions are needed. As you can see in Appendix A, this is a screenshot of the interactive map of pharmacy provision in Barnet, which has been produced and is published on the Barnet website. The map and underlying data are refreshed and updated on a quarterly basis. I'll turn to the next appendix now, so I'll just change the screenshot. So the second area I'd like to draw your attention to is to make a process clearer, and this is the process for commenting on pharmacy change applications. When there are applications for a change in pharmacy provision in the borough, this is shared by NHS England with the Barnet public health team in order for the health and well-being board to comment. To standardize this review process, this is the chart that we've produced for the suggested actions in Appendix B. The current process is similar, but this change involves both the chair and the vice chair of the health and well-being board to review the pharmacy change application. So in brief, the flow chart describes the following steps. Barnet public health received the pharmacy change application. We then send the change application to the pharmaceutical needs assessment technical support, which is currently provided by an external consultancy organization called Soar Beyond to review the proposed change. The technical support team reviews the evidence and provides a recommendation on whether the change is significant or not. If it is significant, the evidence, suggested recommendation and draft response is sent to the chair and vice chair of the health and well-being board for comment and review. Barnet public health team then updates the draft response from the chair and vice chair as needed and sends back to NHS England. After that, if the application is granted, then the Barnet public health presents a supplementary statement or a fresh needs assessment to the health and well-being board if this is needed. Thank you. Back to the chair. Thank you very much. Does anybody have any comments on this? I mean, I would say in welcoming the tightened up procedure for responding to applications, I think it would be very helpful. I would certainly value the vice chair's comments. Clearly, I'm not a professional in this, though I bring, I hope, a community understanding to it. But it's such an important area and pharmacies are playing a larger and larger part in our spread of health and well-being services. And so I think it's really important that we understand the spread and sufficiency of those across the borough. Nick. Thank you. So I don't have any objections to this. I think it's great to have the flowchart. The only comment I make as we're, you know, we're trying to get pharmacies, community pharmacies involved more and more in patients health, more that they can offer to patients. Often patients don't realize is my fear of the opening times of convenient patients. So, for example, now I'm not a personal user of the pharmacy much, thankfully, but whenever I've needed to use it, I've had to hunt around for a supermarket pharmacy that's open to 8 p.m. There are not many and there's not many of those in Barnet, as you can probably see from the map. So thank you. I live in Hertfordshire and there's availability. But I think there's a missing link to say is that you can't predict when you're going to fall ill. And people generally fall ill on the weekend when things are shut. And so in the future, how can the farmers think about providing that provision on Saturday? In particular, Sunday is a crucial day when everything's sharp, but you want the pharmacy to minor illnesses. So how can we think about that provision in the future? Thank you, Nick. Janet? Yes, thank you very much for those comments. They will be noted, I suppose, in the minute. It will be incredibly helpful as we are just about to start the update of the pharmaceutical needs assessment. And I think it in any way, I agree with you. I just yesterday I had to rush a rush of work to catch the pharmacy during their opening times. So I think everyone can resonate with that. And it's important to consider that one more comment as well. As you know, that extended access service by General Practice is now provided on a Saturday from 9 a.m. to 5 p.m. And so I do that maybe one clinic every quarter. And I struggled. I have to print prescriptions for patients and then try and hunt down a pharmacy on a Saturday morning. So it's a challenge for patients, you know, if there's one pharmacy in the area open and you've got 20 people trying to get something on a Saturday morning. And so I understand, you know, the close and it's hard to staff it and the cost of staffing a pharmacy is not cheap. But it's just about what provision can we think about in the future because we are starting to go to a seven-day health basis. I think that's a really, really helpful point and one we should think about, particularly as a growing borough. And one of the discussions we have had recently was about a pharmacy on the west of the borough. My apologies, Jess. On the west of the borough and recognizing it's not only a rising population but perhaps a population with different behaviors and looking at how we work with those who are working lives. I think it's really important. But the reflection of marrying pharmacy timings around an expanded GP practice time is a really well-made point. Did you hear that? Did you hear that? Looking at this map where it says where all the pharmacies are and having had to, like you said, have to hunt for one that's open, how and who can we actually have information both with the addresses and the opening times of all the pharmacies that are available? And it might be, even though these are the ones that are within Barnet, if someone is living on a border, it might be that, say, that a pharmacy just over the border in Enfield is available or over the border in Haringey. And I think we've got a duty to be able to actually have that information on hand. I don't know who will be able to produce it or whether we can pull it out as council information, but for me that seems to be really important that we can plot the addresses and that we can actually tell residents what the opening times are so that when they've got an emergency, they're not, as you said, hunting around in a state of panic wondering where they can get their prescription from. I have Jess and Claire come in. Nick, if you'd like to comment? Yeah, council, so the information that you've got is on the Barnet website, but only patients probably won't use our website or use the NHS website. So the generic one I've got here, you put in your postcode, it shows you all pharmacies in any borough. But I think what Nick is saying is certainly if it is a GP led prescription, you will be able to sign post to the nearest open pharmacy. And whether that's something that we, is there a prescribed definition that is a sort of a national definition? If there is, really we want one that is a Barnet specific, what we want to encourage residents to expect of them. That's a really good point and actually there's been quite a lot of coverage on the radio, certainly on the radio over the last couple of days about pharmacies and the challenges that that changing role will present. Would you mind if I took Simon first and then? That's a very kind chair, thank you, significantly more than it perhaps meant to me three or four years or so ago. I would agree and very much think pharmacies as part of our health and wellbeing family in terms of that broader agenda that we're developing in terms of keeping people well but treating them when they are unwell. Claire? I suppose, I think my intervention for topic for discussion. Debra, do you have anything else to add in summing up the paper and the discussion? Thank you, thanks for all the comments. I think a further discussion on pharmacy provision would be really helpful. We have some links already for future agenda items. Thank you very much, and I look forward to that discussion. It feels like a very mature stage of regarding them as part of that partnership. Formerly as part of the paper, if nobody has any further comments, we are asked to note the changes in pharmacy provision in the London Borough Barnet since July 2023 and agree with the suggested and whether we agree with the suggested process for reviewing applications for the changes in pharmacy provision in the borough as outlined in Appendix B. Is that agreed? Thank you very much. Now move on to item eight. That is the suicide prevention annual suicide prevention plan annual report. To note that we have a which is the annual report itself, and the item will be led by Saher Keke, who is our public health strategist and Rachel Wells consultant in public health. Thank you very much. As part of Barnet's suicide prevention partnership, I'm pleased to present our third annual report since the publication of the strategy. Last year, the partnership created an ambitious action plan in line with the publication of the cross-government suicide prevention plan, and this report made an attempt to demonstrate how each partner contributed to preventing death by suicide in Barnet. In particular, how we collaboratively supported the groups who are known to have elevated risks, putting more emphasis on addressing the wider determinants of health. What is new about this report is the change of reporting period to align our reporting with the ONS statistics. We will continue to report statistics per calendar year as opposed to financial year. Our current suicide rate is five per hundred thousand. Although there is a slight increase in comparison to previous reporting, this is not significant. We are still amongst the five lowest suicide rate in London and probably in the country. Our innovations to reduce death by suicide and the strength of our partnership continue to put Barnet on the map last year, and I hope that you have managed to read some quotes from some of the partners involved. Finally, I want to highlight that this report proposed the renewal of the strategy and welcomed the board to feed into process.

Thanks, Chris Monday, executive director for children and families. Thanks. It was really useful and a good report. It's good to see all of the really positive pieces of work going on. I'm aware that there was a really strong cross-referencing between the findings from what used to be called serious case reviews, now called learning reviews, where the safeguarding partners have come together and undertaken reviews. I'm aware that there have been two or three in relation to suicides, and there's ongoing work in relation to some specific issues now. There's one on suicide and filicide, of which we've had two incidents where there's been a suicide of issues around children experiencing issues, both of their autism and gender. I didn't see those things coming through in the annual report, so I wonder if in the future we can make sure that there's a really strong link to the plans that come out through those multi-agency safeguarding arrangements that set out a whole range of issues. One of the issues that I don't think we're addressing fully in this is the role of private psychiatric services. Both cases that I'm aware of where there were particular challenges, both were being managed through private provision, not through state provision. I know that there were a number of recommendations made in relation to that, but that's absent in the report as far as I can see. I wonder whether we're picking up all of the intelligence that is available. It feels like this is the plan and this is what we've been doing, rather than this is what's been going on in the wider context, and these are some of the things that we found from there. To have two suicide filicides in one borough in the space of possibly less than a year, I think is something that we need to understand more and understand what we're doing about it. Indeed. Thank you, Chris, for that. Fiona Bateman is online and would like to make a comment. Just to provide some assurance, perhaps to Chris as well, all to maybe offer, because Tony and I have met to discuss the learning across the safeguarding adult reviews and the children's learning reviews. What we should do and what we could do is invite, see how to mix those meetings, particularly when we're looking at the learning that's linked to suicide prevention. So I think that would make it much easier for that to kind of connect the work. But going forward, I'm afraid I've had over the last year clashes with the suicide prevention group, so although I do always read the papers, I can't physically be in the room as I'm stuck today. So going forward, the vice chair of the safeguarding adult board will be an active member. She's already really well connected with partnerships across Barnet. So I think that learning will be more embedded in the work of the partnership going forward. But definitely, Ciara, if you'd welcome coming to those meetings that the two boards have to look at, you know, how do we join up the learning from those safeguarding reviews, that would be really helpful. I'm wondering whether, because every child's death, you know, or suicide in particular, has an after-action review, an after-death review, and it's interesting to see what the learning is from that. And I wonder where Chris has mentioned there's some private psychiatrists involved, and that may be just because of the lack of access, some of the NHS services and the long waits of 12 to 18 months is possibly a reason for that, unfortunately. But how can we learn from that? What can we change? The second thing, I say this every year, but one of the biggest things that we see now is social media. And I believe it's certainly linked to possibly death or suicide or people feeling low and depressed, actually signpost people using social media into services available, because we can put things on websites and posters and things, but young people don't use any of that. They don't use Instagram and TikTok and whatever else it is nowadays, they can't even keep track. And I also remember about five years ago, I think it was the police, I can't remember who it was, but came and gave GPs a talk on all the apps that were there, and I was astonished. I was like, never heard of half of these apps that are out there, and how do we educate parents into knowing what are the signs to look out for? Because there are a lot of rogue apps around for children, and how do we educate parents to look at what signs to look out for in their child or young one to pick up if they're going through a bad time and they're at risk of suicide and how to seek help? Because I get a lot of parents coming in who have got young children who have harmed themselves or are low, and they had no warning signs, and there probably was a warning sign, but they're not looking at their phones or looking at the right things on their phones. So I would like us to think about the generation of the future is all online, how do we read that and how do we, I don't know the answer, but just leave you to that. Thank you, it's a very thorough report. I'll take Jasmine Holmes and then Pauline. What jumps out at me is the statistics, sorry, and to echo the fact that this is clearly an excellent program of work, and what we're doing is to sort of pick out the things that we think would be even better. The national statistics around ADHD and autism diagnosis in suicides obviously assume you've had a diagnosis, and to pick up Nick's point again, the issues that we have around delays, waiting times, reduced access to diagnostics for NDD. I suppose I'd like to understand a little bit more about where we're seeing self-harm and suicide as a result of lack of diagnosis, lack of access to support, and I don't know how we can do that work with most of the diagnostics and support. But given that we know that we've got clinical restraints and financial pressures, understanding whether that is playing a significant role and that lack of diagnosis means that you struggle for longer and are likely to there. Yeah, I think to pick up on one of the points you said, I think, and Christopher confirmed that one of the things we found is that people accessing private therapies was often a cultural thing. It wasn't so much that they didn't, they just didn't want to contact NHS, it was different. One of my beliefs is that when you have these private practices, they are not, and I still think it's still the case, they're not required by law, therefore, to inform that person's general practice, therefore it goes unnoticed until the worst has happened. And when we look at the issues, well, the issues with social media and with things like self-harming that can ultimately lead to suicide or be more than one that have taken their own lives and that it's been related back to what you find on social media, they're still reporting that that still can be happening and I don't know how these social medias can be taken into account. They're talking about restricting, they can still access information and if not, they will use somebody else's phone or whatever to access it that then has got a verified aid. I think it's a really hard battle for us and how we can work with schools and parents and health professionals to try and stem this really horrible, you know, plague of social media that is actually influencing young people, whether it's to be for self-harm or their body image to what they think they should be and what they are and I'm sure that that is the root of an awful lot of problems now that would not have existed years ago. Thank you Pauline and I see Nick is nodding and I know that there is some pilot work going on with a range of schools in terms of phone access but that doesn't alter the access to phones outside of school hours. Just in the context and forgive my ignorance on this, is there any way private psychiatrists, private psychiatric health, presumably it's accredited in some way and I wonder if there is any way to lobby for a national change where they're obligated to notify. So because they're regulated by the GMC for example if they're adopted but there isn't anything that they must inform the NHSGP practice so the patient or the guardian has to consent and provide the details of the NHSGP and they can choose if what you're saying is it's cultural, they probably are not consenting to share the information. And then the law is that you don't consent, the practitioner is not allowed to share information because they'll be in GDPR breach. So I suspect it's probably more than not consenting than the clinician hypothesising and what do you do in that situation. Now the clinician can override that decision if they believe it, if that patient is actively suicidal for example. One thing they really should take into account if anything for legislation, it may be that it's just an adult but if that adult, if they know that that family has got young children, that's when the alarm bell should ring to go we need some information, we should not be holding it to ourselves and at the minute it seems that they can not do that. Just to add to that I guess if there's an adult, if thinking about what the right practice should be is that that clinician should then do a safeguarding report because they're lifting up children. Whether that's done or not is another thing but that's what we would do in general practice is do a safeguarding alert. But yeah it's probably what we've done and so I suppose there is some merit in maybe doing an after action review of the deaths that you've mentioned and thinking about what information we could share and certainly in our community I think going to legislation is one thing but in the interim we share something that the nation might be useful. And my recollection is that the same issue around disclosure and sharing has been a challenge in some of the teenage and student deaths as well, nationally not locally so I'm very conscious of that. I'm just going to read out Fiona Bateman made the comment all professionals registered with the GMC, the HCPC etc will be expected to comply with safeguarding duties so should follow local or encouraged by professional regulators. So I think that's a very helpful point, thank you Fiona. So how would you respond to those comments and both in terms of the quality and the value of the report and the work that's gone on because I think that we do need to remember after what is a very fruitful discussion that it is also there is some really good work going on and it's had national recognition, but also what we would what your reflections are on the comments that have been made. We have been working very closely with both Fiona Bateman and also Tony Lewis. And last year, some of the work we did in terms of learning from the safeguarding reviews reflected in the last year's report so I didn't repeat that this year, but that work is ongoing. In fact, in terms of the suicide case and the link with, you know, the issue around lack of communication, any with private sector. So, I have invited Tony to present the learning from the suicide review in the London community platform community of practice for all suicide prevention leads, so that we could collaboratively understand about those issues and also to see if there is any other example in London, and then maybe we can join forces together. You know if there are any good practice. So, we want to raise those issues because they are very, very challenging issues to to tackle. In terms of however I'm going to take all these comments to our start and grow well team in public health to make sure that going forward. We have a better capture of all that learning within the suicide prevention report. In terms of autism and other sort of at risk groups. I know that Jane Abbott, who is our resilience manager. She does a lot of work in schools. And there has been a new service, I believe it's commissions, working with LGBTQI children and young people. With autism, what we have in the councils, we have autism champions group running. I'm a member of that group. And we have been working with Barnet Mancub resources for autism. We have constantly raised awareness amongst the professionals, amongst staff, voluntary sector colleagues, faith organizations about the link between suicide and autism. And inviting people to take up training, which is delivered by Barnet Mancub. I think I'm working closely with family services colleagues from violence against women and girls team. I'm taking part in their reviews. We're gradually building those links. And I will make sure that they all reflect going forward, but that work is emerging and there is a lot more work to be done on that, on these areas. Thank you. Louise is joining us online, has posted, sent through a comment, drawing attention to the suicide and prevention and support after suicide link on Barnet Council's website. And she highlights the stay alive app, which is available on Google Play and other providers, for which the team had recognition and was the source of work with the Middlesex University. So the app has been a very important part of some of the work that you've done. So I don't know whether you want to comment on that, otherwise I'll finish up with some final reflections. Shall I take Pauline's question first and then allow Sahar to sum up? I'm just scrolling down under the figure two, men's lives lost to suicide in Barnet versus everywhere else. And then underneath, this really puzzling sentence. Due to small number suppression and disclosure control issues, we are unable to make accurate interpretation of female suicide rate for Barnet. About suppression of data, but Sahar, if you'd like to. Because it's not reported in the statistics, the rate, because of the small numbers. So we can't -- we don't have the data. Who does have the data? So we receive two such statistics from the Office for National Statistics. And we have the numbers for female suicides, but we don't have the rate. Because of the very low number of female suicide. I know from the safeguarding board when we get reports, we get to know what to give any figure or number in relation to that. I believe, Rachel, you'd like to comment. Could you put your mic on, Rachel? Thank you. Thank you. It was on a previous point, but I just -- I just mentioned on this one. With regards to the numbers, we have the numbers, but they are identifying if they are very small numbers. This report, we wouldn't necessarily put that in, but we do have that information. Can't form a rate on a very low number, but that's why that's there. We do have to suppress them when they're very small. I think that might be something that we can look at a way in which we can present those numbers in a way that gives you more information and appropriate. I just want -- I don't think anyone's asking for dates or times. It's just a comparison between maybe how many suicides are male and how many are female. I think that's all we're asking for. We can do that. We can do that. We can give you some information which would identify that for you. We can amend that in some way. I can quickly mention that from the real-time surveillance system. So we know that about 25% -- 75%. Just one other quick point. Just referring to something that was discussed earlier, and I know that we all know this, but I just thought it might be useful to many digital natives. And thinking about how we work with parents who are also migrating into that world with young people and children who are already in that system. I think it takes more thought across the system. It may well be that trying to engage, and I know that we have done this, but perhaps not as a board with young people around their uses. I think it would be quite an interesting discussion. Because I have a 15-year-old son, so I know what goes on, and it's incredible. And I know some of you probably will be in that situation as well. It's uncontrollable. And I think having a better understanding of how their systems work as a board may well be something worth exploring. And also ways in which their individual resilience can be improved. Chris, I don't know whether you have any comments on how we might use some of our young people's groups to have such a discussion. In fact, there's already that sort of work going on. The mental health charter was developed by a whole group of children and young people, so there's lots of dissipation in that. On the social media side, I think there's some really interesting international changes that are coming about. Very interesting to see as children and young people have the amazing ability to be able to find ways around all of the rules that are -- I'd say this purely as a father whose children seem to be able to bypass every single restriction that we put on their phones. Two of them are old enough to do it themselves now. So I think that there are some things. But I do think it's something that government need to be doing a bit more on the online harm bill. Did that go as far as it should? Is some of the work that's going on in Australia now through their administration about holding providers to account more powerfully? There's been some quite interesting work in that space. But I do think it's something that maybe as a board we should be writing to government about saying, you know, actually should we be going further on? Some of the -- you know, tick tock is supposed to be only available if you're over a certain age. Yeah, lots of children are on tick tock. Instagram is supposed to be over a certain age. You know, these days I think it's about if you're over 50, then you're allowed to be on Facebook. But, you know, there's those sorts of things that are well beyond the realm of us as parents and us as a board. I suppose it's those sorts of things that we need to be saying. What should we be doing in that space and should we be talking to parliamentarians about, you know, are there some things that they want to do more? You know, there's a new children's being act or bill coming forward. Is it something that we want to be saying that there needs to be more in that around online safety? Because I think it is genuinely -- it's a generally scary world that parents don't understand and that children do far more than us. I think the point about data that digital natives versus digital immigrants is a really important point. And Chris has just reinforced that. Nick? I'm just wondering, you know, whether in school programs there could be something around this education about online. Yeah. They had all these icons on the screen and I could recognize about three out of ten. And I thought, oh, God, I'm stupid. But, you know, what does that mean, isn't it? You know, do parents actually know what the apps children have because you just see an icon. So I think we need to -- it's not just the children. I think we need to get adults and parents involved into understanding what's on children's phones and things. And I think that's a wide -- and in reality, that's a wider issue than just around suicide prevention. It's a range of issues across young people's perception of the world and access to data and the online world in a way that maybe those of us who are a bit older just aren't grasping the breadth and depth of that. So that's a really helpful conversation. Sahar, any final comments and then I'll wind up. With regards to the research, the effectiveness of interventions in preventing suicide, suicides are still emerging. It's a relatively new field that's really developing in the last sort of 10, 20 years. In principle, anything that we do in Barnet, I work with colleagues from academia and looking to them to support with their evaluation. And I'm pleased to say that our campaign has been evaluated by Middlesex University, Professor Lisa Marzano and her team. And then they actually demonstrated statistically that the campaign may have contributed to saving 7 to 10 lives across the nine-month period. Of course, there are lots of caveats in this, but nevertheless, it's a very, very positive result and it's a contribution to campaign approach, which was later demonstrated by Dr. Alexandra Pittman from University College London and some other academics from Australia about how actually campaigns can contribute to reducing suicides. That's about it. And I think about the apps. Could I just add to that, please? We are working closely with Metropolitan Police and also Fire Service in terms of monitoring those untoward apps or emerging new methods of suicides. And we are conscious of that. And then sort of jointly in London, we're trying to find solutions if we can identify anything untoward. But these are wicked issues. And I just reflect that we are fortunate to have a university just adjacent to us where you've not only got academic contact, but actually it's a pool of students who might be useful in giving reflections. And I know that some of the work that has gone on through some student courses has been particularly around violence against women and girls, but actually there are a range of other issues that the students will be working on. So that's a possible source of news about the validity and depth in the way that we're doing. But thank you very much to her and thank you for your input. And Rachel, I would reflect that we have in former years discussed at the Health Scrutiny Committee. And I think I would reflect that we've had a really rich and thoughtful discussion this evening. Lots of potential learnings to come out of it. Recognizing the role of joining up and building on and extending relationships across a range of organization and mining the data and intelligence that others have. Taking these opportunities, working, for example, with safeguarding boards. And considering how and looking at how a suicide prevention is set against an evolving online challenge with social media. So thank you very much for all of your input. Now we have three formal recommendations that the Health and Wellbeing Board note the most recent data for the Borough of Barnet. That the Health and Wellbeing Board note the progress on implementation of the Barnet suicide prevention strategy as outlined in Appendix A. And that the Health and Wellbeing Board feed into the forthcoming suicide prevention strategy 2025 to 30 refresh. I think there's been a lot of opportunity to pick this up at some of our informal working sessions. So thank you everyone for that discussion. And we're now going to move on. I would just, because you joined us late, I just want to welcome Monique from Barnet. Good to have you at the table as our BCS representative today. Thank you very much. Very important part of our Health and Wellbeing Board. So thank you. And do pipe up if you want to feed in. Moving on now to Item 9, the Combating Drugs Partnership Board Annual Report. And this will be led by Louisa Songa, who is joining us online because she has COVID. I hope you're not feeling too unwell, Louisa. I bear with me two seconds when I sort my presentation out. Can you see a presentation up on the screen? We can, Louisa. Let me just put it into slide show mode. Thanks, chair. Yeah, forgive me, I'm fine, bit croaky, but all good, all good. But I did put some slides together just to keep me focused, because I'm probably not firing on all cylinders this morning. So hi. Hi, everyone. I'm Louisa Songa, Senior Public Health Strategist in the Public Health Team, and I lead on substance misuse strategy. And I'm here to update you on our Combating Drugs Partnership Board. A little bit of background. It's all in the paper. The board was formed off the back of the new government drug strategy a couple of years ago. We launched in November 2022, I think it was. And all areas were asked to develop Combating Drugs Partnership Boards to do three things. Really want to look at the sort of supply chains of drugs and how we could work with enforcement partners to disrupt these lines and hold offenders to account on it. The second priority was around improving our substance misuse treatment and recovery services, ensuring that they were high quality and accessible. And the third priority was around ensuring a better prevention offer, both in terms of preventing the onset of substance misuse, but also stopping, you know, supporting people from developing those sort of high risk behaviors if they're already using substances. So I put some of our achievements in the paper. There is a huge amount of data available on substance misuse. So it's really hard to try and choose which bits that we put to you. But if there's any interest in any of the areas more broadly, more specifically, we can we're happy to share further information. So the first priority, there's been a huge, I'm sure you're all aware of the work that our police and community safety colleagues have been doing around making the borough a safer place and reducing supply of substances into the community. And so address the sort of wider issues around that they bring around and social behavior and these programs that clear how build approach and some of the other operations that we've had. That certainly partnership approaches which aim to take a really multi-agency approach to the problems and look at it from a systemic point of view. And I put this graph in just to show you that, as you can see, it looks like our drug trafficking offenses in Barnet are increasing. That's a really good thing, because actually what it shows is that the police, this is police data, our police partners are able to respond to supply and, you know, the sale of substances and hold that are actually arresting people and bringing them into the criminal justice system. So it doesn't necessarily mean that there's more drugs coming into the borough, but actually that the police are doing a really good job at targeting those drug dealers. And on the flip side of that, possession, people being arrested for possession of drugs is decreasing, which is good, because actually what we can see then is that people that have substance misuse issues are being signposted into support and treatment rather than being pushed into the criminal justice system. Which can't necessarily address their issues. So in terms of delivering world class treatment service, we've been working really closely with some of our criminal justice partners to improve court pathways, prison pathways, and we've seen an increase in community sentences, lots of work on people with multiple and complex needs. So we have a substance misuse rough sleeping program, which is, I think it's in its third, fourth year of operation, and they're really sort of embedding into the community. The team have managed to build good relationships with people with multiple issues and support them into services. And through that project, we're starting to look at the wider health issues of people who are rough sleeping and also have substance misuse issues. So one of our successes is that last week we launched a dental service for rough sleepers, which is a great success. It's something we've been working on for a long time. So anyone that's rough sleeping can now access a community dentist in Hendon. I think it's one day a week that we're offering that service. It's a fast track service. And also there's oral health training sessions that are being delivered to staff through that program. And we continue to be focused on reducing drug and alcohol related deaths. I've got here rates for barnet remained lower than London, England. Apologies, that's a tie. I think we're actually similar to London and England. What we have seen is over the last few years, the numbers of people dying who are accessing treatment are largely related to alcohol. And what we are understanding from those reviews of those deaths is that there are some significant issues around people with complex physical health problems as a result of their alcohol use and people accessing treatment quite late. So we're really keen to try and change that by getting people into treatment services at an earlier stage in their substance misusing career and also ensure that they have better access to that range of physical health services to prevent those complexities. In terms of opioid related deaths, we remain quite low, which is brilliant. And we are really pushing our harm reduction strategies. So we we have a really good distribution of naloxone across the bar. I think I read yesterday that we're about 70 percent of our opioid users have access to naloxone. Naloxone is an anti overdose medication that people can administer, administer at home or in the community. And also we are now getting nitazine testing strips as well. So you may have heard in the news, there are sort of new synthetic opioid which are way more potent and more lethal than heroin. And so people can can test their drugs before they use them. We have had had one one instance we heard of locally where a chap tested his heroin, found it had nitazine in and actually gave it back to the drug dealer. And I don't want this. So we can see it works and significant engagement with partners to around training and upskilling. And one of our biggest successes that we're really, really proud of is actually the number of young people accessing treatment in Barnet for substance misuse issues has grown exponentially. I think it's at the highest. It's it's been definitely since I've worked in Barnet, but, you know, for a very, very long time. And this is this is great. This is really shows that that service is starting to to get into the right communities and work with schools and really meet that need of young people. In contrast, the numbers of treat people access in adult treatment is staying fairly similar. We really hope to see that drive up. But we it stayed quite flat over the last 12 months. We're really keen to think about how we can improve that through the next year. And again, slide on deaths. And so, obviously, a little bit on the prevention. So we need lots of work with schools around thinking about what the PSHE offer includes and ensuring that schools have access to the substance misuse service to go in and offer that that extra training and upskilling. And we have been looking at upscaling or drink coach service. And again, I think we're in about year three or four of the drink coach service. And for the first time, halfway through the year, we've exceeded the number of counseling sessions that we don't deliver. And there's a slide which just really shows you the how our campaigns have a really positive impact on the numbers of people that are going to the drink coach site and and access in that that intervention. So, yeah, really, really good to see the outcomes of our campaigns. So finally, just a point on the restructure. So we're a couple of years into CDPB now. We formed as a partnership. We've developed our work plan. And now I think we're in a really good position to look at what's working and what's not working. You know, there have been a few challenges to creating ownership and actually getting key stakeholders to drive certain areas forward. So we have reviewed some of the arrangements in other areas and made some recommendations. What we think a revised structure could look like. We presented it to the board in the last meeting in our health and sorry, my competence and drugs board in July and partners were on board with that. This is a structure. So we, if approved by the health and well board, hope to move to this structure in in the coming months. And really, you know, the first one would be very much led around our police and community safety colleagues. The treatment group would be led by public health. And we're looking at how the prevention subgroup can align with things like the only help board and some of the prevention work that's happening in adult social care. And that's it for me. Thank you. Thank you very much, Louise. And before I ask anyone to do for comments around the table, I just want to give a reflection as the chair of the Combating Drugs Partnership Board. And it's been a real it's been a real work in progress over the last two years. I've learned a huge amount. But I've also watched a range of professionals working and discussing what they do and focusing on that issue. Because for members, for counselors, the issues around drugs can be quite a challenging one out in the community. And therefore, it's been really helpful to understand the work that goes on and how the system is coming together. It's relatively unusual to have a counselor chairing the Combating Drugs Partnership Board. But I would reflect that alongside having Councillor Conway, the chair of the Safer Communities Partnership Board, with us at the CDP, I think that's given us I hope it's given us real impetus. It certainly meant that we had we have a member focus on it that I'm not sure that we would have had in other ways. It's been good growing that partner attendance. But as Louise said, it's about ownership of the work outside those meetings. And we want to maximize that that work. So I think the benefit of having a formal Combating Drugs Partnership Board meeting twice a year that's aligned with the Health and Wellbeing and Safer Communities Partnership Board meeting schedule. So that we're maximizing the time for that working group activity and the joining up that goes up on professionally outside the meeting. But also, reporting into the Health and Wellbeing Board and the CDP and the Safer Communities Partnership Board as that public, formal public expression of the work that you do. I think it's a really important the board, the Combating Drugs Partnership Board certainly saw the logic of moving to that format. And I think it would be a very positive thing to do. So I hope the board would share that. So do I have any comments or questions for Louise about the work that's going on? I think I would just reflect that actually it has been a really busy two years and we have moved a number of areas on considerably. But obviously, the work of the police in the Clearhold Build, Operation Dakota work has made a step change in what's gone on. That certainly changes for a part of the borough that I think was probably, it's fair to say, was blighted by drugs issues in that community. So if nobody else has any additional comments or questions, I think Fiona has her hand up. Thank you very much for joining us when you weren't feeling well. It was much appreciated, but really important that we note the value of the work that goes on and the amount of work that goes in to the Combating Drugs Partnership Board and the work that goes on outside that. Thank you very much. Sorry, sorry, Chair. I do apologize. I thought you were wanting to speak. Please do so before we wrap up. It's just a very quick question and taking into account what Nick said when we're looking at the pharmacy needs assessment. I wondered if there were any accessibility issues for individuals who need treatment out from pharmacies like methadone and things like that outside of usual work hours and whether or not we actually as a board should be pushing for things like from the pharmacy need assessment as well. Louisa, if I let Nick to start a comment and then you can follow up if need be. Yes, I think there is, for my understanding, we don't prescribe it anymore, it's done by CGL, but I think there is a provision to CGL based in Edgware. There's a pharmacy in Edgware that provide it on the weekend and then at Binchley Memorial Fair we pharmacy provide it out of hours as well. The majority of patients are on a weekly script, for example, and they'll come on a designated time every week. So let's say that their appointment is every Monday and they'll go every Monday and collect them and it won't be on a weekend generally that they're seen. So probably the likelihood is low, but there are two pharmacies, one in Edgware and one in Binchley and maybe more in the other part of the borough, but I'm not familiar with it. Yes, I thought there was borough coverage in that sense, but Louisa, do you have anything to add? Yeah, there's really good by the borough coverage and we review it regularly through our sort of needs assessment work to make sure that we have got access across the borough. And actually there's a really interesting new medication that's just coming on the market, which we're launching in the service, which is aimed at people who are very, very stable and might be in employment, which allows them to. Don't ask me the chemistry of it, but it's it's a very expensive medication and we will be prescribing it now anytime, actually, which allows people to have really less frequent pickups and it's a much safer medication. So it's really positive. And the service has actually now moved as well. And it's in Hendon. So that was a couple of weeks ago. So we are in the process of updating comms and communicating that out to partners. Yeah. It's a much better location. Thank you, Louisa. And I know that we've had a number of very dynamic discussions within within the partnership board about that. The interface with with housing and a range of other issues. So it's been a very active partnership, but it is about helping people to stay stable. Recover from drugs, but actually also through the education program, preventing young people from getting involved in the first place. Thank you very much for that. We have three formal we have two formal yes, two formal recommendations to make that the health and well-being board note and comment on the progress of the Combating Drugs Partnership and approve the updated structure of the CDPB outlined in section one point six of the report. The reasons for that and the the the reporting that will go on formally going forward. So we agreed on that. Thank you much to everyone. And just to note that Paul, Councillor Paul Edwards had to go at 11. He was he's judging a care home art contest. And so in his role as adults lead, he was going to have to go and do that. So but he had let us know that he was going to do that right. Finally, we're moving on to the last substantive item in the agenda, and that is the communicable disease update from Janet. Janet, Director of Public Health. Thank you very much, Chair. It is a verbal update in other forums across London already. At the moment, they are still setting up and working to sell material, a document, a pack to support them. And next week, we'll be having the annual winter preparations. Infection prevention control. Yes. That's the word. We just agreed with the chair earlier. So going forward, we are happy to bring a more. On why their health protection that work in barnet, which goes beyond the nation. Thank you. Thank you very much, Janet. Does anybody have any questions for that was a really comprehensive item. Thank you. It was my desire that we kept this on the agenda post the code reports. But I think it's really helpful, not least in the light of the discussion that went on at scrutiny. The scrutiny committee at the evening about concerns about vaccination rates and understanding the work that goes on to support that in the context of the cancer screening work. Perhaps you or Claire would like to share the news about your grant. Yeah, congratulations to the happy couple. The congratulations to us as well. So we got notification on Monday that's Barnet along with Harry gave been awarded two hundred and thirty thousand. We mentioned earlier. That's really good. Thank you very much, Claire. I think we're celebrating while it's not a communicable disease, obviously. Well, this is it's just really important that we that we make the most of grants like that, because this is tackling. As I understand it, going some way to tackle the inequalities in uptake of cancer screening across our across some of our communities. So it's really focusing on ensuring that that prevention and intervention that we all want to see is being enabled in that particular area. But there's also the issues around communicable diseases. There are some health inequality issues with that. And, Jess, you'd like to comment or ask a question. Just in terms of the grant. Fantastic news. Keen that we make sure we draw in the work that we've done post Leder. So the Learn Disability Review of Mortality to understand where screening of people with a disability or people can. It's an area that that really is important as part of that. Does anybody online have any comments or questions for us? Thank you. Fiona's made a comment. Yes, that's an AOB. So I'll pick that up under AOB. So thank you for that discussion. Janet, thank you for the report. And I hope that we'll continue to have that. And thank you for undertaking to share those those reports with us ahead of the meeting where possible, because that's a really helpful thing to do. Partners around the table will see those. There's a ghost in the chamber. The partners around the table will see those reports in different contexts, but some of us wouldn't pick those up. And it's really important so that we get that that broad picture of the work that's going on around communicable diseases and vaccination. So our recommendation is that the board notes the update. Thank you very much. We do. We do that. We have. The item 11 is the forward work program and the request is that the board notes the forward work program. Obviously, much of this year is going to be formal reporting, but actually also the development around the joint health and well-being strategy. And so that will be a pivotal meeting in January to to bring that together and send it off for wider consultation. But we will have our working session ahead of that. I hope as many people can join us on October the third as possible so that we have the richest and deepest discussion we have going forward. But a lot of what we've discussed this evening leads into that. So item 12 is always a list of the health and well-being board acronyms, which is useful for those who are not health professionals. I'm going to take item 13 as any items the chair decides is as urgent as an AOB. And I have a message from I don't know whether you'd you'd like to speak Fiona Bateman, who has joined us over the last couple of years as the chair of the adult safeguarding board. Her tenure finishes as chair. At the end of end of December and after she served for seven years. So I think that's a hugely big contribution to safeguarding in Barnet. So it's likely that this will be your last meeting. She says it's been a privilege to have been on the board and for the work of the Barnet safeguarding adults board to have been so well received by partners. Fiona, I think we have a great deal to thank you for in the input that you've had to this and to many other parts of the committee and service structure in Barnet. So thank you very much. I'm sorry this will be your last meeting, but thank you very much for all the input you have had over the years. And we look forward, obviously, to working with your successor, but we will miss your input and insight and the reflections you bring based on that seven years of experience within the board. Thank you very much for your input. Thank you. And I wish we pity in a sense, it's a pity we're not able to be. But you are always welcome to come and sit in the public gallery if you should. Should you feel so motivated in future and ask us questions and hold us to account. But thank you very much for all your input. Thank you to the members of the board who have been who joined us online and at the table today. Thank you very much for your input. And for the public gallery, I know that the former chair of the committee has joined us as well in the public gallery. So it's good to see you, Caroline, to hear our discussions and look forward to both to the next formal meeting, but more importantly, perhaps in the first instance to our working group next month. Thank you very much for your time and for the input from officers.

Transcript

For us, we had a minor technical glitch to start with, but we now have contact with everybody that has had to join us online. So, we are now – we've got a quorum, so chairs – good morning. I'm Councillor Alison Moore, Chair of the Health and Wellbeing Board. Thank you for attending our meeting this morning. Please note that meetings may be recorded and broadcast by the Council or by people present. Can I remind members and officers to use the microphone when speaking by pressing the middle speaker icon? And obviously, for those of us who are online, to unmute yourself when you speak. So, moving on to the agenda properly, we have minutes of the previous meeting. Does anybody have any corrections of matters of facts to those meetings – those minutes? Okay, then I will, at the end of the meeting, sign those – the true record of the meeting. Item 2 is absence of members. We have apologies from Dawn Wakeling. She's substituted by Jess Bames-Home. We have apologies from Sarah Campbell and Deborah Sanders. We also have apologies from Louisa Songer, who, due to COVID, is joining us online. And Fiona Bateman, our Chair of the Adult Safeguarding Board, who has a clash and is joining us online today. So, welcome to online and people – members in the room. I would just ask – we all know each other, I think, well now, but when you speak the first time, it would be useful just to say who you are for the purposes of anyone who is watching us online. Do we have any declarations of interest – members' interests? I would just say – I just want to – though it's in my own declaration, I am the Council's nominee on the Governing Council of the Royal Free Trust, and I welcome that we've got a grant to do some work that's come from the Royal Free Charity. Do we have any dispensations granted by the Monitoring Officer? There are none. Public questions and comments? There are none this month. And so, we move on to our first substantive item, which is the Joint Health and Wellbeing Strategy update. And Claire O'Callaghan, Health and Wellbeing Policy Manager, will introduce the item. Claire, over to you. Lovely. Thank you very much, Chair. I'm just going to make notes. So, this report is the regular six-monthly report on the current health and wellbeing strategy. So, it gives the update on the implementation plan status that we're using to track impact of the strategy. And secondly, it also gives an update on the current – the future health and wellbeing, which I'll talk a bit about later. So, first of all, the current health and wellbeing strategy. So, most of the implementation plan is now either completed or on target to be completed by the date. There are two actions in the plan which are slightly off target. So, the transition of the Healthier High Streets program to its kind of future delivery model. That's slightly delayed from its current completion date and should be completed by the end of 2014. And then secondly, the recommissioning of smoking cessation and NHS health check services. The mobilization date for that has now been confirmed for October. That will be slightly later than advertised. In terms of indicators, roughly the same number of indicators have improved since the baseline, which was set in September 2021. Five indicators are showing a more than 5% adverse movement from the baseline. So, these are the total number of food bank beneficiaries per month, which has gone up. The proportion of babies being breastfed at six to eight weeks at the health visitor review, which has gone down. Emergency admissions from ambulatory care-sensitive physicians and life expectancy at age 65 for both males and males. So, that's the current strategy. Talking about the future strategy. So, over the summer, we've been doing some work with partner conversations looking at the updated Joint Strategic Needs Assessment, which you've seen at a previous meeting, and looking at other boroughs and the ICS population health interest. The priorities might be for Barnet in the new strategy. We are planning to take this to a meeting of health and well-being board members, an informal meeting at the table. And if you don't have it in your diary, you will do by the end of this meeting. And the intention is to have a long list of priorities to take out to wider public consultees over the next few months. We're still on track to have a draft strategy by January. So, the next time we meet, we'll have a nice draft strategy that you can comment on and approve, hopefully. And then, it will be a more formal consultation over the spring, aiming for… Thank you very much. I think there's two parts to this. Obviously, there's the current progress on the current health and well-being strategy. Does anybody have any particular comments or questions to make about that? From my perspective, perhaps you could just clarify the situation with respect to the recommissioning of the smoking cessation services and the adult health checks. And is that a contractual issue? And it's not a major change, but it's a recontracting. Yes. So, my understanding is delivery on both of those things has been continuing. So, it hasn't been a stop in service delivery. I don't know how much, because in some of the documents, that's not entirely clear. There's some crossover with our plan to ban it. And there was an odd phraseology that didn't make that quite clear. So, thank you. That's really helpful. Does anybody else have comments on any of those other areas? Any reflections from our health colleagues about the life expectancy issues and any reflections on how we might be combating that? I think… Sorry, Jess. I do apologize. So, Jess Bains-Holmes, Director of Commissioning for Adult Station Care. The question really was just to clarify. So, our emergency admissions for ambulatory care sensitive conditions have gone up, which is clearly not great. But I just wonder, the baseline is 2020 to 2021, which is the usefulness of using that as a baseline. Probably Janet. So, I'm just understanding if that's useful for us to measure it against or if we've done some other review of… Presumably, it was the baseline that was the start of the well-being strategy. So, I think a narrative around it would be appropriate. I'm assuming that… I don't know whether we are in terms of dates, whether we're in line with other statistics. But it may be important to be comparative. But we will be resetting those baselines with the new strategy, I think. But it's a really valuable point because the same is… There isn't a reflection on the change in life expectancy at 65. Some of that has been influenced by the COVID and post-COVID figures. I am assuming, but I'm not a specialist in that, but I'm assuming that that's the case. Kay. Thank you, Chair. I'm Kay, as Director of Operations. I'd be able to address this. That's a very pertinent point. And if you haven't already had an opportunity to delve into the new joint strategic needs analysis, actually, there's a huge amount of data within that and where it's been possible. Where it's possible to have it at a ward-based level, we do. Slightly, because of the new ward structures introduced in 2022, there's a little bit of transitional data there. But we've also, where we can go down below ward levels to MSOA data, we have done that. Now, that has confused some people because the names are quite colourful and do not align with wards. But actually, that gives you a tie-up through to ONS data. And so we are able to do some of that geographical analysis. And yes, there is, I'm sure there will be differences that we can unpick. And that would be a really helpful exercise to do in terms of then targeting our work and our resources into the places where we will make the most difference. Simon. Thank you, Chair. I'm Simon Wheatley, I'm the Director of Place West for the Integrated Care Board. Just to say that I think it's nationally appreciated that changes in life expectancy are multi-factorial. And certainly, what we're seeing in Barnet is disappointing, but something that's reflective of the national picture. I think you're right, Chair, that actually a recognition of the geography and also some of the specific communities would be even more important. From an ICB perspective, we're introducing a new long-term condition locally enhanced service. Nick would be able to speak to this in far more detail than me, but that is an expansion of investment in general practice to focus really significant investment that we're progressing at the moment, Chair. Thank you, Simon. And as you will know, the Adults and Health Scrutiny Committee have just completed a task and finish group on access to GP. And that will be coming to the Cabinet meeting in November, I believe. And there are recommendations both for us and actually for the ICB as well within that. And that would be really helpful. We recently had some discussions around the GP survey, and that does talk to the issue that some of our GP practices need some support in getting to where you want them to be around that continued management of older patients with those with ongoing health issues. Nick. Thanks, morning. I'm Nick Detani, GP and Clinical Director of PLACE. I think what we saw over COVID was that a lot of patients became deconditioned, and that deconditioning is now having long-term conditions impact. So, for example, we see a massive increase in patients with heart failure, for example, because they've been deconditioned and not exercising and stayed indoors for often a year. And we're seeing a big increase in pre-diabetes. And then we're also seeing a big increase in cancer diagnoses. And so what's really interesting is a lot of those are linked to not exercising, not eating well, and what people have missed out on in the year or two of COVID. So it's going to probably have a knock-on impact for the next 5, 10, 20 years. I don't know. Public health might give us an idea, but it's going to have a massive impact. And so what Simon talked about was the long-term condition locally-commissioned service that's now in North Central London. And really is exactly what Simon said, allowing general practice to focus on prevention, because actually what we've been doing is tackling acute illness, and what we're better at doing is managing people's long-term health to keep them living healthier and for longer. And one of the things I think we need to think about in our strategy is actually getting people more active and understanding their long-term condition, which is a missing feature. So if I diagnose somebody with heart failure, and I can medically optimize them, but what I can't do is get them to the gym and getting them to buy foods from the supermarket and understanding what that means for them. And that, I think, is the missing link. And actually, what we learned over COVID was that people talked to each other, and how did we get COVID vaccinations so great, because everyone talked to each other and encouraged them. It's the same thing with long-term condition. I bet most people on a neighborhood will have congestive cardiac failure or diabetes, and actually want to stick together and actually make a better lifestyle for themselves. So I think that's the things we might need to focus on. Thank you. That's really helpful, and that actually gives us a topic of conversation for the third, because it reflects some of the things that we've been – a conversation that we've been having recently with the Director of Health and Director of Adults. Claire? Yeah, just to come back on the life expectancy. So last year's annual DPA, it's got last year's data, but the factors are very much the same. Thank you, Claire. That's a sensible reminder that, of course, there is a huge amount of information in... And thank you, Nick, particularly, because I think that sense of being able to help people to build agency and understanding and control over their health and understanding that there are things that they can do to improve that situation and what they don't. I think that's a really positive way forward, and I think it's something that brings all of the partners around the table actually together around that issue, because it involves wider parts of the Council, but actually also community and acute health as well. Pauline? Maybe a various communities to try and get an increase, but I think – I mean, what I was trying to explain last night, and I'm sure in fact, was a lot of hesitancy about immunization. We are monitoring progress on immunizations. Those reports aren't public, but thank you for the reminder. We will make other relevant members to share updates on the issue of vaccination hesitancy. It's a national wide issue, unfortunately, and I'm sure a clinical colleague. Thank you. Just to add to that, there's about 5 million population in continental central London eligible for a COVID and flu chapter. I ask Councillor Edwards to speak. I would just reflect, and it's a conversation that we were having following the meeting yesterday evening and that conversation about vaccinations, particularly childhood vaccinations, and actually a reflection that there's a younger generation of parents who may not appreciate the seriousness, for example, of measles. I'm old enough to have grown up with friends who had eye problems or hearing problems or a range of other problems that resulted from having had a measles infection, and it was a relatively common place when I was a child. I don't think young parents now really always understand the real ramifications if we have a measles outbreak, and I know that an awful lot of work has gone in, both across a bonnet in terms of promotion across NCL and the wider NHS in terms of promoting vaccinations pre the school term. And there has been some work, for example, through the London Jewish Forum and other groupings to try to encourage vaccination rates within some of our communities who are most resistant. It is a really important area and it is overcoming all sorts of, I was going to say ignorance, I don't mean it that way, but lack of understanding of the impact for some communities. Yes, thanks to, excuse me for my ignorance, but I can't see anything in here, and this is not a pun, around ophthalmic or eye health in terms of wellbeing. Can you please repeat what health, I mean eye health, I'm sorry, eye health wasn't mentioned specifically on the number of outcome KPIs is limited, and whilst I absolutely agree and appreciate eye health is important sooner than in mature age. Absolutely, and there's somebody whose eye defect was picked up by that first check in school actually when I was first in reception. That's a very good point. Paul, do you want to carry on? Yeah, I also think it's important because I used to wear glasses firmly and I've had cataracts removed and it's helped my vision remarkably. What occurs to me also is the cost of it, and I'm wondering whether for some people that's prohibitive in terms of just going on a regular basis. It's the same, but I'm talking about eyes. I mean you can't go to an optician without paying some money. I discovered because there's something I'm going to have, something done on my eyes. There's even an NHS price that you can pay. So there's the private price, but there's still an NHS price. And I'm just concerned, you know, in general about particularity than somewhere else in the councils. It's a point well made, I think. Any comments from our partners? Okay. Regular eye checks for children. It's not like part of a regular health check. I know I was never offered it. Well, not for my child anyway. I think that's a question for our partners. Nick, if you could shed some light on that because clearly I'm talking about a different generation of my eye tests. There definitely is two sets of eye checks in schools for the ages now, but there definitely are. It probably has changed over the years. I don't remember what it was like when I was a child, but certainly now there is two sets before 16 that I've offered. I mean, certainly that would be something. Fiona Bateman online has made a comment that it's also true of hearing tests. And there is an expense. Thank you, Fiona. Absolutely. Absolutely right. We've got two different things going on here. We've got we've got talking about the cost of eye, dental and and and hearing checks within with people and children's testing. And there is a comment from Louisa Songer, which I'm assuming is from her current understanding. There's hearing and eye tests at school at five and six. And Claire would back that up for those who have pupils. There is there is something that replicates the sort of testing that I remember as a child. But it's not it's not wrong, actually. And the the implications for all of those elements can be quite significant. And if I understand correctly, there is some correlation between loss of hearing and developments of some forms of dementia as well, because I'm assuming because of neurological input. So I think there are that's a question we might well, very sensibly ask. And I would just be moved to comment on how Chris would appreciate you mentioning this. One of the things when we took the AUSTED, the outcomes of the Children's Services report on Tuesday at Cabinet, one of the positive comments was around the timeliness of both optical and dental checks for children looked after. And I think that is something that may not always have been the case. And so it's very pleasing to see that we at corporate parents can be assured that at least in that context, there are checks going on. Thank you. Any other comments? So. Sensory and sensory impairments can lead to social isolation, which sadly increases the risks that adults with care needs will suffer neglect and abuse. So actually, there are a range of reasons. And maybe that's something that we would want to look at in the future. It may be an appropriate subject for a scrutiny commission task and finish group. Nick. So I just checked. So you get a hearing test at birth and an eye test. And then the eye test is done again at the six to eight week check at the GP and then between the age of four and a half and five and a half to school. And then it's then not done again, but it's free for any child to have an eye test or hearing test between the age of five and 16. Hearing tests are actually the GP and the eye test done any optician free of charge for under 16 to 19. Occasionally. I just checked. That's really helpful, Nick. Thank you. So there is a program in place. There may have been disruptions during the Covid period. And it is about and it is about engagement as well as access from parents. Okay. Agree. And that is really helpful. And I suppose it's then just how do we ensure that that message is out? Because if colleagues around this table don't know that, I suspect a significant portion of our population also don't. And therefore, are they taken? How do we make sure collectively we're getting that message out to all families? Both ends of the age range. We're looking at ensuring that people understand what is available. The benefits of that and the risks if they don't. I mean, clearly eye checks for those who are older. It picks up all sorts of things like glaucoma and a range of other conditions and therefore is particularly important for older people. But actually, young people, you know, I had a friend at school who wasn't doing terribly well. And then they moved him alphabetical arrangement in the classroom with a child who joined, moved him from the back to the front of the class. He could see the board. And actually, his results then kind of climbed rather steadily. And so it's just a case in point that understanding that Councillor Coakley Webb's comment was perfectly right. You only know as a person what you see and you don't know whether that's normal or not. It's what you see. Okay. I think that's really helpful thinking about the future. One of the things that we'll want to talk about when we come around the table and discuss how we evolve the next health and wellbeing strategy is a range of those topics that might or might not form part of the strategy. Obviously, I'm really concerned that we make sure that we both for meetings and for the work that we do together, it's where we can collectively add value and make the most difference through the strategy already through these meetings. I think we've had several really insightful comments around the table today. But I look forward to having those deeper discussions in our workshop session at the beginning of October. So the formal part of item joint health and wellbeing strategy update is that the board comments on and notes the progress on the current implementation plan and the key performance indicators the board reflects on the current progress of the joint health and wellbeing strategy development. And unless anybody has anything to add at this stage, can we all agree those recommendations? I'm happy to have the comments that we've made. Are they minuted? They are indeed. And if you look at the minutes that we've taken today and that I'm signing off, PACS does a very good job in trying to capture our sometimes complex discussions around the table. Yes, they are very full minutes, so they do record what we discussed. Thank you. OK, moving on now to the next item, item seven, which is the pharmaceutical needs assessment update. And to note there are two appendices within the PAC, the map of pharmacy provision and the process for responding to applications for changes to pharmaceutical provision. The item will be led by Dr. Deborah Jenkins, consultant of public health. Thank you, Jeff. So this agenda item is to provide the board with a routine update on the pharmaceutical needs. As the board will be the last pharmaceutical needs assessment was approved, approved and published by Barnet in 2022. And since then, if there are changes to pharmaceutical provision, since the last published published statement, the board needs to review the impact of the change. The previous update to the Health and Wellbeing Board about changes to pharmacy provision was in July 2023. Since the update in July 2023, there have been several changes of ownership of various contractors in the area. Only one pharmacy. That pharmacy is Bishop's Pharmacy in Hampstead Garden suburbs. The pharmacy reduced opening hours from 6 p.m. close Monday to Friday. It was previously open until 7 p.m. It is now closed on Saturdays. It was previously open from 9 until 6 p.m. The impact of this change has been reviewed with the conclusion that it would not lead to a potential gap or poor provision of the pharmaceutical services in Barnet. But this and other changes of ownership and maintained pharmacy list has been updated, but no further actions are needed. As you can see in Appendix A, this is a screenshot of the interactive map of pharmacy provision in Barnet, which has been produced and is published on the Barnet website. The map and underlying data are refreshed and updated on a quarterly basis. I'll turn to the next appendix now, so I'll just change the screenshot. So the second area I'd like to draw your attention to is to make a process clearer, and this is the process for commenting on pharmacy change applications. When there are applications for a change in pharmacy provision in the borough, this is shared by NHS England with the Barnet public health team in order for the health and well-being board to comment. To standardize this review process, this is the chart that we've produced for the suggested actions in Appendix B. The current process is similar, but this change involves both the chair and the vice chair of the health and well-being board to review the pharmacy change application. So in brief, the flow chart describes the following steps. Barnet public health received the pharmacy change application. We then send the change application to the pharmaceutical needs assessment technical support, which is currently provided by an external consultancy organization called Soar Beyond to review the proposed change. The technical support team reviews the evidence and provides a recommendation on whether the change is significant or not. If it is significant, the evidence, suggested recommendation and draft response is sent to the chair and vice chair of the health and well-being board for comment and review. Barnet public health team then updates the draft response from the chair and vice chair as needed and sends back to NHS England. After that, if the application is granted, then the Barnet public health presents a supplementary statement or a fresh needs assessment to the health and well-being board if this is needed. Thank you. Back to the chair. Thank you very much. Does anybody have any comments on this? I mean, I would say in welcoming the tightened up procedure for responding to applications, I think it would be very helpful. I would certainly value the vice chair's comments. Clearly, I'm not a professional in this, though I bring, I hope, a community understanding to it. But it's such an important area and pharmacies are playing a larger and larger part in our spread of health and well-being services. And so I think it's really important that we understand the spread and sufficiency of those across the borough. Nick. Thank you. So I don't have any objections to this. I think it's great to have the flowchart. The only comment I make as we're, you know, we're trying to get pharmacies, community pharmacies involved more and more in patients health, more that they can offer to patients. Often patients don't realize is my fear of the opening times of convenient patients. So, for example, now I'm not a personal user of the pharmacy much, thankfully, but whenever I've needed to use it, I've had to hunt around for a supermarket pharmacy that's open to 8 p.m. There are not many and there's not many of those in Barnet, as you can probably see from the map. So thank you. I live in Hertfordshire and there's availability. But I think there's a missing link to say is that you can't predict when you're going to fall ill. And people generally fall ill on the weekend when things are shut. And so in the future, how can the farmers think about providing that provision on Saturday? In particular, Sunday is a crucial day when everything's sharp, but you want the pharmacy to minor illnesses. So how can we think about that provision in the future? Thank you, Nick. Janet? Yes, thank you very much for those comments. They will be noted, I suppose, in the minute. It will be incredibly helpful as we are just about to start the update of the pharmaceutical needs assessment. And I think it in any way, I agree with you. I just yesterday I had to rush a rush of work to catch the pharmacy during their opening times. So I think everyone can resonate with that. And it's important to consider that one more comment as well. As you know, that extended access service by General Practice is now provided on a Saturday from 9 a.m. to 5 p.m. And so I do that maybe one clinic every quarter. And I struggled. I have to print prescriptions for patients and then try and hunt down a pharmacy on a Saturday morning. So it's a challenge for patients, you know, if there's one pharmacy in the area open and you've got 20 people trying to get something on a Saturday morning. And so I understand, you know, the close and it's hard to staff it and the cost of staffing a pharmacy is not cheap. But it's just about what provision can we think about in the future because we are starting to go to a seven-day health basis. I think that's a really, really helpful point and one we should think about, particularly as a growing borough. And one of the discussions we have had recently was about a pharmacy on the west of the borough. My apologies, Jess. On the west of the borough and recognizing it's not only a rising population but perhaps a population with different behaviors and looking at how we work with those who are working lives. I think it's really important. But the reflection of marrying pharmacy timings around an expanded GP practice time is a really well-made point. Did you hear that? Did you hear that? Looking at this map where it says where all the pharmacies are and having had to, like you said, have to hunt for one that's open, how and who can we actually have information both with the addresses and the opening times of all the pharmacies that are available? And it might be, even though these are the ones that are within Barnet, if someone is living on a border, it might be that, say, that a pharmacy just over the border in Enfield is available or over the border in Haringey. And I think we've got a duty to be able to actually have that information on hand. I don't know who will be able to produce it or whether we can pull it out as council information, but for me that seems to be really important that we can plot the addresses and that we can actually tell residents what the opening times are so that when they've got an emergency, they're not, as you said, hunting around in a state of panic wondering where they can get their prescription from. I have Jess and Claire come in. Nick, if you'd like to comment? Yeah, council, so the information that you've got is on the Barnet website, but only patients probably won't use our website or use the NHS website. So the generic one I've got here, you put in your postcode, it shows you all pharmacies in any borough. But I think what Nick is saying is certainly if it is a GP led prescription, you will be able to sign post to the nearest open pharmacy. And whether that's something that we, is there a prescribed definition that is a sort of a national definition? If there is, really we want one that is a Barnet specific, what we want to encourage residents to expect of them. That's a really good point and actually there's been quite a lot of coverage on the radio, certainly on the radio over the last couple of days about pharmacies and the challenges that that changing role will present. Would you mind if I took Simon first and then? That's a very kind chair, thank you, significantly more than it perhaps meant to me three or four years or so ago. I would agree and very much think pharmacies as part of our health and wellbeing family in terms of that broader agenda that we're developing in terms of keeping people well but treating them when they are unwell. Claire? I suppose, I think my intervention for topic for discussion. Debra, do you have anything else to add in summing up the paper and the discussion? Thank you, thanks for all the comments. I think a further discussion on pharmacy provision would be really helpful. We have some links already for future agenda items. Thank you very much, and I look forward to that discussion. It feels like a very mature stage of regarding them as part of that partnership. Formerly as part of the paper, if nobody has any further comments, we are asked to note the changes in pharmacy provision in the London Borough Barnet since July 2023 and agree with the suggested and whether we agree with the suggested process for reviewing applications for the changes in pharmacy provision in the borough as outlined in Appendix B. Is that agreed? Thank you very much. Now move on to item eight. That is the suicide prevention annual suicide prevention plan annual report. To note that we have a which is the annual report itself, and the item will be led by Saher Keke, who is our public health strategist and Rachel Wells consultant in public health. Thank you very much. As part of Barnet's suicide prevention partnership, I'm pleased to present our third annual report since the publication of the strategy. Last year, the partnership created an ambitious action plan in line with the publication of the cross-government suicide prevention plan, and this report made an attempt to demonstrate how each partner contributed to preventing death by suicide in Barnet. In particular, how we collaboratively supported the groups who are known to have elevated risks, putting more emphasis on addressing the wider determinants of health. What is new about this report is the change of reporting period to align our reporting with the ONS statistics. We will continue to report statistics per calendar year as opposed to financial year. Our current suicide rate is five per hundred thousand. Although there is a slight increase in comparison to previous reporting, this is not significant. We are still amongst the five lowest suicide rate in London and probably in the country. Our innovations to reduce death by suicide and the strength of our partnership continue to put Barnet on the map last year, and I hope that you have managed to read some quotes from some of the partners involved. Finally, I want to highlight that this report proposed the renewal of the strategy and welcomed the board to feed into process.

Thanks, Chris Monday, executive director for children and families. Thanks. It was really useful and a good report. It's good to see all of the really positive pieces of work going on. I'm aware that there was a really strong cross-referencing between the findings from what used to be called serious case reviews, now called learning reviews, where the safeguarding partners have come together and undertaken reviews. I'm aware that there have been two or three in relation to suicides, and there's ongoing work in relation to some specific issues now. There's one on suicide and filicide, of which we've had two incidents where there's been a suicide of issues around children experiencing issues, both of their autism and gender. I didn't see those things coming through in the annual report, so I wonder if in the future we can make sure that there's a really strong link to the plans that come out through those multi-agency safeguarding arrangements that set out a whole range of issues. One of the issues that I don't think we're addressing fully in this is the role of private psychiatric services. Both cases that I'm aware of where there were particular challenges, both were being managed through private provision, not through state provision. I know that there were a number of recommendations made in relation to that, but that's absent in the report as far as I can see. I wonder whether we're picking up all of the intelligence that is available. It feels like this is the plan and this is what we've been doing, rather than this is what's been going on in the wider context, and these are some of the things that we found from there. To have two suicide filicides in one borough in the space of possibly less than a year, I think is something that we need to understand more and understand what we're doing about it. Indeed. Thank you, Chris, for that. Fiona Bateman is online and would like to make a comment. Just to provide some assurance, perhaps to Chris as well, all to maybe offer, because Tony and I have met to discuss the learning across the safeguarding adult reviews and the children's learning reviews. What we should do and what we could do is invite, see how to mix those meetings, particularly when we're looking at the learning that's linked to suicide prevention. So I think that would make it much easier for that to kind of connect the work. But going forward, I'm afraid I've had over the last year clashes with the suicide prevention group, so although I do always read the papers, I can't physically be in the room as I'm stuck today. So going forward, the vice chair of the safeguarding adult board will be an active member. She's already really well connected with partnerships across Barnet. So I think that learning will be more embedded in the work of the partnership going forward. But definitely, Ciara, if you'd welcome coming to those meetings that the two boards have to look at, you know, how do we join up the learning from those safeguarding reviews, that would be really helpful. I'm wondering whether, because every child's death, you know, or suicide in particular, has an after-action review, an after-death review, and it's interesting to see what the learning is from that. And I wonder where Chris has mentioned there's some private psychiatrists involved, and that may be just because of the lack of access, some of the NHS services and the long waits of 12 to 18 months is possibly a reason for that, unfortunately. But how can we learn from that? What can we change? The second thing, I say this every year, but one of the biggest things that we see now is social media. And I believe it's certainly linked to possibly death or suicide or people feeling low and depressed, actually signpost people using social media into services available, because we can put things on websites and posters and things, but young people don't use any of that. They don't use Instagram and TikTok and whatever else it is nowadays, they can't even keep track. And I also remember about five years ago, I think it was the police, I can't remember who it was, but came and gave GPs a talk on all the apps that were there, and I was astonished. I was like, never heard of half of these apps that are out there, and how do we educate parents into knowing what are the signs to look out for? Because there are a lot of rogue apps around for children, and how do we educate parents to look at what signs to look out for in their child or young one to pick up if they're going through a bad time and they're at risk of suicide and how to seek help? Because I get a lot of parents coming in who have got young children who have harmed themselves or are low, and they had no warning signs, and there probably was a warning sign, but they're not looking at their phones or looking at the right things on their phones. So I would like us to think about the generation of the future is all online, how do we read that and how do we, I don't know the answer, but just leave you to that. Thank you, it's a very thorough report. I'll take Jasmine Holmes and then Pauline. What jumps out at me is the statistics, sorry, and to echo the fact that this is clearly an excellent program of work, and what we're doing is to sort of pick out the things that we think would be even better. The national statistics around ADHD and autism diagnosis in suicides obviously assume you've had a diagnosis, and to pick up Nick's point again, the issues that we have around delays, waiting times, reduced access to diagnostics for NDD. I suppose I'd like to understand a little bit more about where we're seeing self-harm and suicide as a result of lack of diagnosis, lack of access to support, and I don't know how we can do that work with most of the diagnostics and support. But given that we know that we've got clinical restraints and financial pressures, understanding whether that is playing a significant role and that lack of diagnosis means that you struggle for longer and are likely to there. Yeah, I think to pick up on one of the points you said, I think, and Christopher confirmed that one of the things we found is that people accessing private therapies was often a cultural thing. It wasn't so much that they didn't, they just didn't want to contact NHS, it was different. One of my beliefs is that when you have these private practices, they are not, and I still think it's still the case, they're not required by law, therefore, to inform that person's general practice, therefore it goes unnoticed until the worst has happened. And when we look at the issues, well, the issues with social media and with things like self-harming that can ultimately lead to suicide or be more than one that have taken their own lives and that it's been related back to what you find on social media, they're still reporting that that still can be happening and I don't know how these social medias can be taken into account. They're talking about restricting, they can still access information and if not, they will use somebody else's phone or whatever to access it that then has got a verified aid. I think it's a really hard battle for us and how we can work with schools and parents and health professionals to try and stem this really horrible, you know, plague of social media that is actually influencing young people, whether it's to be for self-harm or their body image to what they think they should be and what they are and I'm sure that that is the root of an awful lot of problems now that would not have existed years ago. Thank you Pauline and I see Nick is nodding and I know that there is some pilot work going on with a range of schools in terms of phone access but that doesn't alter the access to phones outside of school hours. Just in the context and forgive my ignorance on this, is there any way private psychiatrists, private psychiatric health, presumably it's accredited in some way and I wonder if there is any way to lobby for a national change where they're obligated to notify. So because they're regulated by the GMC for example if they're adopted but there isn't anything that they must inform the NHSGP practice so the patient or the guardian has to consent and provide the details of the NHSGP and they can choose if what you're saying is it's cultural, they probably are not consenting to share the information. And then the law is that you don't consent, the practitioner is not allowed to share information because they'll be in GDPR breach. So I suspect it's probably more than not consenting than the clinician hypothesising and what do you do in that situation. Now the clinician can override that decision if they believe it, if that patient is actively suicidal for example. One thing they really should take into account if anything for legislation, it may be that it's just an adult but if that adult, if they know that that family has got young children, that's when the alarm bell should ring to go we need some information, we should not be holding it to ourselves and at the minute it seems that they can not do that. Just to add to that I guess if there's an adult, if thinking about what the right practice should be is that that clinician should then do a safeguarding report because they're lifting up children. Whether that's done or not is another thing but that's what we would do in general practice is do a safeguarding alert. But yeah it's probably what we've done and so I suppose there is some merit in maybe doing an after action review of the deaths that you've mentioned and thinking about what information we could share and certainly in our community I think going to legislation is one thing but in the interim we share something that the nation might be useful. And my recollection is that the same issue around disclosure and sharing has been a challenge in some of the teenage and student deaths as well, nationally not locally so I'm very conscious of that. I'm just going to read out Fiona Bateman made the comment all professionals registered with the GMC, the HCPC etc will be expected to comply with safeguarding duties so should follow local or encouraged by professional regulators. So I think that's a very helpful point, thank you Fiona. So how would you respond to those comments and both in terms of the quality and the value of the report and the work that's gone on because I think that we do need to remember after what is a very fruitful discussion that it is also there is some really good work going on and it's had national recognition, but also what we would what your reflections are on the comments that have been made. We have been working very closely with both Fiona Bateman and also Tony Lewis. And last year, some of the work we did in terms of learning from the safeguarding reviews reflected in the last year's report so I didn't repeat that this year, but that work is ongoing. In fact, in terms of the suicide case and the link with, you know, the issue around lack of communication, any with private sector. So, I have invited Tony to present the learning from the suicide review in the London community platform community of practice for all suicide prevention leads, so that we could collaboratively understand about those issues and also to see if there is any other example in London, and then maybe we can join forces together. You know if there are any good practice. So, we want to raise those issues because they are very, very challenging issues to to tackle. In terms of however I'm going to take all these comments to our start and grow well team in public health to make sure that going forward. We have a better capture of all that learning within the suicide prevention report. In terms of autism and other sort of at risk groups. I know that Jane Abbott, who is our resilience manager. She does a lot of work in schools. And there has been a new service, I believe it's commissions, working with LGBTQI children and young people. With autism, what we have in the councils, we have autism champions group running. I'm a member of that group. And we have been working with Barnet Mancub resources for autism. We have constantly raised awareness amongst the professionals, amongst staff, voluntary sector colleagues, faith organizations about the link between suicide and autism. And inviting people to take up training, which is delivered by Barnet Mancub. I think I'm working closely with family services colleagues from violence against women and girls team. I'm taking part in their reviews. We're gradually building those links. And I will make sure that they all reflect going forward, but that work is emerging and there is a lot more work to be done on that, on these areas. Thank you. Louise is joining us online, has posted, sent through a comment, drawing attention to the suicide and prevention and support after suicide link on Barnet Council's website. And she highlights the stay alive app, which is available on Google Play and other providers, for which the team had recognition and was the source of work with the Middlesex University. So the app has been a very important part of some of the work that you've done. So I don't know whether you want to comment on that, otherwise I'll finish up with some final reflections. Shall I take Pauline's question first and then allow Sahar to sum up? I'm just scrolling down under the figure two, men's lives lost to suicide in Barnet versus everywhere else. And then underneath, this really puzzling sentence. Due to small number suppression and disclosure control issues, we are unable to make accurate interpretation of female suicide rate for Barnet. About suppression of data, but Sahar, if you'd like to. Because it's not reported in the statistics, the rate, because of the small numbers. So we can't -- we don't have the data. Who does have the data? So we receive two such statistics from the Office for National Statistics. And we have the numbers for female suicides, but we don't have the rate. Because of the very low number of female suicide. I know from the safeguarding board when we get reports, we get to know what to give any figure or number in relation to that. I believe, Rachel, you'd like to comment. Could you put your mic on, Rachel? Thank you. Thank you. It was on a previous point, but I just -- I just mentioned on this one. With regards to the numbers, we have the numbers, but they are identifying if they are very small numbers. This report, we wouldn't necessarily put that in, but we do have that information. Can't form a rate on a very low number, but that's why that's there. We do have to suppress them when they're very small. I think that might be something that we can look at a way in which we can present those numbers in a way that gives you more information and appropriate. I just want -- I don't think anyone's asking for dates or times. It's just a comparison between maybe how many suicides are male and how many are female. I think that's all we're asking for. We can do that. We can do that. We can give you some information which would identify that for you. We can amend that in some way. I can quickly mention that from the real-time surveillance system. So we know that about 25% -- 75%. Just one other quick point. Just referring to something that was discussed earlier, and I know that we all know this, but I just thought it might be useful to many digital natives. And thinking about how we work with parents who are also migrating into that world with young people and children who are already in that system. I think it takes more thought across the system. It may well be that trying to engage, and I know that we have done this, but perhaps not as a board with young people around their uses. I think it would be quite an interesting discussion. Because I have a 15-year-old son, so I know what goes on, and it's incredible. And I know some of you probably will be in that situation as well. It's uncontrollable. And I think having a better understanding of how their systems work as a board may well be something worth exploring. And also ways in which their individual resilience can be improved. Chris, I don't know whether you have any comments on how we might use some of our young people's groups to have such a discussion. In fact, there's already that sort of work going on. The mental health charter was developed by a whole group of children and young people, so there's lots of dissipation in that. On the social media side, I think there's some really interesting international changes that are coming about. Very interesting to see as children and young people have the amazing ability to be able to find ways around all of the rules that are -- I'd say this purely as a father whose children seem to be able to bypass every single restriction that we put on their phones. Two of them are old enough to do it themselves now. So I think that there are some things. But I do think it's something that government need to be doing a bit more on the online harm bill. Did that go as far as it should? Is some of the work that's going on in Australia now through their administration about holding providers to account more powerfully? There's been some quite interesting work in that space. But I do think it's something that maybe as a board we should be writing to government about saying, you know, actually should we be going further on? Some of the -- you know, tick tock is supposed to be only available if you're over a certain age. Yeah, lots of children are on tick tock. Instagram is supposed to be over a certain age. You know, these days I think it's about if you're over 50, then you're allowed to be on Facebook. But, you know, there's those sorts of things that are well beyond the realm of us as parents and us as a board. I suppose it's those sorts of things that we need to be saying. What should we be doing in that space and should we be talking to parliamentarians about, you know, are there some things that they want to do more? You know, there's a new children's being act or bill coming forward. Is it something that we want to be saying that there needs to be more in that around online safety? Because I think it is genuinely -- it's a generally scary world that parents don't understand and that children do far more than us. I think the point about data that digital natives versus digital immigrants is a really important point. And Chris has just reinforced that. Nick? I'm just wondering, you know, whether in school programs there could be something around this education about online. Yeah. They had all these icons on the screen and I could recognize about three out of ten. And I thought, oh, God, I'm stupid. But, you know, what does that mean, isn't it? You know, do parents actually know what the apps children have because you just see an icon. So I think we need to -- it's not just the children. I think we need to get adults and parents involved into understanding what's on children's phones and things. And I think that's a wide -- and in reality, that's a wider issue than just around suicide prevention. It's a range of issues across young people's perception of the world and access to data and the online world in a way that maybe those of us who are a bit older just aren't grasping the breadth and depth of that. So that's a really helpful conversation. Sahar, any final comments and then I'll wind up. With regards to the research, the effectiveness of interventions in preventing suicide, suicides are still emerging. It's a relatively new field that's really developing in the last sort of 10, 20 years. In principle, anything that we do in Barnet, I work with colleagues from academia and looking to them to support with their evaluation. And I'm pleased to say that our campaign has been evaluated by Middlesex University, Professor Lisa Marzano and her team. And then they actually demonstrated statistically that the campaign may have contributed to saving 7 to 10 lives across the nine-month period. Of course, there are lots of caveats in this, but nevertheless, it's a very, very positive result and it's a contribution to campaign approach, which was later demonstrated by Dr. Alexandra Pittman from University College London and some other academics from Australia about how actually campaigns can contribute to reducing suicides. That's about it. And I think about the apps. Could I just add to that, please? We are working closely with Metropolitan Police and also Fire Service in terms of monitoring those untoward apps or emerging new methods of suicides. And we are conscious of that. And then sort of jointly in London, we're trying to find solutions if we can identify anything untoward. But these are wicked issues. And I just reflect that we are fortunate to have a university just adjacent to us where you've not only got academic contact, but actually it's a pool of students who might be useful in giving reflections. And I know that some of the work that has gone on through some student courses has been particularly around violence against women and girls, but actually there are a range of other issues that the students will be working on. So that's a possible source of news about the validity and depth in the way that we're doing. But thank you very much to her and thank you for your input. And Rachel, I would reflect that we have in former years discussed at the Health Scrutiny Committee. And I think I would reflect that we've had a really rich and thoughtful discussion this evening. Lots of potential learnings to come out of it. Recognizing the role of joining up and building on and extending relationships across a range of organization and mining the data and intelligence that others have. Taking these opportunities, working, for example, with safeguarding boards. And considering how and looking at how a suicide prevention is set against an evolving online challenge with social media. So thank you very much for all of your input. Now we have three formal recommendations that the Health and Wellbeing Board note the most recent data for the Borough of Barnet. That the Health and Wellbeing Board note the progress on implementation of the Barnet suicide prevention strategy as outlined in Appendix A. And that the Health and Wellbeing Board feed into the forthcoming suicide prevention strategy 2025 to 30 refresh. I think there's been a lot of opportunity to pick this up at some of our informal working sessions. So thank you everyone for that discussion. And we're now going to move on. I would just, because you joined us late, I just want to welcome Monique from Barnet. Good to have you at the table as our BCS representative today. Thank you very much. Very important part of our Health and Wellbeing Board. So thank you. And do pipe up if you want to feed in. Moving on now to Item 9, the Combating Drugs Partnership Board Annual Report. And this will be led by Louisa Songa, who is joining us online because she has COVID. I hope you're not feeling too unwell, Louisa. I bear with me two seconds when I sort my presentation out. Can you see a presentation up on the screen? We can, Louisa. Let me just put it into slide show mode. Thanks, chair. Yeah, forgive me, I'm fine, bit croaky, but all good, all good. But I did put some slides together just to keep me focused, because I'm probably not firing on all cylinders this morning. So hi. Hi, everyone. I'm Louisa Songa, Senior Public Health Strategist in the Public Health Team, and I lead on substance misuse strategy. And I'm here to update you on our Combating Drugs Partnership Board. A little bit of background. It's all in the paper. The board was formed off the back of the new government drug strategy a couple of years ago. We launched in November 2022, I think it was. And all areas were asked to develop Combating Drugs Partnership Boards to do three things. Really want to look at the sort of supply chains of drugs and how we could work with enforcement partners to disrupt these lines and hold offenders to account on it. The second priority was around improving our substance misuse treatment and recovery services, ensuring that they were high quality and accessible. And the third priority was around ensuring a better prevention offer, both in terms of preventing the onset of substance misuse, but also stopping, you know, supporting people from developing those sort of high risk behaviors if they're already using substances. So I put some of our achievements in the paper. There is a huge amount of data available on substance misuse. So it's really hard to try and choose which bits that we put to you. But if there's any interest in any of the areas more broadly, more specifically, we can we're happy to share further information. So the first priority, there's been a huge, I'm sure you're all aware of the work that our police and community safety colleagues have been doing around making the borough a safer place and reducing supply of substances into the community. And so address the sort of wider issues around that they bring around and social behavior and these programs that clear how build approach and some of the other operations that we've had. That certainly partnership approaches which aim to take a really multi-agency approach to the problems and look at it from a systemic point of view. And I put this graph in just to show you that, as you can see, it looks like our drug trafficking offenses in Barnet are increasing. That's a really good thing, because actually what it shows is that the police, this is police data, our police partners are able to respond to supply and, you know, the sale of substances and hold that are actually arresting people and bringing them into the criminal justice system. So it doesn't necessarily mean that there's more drugs coming into the borough, but actually that the police are doing a really good job at targeting those drug dealers. And on the flip side of that, possession, people being arrested for possession of drugs is decreasing, which is good, because actually what we can see then is that people that have substance misuse issues are being signposted into support and treatment rather than being pushed into the criminal justice system. Which can't necessarily address their issues. So in terms of delivering world class treatment service, we've been working really closely with some of our criminal justice partners to improve court pathways, prison pathways, and we've seen an increase in community sentences, lots of work on people with multiple and complex needs. So we have a substance misuse rough sleeping program, which is, I think it's in its third, fourth year of operation, and they're really sort of embedding into the community. The team have managed to build good relationships with people with multiple issues and support them into services. And through that project, we're starting to look at the wider health issues of people who are rough sleeping and also have substance misuse issues. So one of our successes is that last week we launched a dental service for rough sleepers, which is a great success. It's something we've been working on for a long time. So anyone that's rough sleeping can now access a community dentist in Hendon. I think it's one day a week that we're offering that service. It's a fast track service. And also there's oral health training sessions that are being delivered to staff through that program. And we continue to be focused on reducing drug and alcohol related deaths. I've got here rates for barnet remained lower than London, England. Apologies, that's a tie. I think we're actually similar to London and England. What we have seen is over the last few years, the numbers of people dying who are accessing treatment are largely related to alcohol. And what we are understanding from those reviews of those deaths is that there are some significant issues around people with complex physical health problems as a result of their alcohol use and people accessing treatment quite late. So we're really keen to try and change that by getting people into treatment services at an earlier stage in their substance misusing career and also ensure that they have better access to that range of physical health services to prevent those complexities. In terms of opioid related deaths, we remain quite low, which is brilliant. And we are really pushing our harm reduction strategies. So we we have a really good distribution of naloxone across the bar. I think I read yesterday that we're about 70 percent of our opioid users have access to naloxone. Naloxone is an anti overdose medication that people can administer, administer at home or in the community. And also we are now getting nitazine testing strips as well. So you may have heard in the news, there are sort of new synthetic opioid which are way more potent and more lethal than heroin. And so people can can test their drugs before they use them. We have had had one one instance we heard of locally where a chap tested his heroin, found it had nitazine in and actually gave it back to the drug dealer. And I don't want this. So we can see it works and significant engagement with partners to around training and upskilling. And one of our biggest successes that we're really, really proud of is actually the number of young people accessing treatment in Barnet for substance misuse issues has grown exponentially. I think it's at the highest. It's it's been definitely since I've worked in Barnet, but, you know, for a very, very long time. And this is this is great. This is really shows that that service is starting to to get into the right communities and work with schools and really meet that need of young people. In contrast, the numbers of treat people access in adult treatment is staying fairly similar. We really hope to see that drive up. But we it stayed quite flat over the last 12 months. We're really keen to think about how we can improve that through the next year. And again, slide on deaths. And so, obviously, a little bit on the prevention. So we need lots of work with schools around thinking about what the PSHE offer includes and ensuring that schools have access to the substance misuse service to go in and offer that that extra training and upskilling. And we have been looking at upscaling or drink coach service. And again, I think we're in about year three or four of the drink coach service. And for the first time, halfway through the year, we've exceeded the number of counseling sessions that we don't deliver. And there's a slide which just really shows you the how our campaigns have a really positive impact on the numbers of people that are going to the drink coach site and and access in that that intervention. So, yeah, really, really good to see the outcomes of our campaigns. So finally, just a point on the restructure. So we're a couple of years into CDPB now. We formed as a partnership. We've developed our work plan. And now I think we're in a really good position to look at what's working and what's not working. You know, there have been a few challenges to creating ownership and actually getting key stakeholders to drive certain areas forward. So we have reviewed some of the arrangements in other areas and made some recommendations. What we think a revised structure could look like. We presented it to the board in the last meeting in our health and sorry, my competence and drugs board in July and partners were on board with that. This is a structure. So we, if approved by the health and well board, hope to move to this structure in in the coming months. And really, you know, the first one would be very much led around our police and community safety colleagues. The treatment group would be led by public health. And we're looking at how the prevention subgroup can align with things like the only help board and some of the prevention work that's happening in adult social care. And that's it for me. Thank you. Thank you very much, Louise. And before I ask anyone to do for comments around the table, I just want to give a reflection as the chair of the Combating Drugs Partnership Board. And it's been a real it's been a real work in progress over the last two years. I've learned a huge amount. But I've also watched a range of professionals working and discussing what they do and focusing on that issue. Because for members, for counselors, the issues around drugs can be quite a challenging one out in the community. And therefore, it's been really helpful to understand the work that goes on and how the system is coming together. It's relatively unusual to have a counselor chairing the Combating Drugs Partnership Board. But I would reflect that alongside having Councillor Conway, the chair of the Safer Communities Partnership Board, with us at the CDP, I think that's given us I hope it's given us real impetus. It certainly meant that we had we have a member focus on it that I'm not sure that we would have had in other ways. It's been good growing that partner attendance. But as Louise said, it's about ownership of the work outside those meetings. And we want to maximize that that work. So I think the benefit of having a formal Combating Drugs Partnership Board meeting twice a year that's aligned with the Health and Wellbeing and Safer Communities Partnership Board meeting schedule. So that we're maximizing the time for that working group activity and the joining up that goes up on professionally outside the meeting. But also, reporting into the Health and Wellbeing Board and the CDP and the Safer Communities Partnership Board as that public, formal public expression of the work that you do. I think it's a really important the board, the Combating Drugs Partnership Board certainly saw the logic of moving to that format. And I think it would be a very positive thing to do. So I hope the board would share that. So do I have any comments or questions for Louise about the work that's going on? I think I would just reflect that actually it has been a really busy two years and we have moved a number of areas on considerably. But obviously, the work of the police in the Clearhold Build, Operation Dakota work has made a step change in what's gone on. That certainly changes for a part of the borough that I think was probably, it's fair to say, was blighted by drugs issues in that community. So if nobody else has any additional comments or questions, I think Fiona has her hand up. Thank you very much for joining us when you weren't feeling well. It was much appreciated, but really important that we note the value of the work that goes on and the amount of work that goes in to the Combating Drugs Partnership Board and the work that goes on outside that. Thank you very much. Sorry, sorry, Chair. I do apologize. I thought you were wanting to speak. Please do so before we wrap up. It's just a very quick question and taking into account what Nick said when we're looking at the pharmacy needs assessment. I wondered if there were any accessibility issues for individuals who need treatment out from pharmacies like methadone and things like that outside of usual work hours and whether or not we actually as a board should be pushing for things like from the pharmacy need assessment as well. Louisa, if I let Nick to start a comment and then you can follow up if need be. Yes, I think there is, for my understanding, we don't prescribe it anymore, it's done by CGL, but I think there is a provision to CGL based in Edgware. There's a pharmacy in Edgware that provide it on the weekend and then at Binchley Memorial Fair we pharmacy provide it out of hours as well. The majority of patients are on a weekly script, for example, and they'll come on a designated time every week. So let's say that their appointment is every Monday and they'll go every Monday and collect them and it won't be on a weekend generally that they're seen. So probably the likelihood is low, but there are two pharmacies, one in Edgware and one in Binchley and maybe more in the other part of the borough, but I'm not familiar with it. Yes, I thought there was borough coverage in that sense, but Louisa, do you have anything to add? Yeah, there's really good by the borough coverage and we review it regularly through our sort of needs assessment work to make sure that we have got access across the borough. And actually there's a really interesting new medication that's just coming on the market, which we're launching in the service, which is aimed at people who are very, very stable and might be in employment, which allows them to. Don't ask me the chemistry of it, but it's it's a very expensive medication and we will be prescribing it now anytime, actually, which allows people to have really less frequent pickups and it's a much safer medication. So it's really positive. And the service has actually now moved as well. And it's in Hendon. So that was a couple of weeks ago. So we are in the process of updating comms and communicating that out to partners. Yeah. It's a much better location. Thank you, Louisa. And I know that we've had a number of very dynamic discussions within within the partnership board about that. The interface with with housing and a range of other issues. So it's been a very active partnership, but it is about helping people to stay stable. Recover from drugs, but actually also through the education program, preventing young people from getting involved in the first place. Thank you very much for that. We have three formal we have two formal yes, two formal recommendations to make that the health and well-being board note and comment on the progress of the Combating Drugs Partnership and approve the updated structure of the CDPB outlined in section one point six of the report. The reasons for that and the the the reporting that will go on formally going forward. So we agreed on that. Thank you much to everyone. And just to note that Paul, Councillor Paul Edwards had to go at 11. He was he's judging a care home art contest. And so in his role as adults lead, he was going to have to go and do that. So but he had let us know that he was going to do that right. Finally, we're moving on to the last substantive item in the agenda, and that is the communicable disease update from Janet. Janet, Director of Public Health. Thank you very much, Chair. It is a verbal update in other forums across London already. At the moment, they are still setting up and working to sell material, a document, a pack to support them. And next week, we'll be having the annual winter preparations. Infection prevention control. Yes. That's the word. We just agreed with the chair earlier. So going forward, we are happy to bring a more. On why their health protection that work in barnet, which goes beyond the nation. Thank you. Thank you very much, Janet. Does anybody have any questions for that was a really comprehensive item. Thank you. It was my desire that we kept this on the agenda post the code reports. But I think it's really helpful, not least in the light of the discussion that went on at scrutiny. The scrutiny committee at the evening about concerns about vaccination rates and understanding the work that goes on to support that in the context of the cancer screening work. Perhaps you or Claire would like to share the news about your grant. Yeah, congratulations to the happy couple. The congratulations to us as well. So we got notification on Monday that's Barnet along with Harry gave been awarded two hundred and thirty thousand. We mentioned earlier. That's really good. Thank you very much, Claire. I think we're celebrating while it's not a communicable disease, obviously. Well, this is it's just really important that we that we make the most of grants like that, because this is tackling. As I understand it, going some way to tackle the inequalities in uptake of cancer screening across our across some of our communities. So it's really focusing on ensuring that that prevention and intervention that we all want to see is being enabled in that particular area. But there's also the issues around communicable diseases. There are some health inequality issues with that. And, Jess, you'd like to comment or ask a question. Just in terms of the grant. Fantastic news. Keen that we make sure we draw in the work that we've done post Leder. So the Learn Disability Review of Mortality to understand where screening of people with a disability or people can. It's an area that that really is important as part of that. Does anybody online have any comments or questions for us? Thank you. Fiona's made a comment. Yes, that's an AOB. So I'll pick that up under AOB. So thank you for that discussion. Janet, thank you for the report. And I hope that we'll continue to have that. And thank you for undertaking to share those those reports with us ahead of the meeting where possible, because that's a really helpful thing to do. Partners around the table will see those. There's a ghost in the chamber. The partners around the table will see those reports in different contexts, but some of us wouldn't pick those up. And it's really important so that we get that that broad picture of the work that's going on around communicable diseases and vaccination. So our recommendation is that the board notes the update. Thank you very much. We do. We do that. We have. The item 11 is the forward work program and the request is that the board notes the forward work program. Obviously, much of this year is going to be formal reporting, but actually also the development around the joint health and well-being strategy. And so that will be a pivotal meeting in January to to bring that together and send it off for wider consultation. But we will have our working session ahead of that. I hope as many people can join us on October the third as possible so that we have the richest and deepest discussion we have going forward. But a lot of what we've discussed this evening leads into that. So item 12 is always a list of the health and well-being board acronyms, which is useful for those who are not health professionals. I'm going to take item 13 as any items the chair decides is as urgent as an AOB. And I have a message from I don't know whether you'd you'd like to speak Fiona Bateman, who has joined us over the last couple of years as the chair of the adult safeguarding board. Her tenure finishes as chair. At the end of end of December and after she served for seven years. So I think that's a hugely big contribution to safeguarding in Barnet. So it's likely that this will be your last meeting. She says it's been a privilege to have been on the board and for the work of the Barnet safeguarding adults board to have been so well received by partners. Fiona, I think we have a great deal to thank you for in the input that you've had to this and to many other parts of the committee and service structure in Barnet. So thank you very much. I'm sorry this will be your last meeting, but thank you very much for all the input you have had over the years. And we look forward, obviously, to working with your successor, but we will miss your input and insight and the reflections you bring based on that seven years of experience within the board. Thank you very much for your input. Thank you. And I wish we pity in a sense, it's a pity we're not able to be. But you are always welcome to come and sit in the public gallery if you should. Should you feel so motivated in future and ask us questions and hold us to account. But thank you very much for all your input. Thank you to the members of the board who have been who joined us online and at the table today. Thank you very much for your input. And for the public gallery, I know that the former chair of the committee has joined us as well in the public gallery. So it's good to see you, Caroline, to hear our discussions and look forward to both to the next formal meeting, but more importantly, perhaps in the first instance to our working group next month. Thank you very much for your time and for the input from officers.

Transcript

For us, we had a minor technical glitch to start with, but we now have contact with everybody that has had to join us online. So, we are now – we've got a quorum, so chairs – good morning. I'm Councillor Alison Moore, Chair of the Health and Wellbeing Board. Thank you for attending our meeting this morning. Please note that meetings may be recorded and broadcast by the Council or by people present. Can I remind members and officers to use the microphone when speaking by pressing the middle speaker icon? And obviously, for those of us who are online, to unmute yourself when you speak. So, moving on to the agenda properly, we have minutes of the previous meeting. Does anybody have any corrections of matters of facts to those meetings – those minutes? Okay, then I will, at the end of the meeting, sign those – the true record of the meeting. Item 2 is absence of members. We have apologies from Dawn Wakeling. She's substituted by Jess Bames-Home. We have apologies from Sarah Campbell and Deborah Sanders. We also have apologies from Louisa Songer, who, due to COVID, is joining us online. And Fiona Bateman, our Chair of the Adult Safeguarding Board, who has a clash and is joining us online today. So, welcome to online and people – members in the room. I would just ask – we all know each other, I think, well now, but when you speak the first time, it would be useful just to say who you are for the purposes of anyone who is watching us online. Do we have any declarations of interest – members' interests? I would just say – I just want to – though it's in my own declaration, I am the Council's nominee on the Governing Council of the Royal Free Trust, and I welcome that we've got a grant to do some work that's come from the Royal Free Charity. Do we have any dispensations granted by the Monitoring Officer? There are none. Public questions and comments? There are none this month. And so, we move on to our first substantive item, which is the Joint Health and Wellbeing Strategy update. And Claire O'Callaghan, Health and Wellbeing Policy Manager, will introduce the item. Claire, over to you. Lovely. Thank you very much, Chair. I'm just going to make notes. So, this report is the regular six-monthly report on the current health and wellbeing strategy. So, it gives the update on the implementation plan status that we're using to track impact of the strategy. And secondly, it also gives an update on the current – the future health and wellbeing, which I'll talk a bit about later. So, first of all, the current health and wellbeing strategy. So, most of the implementation plan is now either completed or on target to be completed by the date. There are two actions in the plan which are slightly off target. So, the transition of the Healthier High Streets program to its kind of future delivery model. That's slightly delayed from its current completion date and should be completed by the end of 2014. And then secondly, the recommissioning of smoking cessation and NHS health check services. The mobilization date for that has now been confirmed for October. That will be slightly later than advertised. In terms of indicators, roughly the same number of indicators have improved since the baseline, which was set in September 2021. Five indicators are showing a more than 5% adverse movement from the baseline. So, these are the total number of food bank beneficiaries per month, which has gone up. The proportion of babies being breastfed at six to eight weeks at the health visitor review, which has gone down. Emergency admissions from ambulatory care-sensitive physicians and life expectancy at age 65 for both males and males. So, that's the current strategy. Talking about the future strategy. So, over the summer, we've been doing some work with partner conversations looking at the updated Joint Strategic Needs Assessment, which you've seen at a previous meeting, and looking at other boroughs and the ICS population health interest. The priorities might be for Barnet in the new strategy. We are planning to take this to a meeting of health and well-being board members, an informal meeting at the table. And if you don't have it in your diary, you will do by the end of this meeting. And the intention is to have a long list of priorities to take out to wider public consultees over the next few months. We're still on track to have a draft strategy by January. So, the next time we meet, we'll have a nice draft strategy that you can comment on and approve, hopefully. And then, it will be a more formal consultation over the spring, aiming for… Thank you very much. I think there's two parts to this. Obviously, there's the current progress on the current health and well-being strategy. Does anybody have any particular comments or questions to make about that? From my perspective, perhaps you could just clarify the situation with respect to the recommissioning of the smoking cessation services and the adult health checks. And is that a contractual issue? And it's not a major change, but it's a recontracting. Yes. So, my understanding is delivery on both of those things has been continuing. So, it hasn't been a stop in service delivery. I don't know how much, because in some of the documents, that's not entirely clear. There's some crossover with our plan to ban it. And there was an odd phraseology that didn't make that quite clear. So, thank you. That's really helpful. Does anybody else have comments on any of those other areas? Any reflections from our health colleagues about the life expectancy issues and any reflections on how we might be combating that? I think… Sorry, Jess. I do apologize. So, Jess Bains-Holmes, Director of Commissioning for Adult Station Care. The question really was just to clarify. So, our emergency admissions for ambulatory care sensitive conditions have gone up, which is clearly not great. But I just wonder, the baseline is 2020 to 2021, which is the usefulness of using that as a baseline. Probably Janet. So, I'm just understanding if that's useful for us to measure it against or if we've done some other review of… Presumably, it was the baseline that was the start of the well-being strategy. So, I think a narrative around it would be appropriate. I'm assuming that… I don't know whether we are in terms of dates, whether we're in line with other statistics. But it may be important to be comparative. But we will be resetting those baselines with the new strategy, I think. But it's a really valuable point because the same is… There isn't a reflection on the change in life expectancy at 65. Some of that has been influenced by the COVID and post-COVID figures. I am assuming, but I'm not a specialist in that, but I'm assuming that that's the case. Kay. Thank you, Chair. I'm Kay, as Director of Operations. I'd be able to address this. That's a very pertinent point. And if you haven't already had an opportunity to delve into the new joint strategic needs analysis, actually, there's a huge amount of data within that and where it's been possible. Where it's possible to have it at a ward-based level, we do. Slightly, because of the new ward structures introduced in 2022, there's a little bit of transitional data there. But we've also, where we can go down below ward levels to MSOA data, we have done that. Now, that has confused some people because the names are quite colourful and do not align with wards. But actually, that gives you a tie-up through to ONS data. And so we are able to do some of that geographical analysis. And yes, there is, I'm sure there will be differences that we can unpick. And that would be a really helpful exercise to do in terms of then targeting our work and our resources into the places where we will make the most difference. Simon. Thank you, Chair. I'm Simon Wheatley, I'm the Director of Place West for the Integrated Care Board. Just to say that I think it's nationally appreciated that changes in life expectancy are multi-factorial. And certainly, what we're seeing in Barnet is disappointing, but something that's reflective of the national picture. I think you're right, Chair, that actually a recognition of the geography and also some of the specific communities would be even more important. From an ICB perspective, we're introducing a new long-term condition locally enhanced service. Nick would be able to speak to this in far more detail than me, but that is an expansion of investment in general practice to focus really significant investment that we're progressing at the moment, Chair. Thank you, Simon. And as you will know, the Adults and Health Scrutiny Committee have just completed a task and finish group on access to GP. And that will be coming to the Cabinet meeting in November, I believe. And there are recommendations both for us and actually for the ICB as well within that. And that would be really helpful. We recently had some discussions around the GP survey, and that does talk to the issue that some of our GP practices need some support in getting to where you want them to be around that continued management of older patients with those with ongoing health issues. Nick. Thanks, morning. I'm Nick Detani, GP and Clinical Director of PLACE. I think what we saw over COVID was that a lot of patients became deconditioned, and that deconditioning is now having long-term conditions impact. So, for example, we see a massive increase in patients with heart failure, for example, because they've been deconditioned and not exercising and stayed indoors for often a year. And we're seeing a big increase in pre-diabetes. And then we're also seeing a big increase in cancer diagnoses. And so what's really interesting is a lot of those are linked to not exercising, not eating well, and what people have missed out on in the year or two of COVID. So it's going to probably have a knock-on impact for the next 5, 10, 20 years. I don't know. Public health might give us an idea, but it's going to have a massive impact. And so what Simon talked about was the long-term condition locally-commissioned service that's now in North Central London. And really is exactly what Simon said, allowing general practice to focus on prevention, because actually what we've been doing is tackling acute illness, and what we're better at doing is managing people's long-term health to keep them living healthier and for longer. And one of the things I think we need to think about in our strategy is actually getting people more active and understanding their long-term condition, which is a missing feature. So if I diagnose somebody with heart failure, and I can medically optimize them, but what I can't do is get them to the gym and getting them to buy foods from the supermarket and understanding what that means for them. And that, I think, is the missing link. And actually, what we learned over COVID was that people talked to each other, and how did we get COVID vaccinations so great, because everyone talked to each other and encouraged them. It's the same thing with long-term condition. I bet most people on a neighborhood will have congestive cardiac failure or diabetes, and actually want to stick together and actually make a better lifestyle for themselves. So I think that's the things we might need to focus on. Thank you. That's really helpful, and that actually gives us a topic of conversation for the third, because it reflects some of the things that we've been – a conversation that we've been having recently with the Director of Health and Director of Adults. Claire? Yeah, just to come back on the life expectancy. So last year's annual DPA, it's got last year's data, but the factors are very much the same. Thank you, Claire. That's a sensible reminder that, of course, there is a huge amount of information in... And thank you, Nick, particularly, because I think that sense of being able to help people to build agency and understanding and control over their health and understanding that there are things that they can do to improve that situation and what they don't. I think that's a really positive way forward, and I think it's something that brings all of the partners around the table actually together around that issue, because it involves wider parts of the Council, but actually also community and acute health as well. Pauline? Maybe a various communities to try and get an increase, but I think – I mean, what I was trying to explain last night, and I'm sure in fact, was a lot of hesitancy about immunization. We are monitoring progress on immunizations. Those reports aren't public, but thank you for the reminder. We will make other relevant members to share updates on the issue of vaccination hesitancy. It's a national wide issue, unfortunately, and I'm sure a clinical colleague. Thank you. Just to add to that, there's about 5 million population in continental central London eligible for a COVID and flu chapter. I ask Councillor Edwards to speak. I would just reflect, and it's a conversation that we were having following the meeting yesterday evening and that conversation about vaccinations, particularly childhood vaccinations, and actually a reflection that there's a younger generation of parents who may not appreciate the seriousness, for example, of measles. I'm old enough to have grown up with friends who had eye problems or hearing problems or a range of other problems that resulted from having had a measles infection, and it was a relatively common place when I was a child. I don't think young parents now really always understand the real ramifications if we have a measles outbreak, and I know that an awful lot of work has gone in, both across a bonnet in terms of promotion across NCL and the wider NHS in terms of promoting vaccinations pre the school term. And there has been some work, for example, through the London Jewish Forum and other groupings to try to encourage vaccination rates within some of our communities who are most resistant. It is a really important area and it is overcoming all sorts of, I was going to say ignorance, I don't mean it that way, but lack of understanding of the impact for some communities. Yes, thanks to, excuse me for my ignorance, but I can't see anything in here, and this is not a pun, around ophthalmic or eye health in terms of wellbeing. Can you please repeat what health, I mean eye health, I'm sorry, eye health wasn't mentioned specifically on the number of outcome KPIs is limited, and whilst I absolutely agree and appreciate eye health is important sooner than in mature age. Absolutely, and there's somebody whose eye defect was picked up by that first check in school actually when I was first in reception. That's a very good point. Paul, do you want to carry on? Yeah, I also think it's important because I used to wear glasses firmly and I've had cataracts removed and it's helped my vision remarkably. What occurs to me also is the cost of it, and I'm wondering whether for some people that's prohibitive in terms of just going on a regular basis. It's the same, but I'm talking about eyes. I mean you can't go to an optician without paying some money. I discovered because there's something I'm going to have, something done on my eyes. There's even an NHS price that you can pay. So there's the private price, but there's still an NHS price. And I'm just concerned, you know, in general about particularity than somewhere else in the councils. It's a point well made, I think. Any comments from our partners? Okay. Regular eye checks for children. It's not like part of a regular health check. I know I was never offered it. Well, not for my child anyway. I think that's a question for our partners. Nick, if you could shed some light on that because clearly I'm talking about a different generation of my eye tests. There definitely is two sets of eye checks in schools for the ages now, but there definitely are. It probably has changed over the years. I don't remember what it was like when I was a child, but certainly now there is two sets before 16 that I've offered. I mean, certainly that would be something. Fiona Bateman online has made a comment that it's also true of hearing tests. And there is an expense. Thank you, Fiona. Absolutely. Absolutely right. We've got two different things going on here. We've got we've got talking about the cost of eye, dental and and and hearing checks within with people and children's testing. And there is a comment from Louisa Songer, which I'm assuming is from her current understanding. There's hearing and eye tests at school at five and six. And Claire would back that up for those who have pupils. There is there is something that replicates the sort of testing that I remember as a child. But it's not it's not wrong, actually. And the the implications for all of those elements can be quite significant. And if I understand correctly, there is some correlation between loss of hearing and developments of some forms of dementia as well, because I'm assuming because of neurological input. So I think there are that's a question we might well, very sensibly ask. And I would just be moved to comment on how Chris would appreciate you mentioning this. One of the things when we took the AUSTED, the outcomes of the Children's Services report on Tuesday at Cabinet, one of the positive comments was around the timeliness of both optical and dental checks for children looked after. And I think that is something that may not always have been the case. And so it's very pleasing to see that we at corporate parents can be assured that at least in that context, there are checks going on. Thank you. Any other comments? So. Sensory and sensory impairments can lead to social isolation, which sadly increases the risks that adults with care needs will suffer neglect and abuse. So actually, there are a range of reasons. And maybe that's something that we would want to look at in the future. It may be an appropriate subject for a scrutiny commission task and finish group. Nick. So I just checked. So you get a hearing test at birth and an eye test. And then the eye test is done again at the six to eight week check at the GP and then between the age of four and a half and five and a half to school. And then it's then not done again, but it's free for any child to have an eye test or hearing test between the age of five and 16. Hearing tests are actually the GP and the eye test done any optician free of charge for under 16 to 19. Occasionally. I just checked. That's really helpful, Nick. Thank you. So there is a program in place. There may have been disruptions during the Covid period. And it is about and it is about engagement as well as access from parents. Okay. Agree. And that is really helpful. And I suppose it's then just how do we ensure that that message is out? Because if colleagues around this table don't know that, I suspect a significant portion of our population also don't. And therefore, are they taken? How do we make sure collectively we're getting that message out to all families? Both ends of the age range. We're looking at ensuring that people understand what is available. The benefits of that and the risks if they don't. I mean, clearly eye checks for those who are older. It picks up all sorts of things like glaucoma and a range of other conditions and therefore is particularly important for older people. But actually, young people, you know, I had a friend at school who wasn't doing terribly well. And then they moved him alphabetical arrangement in the classroom with a child who joined, moved him from the back to the front of the class. He could see the board. And actually, his results then kind of climbed rather steadily. And so it's just a case in point that understanding that Councillor Coakley Webb's comment was perfectly right. You only know as a person what you see and you don't know whether that's normal or not. It's what you see. Okay. I think that's really helpful thinking about the future. One of the things that we'll want to talk about when we come around the table and discuss how we evolve the next health and wellbeing strategy is a range of those topics that might or might not form part of the strategy. Obviously, I'm really concerned that we make sure that we both for meetings and for the work that we do together, it's where we can collectively add value and make the most difference through the strategy already through these meetings. I think we've had several really insightful comments around the table today. But I look forward to having those deeper discussions in our workshop session at the beginning of October. So the formal part of item joint health and wellbeing strategy update is that the board comments on and notes the progress on the current implementation plan and the key performance indicators the board reflects on the current progress of the joint health and wellbeing strategy development. And unless anybody has anything to add at this stage, can we all agree those recommendations? I'm happy to have the comments that we've made. Are they minuted? They are indeed. And if you look at the minutes that we've taken today and that I'm signing off, PACS does a very good job in trying to capture our sometimes complex discussions around the table. Yes, they are very full minutes, so they do record what we discussed. Thank you. OK, moving on now to the next item, item seven, which is the pharmaceutical needs assessment update. And to note there are two appendices within the PAC, the map of pharmacy provision and the process for responding to applications for changes to pharmaceutical provision. The item will be led by Dr. Deborah Jenkins, consultant of public health. Thank you, Jeff. So this agenda item is to provide the board with a routine update on the pharmaceutical needs. As the board will be the last pharmaceutical needs assessment was approved, approved and published by Barnet in 2022. And since then, if there are changes to pharmaceutical provision, since the last published published statement, the board needs to review the impact of the change. The previous update to the Health and Wellbeing Board about changes to pharmacy provision was in July 2023. Since the update in July 2023, there have been several changes of ownership of various contractors in the area. Only one pharmacy. That pharmacy is Bishop's Pharmacy in Hampstead Garden suburbs. The pharmacy reduced opening hours from 6 p.m. close Monday to Friday. It was previously open until 7 p.m. It is now closed on Saturdays. It was previously open from 9 until 6 p.m. The impact of this change has been reviewed with the conclusion that it would not lead to a potential gap or poor provision of the pharmaceutical services in Barnet. But this and other changes of ownership and maintained pharmacy list has been updated, but no further actions are needed. As you can see in Appendix A, this is a screenshot of the interactive map of pharmacy provision in Barnet, which has been produced and is published on the Barnet website. The map and underlying data are refreshed and updated on a quarterly basis. I'll turn to the next appendix now, so I'll just change the screenshot. So the second area I'd like to draw your attention to is to make a process clearer, and this is the process for commenting on pharmacy change applications. When there are applications for a change in pharmacy provision in the borough, this is shared by NHS England with the Barnet public health team in order for the health and well-being board to comment. To standardize this review process, this is the chart that we've produced for the suggested actions in Appendix B. The current process is similar, but this change involves both the chair and the vice chair of the health and well-being board to review the pharmacy change application. So in brief, the flow chart describes the following steps. Barnet public health received the pharmacy change application. We then send the change application to the pharmaceutical needs assessment technical support, which is currently provided by an external consultancy organization called Soar Beyond to review the proposed change. The technical support team reviews the evidence and provides a recommendation on whether the change is significant or not. If it is significant, the evidence, suggested recommendation and draft response is sent to the chair and vice chair of the health and well-being board for comment and review. Barnet public health team then updates the draft response from the chair and vice chair as needed and sends back to NHS England. After that, if the application is granted, then the Barnet public health presents a supplementary statement or a fresh needs assessment to the health and well-being board if this is needed. Thank you. Back to the chair. Thank you very much. Does anybody have any comments on this? I mean, I would say in welcoming the tightened up procedure for responding to applications, I think it would be very helpful. I would certainly value the vice chair's comments. Clearly, I'm not a professional in this, though I bring, I hope, a community understanding to it. But it's such an important area and pharmacies are playing a larger and larger part in our spread of health and well-being services. And so I think it's really important that we understand the spread and sufficiency of those across the borough. Nick. Thank you. So I don't have any objections to this. I think it's great to have the flowchart. The only comment I make as we're, you know, we're trying to get pharmacies, community pharmacies involved more and more in patients health, more that they can offer to patients. Often patients don't realize is my fear of the opening times of convenient patients. So, for example, now I'm not a personal user of the pharmacy much, thankfully, but whenever I've needed to use it, I've had to hunt around for a supermarket pharmacy that's open to 8 p.m. There are not many and there's not many of those in Barnet, as you can probably see from the map. So thank you. I live in Hertfordshire and there's availability. But I think there's a missing link to say is that you can't predict when you're going to fall ill. And people generally fall ill on the weekend when things are shut. And so in the future, how can the farmers think about providing that provision on Saturday? In particular, Sunday is a crucial day when everything's sharp, but you want the pharmacy to minor illnesses. So how can we think about that provision in the future? Thank you, Nick. Janet? Yes, thank you very much for those comments. They will be noted, I suppose, in the minute. It will be incredibly helpful as we are just about to start the update of the pharmaceutical needs assessment. And I think it in any way, I agree with you. I just yesterday I had to rush a rush of work to catch the pharmacy during their opening times. So I think everyone can resonate with that. And it's important to consider that one more comment as well. As you know, that extended access service by General Practice is now provided on a Saturday from 9 a.m. to 5 p.m. And so I do that maybe one clinic every quarter. And I struggled. I have to print prescriptions for patients and then try and hunt down a pharmacy on a Saturday morning. So it's a challenge for patients, you know, if there's one pharmacy in the area open and you've got 20 people trying to get something on a Saturday morning. And so I understand, you know, the close and it's hard to staff it and the cost of staffing a pharmacy is not cheap. But it's just about what provision can we think about in the future because we are starting to go to a seven-day health basis. I think that's a really, really helpful point and one we should think about, particularly as a growing borough. And one of the discussions we have had recently was about a pharmacy on the west of the borough. My apologies, Jess. On the west of the borough and recognizing it's not only a rising population but perhaps a population with different behaviors and looking at how we work with those who are working lives. I think it's really important. But the reflection of marrying pharmacy timings around an expanded GP practice time is a really well-made point. Did you hear that? Did you hear that? Looking at this map where it says where all the pharmacies are and having had to, like you said, have to hunt for one that's open, how and who can we actually have information both with the addresses and the opening times of all the pharmacies that are available? And it might be, even though these are the ones that are within Barnet, if someone is living on a border, it might be that, say, that a pharmacy just over the border in Enfield is available or over the border in Haringey. And I think we've got a duty to be able to actually have that information on hand. I don't know who will be able to produce it or whether we can pull it out as council information, but for me that seems to be really important that we can plot the addresses and that we can actually tell residents what the opening times are so that when they've got an emergency, they're not, as you said, hunting around in a state of panic wondering where they can get their prescription from. I have Jess and Claire come in. Nick, if you'd like to comment? Yeah, council, so the information that you've got is on the Barnet website, but only patients probably won't use our website or use the NHS website. So the generic one I've got here, you put in your postcode, it shows you all pharmacies in any borough. But I think what Nick is saying is certainly if it is a GP led prescription, you will be able to sign post to the nearest open pharmacy. And whether that's something that we, is there a prescribed definition that is a sort of a national definition? If there is, really we want one that is a Barnet specific, what we want to encourage residents to expect of them. That's a really good point and actually there's been quite a lot of coverage on the radio, certainly on the radio over the last couple of days about pharmacies and the challenges that that changing role will present. Would you mind if I took Simon first and then? That's a very kind chair, thank you, significantly more than it perhaps meant to me three or four years or so ago. I would agree and very much think pharmacies as part of our health and wellbeing family in terms of that broader agenda that we're developing in terms of keeping people well but treating them when they are unwell. Claire? I suppose, I think my intervention for topic for discussion. Debra, do you have anything else to add in summing up the paper and the discussion? Thank you, thanks for all the comments. I think a further discussion on pharmacy provision would be really helpful. We have some links already for future agenda items. Thank you very much, and I look forward to that discussion. It feels like a very mature stage of regarding them as part of that partnership. Formerly as part of the paper, if nobody has any further comments, we are asked to note the changes in pharmacy provision in the London Borough Barnet since July 2023 and agree with the suggested and whether we agree with the suggested process for reviewing applications for the changes in pharmacy provision in the borough as outlined in Appendix B. Is that agreed? Thank you very much. Now move on to item eight. That is the suicide prevention annual suicide prevention plan annual report. To note that we have a which is the annual report itself, and the item will be led by Saher Keke, who is our public health strategist and Rachel Wells consultant in public health. Thank you very much. As part of Barnet's suicide prevention partnership, I'm pleased to present our third annual report since the publication of the strategy. Last year, the partnership created an ambitious action plan in line with the publication of the cross-government suicide prevention plan, and this report made an attempt to demonstrate how each partner contributed to preventing death by suicide in Barnet. In particular, how we collaboratively supported the groups who are known to have elevated risks, putting more emphasis on addressing the wider determinants of health. What is new about this report is the change of reporting period to align our reporting with the ONS statistics. We will continue to report statistics per calendar year as opposed to financial year. Our current suicide rate is five per hundred thousand. Although there is a slight increase in comparison to previous reporting, this is not significant. We are still amongst the five lowest suicide rate in London and probably in the country. Our innovations to reduce death by suicide and the strength of our partnership continue to put Barnet on the map last year, and I hope that you have managed to read some quotes from some of the partners involved. Finally, I want to highlight that this report proposed the renewal of the strategy and welcomed the board to feed into process.

Thanks, Chris Monday, executive director for children and families. Thanks. It was really useful and a good report. It's good to see all of the really positive pieces of work going on. I'm aware that there was a really strong cross-referencing between the findings from what used to be called serious case reviews, now called learning reviews, where the safeguarding partners have come together and undertaken reviews. I'm aware that there have been two or three in relation to suicides, and there's ongoing work in relation to some specific issues now. There's one on suicide and filicide, of which we've had two incidents where there's been a suicide of issues around children experiencing issues, both of their autism and gender. I didn't see those things coming through in the annual report, so I wonder if in the future we can make sure that there's a really strong link to the plans that come out through those multi-agency safeguarding arrangements that set out a whole range of issues. One of the issues that I don't think we're addressing fully in this is the role of private psychiatric services. Both cases that I'm aware of where there were particular challenges, both were being managed through private provision, not through state provision. I know that there were a number of recommendations made in relation to that, but that's absent in the report as far as I can see. I wonder whether we're picking up all of the intelligence that is available. It feels like this is the plan and this is what we've been doing, rather than this is what's been going on in the wider context, and these are some of the things that we found from there. To have two suicide filicides in one borough in the space of possibly less than a year, I think is something that we need to understand more and understand what we're doing about it. Indeed. Thank you, Chris, for that. Fiona Bateman is online and would like to make a comment. Just to provide some assurance, perhaps to Chris as well, all to maybe offer, because Tony and I have met to discuss the learning across the safeguarding adult reviews and the children's learning reviews. What we should do and what we could do is invite, see how to mix those meetings, particularly when we're looking at the learning that's linked to suicide prevention. So I think that would make it much easier for that to kind of connect the work. But going forward, I'm afraid I've had over the last year clashes with the suicide prevention group, so although I do always read the papers, I can't physically be in the room as I'm stuck today. So going forward, the vice chair of the safeguarding adult board will be an active member. She's already really well connected with partnerships across Barnet. So I think that learning will be more embedded in the work of the partnership going forward. But definitely, Ciara, if you'd welcome coming to those meetings that the two boards have to look at, you know, how do we join up the learning from those safeguarding reviews, that would be really helpful. I'm wondering whether, because every child's death, you know, or suicide in particular, has an after-action review, an after-death review, and it's interesting to see what the learning is from that. And I wonder where Chris has mentioned there's some private psychiatrists involved, and that may be just because of the lack of access, some of the NHS services and the long waits of 12 to 18 months is possibly a reason for that, unfortunately. But how can we learn from that? What can we change? The second thing, I say this every year, but one of the biggest things that we see now is social media. And I believe it's certainly linked to possibly death or suicide or people feeling low and depressed, actually signpost people using social media into services available, because we can put things on websites and posters and things, but young people don't use any of that. They don't use Instagram and TikTok and whatever else it is nowadays, they can't even keep track. And I also remember about five years ago, I think it was the police, I can't remember who it was, but came and gave GPs a talk on all the apps that were there, and I was astonished. I was like, never heard of half of these apps that are out there, and how do we educate parents into knowing what are the signs to look out for? Because there are a lot of rogue apps around for children, and how do we educate parents to look at what signs to look out for in their child or young one to pick up if they're going through a bad time and they're at risk of suicide and how to seek help? Because I get a lot of parents coming in who have got young children who have harmed themselves or are low, and they had no warning signs, and there probably was a warning sign, but they're not looking at their phones or looking at the right things on their phones. So I would like us to think about the generation of the future is all online, how do we read that and how do we, I don't know the answer, but just leave you to that. Thank you, it's a very thorough report. I'll take Jasmine Holmes and then Pauline. What jumps out at me is the statistics, sorry, and to echo the fact that this is clearly an excellent program of work, and what we're doing is to sort of pick out the things that we think would be even better. The national statistics around ADHD and autism diagnosis in suicides obviously assume you've had a diagnosis, and to pick up Nick's point again, the issues that we have around delays, waiting times, reduced access to diagnostics for NDD. I suppose I'd like to understand a little bit more about where we're seeing self-harm and suicide as a result of lack of diagnosis, lack of access to support, and I don't know how we can do that work with most of the diagnostics and support. But given that we know that we've got clinical restraints and financial pressures, understanding whether that is playing a significant role and that lack of diagnosis means that you struggle for longer and are likely to there. Yeah, I think to pick up on one of the points you said, I think, and Christopher confirmed that one of the things we found is that people accessing private therapies was often a cultural thing. It wasn't so much that they didn't, they just didn't want to contact NHS, it was different. One of my beliefs is that when you have these private practices, they are not, and I still think it's still the case, they're not required by law, therefore, to inform that person's general practice, therefore it goes unnoticed until the worst has happened. And when we look at the issues, well, the issues with social media and with things like self-harming that can ultimately lead to suicide or be more than one that have taken their own lives and that it's been related back to what you find on social media, they're still reporting that that still can be happening and I don't know how these social medias can be taken into account. They're talking about restricting, they can still access information and if not, they will use somebody else's phone or whatever to access it that then has got a verified aid. I think it's a really hard battle for us and how we can work with schools and parents and health professionals to try and stem this really horrible, you know, plague of social media that is actually influencing young people, whether it's to be for self-harm or their body image to what they think they should be and what they are and I'm sure that that is the root of an awful lot of problems now that would not have existed years ago. Thank you Pauline and I see Nick is nodding and I know that there is some pilot work going on with a range of schools in terms of phone access but that doesn't alter the access to phones outside of school hours. Just in the context and forgive my ignorance on this, is there any way private psychiatrists, private psychiatric health, presumably it's accredited in some way and I wonder if there is any way to lobby for a national change where they're obligated to notify. So because they're regulated by the GMC for example if they're adopted but there isn't anything that they must inform the NHSGP practice so the patient or the guardian has to consent and provide the details of the NHSGP and they can choose if what you're saying is it's cultural, they probably are not consenting to share the information. And then the law is that you don't consent, the practitioner is not allowed to share information because they'll be in GDPR breach. So I suspect it's probably more than not consenting than the clinician hypothesising and what do you do in that situation. Now the clinician can override that decision if they believe it, if that patient is actively suicidal for example. One thing they really should take into account if anything for legislation, it may be that it's just an adult but if that adult, if they know that that family has got young children, that's when the alarm bell should ring to go we need some information, we should not be holding it to ourselves and at the minute it seems that they can not do that. Just to add to that I guess if there's an adult, if thinking about what the right practice should be is that that clinician should then do a safeguarding report because they're lifting up children. Whether that's done or not is another thing but that's what we would do in general practice is do a safeguarding alert. But yeah it's probably what we've done and so I suppose there is some merit in maybe doing an after action review of the deaths that you've mentioned and thinking about what information we could share and certainly in our community I think going to legislation is one thing but in the interim we share something that the nation might be useful. And my recollection is that the same issue around disclosure and sharing has been a challenge in some of the teenage and student deaths as well, nationally not locally so I'm very conscious of that. I'm just going to read out Fiona Bateman made the comment all professionals registered with the GMC, the HCPC etc will be expected to comply with safeguarding duties so should follow local or encouraged by professional regulators. So I think that's a very helpful point, thank you Fiona. So how would you respond to those comments and both in terms of the quality and the value of the report and the work that's gone on because I think that we do need to remember after what is a very fruitful discussion that it is also there is some really good work going on and it's had national recognition, but also what we would what your reflections are on the comments that have been made. We have been working very closely with both Fiona Bateman and also Tony Lewis. And last year, some of the work we did in terms of learning from the safeguarding reviews reflected in the last year's report so I didn't repeat that this year, but that work is ongoing. In fact, in terms of the suicide case and the link with, you know, the issue around lack of communication, any with private sector. So, I have invited Tony to present the learning from the suicide review in the London community platform community of practice for all suicide prevention leads, so that we could collaboratively understand about those issues and also to see if there is any other example in London, and then maybe we can join forces together. You know if there are any good practice. So, we want to raise those issues because they are very, very challenging issues to to tackle. In terms of however I'm going to take all these comments to our start and grow well team in public health to make sure that going forward. We have a better capture of all that learning within the suicide prevention report. In terms of autism and other sort of at risk groups. I know that Jane Abbott, who is our resilience manager. She does a lot of work in schools. And there has been a new service, I believe it's commissions, working with LGBTQI children and young people. With autism, what we have in the councils, we have autism champions group running. I'm a member of that group. And we have been working with Barnet Mancub resources for autism. We have constantly raised awareness amongst the professionals, amongst staff, voluntary sector colleagues, faith organizations about the link between suicide and autism. And inviting people to take up training, which is delivered by Barnet Mancub. I think I'm working closely with family services colleagues from violence against women and girls team. I'm taking part in their reviews. We're gradually building those links. And I will make sure that they all reflect going forward, but that work is emerging and there is a lot more work to be done on that, on these areas. Thank you. Louise is joining us online, has posted, sent through a comment, drawing attention to the suicide and prevention and support after suicide link on Barnet Council's website. And she highlights the stay alive app, which is available on Google Play and other providers, for which the team had recognition and was the source of work with the Middlesex University. So the app has been a very important part of some of the work that you've done. So I don't know whether you want to comment on that, otherwise I'll finish up with some final reflections. Shall I take Pauline's question first and then allow Sahar to sum up? I'm just scrolling down under the figure two, men's lives lost to suicide in Barnet versus everywhere else. And then underneath, this really puzzling sentence. Due to small number suppression and disclosure control issues, we are unable to make accurate interpretation of female suicide rate for Barnet. About suppression of data, but Sahar, if you'd like to. Because it's not reported in the statistics, the rate, because of the small numbers. So we can't -- we don't have the data. Who does have the data? So we receive two such statistics from the Office for National Statistics. And we have the numbers for female suicides, but we don't have the rate. Because of the very low number of female suicide. I know from the safeguarding board when we get reports, we get to know what to give any figure or number in relation to that. I believe, Rachel, you'd like to comment. Could you put your mic on, Rachel? Thank you. Thank you. It was on a previous point, but I just -- I just mentioned on this one. With regards to the numbers, we have the numbers, but they are identifying if they are very small numbers. This report, we wouldn't necessarily put that in, but we do have that information. Can't form a rate on a very low number, but that's why that's there. We do have to suppress them when they're very small. I think that might be something that we can look at a way in which we can present those numbers in a way that gives you more information and appropriate. I just want -- I don't think anyone's asking for dates or times. It's just a comparison between maybe how many suicides are male and how many are female. I think that's all we're asking for. We can do that. We can do that. We can give you some information which would identify that for you. We can amend that in some way. I can quickly mention that from the real-time surveillance system. So we know that about 25% -- 75%. Just one other quick point. Just referring to something that was discussed earlier, and I know that we all know this, but I just thought it might be useful to many digital natives. And thinking about how we work with parents who are also migrating into that world with young people and children who are already in that system. I think it takes more thought across the system. It may well be that trying to engage, and I know that we have done this, but perhaps not as a board with young people around their uses. I think it would be quite an interesting discussion. Because I have a 15-year-old son, so I know what goes on, and it's incredible. And I know some of you probably will be in that situation as well. It's uncontrollable. And I think having a better understanding of how their systems work as a board may well be something worth exploring. And also ways in which their individual resilience can be improved. Chris, I don't know whether you have any comments on how we might use some of our young people's groups to have such a discussion. In fact, there's already that sort of work going on. The mental health charter was developed by a whole group of children and young people, so there's lots of dissipation in that. On the social media side, I think there's some really interesting international changes that are coming about. Very interesting to see as children and young people have the amazing ability to be able to find ways around all of the rules that are -- I'd say this purely as a father whose children seem to be able to bypass every single restriction that we put on their phones. Two of them are old enough to do it themselves now. So I think that there are some things. But I do think it's something that government need to be doing a bit more on the online harm bill. Did that go as far as it should? Is some of the work that's going on in Australia now through their administration about holding providers to account more powerfully? There's been some quite interesting work in that space. But I do think it's something that maybe as a board we should be writing to government about saying, you know, actually should we be going further on? Some of the -- you know, tick tock is supposed to be only available if you're over a certain age. Yeah, lots of children are on tick tock. Instagram is supposed to be over a certain age. You know, these days I think it's about if you're over 50, then you're allowed to be on Facebook. But, you know, there's those sorts of things that are well beyond the realm of us as parents and us as a board. I suppose it's those sorts of things that we need to be saying. What should we be doing in that space and should we be talking to parliamentarians about, you know, are there some things that they want to do more? You know, there's a new children's being act or bill coming forward. Is it something that we want to be saying that there needs to be more in that around online safety? Because I think it is genuinely -- it's a generally scary world that parents don't understand and that children do far more than us. I think the point about data that digital natives versus digital immigrants is a really important point. And Chris has just reinforced that. Nick? I'm just wondering, you know, whether in school programs there could be something around this education about online. Yeah. They had all these icons on the screen and I could recognize about three out of ten. And I thought, oh, God, I'm stupid. But, you know, what does that mean, isn't it? You know, do parents actually know what the apps children have because you just see an icon. So I think we need to -- it's not just the children. I think we need to get adults and parents involved into understanding what's on children's phones and things. And I think that's a wide -- and in reality, that's a wider issue than just around suicide prevention. It's a range of issues across young people's perception of the world and access to data and the online world in a way that maybe those of us who are a bit older just aren't grasping the breadth and depth of that. So that's a really helpful conversation. Sahar, any final comments and then I'll wind up. With regards to the research, the effectiveness of interventions in preventing suicide, suicides are still emerging. It's a relatively new field that's really developing in the last sort of 10, 20 years. In principle, anything that we do in Barnet, I work with colleagues from academia and looking to them to support with their evaluation. And I'm pleased to say that our campaign has been evaluated by Middlesex University, Professor Lisa Marzano and her team. And then they actually demonstrated statistically that the campaign may have contributed to saving 7 to 10 lives across the nine-month period. Of course, there are lots of caveats in this, but nevertheless, it's a very, very positive result and it's a contribution to campaign approach, which was later demonstrated by Dr. Alexandra Pittman from University College London and some other academics from Australia about how actually campaigns can contribute to reducing suicides. That's about it. And I think about the apps. Could I just add to that, please? We are working closely with Metropolitan Police and also Fire Service in terms of monitoring those untoward apps or emerging new methods of suicides. And we are conscious of that. And then sort of jointly in London, we're trying to find solutions if we can identify anything untoward. But these are wicked issues. And I just reflect that we are fortunate to have a university just adjacent to us where you've not only got academic contact, but actually it's a pool of students who might be useful in giving reflections. And I know that some of the work that has gone on through some student courses has been particularly around violence against women and girls, but actually there are a range of other issues that the students will be working on. So that's a possible source of news about the validity and depth in the way that we're doing. But thank you very much to her and thank you for your input. And Rachel, I would reflect that we have in former years discussed at the Health Scrutiny Committee. And I think I would reflect that we've had a really rich and thoughtful discussion this evening. Lots of potential learnings to come out of it. Recognizing the role of joining up and building on and extending relationships across a range of organization and mining the data and intelligence that others have. Taking these opportunities, working, for example, with safeguarding boards. And considering how and looking at how a suicide prevention is set against an evolving online challenge with social media. So thank you very much for all of your input. Now we have three formal recommendations that the Health and Wellbeing Board note the most recent data for the Borough of Barnet. That the Health and Wellbeing Board note the progress on implementation of the Barnet suicide prevention strategy as outlined in Appendix A. And that the Health and Wellbeing Board feed into the forthcoming suicide prevention strategy 2025 to 30 refresh. I think there's been a lot of opportunity to pick this up at some of our informal working sessions. So thank you everyone for that discussion. And we're now going to move on. I would just, because you joined us late, I just want to welcome Monique from Barnet. Good to have you at the table as our BCS representative today. Thank you very much. Very important part of our Health and Wellbeing Board. So thank you. And do pipe up if you want to feed in. Moving on now to Item 9, the Combating Drugs Partnership Board Annual Report. And this will be led by Louisa Songa, who is joining us online because she has COVID. I hope you're not feeling too unwell, Louisa. I bear with me two seconds when I sort my presentation out. Can you see a presentation up on the screen? We can, Louisa. Let me just put it into slide show mode. Thanks, chair. Yeah, forgive me, I'm fine, bit croaky, but all good, all good. But I did put some slides together just to keep me focused, because I'm probably not firing on all cylinders this morning. So hi. Hi, everyone. I'm Louisa Songa, Senior Public Health Strategist in the Public Health Team, and I lead on substance misuse strategy. And I'm here to update you on our Combating Drugs Partnership Board. A little bit of background. It's all in the paper. The board was formed off the back of the new government drug strategy a couple of years ago. We launched in November 2022, I think it was. And all areas were asked to develop Combating Drugs Partnership Boards to do three things. Really want to look at the sort of supply chains of drugs and how we could work with enforcement partners to disrupt these lines and hold offenders to account on it. The second priority was around improving our substance misuse treatment and recovery services, ensuring that they were high quality and accessible. And the third priority was around ensuring a better prevention offer, both in terms of preventing the onset of substance misuse, but also stopping, you know, supporting people from developing those sort of high risk behaviors if they're already using substances. So I put some of our achievements in the paper. There is a huge amount of data available on substance misuse. So it's really hard to try and choose which bits that we put to you. But if there's any interest in any of the areas more broadly, more specifically, we can we're happy to share further information. So the first priority, there's been a huge, I'm sure you're all aware of the work that our police and community safety colleagues have been doing around making the borough a safer place and reducing supply of substances into the community. And so address the sort of wider issues around that they bring around and social behavior and these programs that clear how build approach and some of the other operations that we've had. That certainly partnership approaches which aim to take a really multi-agency approach to the problems and look at it from a systemic point of view. And I put this graph in just to show you that, as you can see, it looks like our drug trafficking offenses in Barnet are increasing. That's a really good thing, because actually what it shows is that the police, this is police data, our police partners are able to respond to supply and, you know, the sale of substances and hold that are actually arresting people and bringing them into the criminal justice system. So it doesn't necessarily mean that there's more drugs coming into the borough, but actually that the police are doing a really good job at targeting those drug dealers. And on the flip side of that, possession, people being arrested for possession of drugs is decreasing, which is good, because actually what we can see then is that people that have substance misuse issues are being signposted into support and treatment rather than being pushed into the criminal justice system. Which can't necessarily address their issues. So in terms of delivering world class treatment service, we've been working really closely with some of our criminal justice partners to improve court pathways, prison pathways, and we've seen an increase in community sentences, lots of work on people with multiple and complex needs. So we have a substance misuse rough sleeping program, which is, I think it's in its third, fourth year of operation, and they're really sort of embedding into the community. The team have managed to build good relationships with people with multiple issues and support them into services. And through that project, we're starting to look at the wider health issues of people who are rough sleeping and also have substance misuse issues. So one of our successes is that last week we launched a dental service for rough sleepers, which is a great success. It's something we've been working on for a long time. So anyone that's rough sleeping can now access a community dentist in Hendon. I think it's one day a week that we're offering that service. It's a fast track service. And also there's oral health training sessions that are being delivered to staff through that program. And we continue to be focused on reducing drug and alcohol related deaths. I've got here rates for barnet remained lower than London, England. Apologies, that's a tie. I think we're actually similar to London and England. What we have seen is over the last few years, the numbers of people dying who are accessing treatment are largely related to alcohol. And what we are understanding from those reviews of those deaths is that there are some significant issues around people with complex physical health problems as a result of their alcohol use and people accessing treatment quite late. So we're really keen to try and change that by getting people into treatment services at an earlier stage in their substance misusing career and also ensure that they have better access to that range of physical health services to prevent those complexities. In terms of opioid related deaths, we remain quite low, which is brilliant. And we are really pushing our harm reduction strategies. So we we have a really good distribution of naloxone across the bar. I think I read yesterday that we're about 70 percent of our opioid users have access to naloxone. Naloxone is an anti overdose medication that people can administer, administer at home or in the community. And also we are now getting nitazine testing strips as well. So you may have heard in the news, there are sort of new synthetic opioid which are way more potent and more lethal than heroin. And so people can can test their drugs before they use them. We have had had one one instance we heard of locally where a chap tested his heroin, found it had nitazine in and actually gave it back to the drug dealer. And I don't want this. So we can see it works and significant engagement with partners to around training and upskilling. And one of our biggest successes that we're really, really proud of is actually the number of young people accessing treatment in Barnet for substance misuse issues has grown exponentially. I think it's at the highest. It's it's been definitely since I've worked in Barnet, but, you know, for a very, very long time. And this is this is great. This is really shows that that service is starting to to get into the right communities and work with schools and really meet that need of young people. In contrast, the numbers of treat people access in adult treatment is staying fairly similar. We really hope to see that drive up. But we it stayed quite flat over the last 12 months. We're really keen to think about how we can improve that through the next year. And again, slide on deaths. And so, obviously, a little bit on the prevention. So we need lots of work with schools around thinking about what the PSHE offer includes and ensuring that schools have access to the substance misuse service to go in and offer that that extra training and upskilling. And we have been looking at upscaling or drink coach service. And again, I think we're in about year three or four of the drink coach service. And for the first time, halfway through the year, we've exceeded the number of counseling sessions that we don't deliver. And there's a slide which just really shows you the how our campaigns have a really positive impact on the numbers of people that are going to the drink coach site and and access in that that intervention. So, yeah, really, really good to see the outcomes of our campaigns. So finally, just a point on the restructure. So we're a couple of years into CDPB now. We formed as a partnership. We've developed our work plan. And now I think we're in a really good position to look at what's working and what's not working. You know, there have been a few challenges to creating ownership and actually getting key stakeholders to drive certain areas forward. So we have reviewed some of the arrangements in other areas and made some recommendations. What we think a revised structure could look like. We presented it to the board in the last meeting in our health and sorry, my competence and drugs board in July and partners were on board with that. This is a structure. So we, if approved by the health and well board, hope to move to this structure in in the coming months. And really, you know, the first one would be very much led around our police and community safety colleagues. The treatment group would be led by public health. And we're looking at how the prevention subgroup can align with things like the only help board and some of the prevention work that's happening in adult social care. And that's it for me. Thank you. Thank you very much, Louise. And before I ask anyone to do for comments around the table, I just want to give a reflection as the chair of the Combating Drugs Partnership Board. And it's been a real it's been a real work in progress over the last two years. I've learned a huge amount. But I've also watched a range of professionals working and discussing what they do and focusing on that issue. Because for members, for counselors, the issues around drugs can be quite a challenging one out in the community. And therefore, it's been really helpful to understand the work that goes on and how the system is coming together. It's relatively unusual to have a counselor chairing the Combating Drugs Partnership Board. But I would reflect that alongside having Councillor Conway, the chair of the Safer Communities Partnership Board, with us at the CDP, I think that's given us I hope it's given us real impetus. It certainly meant that we had we have a member focus on it that I'm not sure that we would have had in other ways. It's been good growing that partner attendance. But as Louise said, it's about ownership of the work outside those meetings. And we want to maximize that that work. So I think the benefit of having a formal Combating Drugs Partnership Board meeting twice a year that's aligned with the Health and Wellbeing and Safer Communities Partnership Board meeting schedule. So that we're maximizing the time for that working group activity and the joining up that goes up on professionally outside the meeting. But also, reporting into the Health and Wellbeing Board and the CDP and the Safer Communities Partnership Board as that public, formal public expression of the work that you do. I think it's a really important the board, the Combating Drugs Partnership Board certainly saw the logic of moving to that format. And I think it would be a very positive thing to do. So I hope the board would share that. So do I have any comments or questions for Louise about the work that's going on? I think I would just reflect that actually it has been a really busy two years and we have moved a number of areas on considerably. But obviously, the work of the police in the Clearhold Build, Operation Dakota work has made a step change in what's gone on. That certainly changes for a part of the borough that I think was probably, it's fair to say, was blighted by drugs issues in that community. So if nobody else has any additional comments or questions, I think Fiona has her hand up. Thank you very much for joining us when you weren't feeling well. It was much appreciated, but really important that we note the value of the work that goes on and the amount of work that goes in to the Combating Drugs Partnership Board and the work that goes on outside that. Thank you very much. Sorry, sorry, Chair. I do apologize. I thought you were wanting to speak. Please do so before we wrap up. It's just a very quick question and taking into account what Nick said when we're looking at the pharmacy needs assessment. I wondered if there were any accessibility issues for individuals who need treatment out from pharmacies like methadone and things like that outside of usual work hours and whether or not we actually as a board should be pushing for things like from the pharmacy need assessment as well. Louisa, if I let Nick to start a comment and then you can follow up if need be. Yes, I think there is, for my understanding, we don't prescribe it anymore, it's done by CGL, but I think there is a provision to CGL based in Edgware. There's a pharmacy in Edgware that provide it on the weekend and then at Binchley Memorial Fair we pharmacy provide it out of hours as well. The majority of patients are on a weekly script, for example, and they'll come on a designated time every week. So let's say that their appointment is every Monday and they'll go every Monday and collect them and it won't be on a weekend generally that they're seen. So probably the likelihood is low, but there are two pharmacies, one in Edgware and one in Binchley and maybe more in the other part of the borough, but I'm not familiar with it. Yes, I thought there was borough coverage in that sense, but Louisa, do you have anything to add? Yeah, there's really good by the borough coverage and we review it regularly through our sort of needs assessment work to make sure that we have got access across the borough. And actually there's a really interesting new medication that's just coming on the market, which we're launching in the service, which is aimed at people who are very, very stable and might be in employment, which allows them to. Don't ask me the chemistry of it, but it's it's a very expensive medication and we will be prescribing it now anytime, actually, which allows people to have really less frequent pickups and it's a much safer medication. So it's really positive. And the service has actually now moved as well. And it's in Hendon. So that was a couple of weeks ago. So we are in the process of updating comms and communicating that out to partners. Yeah. It's a much better location. Thank you, Louisa. And I know that we've had a number of very dynamic discussions within within the partnership board about that. The interface with with housing and a range of other issues. So it's been a very active partnership, but it is about helping people to stay stable. Recover from drugs, but actually also through the education program, preventing young people from getting involved in the first place. Thank you very much for that. We have three formal we have two formal yes, two formal recommendations to make that the health and well-being board note and comment on the progress of the Combating Drugs Partnership and approve the updated structure of the CDPB outlined in section one point six of the report. The reasons for that and the the the reporting that will go on formally going forward. So we agreed on that. Thank you much to everyone. And just to note that Paul, Councillor Paul Edwards had to go at 11. He was he's judging a care home art contest. And so in his role as adults lead, he was going to have to go and do that. So but he had let us know that he was going to do that right. Finally, we're moving on to the last substantive item in the agenda, and that is the communicable disease update from Janet. Janet, Director of Public Health. Thank you very much, Chair. It is a verbal update in other forums across London already. At the moment, they are still setting up and working to sell material, a document, a pack to support them. And next week, we'll be having the annual winter preparations. Infection prevention control. Yes. That's the word. We just agreed with the chair earlier. So going forward, we are happy to bring a more. On why their health protection that work in barnet, which goes beyond the nation. Thank you. Thank you very much, Janet. Does anybody have any questions for that was a really comprehensive item. Thank you. It was my desire that we kept this on the agenda post the code reports. But I think it's really helpful, not least in the light of the discussion that went on at scrutiny. The scrutiny committee at the evening about concerns about vaccination rates and understanding the work that goes on to support that in the context of the cancer screening work. Perhaps you or Claire would like to share the news about your grant. Yeah, congratulations to the happy couple. The congratulations to us as well. So we got notification on Monday that's Barnet along with Harry gave been awarded two hundred and thirty thousand. We mentioned earlier. That's really good. Thank you very much, Claire. I think we're celebrating while it's not a communicable disease, obviously. Well, this is it's just really important that we that we make the most of grants like that, because this is tackling. As I understand it, going some way to tackle the inequalities in uptake of cancer screening across our across some of our communities. So it's really focusing on ensuring that that prevention and intervention that we all want to see is being enabled in that particular area. But there's also the issues around communicable diseases. There are some health inequality issues with that. And, Jess, you'd like to comment or ask a question. Just in terms of the grant. Fantastic news. Keen that we make sure we draw in the work that we've done post Leder. So the Learn Disability Review of Mortality to understand where screening of people with a disability or people can. It's an area that that really is important as part of that. Does anybody online have any comments or questions for us? Thank you. Fiona's made a comment. Yes, that's an AOB. So I'll pick that up under AOB. So thank you for that discussion. Janet, thank you for the report. And I hope that we'll continue to have that. And thank you for undertaking to share those those reports with us ahead of the meeting where possible, because that's a really helpful thing to do. Partners around the table will see those. There's a ghost in the chamber. The partners around the table will see those reports in different contexts, but some of us wouldn't pick those up. And it's really important so that we get that that broad picture of the work that's going on around communicable diseases and vaccination. So our recommendation is that the board notes the update. Thank you very much. We do. We do that. We have. The item 11 is the forward work program and the request is that the board notes the forward work program. Obviously, much of this year is going to be formal reporting, but actually also the development around the joint health and well-being strategy. And so that will be a pivotal meeting in January to to bring that together and send it off for wider consultation. But we will have our working session ahead of that. I hope as many people can join us on October the third as possible so that we have the richest and deepest discussion we have going forward. But a lot of what we've discussed this evening leads into that. So item 12 is always a list of the health and well-being board acronyms, which is useful for those who are not health professionals. I'm going to take item 13 as any items the chair decides is as urgent as an AOB. And I have a message from I don't know whether you'd you'd like to speak Fiona Bateman, who has joined us over the last couple of years as the chair of the adult safeguarding board. Her tenure finishes as chair. At the end of end of December and after she served for seven years. So I think that's a hugely big contribution to safeguarding in Barnet. So it's likely that this will be your last meeting. She says it's been a privilege to have been on the board and for the work of the Barnet safeguarding adults board to have been so well received by partners. Fiona, I think we have a great deal to thank you for in the input that you've had to this and to many other parts of the committee and service structure in Barnet. So thank you very much. I'm sorry this will be your last meeting, but thank you very much for all the input you have had over the years. And we look forward, obviously, to working with your successor, but we will miss your input and insight and the reflections you bring based on that seven years of experience within the board. Thank you very much for your input. Thank you. And I wish we pity in a sense, it's a pity we're not able to be. But you are always welcome to come and sit in the public gallery if you should. Should you feel so motivated in future and ask us questions and hold us to account. But thank you very much for all your input. Thank you to the members of the board who have been who joined us online and at the table today. Thank you very much for your input. And for the public gallery, I know that the former chair of the committee has joined us as well in the public gallery. So it's good to see you, Caroline, to hear our discussions and look forward to both to the next formal meeting, but more importantly, perhaps in the first instance to our working group next month. Thank you very much for your time and for the input from officers.

Transcript

For us, we had a minor technical glitch to start with, but we now have contact with everybody that has had to join us online. So, we are now – we've got a quorum, so chairs – good morning. I'm Councillor Alison Moore, Chair of the Health and Wellbeing Board. Thank you for attending our meeting this morning. Please note that meetings may be recorded and broadcast by the Council or by people present. Can I remind members and officers to use the microphone when speaking by pressing the middle speaker icon? And obviously, for those of us who are online, to unmute yourself when you speak. So, moving on to the agenda properly, we have minutes of the previous meeting. Does anybody have any corrections of matters of facts to those meetings – those minutes? Okay, then I will, at the end of the meeting, sign those – the true record of the meeting. Item 2 is absence of members. We have apologies from Dawn Wakeling. She's substituted by Jess Bames-Home. We have apologies from Sarah Campbell and Deborah Sanders. We also have apologies from Louisa Songer, who, due to COVID, is joining us online. And Fiona Bateman, our Chair of the Adult Safeguarding Board, who has a clash and is joining us online today. So, welcome to online and people – members in the room. I would just ask – we all know each other, I think, well now, but when you speak the first time, it would be useful just to say who you are for the purposes of anyone who is watching us online. Do we have any declarations of interest – members' interests? I would just say – I just want to – though it's in my own declaration, I am the Council's nominee on the Governing Council of the Royal Free Trust, and I welcome that we've got a grant to do some work that's come from the Royal Free Charity. Do we have any dispensations granted by the Monitoring Officer? There are none. Public questions and comments? There are none this month. And so, we move on to our first substantive item, which is the Joint Health and Wellbeing Strategy update. And Claire O'Callaghan, Health and Wellbeing Policy Manager, will introduce the item. Claire, over to you. Lovely. Thank you very much, Chair. I'm just going to make notes. So, this report is the regular six-monthly report on the current health and wellbeing strategy. So, it gives the update on the implementation plan status that we're using to track impact of the strategy. And secondly, it also gives an update on the current – the future health and wellbeing, which I'll talk a bit about later. So, first of all, the current health and wellbeing strategy. So, most of the implementation plan is now either completed or on target to be completed by the date. There are two actions in the plan which are slightly off target. So, the transition of the Healthier High Streets program to its kind of future delivery model. That's slightly delayed from its current completion date and should be completed by the end of 2014. And then secondly, the recommissioning of smoking cessation and NHS health check services. The mobilization date for that has now been confirmed for October. That will be slightly later than advertised. In terms of indicators, roughly the same number of indicators have improved since the baseline, which was set in September 2021. Five indicators are showing a more than 5% adverse movement from the baseline. So, these are the total number of food bank beneficiaries per month, which has gone up. The proportion of babies being breastfed at six to eight weeks at the health visitor review, which has gone down. Emergency admissions from ambulatory care-sensitive physicians and life expectancy at age 65 for both males and males. So, that's the current strategy. Talking about the future strategy. So, over the summer, we've been doing some work with partner conversations looking at the updated Joint Strategic Needs Assessment, which you've seen at a previous meeting, and looking at other boroughs and the ICS population health interest. The priorities might be for Barnet in the new strategy. We are planning to take this to a meeting of health and well-being board members, an informal meeting at the table. And if you don't have it in your diary, you will do by the end of this meeting. And the intention is to have a long list of priorities to take out to wider public consultees over the next few months. We're still on track to have a draft strategy by January. So, the next time we meet, we'll have a nice draft strategy that you can comment on and approve, hopefully. And then, it will be a more formal consultation over the spring, aiming for… Thank you very much. I think there's two parts to this. Obviously, there's the current progress on the current health and well-being strategy. Does anybody have any particular comments or questions to make about that? From my perspective, perhaps you could just clarify the situation with respect to the recommissioning of the smoking cessation services and the adult health checks. And is that a contractual issue? And it's not a major change, but it's a recontracting. Yes. So, my understanding is delivery on both of those things has been continuing. So, it hasn't been a stop in service delivery. I don't know how much, because in some of the documents, that's not entirely clear. There's some crossover with our plan to ban it. And there was an odd phraseology that didn't make that quite clear. So, thank you. That's really helpful. Does anybody else have comments on any of those other areas? Any reflections from our health colleagues about the life expectancy issues and any reflections on how we might be combating that? I think… Sorry, Jess. I do apologize. So, Jess Bains-Holmes, Director of Commissioning for Adult Station Care. The question really was just to clarify. So, our emergency admissions for ambulatory care sensitive conditions have gone up, which is clearly not great. But I just wonder, the baseline is 2020 to 2021, which is the usefulness of using that as a baseline. Probably Janet. So, I'm just understanding if that's useful for us to measure it against or if we've done some other review of… Presumably, it was the baseline that was the start of the well-being strategy. So, I think a narrative around it would be appropriate. I'm assuming that… I don't know whether we are in terms of dates, whether we're in line with other statistics. But it may be important to be comparative. But we will be resetting those baselines with the new strategy, I think. But it's a really valuable point because the same is… There isn't a reflection on the change in life expectancy at 65. Some of that has been influenced by the COVID and post-COVID figures. I am assuming, but I'm not a specialist in that, but I'm assuming that that's the case. Kay. Thank you, Chair. I'm Kay, as Director of Operations. I'd be able to address this. That's a very pertinent point. And if you haven't already had an opportunity to delve into the new joint strategic needs analysis, actually, there's a huge amount of data within that and where it's been possible. Where it's possible to have it at a ward-based level, we do. Slightly, because of the new ward structures introduced in 2022, there's a little bit of transitional data there. But we've also, where we can go down below ward levels to MSOA data, we have done that. Now, that has confused some people because the names are quite colourful and do not align with wards. But actually, that gives you a tie-up through to ONS data. And so we are able to do some of that geographical analysis. And yes, there is, I'm sure there will be differences that we can unpick. And that would be a really helpful exercise to do in terms of then targeting our work and our resources into the places where we will make the most difference. Simon. Thank you, Chair. I'm Simon Wheatley, I'm the Director of Place West for the Integrated Care Board. Just to say that I think it's nationally appreciated that changes in life expectancy are multi-factorial. And certainly, what we're seeing in Barnet is disappointing, but something that's reflective of the national picture. I think you're right, Chair, that actually a recognition of the geography and also some of the specific communities would be even more important. From an ICB perspective, we're introducing a new long-term condition locally enhanced service. Nick would be able to speak to this in far more detail than me, but that is an expansion of investment in general practice to focus really significant investment that we're progressing at the moment, Chair. Thank you, Simon. And as you will know, the Adults and Health Scrutiny Committee have just completed a task and finish group on access to GP. And that will be coming to the Cabinet meeting in November, I believe. And there are recommendations both for us and actually for the ICB as well within that. And that would be really helpful. We recently had some discussions around the GP survey, and that does talk to the issue that some of our GP practices need some support in getting to where you want them to be around that continued management of older patients with those with ongoing health issues. Nick. Thanks, morning. I'm Nick Detani, GP and Clinical Director of PLACE. I think what we saw over COVID was that a lot of patients became deconditioned, and that deconditioning is now having long-term conditions impact. So, for example, we see a massive increase in patients with heart failure, for example, because they've been deconditioned and not exercising and stayed indoors for often a year. And we're seeing a big increase in pre-diabetes. And then we're also seeing a big increase in cancer diagnoses. And so what's really interesting is a lot of those are linked to not exercising, not eating well, and what people have missed out on in the year or two of COVID. So it's going to probably have a knock-on impact for the next 5, 10, 20 years. I don't know. Public health might give us an idea, but it's going to have a massive impact. And so what Simon talked about was the long-term condition locally-commissioned service that's now in North Central London. And really is exactly what Simon said, allowing general practice to focus on prevention, because actually what we've been doing is tackling acute illness, and what we're better at doing is managing people's long-term health to keep them living healthier and for longer. And one of the things I think we need to think about in our strategy is actually getting people more active and understanding their long-term condition, which is a missing feature. So if I diagnose somebody with heart failure, and I can medically optimize them, but what I can't do is get them to the gym and getting them to buy foods from the supermarket and understanding what that means for them. And that, I think, is the missing link. And actually, what we learned over COVID was that people talked to each other, and how did we get COVID vaccinations so great, because everyone talked to each other and encouraged them. It's the same thing with long-term condition. I bet most people on a neighborhood will have congestive cardiac failure or diabetes, and actually want to stick together and actually make a better lifestyle for themselves. So I think that's the things we might need to focus on. Thank you. That's really helpful, and that actually gives us a topic of conversation for the third, because it reflects some of the things that we've been – a conversation that we've been having recently with the Director of Health and Director of Adults. Claire? Yeah, just to come back on the life expectancy. So last year's annual DPA, it's got last year's data, but the factors are very much the same. Thank you, Claire. That's a sensible reminder that, of course, there is a huge amount of information in... And thank you, Nick, particularly, because I think that sense of being able to help people to build agency and understanding and control over their health and understanding that there are things that they can do to improve that situation and what they don't. I think that's a really positive way forward, and I think it's something that brings all of the partners around the table actually together around that issue, because it involves wider parts of the Council, but actually also community and acute health as well. Pauline? Maybe a various communities to try and get an increase, but I think – I mean, what I was trying to explain last night, and I'm sure in fact, was a lot of hesitancy about immunization. We are monitoring progress on immunizations. Those reports aren't public, but thank you for the reminder. We will make other relevant members to share updates on the issue of vaccination hesitancy. It's a national wide issue, unfortunately, and I'm sure a clinical colleague. Thank you. Just to add to that, there's about 5 million population in continental central London eligible for a COVID and flu chapter. I ask Councillor Edwards to speak. I would just reflect, and it's a conversation that we were having following the meeting yesterday evening and that conversation about vaccinations, particularly childhood vaccinations, and actually a reflection that there's a younger generation of parents who may not appreciate the seriousness, for example, of measles. I'm old enough to have grown up with friends who had eye problems or hearing problems or a range of other problems that resulted from having had a measles infection, and it was a relatively common place when I was a child. I don't think young parents now really always understand the real ramifications if we have a measles outbreak, and I know that an awful lot of work has gone in, both across a bonnet in terms of promotion across NCL and the wider NHS in terms of promoting vaccinations pre the school term. And there has been some work, for example, through the London Jewish Forum and other groupings to try to encourage vaccination rates within some of our communities who are most resistant. It is a really important area and it is overcoming all sorts of, I was going to say ignorance, I don't mean it that way, but lack of understanding of the impact for some communities. Yes, thanks to, excuse me for my ignorance, but I can't see anything in here, and this is not a pun, around ophthalmic or eye health in terms of wellbeing. Can you please repeat what health, I mean eye health, I'm sorry, eye health wasn't mentioned specifically on the number of outcome KPIs is limited, and whilst I absolutely agree and appreciate eye health is important sooner than in mature age. Absolutely, and there's somebody whose eye defect was picked up by that first check in school actually when I was first in reception. That's a very good point. Paul, do you want to carry on? Yeah, I also think it's important because I used to wear glasses firmly and I've had cataracts removed and it's helped my vision remarkably. What occurs to me also is the cost of it, and I'm wondering whether for some people that's prohibitive in terms of just going on a regular basis. It's the same, but I'm talking about eyes. I mean you can't go to an optician without paying some money. I discovered because there's something I'm going to have, something done on my eyes. There's even an NHS price that you can pay. So there's the private price, but there's still an NHS price. And I'm just concerned, you know, in general about particularity than somewhere else in the councils. It's a point well made, I think. Any comments from our partners? Okay. Regular eye checks for children. It's not like part of a regular health check. I know I was never offered it. Well, not for my child anyway. I think that's a question for our partners. Nick, if you could shed some light on that because clearly I'm talking about a different generation of my eye tests. There definitely is two sets of eye checks in schools for the ages now, but there definitely are. It probably has changed over the years. I don't remember what it was like when I was a child, but certainly now there is two sets before 16 that I've offered. I mean, certainly that would be something. Fiona Bateman online has made a comment that it's also true of hearing tests. And there is an expense. Thank you, Fiona. Absolutely. Absolutely right. We've got two different things going on here. We've got we've got talking about the cost of eye, dental and and and hearing checks within with people and children's testing. And there is a comment from Louisa Songer, which I'm assuming is from her current understanding. There's hearing and eye tests at school at five and six. And Claire would back that up for those who have pupils. There is there is something that replicates the sort of testing that I remember as a child. But it's not it's not wrong, actually. And the the implications for all of those elements can be quite significant. And if I understand correctly, there is some correlation between loss of hearing and developments of some forms of dementia as well, because I'm assuming because of neurological input. So I think there are that's a question we might well, very sensibly ask. And I would just be moved to comment on how Chris would appreciate you mentioning this. One of the things when we took the AUSTED, the outcomes of the Children's Services report on Tuesday at Cabinet, one of the positive comments was around the timeliness of both optical and dental checks for children looked after. And I think that is something that may not always have been the case. And so it's very pleasing to see that we at corporate parents can be assured that at least in that context, there are checks going on. Thank you. Any other comments? So. Sensory and sensory impairments can lead to social isolation, which sadly increases the risks that adults with care needs will suffer neglect and abuse. So actually, there are a range of reasons. And maybe that's something that we would want to look at in the future. It may be an appropriate subject for a scrutiny commission task and finish group. Nick. So I just checked. So you get a hearing test at birth and an eye test. And then the eye test is done again at the six to eight week check at the GP and then between the age of four and a half and five and a half to school. And then it's then not done again, but it's free for any child to have an eye test or hearing test between the age of five and 16. Hearing tests are actually the GP and the eye test done any optician free of charge for under 16 to 19. Occasionally. I just checked. That's really helpful, Nick. Thank you. So there is a program in place. There may have been disruptions during the Covid period. And it is about and it is about engagement as well as access from parents. Okay. Agree. And that is really helpful. And I suppose it's then just how do we ensure that that message is out? Because if colleagues around this table don't know that, I suspect a significant portion of our population also don't. And therefore, are they taken? How do we make sure collectively we're getting that message out to all families? Both ends of the age range. We're looking at ensuring that people understand what is available. The benefits of that and the risks if they don't. I mean, clearly eye checks for those who are older. It picks up all sorts of things like glaucoma and a range of other conditions and therefore is particularly important for older people. But actually, young people, you know, I had a friend at school who wasn't doing terribly well. And then they moved him alphabetical arrangement in the classroom with a child who joined, moved him from the back to the front of the class. He could see the board. And actually, his results then kind of climbed rather steadily. And so it's just a case in point that understanding that Councillor Coakley Webb's comment was perfectly right. You only know as a person what you see and you don't know whether that's normal or not. It's what you see. Okay. I think that's really helpful thinking about the future. One of the things that we'll want to talk about when we come around the table and discuss how we evolve the next health and wellbeing strategy is a range of those topics that might or might not form part of the strategy. Obviously, I'm really concerned that we make sure that we both for meetings and for the work that we do together, it's where we can collectively add value and make the most difference through the strategy already through these meetings. I think we've had several really insightful comments around the table today. But I look forward to having those deeper discussions in our workshop session at the beginning of October. So the formal part of item joint health and wellbeing strategy update is that the board comments on and notes the progress on the current implementation plan and the key performance indicators the board reflects on the current progress of the joint health and wellbeing strategy development. And unless anybody has anything to add at this stage, can we all agree those recommendations? I'm happy to have the comments that we've made. Are they minuted? They are indeed. And if you look at the minutes that we've taken today and that I'm signing off, PACS does a very good job in trying to capture our sometimes complex discussions around the table. Yes, they are very full minutes, so they do record what we discussed. Thank you. OK, moving on now to the next item, item seven, which is the pharmaceutical needs assessment update. And to note there are two appendices within the PAC, the map of pharmacy provision and the process for responding to applications for changes to pharmaceutical provision. The item will be led by Dr. Deborah Jenkins, consultant of public health. Thank you, Jeff. So this agenda item is to provide the board with a routine update on the pharmaceutical needs. As the board will be the last pharmaceutical needs assessment was approved, approved and published by Barnet in 2022. And since then, if there are changes to pharmaceutical provision, since the last published published statement, the board needs to review the impact of the change. The previous update to the Health and Wellbeing Board about changes to pharmacy provision was in July 2023. Since the update in July 2023, there have been several changes of ownership of various contractors in the area. Only one pharmacy. That pharmacy is Bishop's Pharmacy in Hampstead Garden suburbs. The pharmacy reduced opening hours from 6 p.m. close Monday to Friday. It was previously open until 7 p.m. It is now closed on Saturdays. It was previously open from 9 until 6 p.m. The impact of this change has been reviewed with the conclusion that it would not lead to a potential gap or poor provision of the pharmaceutical services in Barnet. But this and other changes of ownership and maintained pharmacy list has been updated, but no further actions are needed. As you can see in Appendix A, this is a screenshot of the interactive map of pharmacy provision in Barnet, which has been produced and is published on the Barnet website. The map and underlying data are refreshed and updated on a quarterly basis. I'll turn to the next appendix now, so I'll just change the screenshot. So the second area I'd like to draw your attention to is to make a process clearer, and this is the process for commenting on pharmacy change applications. When there are applications for a change in pharmacy provision in the borough, this is shared by NHS England with the Barnet public health team in order for the health and well-being board to comment. To standardize this review process, this is the chart that we've produced for the suggested actions in Appendix B. The current process is similar, but this change involves both the chair and the vice chair of the health and well-being board to review the pharmacy change application. So in brief, the flow chart describes the following steps. Barnet public health received the pharmacy change application. We then send the change application to the pharmaceutical needs assessment technical support, which is currently provided by an external consultancy organization called Soar Beyond to review the proposed change. The technical support team reviews the evidence and provides a recommendation on whether the change is significant or not. If it is significant, the evidence, suggested recommendation and draft response is sent to the chair and vice chair of the health and well-being board for comment and review. Barnet public health team then updates the draft response from the chair and vice chair as needed and sends back to NHS England. After that, if the application is granted, then the Barnet public health presents a supplementary statement or a fresh needs assessment to the health and well-being board if this is needed. Thank you. Back to the chair. Thank you very much. Does anybody have any comments on this? I mean, I would say in welcoming the tightened up procedure for responding to applications, I think it would be very helpful. I would certainly value the vice chair's comments. Clearly, I'm not a professional in this, though I bring, I hope, a community understanding to it. But it's such an important area and pharmacies are playing a larger and larger part in our spread of health and well-being services. And so I think it's really important that we understand the spread and sufficiency of those across the borough. Nick. Thank you. So I don't have any objections to this. I think it's great to have the flowchart. The only comment I make as we're, you know, we're trying to get pharmacies, community pharmacies involved more and more in patients health, more that they can offer to patients. Often patients don't realize is my fear of the opening times of convenient patients. So, for example, now I'm not a personal user of the pharmacy much, thankfully, but whenever I've needed to use it, I've had to hunt around for a supermarket pharmacy that's open to 8 p.m. There are not many and there's not many of those in Barnet, as you can probably see from the map. So thank you. I live in Hertfordshire and there's availability. But I think there's a missing link to say is that you can't predict when you're going to fall ill. And people generally fall ill on the weekend when things are shut. And so in the future, how can the farmers think about providing that provision on Saturday? In particular, Sunday is a crucial day when everything's sharp, but you want the pharmacy to minor illnesses. So how can we think about that provision in the future? Thank you, Nick. Janet? Yes, thank you very much for those comments. They will be noted, I suppose, in the minute. It will be incredibly helpful as we are just about to start the update of the pharmaceutical needs assessment. And I think it in any way, I agree with you. I just yesterday I had to rush a rush of work to catch the pharmacy during their opening times. So I think everyone can resonate with that. And it's important to consider that one more comment as well. As you know, that extended access service by General Practice is now provided on a Saturday from 9 a.m. to 5 p.m. And so I do that maybe one clinic every quarter. And I struggled. I have to print prescriptions for patients and then try and hunt down a pharmacy on a Saturday morning. So it's a challenge for patients, you know, if there's one pharmacy in the area open and you've got 20 people trying to get something on a Saturday morning. And so I understand, you know, the close and it's hard to staff it and the cost of staffing a pharmacy is not cheap. But it's just about what provision can we think about in the future because we are starting to go to a seven-day health basis. I think that's a really, really helpful point and one we should think about, particularly as a growing borough. And one of the discussions we have had recently was about a pharmacy on the west of the borough. My apologies, Jess. On the west of the borough and recognizing it's not only a rising population but perhaps a population with different behaviors and looking at how we work with those who are working lives. I think it's really important. But the reflection of marrying pharmacy timings around an expanded GP practice time is a really well-made point. Did you hear that? Did you hear that? Looking at this map where it says where all the pharmacies are and having had to, like you said, have to hunt for one that's open, how and who can we actually have information both with the addresses and the opening times of all the pharmacies that are available? And it might be, even though these are the ones that are within Barnet, if someone is living on a border, it might be that, say, that a pharmacy just over the border in Enfield is available or over the border in Haringey. And I think we've got a duty to be able to actually have that information on hand. I don't know who will be able to produce it or whether we can pull it out as council information, but for me that seems to be really important that we can plot the addresses and that we can actually tell residents what the opening times are so that when they've got an emergency, they're not, as you said, hunting around in a state of panic wondering where they can get their prescription from. I have Jess and Claire come in. Nick, if you'd like to comment? Yeah, council, so the information that you've got is on the Barnet website, but only patients probably won't use our website or use the NHS website. So the generic one I've got here, you put in your postcode, it shows you all pharmacies in any borough. But I think what Nick is saying is certainly if it is a GP led prescription, you will be able to sign post to the nearest open pharmacy. And whether that's something that we, is there a prescribed definition that is a sort of a national definition? If there is, really we want one that is a Barnet specific, what we want to encourage residents to expect of them. That's a really good point and actually there's been quite a lot of coverage on the radio, certainly on the radio over the last couple of days about pharmacies and the challenges that that changing role will present. Would you mind if I took Simon first and then? That's a very kind chair, thank you, significantly more than it perhaps meant to me three or four years or so ago. I would agree and very much think pharmacies as part of our health and wellbeing family in terms of that broader agenda that we're developing in terms of keeping people well but treating them when they are unwell. Claire? I suppose, I think my intervention for topic for discussion. Debra, do you have anything else to add in summing up the paper and the discussion? Thank you, thanks for all the comments. I think a further discussion on pharmacy provision would be really helpful. We have some links already for future agenda items. Thank you very much, and I look forward to that discussion. It feels like a very mature stage of regarding them as part of that partnership. Formerly as part of the paper, if nobody has any further comments, we are asked to note the changes in pharmacy provision in the London Borough Barnet since July 2023 and agree with the suggested and whether we agree with the suggested process for reviewing applications for the changes in pharmacy provision in the borough as outlined in Appendix B. Is that agreed? Thank you very much. Now move on to item eight. That is the suicide prevention annual suicide prevention plan annual report. To note that we have a which is the annual report itself, and the item will be led by Saher Keke, who is our public health strategist and Rachel Wells consultant in public health. Thank you very much. As part of Barnet's suicide prevention partnership, I'm pleased to present our third annual report since the publication of the strategy. Last year, the partnership created an ambitious action plan in line with the publication of the cross-government suicide prevention plan, and this report made an attempt to demonstrate how each partner contributed to preventing death by suicide in Barnet. In particular, how we collaboratively supported the groups who are known to have elevated risks, putting more emphasis on addressing the wider determinants of health. What is new about this report is the change of reporting period to align our reporting with the ONS statistics. We will continue to report statistics per calendar year as opposed to financial year. Our current suicide rate is five per hundred thousand. Although there is a slight increase in comparison to previous reporting, this is not significant. We are still amongst the five lowest suicide rate in London and probably in the country. Our innovations to reduce death by suicide and the strength of our partnership continue to put Barnet on the map last year, and I hope that you have managed to read some quotes from some of the partners involved. Finally, I want to highlight that this report proposed the renewal of the strategy and welcomed the board to feed into process.

Thanks, Chris Monday, executive director for children and families. Thanks. It was really useful and a good report. It's good to see all of the really positive pieces of work going on. I'm aware that there was a really strong cross-referencing between the findings from what used to be called serious case reviews, now called learning reviews, where the safeguarding partners have come together and undertaken reviews. I'm aware that there have been two or three in relation to suicides, and there's ongoing work in relation to some specific issues now. There's one on suicide and filicide, of which we've had two incidents where there's been a suicide of issues around children experiencing issues, both of their autism and gender. I didn't see those things coming through in the annual report, so I wonder if in the future we can make sure that there's a really strong link to the plans that come out through those multi-agency safeguarding arrangements that set out a whole range of issues. One of the issues that I don't think we're addressing fully in this is the role of private psychiatric services. Both cases that I'm aware of where there were particular challenges, both were being managed through private provision, not through state provision. I know that there were a number of recommendations made in relation to that, but that's absent in the report as far as I can see. I wonder whether we're picking up all of the intelligence that is available. It feels like this is the plan and this is what we've been doing, rather than this is what's been going on in the wider context, and these are some of the things that we found from there. To have two suicide filicides in one borough in the space of possibly less than a year, I think is something that we need to understand more and understand what we're doing about it. Indeed. Thank you, Chris, for that. Fiona Bateman is online and would like to make a comment. Just to provide some assurance, perhaps to Chris as well, all to maybe offer, because Tony and I have met to discuss the learning across the safeguarding adult reviews and the children's learning reviews. What we should do and what we could do is invite, see how to mix those meetings, particularly when we're looking at the learning that's linked to suicide prevention. So I think that would make it much easier for that to kind of connect the work. But going forward, I'm afraid I've had over the last year clashes with the suicide prevention group, so although I do always read the papers, I can't physically be in the room as I'm stuck today. So going forward, the vice chair of the safeguarding adult board will be an active member. She's already really well connected with partnerships across Barnet. So I think that learning will be more embedded in the work of the partnership going forward. But definitely, Ciara, if you'd welcome coming to those meetings that the two boards have to look at, you know, how do we join up the learning from those safeguarding reviews, that would be really helpful. I'm wondering whether, because every child's death, you know, or suicide in particular, has an after-action review, an after-death review, and it's interesting to see what the learning is from that. And I wonder where Chris has mentioned there's some private psychiatrists involved, and that may be just because of the lack of access, some of the NHS services and the long waits of 12 to 18 months is possibly a reason for that, unfortunately. But how can we learn from that? What can we change? The second thing, I say this every year, but one of the biggest things that we see now is social media. And I believe it's certainly linked to possibly death or suicide or people feeling low and depressed, actually signpost people using social media into services available, because we can put things on websites and posters and things, but young people don't use any of that. They don't use Instagram and TikTok and whatever else it is nowadays, they can't even keep track. And I also remember about five years ago, I think it was the police, I can't remember who it was, but came and gave GPs a talk on all the apps that were there, and I was astonished. I was like, never heard of half of these apps that are out there, and how do we educate parents into knowing what are the signs to look out for? Because there are a lot of rogue apps around for children, and how do we educate parents to look at what signs to look out for in their child or young one to pick up if they're going through a bad time and they're at risk of suicide and how to seek help? Because I get a lot of parents coming in who have got young children who have harmed themselves or are low, and they had no warning signs, and there probably was a warning sign, but they're not looking at their phones or looking at the right things on their phones. So I would like us to think about the generation of the future is all online, how do we read that and how do we, I don't know the answer, but just leave you to that. Thank you, it's a very thorough report. I'll take Jasmine Holmes and then Pauline. What jumps out at me is the statistics, sorry, and to echo the fact that this is clearly an excellent program of work, and what we're doing is to sort of pick out the things that we think would be even better. The national statistics around ADHD and autism diagnosis in suicides obviously assume you've had a diagnosis, and to pick up Nick's point again, the issues that we have around delays, waiting times, reduced access to diagnostics for NDD. I suppose I'd like to understand a little bit more about where we're seeing self-harm and suicide as a result of lack of diagnosis, lack of access to support, and I don't know how we can do that work with most of the diagnostics and support. But given that we know that we've got clinical restraints and financial pressures, understanding whether that is playing a significant role and that lack of diagnosis means that you struggle for longer and are likely to there. Yeah, I think to pick up on one of the points you said, I think, and Christopher confirmed that one of the things we found is that people accessing private therapies was often a cultural thing. It wasn't so much that they didn't, they just didn't want to contact NHS, it was different. One of my beliefs is that when you have these private practices, they are not, and I still think it's still the case, they're not required by law, therefore, to inform that person's general practice, therefore it goes unnoticed until the worst has happened. And when we look at the issues, well, the issues with social media and with things like self-harming that can ultimately lead to suicide or be more than one that have taken their own lives and that it's been related back to what you find on social media, they're still reporting that that still can be happening and I don't know how these social medias can be taken into account. They're talking about restricting, they can still access information and if not, they will use somebody else's phone or whatever to access it that then has got a verified aid. I think it's a really hard battle for us and how we can work with schools and parents and health professionals to try and stem this really horrible, you know, plague of social media that is actually influencing young people, whether it's to be for self-harm or their body image to what they think they should be and what they are and I'm sure that that is the root of an awful lot of problems now that would not have existed years ago. Thank you Pauline and I see Nick is nodding and I know that there is some pilot work going on with a range of schools in terms of phone access but that doesn't alter the access to phones outside of school hours. Just in the context and forgive my ignorance on this, is there any way private psychiatrists, private psychiatric health, presumably it's accredited in some way and I wonder if there is any way to lobby for a national change where they're obligated to notify. So because they're regulated by the GMC for example if they're adopted but there isn't anything that they must inform the NHSGP practice so the patient or the guardian has to consent and provide the details of the NHSGP and they can choose if what you're saying is it's cultural, they probably are not consenting to share the information. And then the law is that you don't consent, the practitioner is not allowed to share information because they'll be in GDPR breach. So I suspect it's probably more than not consenting than the clinician hypothesising and what do you do in that situation. Now the clinician can override that decision if they believe it, if that patient is actively suicidal for example. One thing they really should take into account if anything for legislation, it may be that it's just an adult but if that adult, if they know that that family has got young children, that's when the alarm bell should ring to go we need some information, we should not be holding it to ourselves and at the minute it seems that they can not do that. Just to add to that I guess if there's an adult, if thinking about what the right practice should be is that that clinician should then do a safeguarding report because they're lifting up children. Whether that's done or not is another thing but that's what we would do in general practice is do a safeguarding alert. But yeah it's probably what we've done and so I suppose there is some merit in maybe doing an after action review of the deaths that you've mentioned and thinking about what information we could share and certainly in our community I think going to legislation is one thing but in the interim we share something that the nation might be useful. And my recollection is that the same issue around disclosure and sharing has been a challenge in some of the teenage and student deaths as well, nationally not locally so I'm very conscious of that. I'm just going to read out Fiona Bateman made the comment all professionals registered with the GMC, the HCPC etc will be expected to comply with safeguarding duties so should follow local or encouraged by professional regulators. So I think that's a very helpful point, thank you Fiona. So how would you respond to those comments and both in terms of the quality and the value of the report and the work that's gone on because I think that we do need to remember after what is a very fruitful discussion that it is also there is some really good work going on and it's had national recognition, but also what we would what your reflections are on the comments that have been made. We have been working very closely with both Fiona Bateman and also Tony Lewis. And last year, some of the work we did in terms of learning from the safeguarding reviews reflected in the last year's report so I didn't repeat that this year, but that work is ongoing. In fact, in terms of the suicide case and the link with, you know, the issue around lack of communication, any with private sector. So, I have invited Tony to present the learning from the suicide review in the London community platform community of practice for all suicide prevention leads, so that we could collaboratively understand about those issues and also to see if there is any other example in London, and then maybe we can join forces together. You know if there are any good practice. So, we want to raise those issues because they are very, very challenging issues to to tackle. In terms of however I'm going to take all these comments to our start and grow well team in public health to make sure that going forward. We have a better capture of all that learning within the suicide prevention report. In terms of autism and other sort of at risk groups. I know that Jane Abbott, who is our resilience manager. She does a lot of work in schools. And there has been a new service, I believe it's commissions, working with LGBTQI children and young people. With autism, what we have in the councils, we have autism champions group running. I'm a member of that group. And we have been working with Barnet Mancub resources for autism. We have constantly raised awareness amongst the professionals, amongst staff, voluntary sector colleagues, faith organizations about the link between suicide and autism. And inviting people to take up training, which is delivered by Barnet Mancub. I think I'm working closely with family services colleagues from violence against women and girls team. I'm taking part in their reviews. We're gradually building those links. And I will make sure that they all reflect going forward, but that work is emerging and there is a lot more work to be done on that, on these areas. Thank you. Louise is joining us online, has posted, sent through a comment, drawing attention to the suicide and prevention and support after suicide link on Barnet Council's website. And she highlights the stay alive app, which is available on Google Play and other providers, for which the team had recognition and was the source of work with the Middlesex University. So the app has been a very important part of some of the work that you've done. So I don't know whether you want to comment on that, otherwise I'll finish up with some final reflections. Shall I take Pauline's question first and then allow Sahar to sum up? I'm just scrolling down under the figure two, men's lives lost to suicide in Barnet versus everywhere else. And then underneath, this really puzzling sentence. Due to small number suppression and disclosure control issues, we are unable to make accurate interpretation of female suicide rate for Barnet. About suppression of data, but Sahar, if you'd like to. Because it's not reported in the statistics, the rate, because of the small numbers. So we can't -- we don't have the data. Who does have the data? So we receive two such statistics from the Office for National Statistics. And we have the numbers for female suicides, but we don't have the rate. Because of the very low number of female suicide. I know from the safeguarding board when we get reports, we get to know what to give any figure or number in relation to that. I believe, Rachel, you'd like to comment. Could you put your mic on, Rachel? Thank you. Thank you. It was on a previous point, but I just -- I just mentioned on this one. With regards to the numbers, we have the numbers, but they are identifying if they are very small numbers. This report, we wouldn't necessarily put that in, but we do have that information. Can't form a rate on a very low number, but that's why that's there. We do have to suppress them when they're very small. I think that might be something that we can look at a way in which we can present those numbers in a way that gives you more information and appropriate. I just want -- I don't think anyone's asking for dates or times. It's just a comparison between maybe how many suicides are male and how many are female. I think that's all we're asking for. We can do that. We can do that. We can give you some information which would identify that for you. We can amend that in some way. I can quickly mention that from the real-time surveillance system. So we know that about 25% -- 75%. Just one other quick point. Just referring to something that was discussed earlier, and I know that we all know this, but I just thought it might be useful to many digital natives. And thinking about how we work with parents who are also migrating into that world with young people and children who are already in that system. I think it takes more thought across the system. It may well be that trying to engage, and I know that we have done this, but perhaps not as a board with young people around their uses. I think it would be quite an interesting discussion. Because I have a 15-year-old son, so I know what goes on, and it's incredible. And I know some of you probably will be in that situation as well. It's uncontrollable. And I think having a better understanding of how their systems work as a board may well be something worth exploring. And also ways in which their individual resilience can be improved. Chris, I don't know whether you have any comments on how we might use some of our young people's groups to have such a discussion. In fact, there's already that sort of work going on. The mental health charter was developed by a whole group of children and young people, so there's lots of dissipation in that. On the social media side, I think there's some really interesting international changes that are coming about. Very interesting to see as children and young people have the amazing ability to be able to find ways around all of the rules that are -- I'd say this purely as a father whose children seem to be able to bypass every single restriction that we put on their phones. Two of them are old enough to do it themselves now. So I think that there are some things. But I do think it's something that government need to be doing a bit more on the online harm bill. Did that go as far as it should? Is some of the work that's going on in Australia now through their administration about holding providers to account more powerfully? There's been some quite interesting work in that space. But I do think it's something that maybe as a board we should be writing to government about saying, you know, actually should we be going further on? Some of the -- you know, tick tock is supposed to be only available if you're over a certain age. Yeah, lots of children are on tick tock. Instagram is supposed to be over a certain age. You know, these days I think it's about if you're over 50, then you're allowed to be on Facebook. But, you know, there's those sorts of things that are well beyond the realm of us as parents and us as a board. I suppose it's those sorts of things that we need to be saying. What should we be doing in that space and should we be talking to parliamentarians about, you know, are there some things that they want to do more? You know, there's a new children's being act or bill coming forward. Is it something that we want to be saying that there needs to be more in that around online safety? Because I think it is genuinely -- it's a generally scary world that parents don't understand and that children do far more than us. I think the point about data that digital natives versus digital immigrants is a really important point. And Chris has just reinforced that. Nick? I'm just wondering, you know, whether in school programs there could be something around this education about online. Yeah. They had all these icons on the screen and I could recognize about three out of ten. And I thought, oh, God, I'm stupid. But, you know, what does that mean, isn't it? You know, do parents actually know what the apps children have because you just see an icon. So I think we need to -- it's not just the children. I think we need to get adults and parents involved into understanding what's on children's phones and things. And I think that's a wide -- and in reality, that's a wider issue than just around suicide prevention. It's a range of issues across young people's perception of the world and access to data and the online world in a way that maybe those of us who are a bit older just aren't grasping the breadth and depth of that. So that's a really helpful conversation. Sahar, any final comments and then I'll wind up. With regards to the research, the effectiveness of interventions in preventing suicide, suicides are still emerging. It's a relatively new field that's really developing in the last sort of 10, 20 years. In principle, anything that we do in Barnet, I work with colleagues from academia and looking to them to support with their evaluation. And I'm pleased to say that our campaign has been evaluated by Middlesex University, Professor Lisa Marzano and her team. And then they actually demonstrated statistically that the campaign may have contributed to saving 7 to 10 lives across the nine-month period. Of course, there are lots of caveats in this, but nevertheless, it's a very, very positive result and it's a contribution to campaign approach, which was later demonstrated by Dr. Alexandra Pittman from University College London and some other academics from Australia about how actually campaigns can contribute to reducing suicides. That's about it. And I think about the apps. Could I just add to that, please? We are working closely with Metropolitan Police and also Fire Service in terms of monitoring those untoward apps or emerging new methods of suicides. And we are conscious of that. And then sort of jointly in London, we're trying to find solutions if we can identify anything untoward. But these are wicked issues. And I just reflect that we are fortunate to have a university just adjacent to us where you've not only got academic contact, but actually it's a pool of students who might be useful in giving reflections. And I know that some of the work that has gone on through some student courses has been particularly around violence against women and girls, but actually there are a range of other issues that the students will be working on. So that's a possible source of news about the validity and depth in the way that we're doing. But thank you very much to her and thank you for your input. And Rachel, I would reflect that we have in former years discussed at the Health Scrutiny Committee. And I think I would reflect that we've had a really rich and thoughtful discussion this evening. Lots of potential learnings to come out of it. Recognizing the role of joining up and building on and extending relationships across a range of organization and mining the data and intelligence that others have. Taking these opportunities, working, for example, with safeguarding boards. And considering how and looking at how a suicide prevention is set against an evolving online challenge with social media. So thank you very much for all of your input. Now we have three formal recommendations that the Health and Wellbeing Board note the most recent data for the Borough of Barnet. That the Health and Wellbeing Board note the progress on implementation of the Barnet suicide prevention strategy as outlined in Appendix A. And that the Health and Wellbeing Board feed into the forthcoming suicide prevention strategy 2025 to 30 refresh. I think there's been a lot of opportunity to pick this up at some of our informal working sessions. So thank you everyone for that discussion. And we're now going to move on. I would just, because you joined us late, I just want to welcome Monique from Barnet. Good to have you at the table as our BCS representative today. Thank you very much. Very important part of our Health and Wellbeing Board. So thank you. And do pipe up if you want to feed in. Moving on now to Item 9, the Combating Drugs Partnership Board Annual Report. And this will be led by Louisa Songa, who is joining us online because she has COVID. I hope you're not feeling too unwell, Louisa. I bear with me two seconds when I sort my presentation out. Can you see a presentation up on the screen? We can, Louisa. Let me just put it into slide show mode. Thanks, chair. Yeah, forgive me, I'm fine, bit croaky, but all good, all good. But I did put some slides together just to keep me focused, because I'm probably not firing on all cylinders this morning. So hi. Hi, everyone. I'm Louisa Songa, Senior Public Health Strategist in the Public Health Team, and I lead on substance misuse strategy. And I'm here to update you on our Combating Drugs Partnership Board. A little bit of background. It's all in the paper. The board was formed off the back of the new government drug strategy a couple of years ago. We launched in November 2022, I think it was. And all areas were asked to develop Combating Drugs Partnership Boards to do three things. Really want to look at the sort of supply chains of drugs and how we could work with enforcement partners to disrupt these lines and hold offenders to account on it. The second priority was around improving our substance misuse treatment and recovery services, ensuring that they were high quality and accessible. And the third priority was around ensuring a better prevention offer, both in terms of preventing the onset of substance misuse, but also stopping, you know, supporting people from developing those sort of high risk behaviors if they're already using substances. So I put some of our achievements in the paper. There is a huge amount of data available on substance misuse. So it's really hard to try and choose which bits that we put to you. But if there's any interest in any of the areas more broadly, more specifically, we can we're happy to share further information. So the first priority, there's been a huge, I'm sure you're all aware of the work that our police and community safety colleagues have been doing around making the borough a safer place and reducing supply of substances into the community. And so address the sort of wider issues around that they bring around and social behavior and these programs that clear how build approach and some of the other operations that we've had. That certainly partnership approaches which aim to take a really multi-agency approach to the problems and look at it from a systemic point of view. And I put this graph in just to show you that, as you can see, it looks like our drug trafficking offenses in Barnet are increasing. That's a really good thing, because actually what it shows is that the police, this is police data, our police partners are able to respond to supply and, you know, the sale of substances and hold that are actually arresting people and bringing them into the criminal justice system. So it doesn't necessarily mean that there's more drugs coming into the borough, but actually that the police are doing a really good job at targeting those drug dealers. And on the flip side of that, possession, people being arrested for possession of drugs is decreasing, which is good, because actually what we can see then is that people that have substance misuse issues are being signposted into support and treatment rather than being pushed into the criminal justice system. Which can't necessarily address their issues. So in terms of delivering world class treatment service, we've been working really closely with some of our criminal justice partners to improve court pathways, prison pathways, and we've seen an increase in community sentences, lots of work on people with multiple and complex needs. So we have a substance misuse rough sleeping program, which is, I think it's in its third, fourth year of operation, and they're really sort of embedding into the community. The team have managed to build good relationships with people with multiple issues and support them into services. And through that project, we're starting to look at the wider health issues of people who are rough sleeping and also have substance misuse issues. So one of our successes is that last week we launched a dental service for rough sleepers, which is a great success. It's something we've been working on for a long time. So anyone that's rough sleeping can now access a community dentist in Hendon. I think it's one day a week that we're offering that service. It's a fast track service. And also there's oral health training sessions that are being delivered to staff through that program. And we continue to be focused on reducing drug and alcohol related deaths. I've got here rates for barnet remained lower than London, England. Apologies, that's a tie. I think we're actually similar to London and England. What we have seen is over the last few years, the numbers of people dying who are accessing treatment are largely related to alcohol. And what we are understanding from those reviews of those deaths is that there are some significant issues around people with complex physical health problems as a result of their alcohol use and people accessing treatment quite late. So we're really keen to try and change that by getting people into treatment services at an earlier stage in their substance misusing career and also ensure that they have better access to that range of physical health services to prevent those complexities. In terms of opioid related deaths, we remain quite low, which is brilliant. And we are really pushing our harm reduction strategies. So we we have a really good distribution of naloxone across the bar. I think I read yesterday that we're about 70 percent of our opioid users have access to naloxone. Naloxone is an anti overdose medication that people can administer, administer at home or in the community. And also we are now getting nitazine testing strips as well. So you may have heard in the news, there are sort of new synthetic opioid which are way more potent and more lethal than heroin. And so people can can test their drugs before they use them. We have had had one one instance we heard of locally where a chap tested his heroin, found it had nitazine in and actually gave it back to the drug dealer. And I don't want this. So we can see it works and significant engagement with partners to around training and upskilling. And one of our biggest successes that we're really, really proud of is actually the number of young people accessing treatment in Barnet for substance misuse issues has grown exponentially. I think it's at the highest. It's it's been definitely since I've worked in Barnet, but, you know, for a very, very long time. And this is this is great. This is really shows that that service is starting to to get into the right communities and work with schools and really meet that need of young people. In contrast, the numbers of treat people access in adult treatment is staying fairly similar. We really hope to see that drive up. But we it stayed quite flat over the last 12 months. We're really keen to think about how we can improve that through the next year. And again, slide on deaths. And so, obviously, a little bit on the prevention. So we need lots of work with schools around thinking about what the PSHE offer includes and ensuring that schools have access to the substance misuse service to go in and offer that that extra training and upskilling. And we have been looking at upscaling or drink coach service. And again, I think we're in about year three or four of the drink coach service. And for the first time, halfway through the year, we've exceeded the number of counseling sessions that we don't deliver. And there's a slide which just really shows you the how our campaigns have a really positive impact on the numbers of people that are going to the drink coach site and and access in that that intervention. So, yeah, really, really good to see the outcomes of our campaigns. So finally, just a point on the restructure. So we're a couple of years into CDPB now. We formed as a partnership. We've developed our work plan. And now I think we're in a really good position to look at what's working and what's not working. You know, there have been a few challenges to creating ownership and actually getting key stakeholders to drive certain areas forward. So we have reviewed some of the arrangements in other areas and made some recommendations. What we think a revised structure could look like. We presented it to the board in the last meeting in our health and sorry, my competence and drugs board in July and partners were on board with that. This is a structure. So we, if approved by the health and well board, hope to move to this structure in in the coming months. And really, you know, the first one would be very much led around our police and community safety colleagues. The treatment group would be led by public health. And we're looking at how the prevention subgroup can align with things like the only help board and some of the prevention work that's happening in adult social care. And that's it for me. Thank you. Thank you very much, Louise. And before I ask anyone to do for comments around the table, I just want to give a reflection as the chair of the Combating Drugs Partnership Board. And it's been a real it's been a real work in progress over the last two years. I've learned a huge amount. But I've also watched a range of professionals working and discussing what they do and focusing on that issue. Because for members, for counselors, the issues around drugs can be quite a challenging one out in the community. And therefore, it's been really helpful to understand the work that goes on and how the system is coming together. It's relatively unusual to have a counselor chairing the Combating Drugs Partnership Board. But I would reflect that alongside having Councillor Conway, the chair of the Safer Communities Partnership Board, with us at the CDP, I think that's given us I hope it's given us real impetus. It certainly meant that we had we have a member focus on it that I'm not sure that we would have had in other ways. It's been good growing that partner attendance. But as Louise said, it's about ownership of the work outside those meetings. And we want to maximize that that work. So I think the benefit of having a formal Combating Drugs Partnership Board meeting twice a year that's aligned with the Health and Wellbeing and Safer Communities Partnership Board meeting schedule. So that we're maximizing the time for that working group activity and the joining up that goes up on professionally outside the meeting. But also, reporting into the Health and Wellbeing Board and the CDP and the Safer Communities Partnership Board as that public, formal public expression of the work that you do. I think it's a really important the board, the Combating Drugs Partnership Board certainly saw the logic of moving to that format. And I think it would be a very positive thing to do. So I hope the board would share that. So do I have any comments or questions for Louise about the work that's going on? I think I would just reflect that actually it has been a really busy two years and we have moved a number of areas on considerably. But obviously, the work of the police in the Clearhold Build, Operation Dakota work has made a step change in what's gone on. That certainly changes for a part of the borough that I think was probably, it's fair to say, was blighted by drugs issues in that community. So if nobody else has any additional comments or questions, I think Fiona has her hand up. Thank you very much for joining us when you weren't feeling well. It was much appreciated, but really important that we note the value of the work that goes on and the amount of work that goes in to the Combating Drugs Partnership Board and the work that goes on outside that. Thank you very much. Sorry, sorry, Chair. I do apologize. I thought you were wanting to speak. Please do so before we wrap up. It's just a very quick question and taking into account what Nick said when we're looking at the pharmacy needs assessment. I wondered if there were any accessibility issues for individuals who need treatment out from pharmacies like methadone and things like that outside of usual work hours and whether or not we actually as a board should be pushing for things like from the pharmacy need assessment as well. Louisa, if I let Nick to start a comment and then you can follow up if need be. Yes, I think there is, for my understanding, we don't prescribe it anymore, it's done by CGL, but I think there is a provision to CGL based in Edgware. There's a pharmacy in Edgware that provide it on the weekend and then at Binchley Memorial Fair we pharmacy provide it out of hours as well. The majority of patients are on a weekly script, for example, and they'll come on a designated time every week. So let's say that their appointment is every Monday and they'll go every Monday and collect them and it won't be on a weekend generally that they're seen. So probably the likelihood is low, but there are two pharmacies, one in Edgware and one in Binchley and maybe more in the other part of the borough, but I'm not familiar with it. Yes, I thought there was borough coverage in that sense, but Louisa, do you have anything to add? Yeah, there's really good by the borough coverage and we review it regularly through our sort of needs assessment work to make sure that we have got access across the borough. And actually there's a really interesting new medication that's just coming on the market, which we're launching in the service, which is aimed at people who are very, very stable and might be in employment, which allows them to. Don't ask me the chemistry of it, but it's it's a very expensive medication and we will be prescribing it now anytime, actually, which allows people to have really less frequent pickups and it's a much safer medication. So it's really positive. And the service has actually now moved as well. And it's in Hendon. So that was a couple of weeks ago. So we are in the process of updating comms and communicating that out to partners. Yeah. It's a much better location. Thank you, Louisa. And I know that we've had a number of very dynamic discussions within within the partnership board about that. The interface with with housing and a range of other issues. So it's been a very active partnership, but it is about helping people to stay stable. Recover from drugs, but actually also through the education program, preventing young people from getting involved in the first place. Thank you very much for that. We have three formal we have two formal yes, two formal recommendations to make that the health and well-being board note and comment on the progress of the Combating Drugs Partnership and approve the updated structure of the CDPB outlined in section one point six of the report. The reasons for that and the the the reporting that will go on formally going forward. So we agreed on that. Thank you much to everyone. And just to note that Paul, Councillor Paul Edwards had to go at 11. He was he's judging a care home art contest. And so in his role as adults lead, he was going to have to go and do that. So but he had let us know that he was going to do that right. Finally, we're moving on to the last substantive item in the agenda, and that is the communicable disease update from Janet. Janet, Director of Public Health. Thank you very much, Chair. It is a verbal update in other forums across London already. At the moment, they are still setting up and working to sell material, a document, a pack to support them. And next week, we'll be having the annual winter preparations. Infection prevention control. Yes. That's the word. We just agreed with the chair earlier. So going forward, we are happy to bring a more. On why their health protection that work in barnet, which goes beyond the nation. Thank you. Thank you very much, Janet. Does anybody have any questions for that was a really comprehensive item. Thank you. It was my desire that we kept this on the agenda post the code reports. But I think it's really helpful, not least in the light of the discussion that went on at scrutiny. The scrutiny committee at the evening about concerns about vaccination rates and understanding the work that goes on to support that in the context of the cancer screening work. Perhaps you or Claire would like to share the news about your grant. Yeah, congratulations to the happy couple. The congratulations to us as well. So we got notification on Monday that's Barnet along with Harry gave been awarded two hundred and thirty thousand. We mentioned earlier. That's really good. Thank you very much, Claire. I think we're celebrating while it's not a communicable disease, obviously. Well, this is it's just really important that we that we make the most of grants like that, because this is tackling. As I understand it, going some way to tackle the inequalities in uptake of cancer screening across our across some of our communities. So it's really focusing on ensuring that that prevention and intervention that we all want to see is being enabled in that particular area. But there's also the issues around communicable diseases. There are some health inequality issues with that. And, Jess, you'd like to comment or ask a question. Just in terms of the grant. Fantastic news. Keen that we make sure we draw in the work that we've done post Leder. So the Learn Disability Review of Mortality to understand where screening of people with a disability or people can. It's an area that that really is important as part of that. Does anybody online have any comments or questions for us? Thank you. Fiona's made a comment. Yes, that's an AOB. So I'll pick that up under AOB. So thank you for that discussion. Janet, thank you for the report. And I hope that we'll continue to have that. And thank you for undertaking to share those those reports with us ahead of the meeting where possible, because that's a really helpful thing to do. Partners around the table will see those. There's a ghost in the chamber. The partners around the table will see those reports in different contexts, but some of us wouldn't pick those up. And it's really important so that we get that that broad picture of the work that's going on around communicable diseases and vaccination. So our recommendation is that the board notes the update. Thank you very much. We do. We do that. We have. The item 11 is the forward work program and the request is that the board notes the forward work program. Obviously, much of this year is going to be formal reporting, but actually also the development around the joint health and well-being strategy. And so that will be a pivotal meeting in January to to bring that together and send it off for wider consultation. But we will have our working session ahead of that. I hope as many people can join us on October the third as possible so that we have the richest and deepest discussion we have going forward. But a lot of what we've discussed this evening leads into that. So item 12 is always a list of the health and well-being board acronyms, which is useful for those who are not health professionals. I'm going to take item 13 as any items the chair decides is as urgent as an AOB. And I have a message from I don't know whether you'd you'd like to speak Fiona Bateman, who has joined us over the last couple of years as the chair of the adult safeguarding board. Her tenure finishes as chair. At the end of end of December and after she served for seven years. So I think that's a hugely big contribution to safeguarding in Barnet. So it's likely that this will be your last meeting. She says it's been a privilege to have been on the board and for the work of the Barnet safeguarding adults board to have been so well received by partners. Fiona, I think we have a great deal to thank you for in the input that you've had to this and to many other parts of the committee and service structure in Barnet. So thank you very much. I'm sorry this will be your last meeting, but thank you very much for all the input you have had over the years. And we look forward, obviously, to working with your successor, but we will miss your input and insight and the reflections you bring based on that seven years of experience within the board. Thank you very much for your input. Thank you. And I wish we pity in a sense, it's a pity we're not able to be. But you are always welcome to come and sit in the public gallery if you should. Should you feel so motivated in future and ask us questions and hold us to account. But thank you very much for all your input. Thank you to the members of the board who have been who joined us online and at the table today. Thank you very much for your input. And for the public gallery, I know that the former chair of the committee has joined us as well in the public gallery. So it's good to see you, Caroline, to hear our discussions and look forward to both to the next formal meeting, but more importantly, perhaps in the first instance to our working group next month. Thank you very much for your time and for the input from officers.

Transcript

For us, we had a minor technical glitch to start with, but we now have contact with everybody that has had to join us online. So, we are now – we've got a quorum, so chairs – good morning. I'm Councillor Alison Moore, Chair of the Health and Wellbeing Board. Thank you for attending our meeting this morning. Please note that meetings may be recorded and broadcast by the Council or by people present. Can I remind members and officers to use the microphone when speaking by pressing the middle speaker icon? And obviously, for those of us who are online, to unmute yourself when you speak. So, moving on to the agenda properly, we have minutes of the previous meeting. Does anybody have any corrections of matters of facts to those meetings – those minutes? Okay, then I will, at the end of the meeting, sign those – the true record of the meeting. Item 2 is absence of members. We have apologies from Dawn Wakeling. She's substituted by Jess Bames-Home. We have apologies from Sarah Campbell and Deborah Sanders. We also have apologies from Louisa Songer, who, due to COVID, is joining us online. And Fiona Bateman, our Chair of the Adult Safeguarding Board, who has a clash and is joining us online today. So, welcome to online and people – members in the room. I would just ask – we all know each other, I think, well now, but when you speak the first time, it would be useful just to say who you are for the purposes of anyone who is watching us online. Do we have any declarations of interest – members' interests? I would just say – I just want to – though it's in my own declaration, I am the Council's nominee on the Governing Council of the Royal Free Trust, and I welcome that we've got a grant to do some work that's come from the Royal Free Charity. Do we have any dispensations granted by the Monitoring Officer? There are none. Public questions and comments? There are none this month. And so, we move on to our first substantive item, which is the Joint Health and Wellbeing Strategy update. And Claire O'Callaghan, Health and Wellbeing Policy Manager, will introduce the item. Claire, over to you. Lovely. Thank you very much, Chair. I'm just going to make notes. So, this report is the regular six-monthly report on the current health and wellbeing strategy. So, it gives the update on the implementation plan status that we're using to track impact of the strategy. And secondly, it also gives an update on the current – the future health and wellbeing, which I'll talk a bit about later. So, first of all, the current health and wellbeing strategy. So, most of the implementation plan is now either completed or on target to be completed by the date. There are two actions in the plan which are slightly off target. So, the transition of the Healthier High Streets program to its kind of future delivery model. That's slightly delayed from its current completion date and should be completed by the end of 2014. And then secondly, the recommissioning of smoking cessation and NHS health check services. The mobilization date for that has now been confirmed for October. That will be slightly later than advertised. In terms of indicators, roughly the same number of indicators have improved since the baseline, which was set in September 2021. Five indicators are showing a more than 5% adverse movement from the baseline. So, these are the total number of food bank beneficiaries per month, which has gone up. The proportion of babies being breastfed at six to eight weeks at the health visitor review, which has gone down. Emergency admissions from ambulatory care-sensitive physicians and life expectancy at age 65 for both males and males. So, that's the current strategy. Talking about the future strategy. So, over the summer, we've been doing some work with partner conversations looking at the updated Joint Strategic Needs Assessment, which you've seen at a previous meeting, and looking at other boroughs and the ICS population health interest. The priorities might be for Barnet in the new strategy. We are planning to take this to a meeting of health and well-being board members, an informal meeting at the table. And if you don't have it in your diary, you will do by the end of this meeting. And the intention is to have a long list of priorities to take out to wider public consultees over the next few months. We're still on track to have a draft strategy by January. So, the next time we meet, we'll have a nice draft strategy that you can comment on and approve, hopefully. And then, it will be a more formal consultation over the spring, aiming for… Thank you very much. I think there's two parts to this. Obviously, there's the current progress on the current health and well-being strategy. Does anybody have any particular comments or questions to make about that? From my perspective, perhaps you could just clarify the situation with respect to the recommissioning of the smoking cessation services and the adult health checks. And is that a contractual issue? And it's not a major change, but it's a recontracting. Yes. So, my understanding is delivery on both of those things has been continuing. So, it hasn't been a stop in service delivery. I don't know how much, because in some of the documents, that's not entirely clear. There's some crossover with our plan to ban it. And there was an odd phraseology that didn't make that quite clear. So, thank you. That's really helpful. Does anybody else have comments on any of those other areas? Any reflections from our health colleagues about the life expectancy issues and any reflections on how we might be combating that? I think… Sorry, Jess. I do apologize. So, Jess Bains-Holmes, Director of Commissioning for Adult Station Care. The question really was just to clarify. So, our emergency admissions for ambulatory care sensitive conditions have gone up, which is clearly not great. But I just wonder, the baseline is 2020 to 2021, which is the usefulness of using that as a baseline. Probably Janet. So, I'm just understanding if that's useful for us to measure it against or if we've done some other review of… Presumably, it was the baseline that was the start of the well-being strategy. So, I think a narrative around it would be appropriate. I'm assuming that… I don't know whether we are in terms of dates, whether we're in line with other statistics. But it may be important to be comparative. But we will be resetting those baselines with the new strategy, I think. But it's a really valuable point because the same is… There isn't a reflection on the change in life expectancy at 65. Some of that has been influenced by the COVID and post-COVID figures. I am assuming, but I'm not a specialist in that, but I'm assuming that that's the case. Kay. Thank you, Chair. I'm Kay, as Director of Operations. I'd be able to address this. That's a very pertinent point. And if you haven't already had an opportunity to delve into the new joint strategic needs analysis, actually, there's a huge amount of data within that and where it's been possible. Where it's possible to have it at a ward-based level, we do. Slightly, because of the new ward structures introduced in 2022, there's a little bit of transitional data there. But we've also, where we can go down below ward levels to MSOA data, we have done that. Now, that has confused some people because the names are quite colourful and do not align with wards. But actually, that gives you a tie-up through to ONS data. And so we are able to do some of that geographical analysis. And yes, there is, I'm sure there will be differences that we can unpick. And that would be a really helpful exercise to do in terms of then targeting our work and our resources into the places where we will make the most difference. Simon. Thank you, Chair. I'm Simon Wheatley, I'm the Director of Place West for the Integrated Care Board. Just to say that I think it's nationally appreciated that changes in life expectancy are multi-factorial. And certainly, what we're seeing in Barnet is disappointing, but something that's reflective of the national picture. I think you're right, Chair, that actually a recognition of the geography and also some of the specific communities would be even more important. From an ICB perspective, we're introducing a new long-term condition locally enhanced service. Nick would be able to speak to this in far more detail than me, but that is an expansion of investment in general practice to focus really significant investment that we're progressing at the moment, Chair. Thank you, Simon. And as you will know, the Adults and Health Scrutiny Committee have just completed a task and finish group on access to GP. And that will be coming to the Cabinet meeting in November, I believe. And there are recommendations both for us and actually for the ICB as well within that. And that would be really helpful. We recently had some discussions around the GP survey, and that does talk to the issue that some of our GP practices need some support in getting to where you want them to be around that continued management of older patients with those with ongoing health issues. Nick. Thanks, morning. I'm Nick Detani, GP and Clinical Director of PLACE. I think what we saw over COVID was that a lot of patients became deconditioned, and that deconditioning is now having long-term conditions impact. So, for example, we see a massive increase in patients with heart failure, for example, because they've been deconditioned and not exercising and stayed indoors for often a year. And we're seeing a big increase in pre-diabetes. And then we're also seeing a big increase in cancer diagnoses. And so what's really interesting is a lot of those are linked to not exercising, not eating well, and what people have missed out on in the year or two of COVID. So it's going to probably have a knock-on impact for the next 5, 10, 20 years. I don't know. Public health might give us an idea, but it's going to have a massive impact. And so what Simon talked about was the long-term condition locally-commissioned service that's now in North Central London. And really is exactly what Simon said, allowing general practice to focus on prevention, because actually what we've been doing is tackling acute illness, and what we're better at doing is managing people's long-term health to keep them living healthier and for longer. And one of the things I think we need to think about in our strategy is actually getting people more active and understanding their long-term condition, which is a missing feature. So if I diagnose somebody with heart failure, and I can medically optimize them, but what I can't do is get them to the gym and getting them to buy foods from the supermarket and understanding what that means for them. And that, I think, is the missing link. And actually, what we learned over COVID was that people talked to each other, and how did we get COVID vaccinations so great, because everyone talked to each other and encouraged them. It's the same thing with long-term condition. I bet most people on a neighborhood will have congestive cardiac failure or diabetes, and actually want to stick together and actually make a better lifestyle for themselves. So I think that's the things we might need to focus on. Thank you. That's really helpful, and that actually gives us a topic of conversation for the third, because it reflects some of the things that we've been – a conversation that we've been having recently with the Director of Health and Director of Adults. Claire? Yeah, just to come back on the life expectancy. So last year's annual DPA, it's got last year's data, but the factors are very much the same. Thank you, Claire. That's a sensible reminder that, of course, there is a huge amount of information in... And thank you, Nick, particularly, because I think that sense of being able to help people to build agency and understanding and control over their health and understanding that there are things that they can do to improve that situation and what they don't. I think that's a really positive way forward, and I think it's something that brings all of the partners around the table actually together around that issue, because it involves wider parts of the Council, but actually also community and acute health as well. Pauline? Maybe a various communities to try and get an increase, but I think – I mean, what I was trying to explain last night, and I'm sure in fact, was a lot of hesitancy about immunization. We are monitoring progress on immunizations. Those reports aren't public, but thank you for the reminder. We will make other relevant members to share updates on the issue of vaccination hesitancy. It's a national wide issue, unfortunately, and I'm sure a clinical colleague. Thank you. Just to add to that, there's about 5 million population in continental central London eligible for a COVID and flu chapter. I ask Councillor Edwards to speak. I would just reflect, and it's a conversation that we were having following the meeting yesterday evening and that conversation about vaccinations, particularly childhood vaccinations, and actually a reflection that there's a younger generation of parents who may not appreciate the seriousness, for example, of measles. I'm old enough to have grown up with friends who had eye problems or hearing problems or a range of other problems that resulted from having had a measles infection, and it was a relatively common place when I was a child. I don't think young parents now really always understand the real ramifications if we have a measles outbreak, and I know that an awful lot of work has gone in, both across a bonnet in terms of promotion across NCL and the wider NHS in terms of promoting vaccinations pre the school term. And there has been some work, for example, through the London Jewish Forum and other groupings to try to encourage vaccination rates within some of our communities who are most resistant. It is a really important area and it is overcoming all sorts of, I was going to say ignorance, I don't mean it that way, but lack of understanding of the impact for some communities. Yes, thanks to, excuse me for my ignorance, but I can't see anything in here, and this is not a pun, around ophthalmic or eye health in terms of wellbeing. Can you please repeat what health, I mean eye health, I'm sorry, eye health wasn't mentioned specifically on the number of outcome KPIs is limited, and whilst I absolutely agree and appreciate eye health is important sooner than in mature age. Absolutely, and there's somebody whose eye defect was picked up by that first check in school actually when I was first in reception. That's a very good point. Paul, do you want to carry on? Yeah, I also think it's important because I used to wear glasses firmly and I've had cataracts removed and it's helped my vision remarkably. What occurs to me also is the cost of it, and I'm wondering whether for some people that's prohibitive in terms of just going on a regular basis. It's the same, but I'm talking about eyes. I mean you can't go to an optician without paying some money. I discovered because there's something I'm going to have, something done on my eyes. There's even an NHS price that you can pay. So there's the private price, but there's still an NHS price. And I'm just concerned, you know, in general about particularity than somewhere else in the councils. It's a point well made, I think. Any comments from our partners? Okay. Regular eye checks for children. It's not like part of a regular health check. I know I was never offered it. Well, not for my child anyway. I think that's a question for our partners. Nick, if you could shed some light on that because clearly I'm talking about a different generation of my eye tests. There definitely is two sets of eye checks in schools for the ages now, but there definitely are. It probably has changed over the years. I don't remember what it was like when I was a child, but certainly now there is two sets before 16 that I've offered. I mean, certainly that would be something. Fiona Bateman online has made a comment that it's also true of hearing tests. And there is an expense. Thank you, Fiona. Absolutely. Absolutely right. We've got two different things going on here. We've got we've got talking about the cost of eye, dental and and and hearing checks within with people and children's testing. And there is a comment from Louisa Songer, which I'm assuming is from her current understanding. There's hearing and eye tests at school at five and six. And Claire would back that up for those who have pupils. There is there is something that replicates the sort of testing that I remember as a child. But it's not it's not wrong, actually. And the the implications for all of those elements can be quite significant. And if I understand correctly, there is some correlation between loss of hearing and developments of some forms of dementia as well, because I'm assuming because of neurological input. So I think there are that's a question we might well, very sensibly ask. And I would just be moved to comment on how Chris would appreciate you mentioning this. One of the things when we took the AUSTED, the outcomes of the Children's Services report on Tuesday at Cabinet, one of the positive comments was around the timeliness of both optical and dental checks for children looked after. And I think that is something that may not always have been the case. And so it's very pleasing to see that we at corporate parents can be assured that at least in that context, there are checks going on. Thank you. Any other comments? So. Sensory and sensory impairments can lead to social isolation, which sadly increases the risks that adults with care needs will suffer neglect and abuse. So actually, there are a range of reasons. And maybe that's something that we would want to look at in the future. It may be an appropriate subject for a scrutiny commission task and finish group. Nick. So I just checked. So you get a hearing test at birth and an eye test. And then the eye test is done again at the six to eight week check at the GP and then between the age of four and a half and five and a half to school. And then it's then not done again, but it's free for any child to have an eye test or hearing test between the age of five and 16. Hearing tests are actually the GP and the eye test done any optician free of charge for under 16 to 19. Occasionally. I just checked. That's really helpful, Nick. Thank you. So there is a program in place. There may have been disruptions during the Covid period. And it is about and it is about engagement as well as access from parents. Okay. Agree. And that is really helpful. And I suppose it's then just how do we ensure that that message is out? Because if colleagues around this table don't know that, I suspect a significant portion of our population also don't. And therefore, are they taken? How do we make sure collectively we're getting that message out to all families? Both ends of the age range. We're looking at ensuring that people understand what is available. The benefits of that and the risks if they don't. I mean, clearly eye checks for those who are older. It picks up all sorts of things like glaucoma and a range of other conditions and therefore is particularly important for older people. But actually, young people, you know, I had a friend at school who wasn't doing terribly well. And then they moved him alphabetical arrangement in the classroom with a child who joined, moved him from the back to the front of the class. He could see the board. And actually, his results then kind of climbed rather steadily. And so it's just a case in point that understanding that Councillor Coakley Webb's comment was perfectly right. You only know as a person what you see and you don't know whether that's normal or not. It's what you see. Okay. I think that's really helpful thinking about the future. One of the things that we'll want to talk about when we come around the table and discuss how we evolve the next health and wellbeing strategy is a range of those topics that might or might not form part of the strategy. Obviously, I'm really concerned that we make sure that we both for meetings and for the work that we do together, it's where we can collectively add value and make the most difference through the strategy already through these meetings. I think we've had several really insightful comments around the table today. But I look forward to having those deeper discussions in our workshop session at the beginning of October. So the formal part of item joint health and wellbeing strategy update is that the board comments on and notes the progress on the current implementation plan and the key performance indicators the board reflects on the current progress of the joint health and wellbeing strategy development. And unless anybody has anything to add at this stage, can we all agree those recommendations? I'm happy to have the comments that we've made. Are they minuted? They are indeed. And if you look at the minutes that we've taken today and that I'm signing off, PACS does a very good job in trying to capture our sometimes complex discussions around the table. Yes, they are very full minutes, so they do record what we discussed. Thank you. OK, moving on now to the next item, item seven, which is the pharmaceutical needs assessment update. And to note there are two appendices within the PAC, the map of pharmacy provision and the process for responding to applications for changes to pharmaceutical provision. The item will be led by Dr. Deborah Jenkins, consultant of public health. Thank you, Jeff. So this agenda item is to provide the board with a routine update on the pharmaceutical needs. As the board will be the last pharmaceutical needs assessment was approved, approved and published by Barnet in 2022. And since then, if there are changes to pharmaceutical provision, since the last published published statement, the board needs to review the impact of the change. The previous update to the Health and Wellbeing Board about changes to pharmacy provision was in July 2023. Since the update in July 2023, there have been several changes of ownership of various contractors in the area. Only one pharmacy. That pharmacy is Bishop's Pharmacy in Hampstead Garden suburbs. The pharmacy reduced opening hours from 6 p.m. close Monday to Friday. It was previously open until 7 p.m. It is now closed on Saturdays. It was previously open from 9 until 6 p.m. The impact of this change has been reviewed with the conclusion that it would not lead to a potential gap or poor provision of the pharmaceutical services in Barnet. But this and other changes of ownership and maintained pharmacy list has been updated, but no further actions are needed. As you can see in Appendix A, this is a screenshot of the interactive map of pharmacy provision in Barnet, which has been produced and is published on the Barnet website. The map and underlying data are refreshed and updated on a quarterly basis. I'll turn to the next appendix now, so I'll just change the screenshot. So the second area I'd like to draw your attention to is to make a process clearer, and this is the process for commenting on pharmacy change applications. When there are applications for a change in pharmacy provision in the borough, this is shared by NHS England with the Barnet public health team in order for the health and well-being board to comment. To standardize this review process, this is the chart that we've produced for the suggested actions in Appendix B. The current process is similar, but this change involves both the chair and the vice chair of the health and well-being board to review the pharmacy change application. So in brief, the flow chart describes the following steps. Barnet public health received the pharmacy change application. We then send the change application to the pharmaceutical needs assessment technical support, which is currently provided by an external consultancy organization called Soar Beyond to review the proposed change. The technical support team reviews the evidence and provides a recommendation on whether the change is significant or not. If it is significant, the evidence, suggested recommendation and draft response is sent to the chair and vice chair of the health and well-being board for comment and review. Barnet public health team then updates the draft response from the chair and vice chair as needed and sends back to NHS England. After that, if the application is granted, then the Barnet public health presents a supplementary statement or a fresh needs assessment to the health and well-being board if this is needed. Thank you. Back to the chair. Thank you very much. Does anybody have any comments on this? I mean, I would say in welcoming the tightened up procedure for responding to applications, I think it would be very helpful. I would certainly value the vice chair's comments. Clearly, I'm not a professional in this, though I bring, I hope, a community understanding to it. But it's such an important area and pharmacies are playing a larger and larger part in our spread of health and well-being services. And so I think it's really important that we understand the spread and sufficiency of those across the borough. Nick. Thank you. So I don't have any objections to this. I think it's great to have the flowchart. The only comment I make as we're, you know, we're trying to get pharmacies, community pharmacies involved more and more in patients health, more that they can offer to patients. Often patients don't realize is my fear of the opening times of convenient patients. So, for example, now I'm not a personal user of the pharmacy much, thankfully, but whenever I've needed to use it, I've had to hunt around for a supermarket pharmacy that's open to 8 p.m. There are not many and there's not many of those in Barnet, as you can probably see from the map. So thank you. I live in Hertfordshire and there's availability. But I think there's a missing link to say is that you can't predict when you're going to fall ill. And people generally fall ill on the weekend when things are shut. And so in the future, how can the farmers think about providing that provision on Saturday? In particular, Sunday is a crucial day when everything's sharp, but you want the pharmacy to minor illnesses. So how can we think about that provision in the future? Thank you, Nick. Janet? Yes, thank you very much for those comments. They will be noted, I suppose, in the minute. It will be incredibly helpful as we are just about to start the update of the pharmaceutical needs assessment. And I think it in any way, I agree with you. I just yesterday I had to rush a rush of work to catch the pharmacy during their opening times. So I think everyone can resonate with that. And it's important to consider that one more comment as well. As you know, that extended access service by General Practice is now provided on a Saturday from 9 a.m. to 5 p.m. And so I do that maybe one clinic every quarter. And I struggled. I have to print prescriptions for patients and then try and hunt down a pharmacy on a Saturday morning. So it's a challenge for patients, you know, if there's one pharmacy in the area open and you've got 20 people trying to get something on a Saturday morning. And so I understand, you know, the close and it's hard to staff it and the cost of staffing a pharmacy is not cheap. But it's just about what provision can we think about in the future because we are starting to go to a seven-day health basis. I think that's a really, really helpful point and one we should think about, particularly as a growing borough. And one of the discussions we have had recently was about a pharmacy on the west of the borough. My apologies, Jess. On the west of the borough and recognizing it's not only a rising population but perhaps a population with different behaviors and looking at how we work with those who are working lives. I think it's really important. But the reflection of marrying pharmacy timings around an expanded GP practice time is a really well-made point. Did you hear that? Did you hear that? Looking at this map where it says where all the pharmacies are and having had to, like you said, have to hunt for one that's open, how and who can we actually have information both with the addresses and the opening times of all the pharmacies that are available? And it might be, even though these are the ones that are within Barnet, if someone is living on a border, it might be that, say, that a pharmacy just over the border in Enfield is available or over the border in Haringey. And I think we've got a duty to be able to actually have that information on hand. I don't know who will be able to produce it or whether we can pull it out as council information, but for me that seems to be really important that we can plot the addresses and that we can actually tell residents what the opening times are so that when they've got an emergency, they're not, as you said, hunting around in a state of panic wondering where they can get their prescription from. I have Jess and Claire come in. Nick, if you'd like to comment? Yeah, council, so the information that you've got is on the Barnet website, but only patients probably won't use our website or use the NHS website. So the generic one I've got here, you put in your postcode, it shows you all pharmacies in any borough. But I think what Nick is saying is certainly if it is a GP led prescription, you will be able to sign post to the nearest open pharmacy. And whether that's something that we, is there a prescribed definition that is a sort of a national definition? If there is, really we want one that is a Barnet specific, what we want to encourage residents to expect of them. That's a really good point and actually there's been quite a lot of coverage on the radio, certainly on the radio over the last couple of days about pharmacies and the challenges that that changing role will present. Would you mind if I took Simon first and then? That's a very kind chair, thank you, significantly more than it perhaps meant to me three or four years or so ago. I would agree and very much think pharmacies as part of our health and wellbeing family in terms of that broader agenda that we're developing in terms of keeping people well but treating them when they are unwell. Claire? I suppose, I think my intervention for topic for discussion. Debra, do you have anything else to add in summing up the paper and the discussion? Thank you, thanks for all the comments. I think a further discussion on pharmacy provision would be really helpful. We have some links already for future agenda items. Thank you very much, and I look forward to that discussion. It feels like a very mature stage of regarding them as part of that partnership. Formerly as part of the paper, if nobody has any further comments, we are asked to note the changes in pharmacy provision in the London Borough Barnet since July 2023 and agree with the suggested and whether we agree with the suggested process for reviewing applications for the changes in pharmacy provision in the borough as outlined in Appendix B. Is that agreed? Thank you very much. Now move on to item eight. That is the suicide prevention annual suicide prevention plan annual report. To note that we have a which is the annual report itself, and the item will be led by Saher Keke, who is our public health strategist and Rachel Wells consultant in public health. Thank you very much. As part of Barnet's suicide prevention partnership, I'm pleased to present our third annual report since the publication of the strategy. Last year, the partnership created an ambitious action plan in line with the publication of the cross-government suicide prevention plan, and this report made an attempt to demonstrate how each partner contributed to preventing death by suicide in Barnet. In particular, how we collaboratively supported the groups who are known to have elevated risks, putting more emphasis on addressing the wider determinants of health. What is new about this report is the change of reporting period to align our reporting with the ONS statistics. We will continue to report statistics per calendar year as opposed to financial year. Our current suicide rate is five per hundred thousand. Although there is a slight increase in comparison to previous reporting, this is not significant. We are still amongst the five lowest suicide rate in London and probably in the country. Our innovations to reduce death by suicide and the strength of our partnership continue to put Barnet on the map last year, and I hope that you have managed to read some quotes from some of the partners involved. Finally, I want to highlight that this report proposed the renewal of the strategy and welcomed the board to feed into process.

Thanks, Chris Monday, executive director for children and families. Thanks. It was really useful and a good report. It's good to see all of the really positive pieces of work going on. I'm aware that there was a really strong cross-referencing between the findings from what used to be called serious case reviews, now called learning reviews, where the safeguarding partners have come together and undertaken reviews. I'm aware that there have been two or three in relation to suicides, and there's ongoing work in relation to some specific issues now. There's one on suicide and filicide, of which we've had two incidents where there's been a suicide of issues around children experiencing issues, both of their autism and gender. I didn't see those things coming through in the annual report, so I wonder if in the future we can make sure that there's a really strong link to the plans that come out through those multi-agency safeguarding arrangements that set out a whole range of issues. One of the issues that I don't think we're addressing fully in this is the role of private psychiatric services. Both cases that I'm aware of where there were particular challenges, both were being managed through private provision, not through state provision. I know that there were a number of recommendations made in relation to that, but that's absent in the report as far as I can see. I wonder whether we're picking up all of the intelligence that is available. It feels like this is the plan and this is what we've been doing, rather than this is what's been going on in the wider context, and these are some of the things that we found from there. To have two suicide filicides in one borough in the space of possibly less than a year, I think is something that we need to understand more and understand what we're doing about it. Indeed. Thank you, Chris, for that. Fiona Bateman is online and would like to make a comment. Just to provide some assurance, perhaps to Chris as well, all to maybe offer, because Tony and I have met to discuss the learning across the safeguarding adult reviews and the children's learning reviews. What we should do and what we could do is invite, see how to mix those meetings, particularly when we're looking at the learning that's linked to suicide prevention. So I think that would make it much easier for that to kind of connect the work. But going forward, I'm afraid I've had over the last year clashes with the suicide prevention group, so although I do always read the papers, I can't physically be in the room as I'm stuck today. So going forward, the vice chair of the safeguarding adult board will be an active member. She's already really well connected with partnerships across Barnet. So I think that learning will be more embedded in the work of the partnership going forward. But definitely, Ciara, if you'd welcome coming to those meetings that the two boards have to look at, you know, how do we join up the learning from those safeguarding reviews, that would be really helpful. I'm wondering whether, because every child's death, you know, or suicide in particular, has an after-action review, an after-death review, and it's interesting to see what the learning is from that. And I wonder where Chris has mentioned there's some private psychiatrists involved, and that may be just because of the lack of access, some of the NHS services and the long waits of 12 to 18 months is possibly a reason for that, unfortunately. But how can we learn from that? What can we change? The second thing, I say this every year, but one of the biggest things that we see now is social media. And I believe it's certainly linked to possibly death or suicide or people feeling low and depressed, actually signpost people using social media into services available, because we can put things on websites and posters and things, but young people don't use any of that. They don't use Instagram and TikTok and whatever else it is nowadays, they can't even keep track. And I also remember about five years ago, I think it was the police, I can't remember who it was, but came and gave GPs a talk on all the apps that were there, and I was astonished. I was like, never heard of half of these apps that are out there, and how do we educate parents into knowing what are the signs to look out for? Because there are a lot of rogue apps around for children, and how do we educate parents to look at what signs to look out for in their child or young one to pick up if they're going through a bad time and they're at risk of suicide and how to seek help? Because I get a lot of parents coming in who have got young children who have harmed themselves or are low, and they had no warning signs, and there probably was a warning sign, but they're not looking at their phones or looking at the right things on their phones. So I would like us to think about the generation of the future is all online, how do we read that and how do we, I don't know the answer, but just leave you to that. Thank you, it's a very thorough report. I'll take Jasmine Holmes and then Pauline. What jumps out at me is the statistics, sorry, and to echo the fact that this is clearly an excellent program of work, and what we're doing is to sort of pick out the things that we think would be even better. The national statistics around ADHD and autism diagnosis in suicides obviously assume you've had a diagnosis, and to pick up Nick's point again, the issues that we have around delays, waiting times, reduced access to diagnostics for NDD. I suppose I'd like to understand a little bit more about where we're seeing self-harm and suicide as a result of lack of diagnosis, lack of access to support, and I don't know how we can do that work with most of the diagnostics and support. But given that we know that we've got clinical restraints and financial pressures, understanding whether that is playing a significant role and that lack of diagnosis means that you struggle for longer and are likely to there. Yeah, I think to pick up on one of the points you said, I think, and Christopher confirmed that one of the things we found is that people accessing private therapies was often a cultural thing. It wasn't so much that they didn't, they just didn't want to contact NHS, it was different. One of my beliefs is that when you have these private practices, they are not, and I still think it's still the case, they're not required by law, therefore, to inform that person's general practice, therefore it goes unnoticed until the worst has happened. And when we look at the issues, well, the issues with social media and with things like self-harming that can ultimately lead to suicide or be more than one that have taken their own lives and that it's been related back to what you find on social media, they're still reporting that that still can be happening and I don't know how these social medias can be taken into account. They're talking about restricting, they can still access information and if not, they will use somebody else's phone or whatever to access it that then has got a verified aid. I think it's a really hard battle for us and how we can work with schools and parents and health professionals to try and stem this really horrible, you know, plague of social media that is actually influencing young people, whether it's to be for self-harm or their body image to what they think they should be and what they are and I'm sure that that is the root of an awful lot of problems now that would not have existed years ago. Thank you Pauline and I see Nick is nodding and I know that there is some pilot work going on with a range of schools in terms of phone access but that doesn't alter the access to phones outside of school hours. Just in the context and forgive my ignorance on this, is there any way private psychiatrists, private psychiatric health, presumably it's accredited in some way and I wonder if there is any way to lobby for a national change where they're obligated to notify. So because they're regulated by the GMC for example if they're adopted but there isn't anything that they must inform the NHSGP practice so the patient or the guardian has to consent and provide the details of the NHSGP and they can choose if what you're saying is it's cultural, they probably are not consenting to share the information. And then the law is that you don't consent, the practitioner is not allowed to share information because they'll be in GDPR breach. So I suspect it's probably more than not consenting than the clinician hypothesising and what do you do in that situation. Now the clinician can override that decision if they believe it, if that patient is actively suicidal for example. One thing they really should take into account if anything for legislation, it may be that it's just an adult but if that adult, if they know that that family has got young children, that's when the alarm bell should ring to go we need some information, we should not be holding it to ourselves and at the minute it seems that they can not do that. Just to add to that I guess if there's an adult, if thinking about what the right practice should be is that that clinician should then do a safeguarding report because they're lifting up children. Whether that's done or not is another thing but that's what we would do in general practice is do a safeguarding alert. But yeah it's probably what we've done and so I suppose there is some merit in maybe doing an after action review of the deaths that you've mentioned and thinking about what information we could share and certainly in our community I think going to legislation is one thing but in the interim we share something that the nation might be useful. And my recollection is that the same issue around disclosure and sharing has been a challenge in some of the teenage and student deaths as well, nationally not locally so I'm very conscious of that. I'm just going to read out Fiona Bateman made the comment all professionals registered with the GMC, the HCPC etc will be expected to comply with safeguarding duties so should follow local or encouraged by professional regulators. So I think that's a very helpful point, thank you Fiona. So how would you respond to those comments and both in terms of the quality and the value of the report and the work that's gone on because I think that we do need to remember after what is a very fruitful discussion that it is also there is some really good work going on and it's had national recognition, but also what we would what your reflections are on the comments that have been made. We have been working very closely with both Fiona Bateman and also Tony Lewis. And last year, some of the work we did in terms of learning from the safeguarding reviews reflected in the last year's report so I didn't repeat that this year, but that work is ongoing. In fact, in terms of the suicide case and the link with, you know, the issue around lack of communication, any with private sector. So, I have invited Tony to present the learning from the suicide review in the London community platform community of practice for all suicide prevention leads, so that we could collaboratively understand about those issues and also to see if there is any other example in London, and then maybe we can join forces together. You know if there are any good practice. So, we want to raise those issues because they are very, very challenging issues to to tackle. In terms of however I'm going to take all these comments to our start and grow well team in public health to make sure that going forward. We have a better capture of all that learning within the suicide prevention report. In terms of autism and other sort of at risk groups. I know that Jane Abbott, who is our resilience manager. She does a lot of work in schools. And there has been a new service, I believe it's commissions, working with LGBTQI children and young people. With autism, what we have in the councils, we have autism champions group running. I'm a member of that group. And we have been working with Barnet Mancub resources for autism. We have constantly raised awareness amongst the professionals, amongst staff, voluntary sector colleagues, faith organizations about the link between suicide and autism. And inviting people to take up training, which is delivered by Barnet Mancub. I think I'm working closely with family services colleagues from violence against women and girls team. I'm taking part in their reviews. We're gradually building those links. And I will make sure that they all reflect going forward, but that work is emerging and there is a lot more work to be done on that, on these areas. Thank you. Louise is joining us online, has posted, sent through a comment, drawing attention to the suicide and prevention and support after suicide link on Barnet Council's website. And she highlights the stay alive app, which is available on Google Play and other providers, for which the team had recognition and was the source of work with the Middlesex University. So the app has been a very important part of some of the work that you've done. So I don't know whether you want to comment on that, otherwise I'll finish up with some final reflections. Shall I take Pauline's question first and then allow Sahar to sum up? I'm just scrolling down under the figure two, men's lives lost to suicide in Barnet versus everywhere else. And then underneath, this really puzzling sentence. Due to small number suppression and disclosure control issues, we are unable to make accurate interpretation of female suicide rate for Barnet. About suppression of data, but Sahar, if you'd like to. Because it's not reported in the statistics, the rate, because of the small numbers. So we can't -- we don't have the data. Who does have the data? So we receive two such statistics from the Office for National Statistics. And we have the numbers for female suicides, but we don't have the rate. Because of the very low number of female suicide. I know from the safeguarding board when we get reports, we get to know what to give any figure or number in relation to that. I believe, Rachel, you'd like to comment. Could you put your mic on, Rachel? Thank you. Thank you. It was on a previous point, but I just -- I just mentioned on this one. With regards to the numbers, we have the numbers, but they are identifying if they are very small numbers. This report, we wouldn't necessarily put that in, but we do have that information. Can't form a rate on a very low number, but that's why that's there. We do have to suppress them when they're very small. I think that might be something that we can look at a way in which we can present those numbers in a way that gives you more information and appropriate. I just want -- I don't think anyone's asking for dates or times. It's just a comparison between maybe how many suicides are male and how many are female. I think that's all we're asking for. We can do that. We can do that. We can give you some information which would identify that for you. We can amend that in some way. I can quickly mention that from the real-time surveillance system. So we know that about 25% -- 75%. Just one other quick point. Just referring to something that was discussed earlier, and I know that we all know this, but I just thought it might be useful to many digital natives. And thinking about how we work with parents who are also migrating into that world with young people and children who are already in that system. I think it takes more thought across the system. It may well be that trying to engage, and I know that we have done this, but perhaps not as a board with young people around their uses. I think it would be quite an interesting discussion. Because I have a 15-year-old son, so I know what goes on, and it's incredible. And I know some of you probably will be in that situation as well. It's uncontrollable. And I think having a better understanding of how their systems work as a board may well be something worth exploring. And also ways in which their individual resilience can be improved. Chris, I don't know whether you have any comments on how we might use some of our young people's groups to have such a discussion. In fact, there's already that sort of work going on. The mental health charter was developed by a whole group of children and young people, so there's lots of dissipation in that. On the social media side, I think there's some really interesting international changes that are coming about. Very interesting to see as children and young people have the amazing ability to be able to find ways around all of the rules that are -- I'd say this purely as a father whose children seem to be able to bypass every single restriction that we put on their phones. Two of them are old enough to do it themselves now. So I think that there are some things. But I do think it's something that government need to be doing a bit more on the online harm bill. Did that go as far as it should? Is some of the work that's going on in Australia now through their administration about holding providers to account more powerfully? There's been some quite interesting work in that space. But I do think it's something that maybe as a board we should be writing to government about saying, you know, actually should we be going further on? Some of the -- you know, tick tock is supposed to be only available if you're over a certain age. Yeah, lots of children are on tick tock. Instagram is supposed to be over a certain age. You know, these days I think it's about if you're over 50, then you're allowed to be on Facebook. But, you know, there's those sorts of things that are well beyond the realm of us as parents and us as a board. I suppose it's those sorts of things that we need to be saying. What should we be doing in that space and should we be talking to parliamentarians about, you know, are there some things that they want to do more? You know, there's a new children's being act or bill coming forward. Is it something that we want to be saying that there needs to be more in that around online safety? Because I think it is genuinely -- it's a generally scary world that parents don't understand and that children do far more than us. I think the point about data that digital natives versus digital immigrants is a really important point. And Chris has just reinforced that. Nick? I'm just wondering, you know, whether in school programs there could be something around this education about online. Yeah. They had all these icons on the screen and I could recognize about three out of ten. And I thought, oh, God, I'm stupid. But, you know, what does that mean, isn't it? You know, do parents actually know what the apps children have because you just see an icon. So I think we need to -- it's not just the children. I think we need to get adults and parents involved into understanding what's on children's phones and things. And I think that's a wide -- and in reality, that's a wider issue than just around suicide prevention. It's a range of issues across young people's perception of the world and access to data and the online world in a way that maybe those of us who are a bit older just aren't grasping the breadth and depth of that. So that's a really helpful conversation. Sahar, any final comments and then I'll wind up. With regards to the research, the effectiveness of interventions in preventing suicide, suicides are still emerging. It's a relatively new field that's really developing in the last sort of 10, 20 years. In principle, anything that we do in Barnet, I work with colleagues from academia and looking to them to support with their evaluation. And I'm pleased to say that our campaign has been evaluated by Middlesex University, Professor Lisa Marzano and her team. And then they actually demonstrated statistically that the campaign may have contributed to saving 7 to 10 lives across the nine-month period. Of course, there are lots of caveats in this, but nevertheless, it's a very, very positive result and it's a contribution to campaign approach, which was later demonstrated by Dr. Alexandra Pittman from University College London and some other academics from Australia about how actually campaigns can contribute to reducing suicides. That's about it. And I think about the apps. Could I just add to that, please? We are working closely with Metropolitan Police and also Fire Service in terms of monitoring those untoward apps or emerging new methods of suicides. And we are conscious of that. And then sort of jointly in London, we're trying to find solutions if we can identify anything untoward. But these are wicked issues. And I just reflect that we are fortunate to have a university just adjacent to us where you've not only got academic contact, but actually it's a pool of students who might be useful in giving reflections. And I know that some of the work that has gone on through some student courses has been particularly around violence against women and girls, but actually there are a range of other issues that the students will be working on. So that's a possible source of news about the validity and depth in the way that we're doing. But thank you very much to her and thank you for your input. And Rachel, I would reflect that we have in former years discussed at the Health Scrutiny Committee. And I think I would reflect that we've had a really rich and thoughtful discussion this evening. Lots of potential learnings to come out of it. Recognizing the role of joining up and building on and extending relationships across a range of organization and mining the data and intelligence that others have. Taking these opportunities, working, for example, with safeguarding boards. And considering how and looking at how a suicide prevention is set against an evolving online challenge with social media. So thank you very much for all of your input. Now we have three formal recommendations that the Health and Wellbeing Board note the most recent data for the Borough of Barnet. That the Health and Wellbeing Board note the progress on implementation of the Barnet suicide prevention strategy as outlined in Appendix A. And that the Health and Wellbeing Board feed into the forthcoming suicide prevention strategy 2025 to 30 refresh. I think there's been a lot of opportunity to pick this up at some of our informal working sessions. So thank you everyone for that discussion. And we're now going to move on. I would just, because you joined us late, I just want to welcome Monique from Barnet. Good to have you at the table as our BCS representative today. Thank you very much. Very important part of our Health and Wellbeing Board. So thank you. And do pipe up if you want to feed in. Moving on now to Item 9, the Combating Drugs Partnership Board Annual Report. And this will be led by Louisa Songa, who is joining us online because she has COVID. I hope you're not feeling too unwell, Louisa. I bear with me two seconds when I sort my presentation out. Can you see a presentation up on the screen? We can, Louisa. Let me just put it into slide show mode. Thanks, chair. Yeah, forgive me, I'm fine, bit croaky, but all good, all good. But I did put some slides together just to keep me focused, because I'm probably not firing on all cylinders this morning. So hi. Hi, everyone. I'm Louisa Songa, Senior Public Health Strategist in the Public Health Team, and I lead on substance misuse strategy. And I'm here to update you on our Combating Drugs Partnership Board. A little bit of background. It's all in the paper. The board was formed off the back of the new government drug strategy a couple of years ago. We launched in November 2022, I think it was. And all areas were asked to develop Combating Drugs Partnership Boards to do three things. Really want to look at the sort of supply chains of drugs and how we could work with enforcement partners to disrupt these lines and hold offenders to account on it. The second priority was around improving our substance misuse treatment and recovery services, ensuring that they were high quality and accessible. And the third priority was around ensuring a better prevention offer, both in terms of preventing the onset of substance misuse, but also stopping, you know, supporting people from developing those sort of high risk behaviors if they're already using substances. So I put some of our achievements in the paper. There is a huge amount of data available on substance misuse. So it's really hard to try and choose which bits that we put to you. But if there's any interest in any of the areas more broadly, more specifically, we can we're happy to share further information. So the first priority, there's been a huge, I'm sure you're all aware of the work that our police and community safety colleagues have been doing around making the borough a safer place and reducing supply of substances into the community. And so address the sort of wider issues around that they bring around and social behavior and these programs that clear how build approach and some of the other operations that we've had. That certainly partnership approaches which aim to take a really multi-agency approach to the problems and look at it from a systemic point of view. And I put this graph in just to show you that, as you can see, it looks like our drug trafficking offenses in Barnet are increasing. That's a really good thing, because actually what it shows is that the police, this is police data, our police partners are able to respond to supply and, you know, the sale of substances and hold that are actually arresting people and bringing them into the criminal justice system. So it doesn't necessarily mean that there's more drugs coming into the borough, but actually that the police are doing a really good job at targeting those drug dealers. And on the flip side of that, possession, people being arrested for possession of drugs is decreasing, which is good, because actually what we can see then is that people that have substance misuse issues are being signposted into support and treatment rather than being pushed into the criminal justice system. Which can't necessarily address their issues. So in terms of delivering world class treatment service, we've been working really closely with some of our criminal justice partners to improve court pathways, prison pathways, and we've seen an increase in community sentences, lots of work on people with multiple and complex needs. So we have a substance misuse rough sleeping program, which is, I think it's in its third, fourth year of operation, and they're really sort of embedding into the community. The team have managed to build good relationships with people with multiple issues and support them into services. And through that project, we're starting to look at the wider health issues of people who are rough sleeping and also have substance misuse issues. So one of our successes is that last week we launched a dental service for rough sleepers, which is a great success. It's something we've been working on for a long time. So anyone that's rough sleeping can now access a community dentist in Hendon. I think it's one day a week that we're offering that service. It's a fast track service. And also there's oral health training sessions that are being delivered to staff through that program. And we continue to be focused on reducing drug and alcohol related deaths. I've got here rates for barnet remained lower than London, England. Apologies, that's a tie. I think we're actually similar to London and England. What we have seen is over the last few years, the numbers of people dying who are accessing treatment are largely related to alcohol. And what we are understanding from those reviews of those deaths is that there are some significant issues around people with complex physical health problems as a result of their alcohol use and people accessing treatment quite late. So we're really keen to try and change that by getting people into treatment services at an earlier stage in their substance misusing career and also ensure that they have better access to that range of physical health services to prevent those complexities. In terms of opioid related deaths, we remain quite low, which is brilliant. And we are really pushing our harm reduction strategies. So we we have a really good distribution of naloxone across the bar. I think I read yesterday that we're about 70 percent of our opioid users have access to naloxone. Naloxone is an anti overdose medication that people can administer, administer at home or in the community. And also we are now getting nitazine testing strips as well. So you may have heard in the news, there are sort of new synthetic opioid which are way more potent and more lethal than heroin. And so people can can test their drugs before they use them. We have had had one one instance we heard of locally where a chap tested his heroin, found it had nitazine in and actually gave it back to the drug dealer. And I don't want this. So we can see it works and significant engagement with partners to around training and upskilling. And one of our biggest successes that we're really, really proud of is actually the number of young people accessing treatment in Barnet for substance misuse issues has grown exponentially. I think it's at the highest. It's it's been definitely since I've worked in Barnet, but, you know, for a very, very long time. And this is this is great. This is really shows that that service is starting to to get into the right communities and work with schools and really meet that need of young people. In contrast, the numbers of treat people access in adult treatment is staying fairly similar. We really hope to see that drive up. But we it stayed quite flat over the last 12 months. We're really keen to think about how we can improve that through the next year. And again, slide on deaths. And so, obviously, a little bit on the prevention. So we need lots of work with schools around thinking about what the PSHE offer includes and ensuring that schools have access to the substance misuse service to go in and offer that that extra training and upskilling. And we have been looking at upscaling or drink coach service. And again, I think we're in about year three or four of the drink coach service. And for the first time, halfway through the year, we've exceeded the number of counseling sessions that we don't deliver. And there's a slide which just really shows you the how our campaigns have a really positive impact on the numbers of people that are going to the drink coach site and and access in that that intervention. So, yeah, really, really good to see the outcomes of our campaigns. So finally, just a point on the restructure. So we're a couple of years into CDPB now. We formed as a partnership. We've developed our work plan. And now I think we're in a really good position to look at what's working and what's not working. You know, there have been a few challenges to creating ownership and actually getting key stakeholders to drive certain areas forward. So we have reviewed some of the arrangements in other areas and made some recommendations. What we think a revised structure could look like. We presented it to the board in the last meeting in our health and sorry, my competence and drugs board in July and partners were on board with that. This is a structure. So we, if approved by the health and well board, hope to move to this structure in in the coming months. And really, you know, the first one would be very much led around our police and community safety colleagues. The treatment group would be led by public health. And we're looking at how the prevention subgroup can align with things like the only help board and some of the prevention work that's happening in adult social care. And that's it for me. Thank you. Thank you very much, Louise. And before I ask anyone to do for comments around the table, I just want to give a reflection as the chair of the Combating Drugs Partnership Board. And it's been a real it's been a real work in progress over the last two years. I've learned a huge amount. But I've also watched a range of professionals working and discussing what they do and focusing on that issue. Because for members, for counselors, the issues around drugs can be quite a challenging one out in the community. And therefore, it's been really helpful to understand the work that goes on and how the system is coming together. It's relatively unusual to have a counselor chairing the Combating Drugs Partnership Board. But I would reflect that alongside having Councillor Conway, the chair of the Safer Communities Partnership Board, with us at the CDP, I think that's given us I hope it's given us real impetus. It certainly meant that we had we have a member focus on it that I'm not sure that we would have had in other ways. It's been good growing that partner attendance. But as Louise said, it's about ownership of the work outside those meetings. And we want to maximize that that work. So I think the benefit of having a formal Combating Drugs Partnership Board meeting twice a year that's aligned with the Health and Wellbeing and Safer Communities Partnership Board meeting schedule. So that we're maximizing the time for that working group activity and the joining up that goes up on professionally outside the meeting. But also, reporting into the Health and Wellbeing Board and the CDP and the Safer Communities Partnership Board as that public, formal public expression of the work that you do. I think it's a really important the board, the Combating Drugs Partnership Board certainly saw the logic of moving to that format. And I think it would be a very positive thing to do. So I hope the board would share that. So do I have any comments or questions for Louise about the work that's going on? I think I would just reflect that actually it has been a really busy two years and we have moved a number of areas on considerably. But obviously, the work of the police in the Clearhold Build, Operation Dakota work has made a step change in what's gone on. That certainly changes for a part of the borough that I think was probably, it's fair to say, was blighted by drugs issues in that community. So if nobody else has any additional comments or questions, I think Fiona has her hand up. Thank you very much for joining us when you weren't feeling well. It was much appreciated, but really important that we note the value of the work that goes on and the amount of work that goes in to the Combating Drugs Partnership Board and the work that goes on outside that. Thank you very much. Sorry, sorry, Chair. I do apologize. I thought you were wanting to speak. Please do so before we wrap up. It's just a very quick question and taking into account what Nick said when we're looking at the pharmacy needs assessment. I wondered if there were any accessibility issues for individuals who need treatment out from pharmacies like methadone and things like that outside of usual work hours and whether or not we actually as a board should be pushing for things like from the pharmacy need assessment as well. Louisa, if I let Nick to start a comment and then you can follow up if need be. Yes, I think there is, for my understanding, we don't prescribe it anymore, it's done by CGL, but I think there is a provision to CGL based in Edgware. There's a pharmacy in Edgware that provide it on the weekend and then at Binchley Memorial Fair we pharmacy provide it out of hours as well. The majority of patients are on a weekly script, for example, and they'll come on a designated time every week. So let's say that their appointment is every Monday and they'll go every Monday and collect them and it won't be on a weekend generally that they're seen. So probably the likelihood is low, but there are two pharmacies, one in Edgware and one in Binchley and maybe more in the other part of the borough, but I'm not familiar with it. Yes, I thought there was borough coverage in that sense, but Louisa, do you have anything to add? Yeah, there's really good by the borough coverage and we review it regularly through our sort of needs assessment work to make sure that we have got access across the borough. And actually there's a really interesting new medication that's just coming on the market, which we're launching in the service, which is aimed at people who are very, very stable and might be in employment, which allows them to. Don't ask me the chemistry of it, but it's it's a very expensive medication and we will be prescribing it now anytime, actually, which allows people to have really less frequent pickups and it's a much safer medication. So it's really positive. And the service has actually now moved as well. And it's in Hendon. So that was a couple of weeks ago. So we are in the process of updating comms and communicating that out to partners. Yeah. It's a much better location. Thank you, Louisa. And I know that we've had a number of very dynamic discussions within within the partnership board about that. The interface with with housing and a range of other issues. So it's been a very active partnership, but it is about helping people to stay stable. Recover from drugs, but actually also through the education program, preventing young people from getting involved in the first place. Thank you very much for that. We have three formal we have two formal yes, two formal recommendations to make that the health and well-being board note and comment on the progress of the Combating Drugs Partnership and approve the updated structure of the CDPB outlined in section one point six of the report. The reasons for that and the the the reporting that will go on formally going forward. So we agreed on that. Thank you much to everyone. And just to note that Paul, Councillor Paul Edwards had to go at 11. He was he's judging a care home art contest. And so in his role as adults lead, he was going to have to go and do that. So but he had let us know that he was going to do that right. Finally, we're moving on to the last substantive item in the agenda, and that is the communicable disease update from Janet. Janet, Director of Public Health. Thank you very much, Chair. It is a verbal update in other forums across London already. At the moment, they are still setting up and working to sell material, a document, a pack to support them. And next week, we'll be having the annual winter preparations. Infection prevention control. Yes. That's the word. We just agreed with the chair earlier. So going forward, we are happy to bring a more. On why their health protection that work in barnet, which goes beyond the nation. Thank you. Thank you very much, Janet. Does anybody have any questions for that was a really comprehensive item. Thank you. It was my desire that we kept this on the agenda post the code reports. But I think it's really helpful, not least in the light of the discussion that went on at scrutiny. The scrutiny committee at the evening about concerns about vaccination rates and understanding the work that goes on to support that in the context of the cancer screening work. Perhaps you or Claire would like to share the news about your grant. Yeah, congratulations to the happy couple. The congratulations to us as well. So we got notification on Monday that's Barnet along with Harry gave been awarded two hundred and thirty thousand. We mentioned earlier. That's really good. Thank you very much, Claire. I think we're celebrating while it's not a communicable disease, obviously. Well, this is it's just really important that we that we make the most of grants like that, because this is tackling. As I understand it, going some way to tackle the inequalities in uptake of cancer screening across our across some of our communities. So it's really focusing on ensuring that that prevention and intervention that we all want to see is being enabled in that particular area. But there's also the issues around communicable diseases. There are some health inequality issues with that. And, Jess, you'd like to comment or ask a question. Just in terms of the grant. Fantastic news. Keen that we make sure we draw in the work that we've done post Leder. So the Learn Disability Review of Mortality to understand where screening of people with a disability or people can. It's an area that that really is important as part of that. Does anybody online have any comments or questions for us? Thank you. Fiona's made a comment. Yes, that's an AOB. So I'll pick that up under AOB. So thank you for that discussion. Janet, thank you for the report. And I hope that we'll continue to have that. And thank you for undertaking to share those those reports with us ahead of the meeting where possible, because that's a really helpful thing to do. Partners around the table will see those. There's a ghost in the chamber. The partners around the table will see those reports in different contexts, but some of us wouldn't pick those up. And it's really important so that we get that that broad picture of the work that's going on around communicable diseases and vaccination. So our recommendation is that the board notes the update. Thank you very much. We do. We do that. We have. The item 11 is the forward work program and the request is that the board notes the forward work program. Obviously, much of this year is going to be formal reporting, but actually also the development around the joint health and well-being strategy. And so that will be a pivotal meeting in January to to bring that together and send it off for wider consultation. But we will have our working session ahead of that. I hope as many people can join us on October the third as possible so that we have the richest and deepest discussion we have going forward. But a lot of what we've discussed this evening leads into that. So item 12 is always a list of the health and well-being board acronyms, which is useful for those who are not health professionals. I'm going to take item 13 as any items the chair decides is as urgent as an AOB. And I have a message from I don't know whether you'd you'd like to speak Fiona Bateman, who has joined us over the last couple of years as the chair of the adult safeguarding board. Her tenure finishes as chair. At the end of end of December and after she served for seven years. So I think that's a hugely big contribution to safeguarding in Barnet. So it's likely that this will be your last meeting. She says it's been a privilege to have been on the board and for the work of the Barnet safeguarding adults board to have been so well received by partners. Fiona, I think we have a great deal to thank you for in the input that you've had to this and to many other parts of the committee and service structure in Barnet. So thank you very much. I'm sorry this will be your last meeting, but thank you very much for all the input you have had over the years. And we look forward, obviously, to working with your successor, but we will miss your input and insight and the reflections you bring based on that seven years of experience within the board. Thank you very much for your input. Thank you. And I wish we pity in a sense, it's a pity we're not able to be. But you are always welcome to come and sit in the public gallery if you should. Should you feel so motivated in future and ask us questions and hold us to account. But thank you very much for all your input. Thank you to the members of the board who have been who joined us online and at the table today. Thank you very much for your input. And for the public gallery, I know that the former chair of the committee has joined us as well in the public gallery. So it's good to see you, Caroline, to hear our discussions and look forward to both to the next formal meeting, but more importantly, perhaps in the first instance to our working group next month. Thank you very much for your time and for the input from officers.

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