The Health Scrutiny Committee of Barking and Dagenham Council met on Wednesday 24 May 2023 to discuss the Health Inequalities Programme and the Mental Health Transformation Programme. Key decisions included noting the progress and future plans for both programmes, with a particular focus on partnership working and community engagement.

Health Inequalities Programme

The committee received an update on the Health Inequalities Programme, which has been funded by the North East London Integrated Care Board (NEL ICB) to address disparities in health outcomes across Barking and Dagenham. The programme aims to build a place-based, co-produced, and co-delivered approach to tackling health inequalities, influencing the wider system's working culture.

Key points discussed included:

• Challenges in Barking and Dagenham: The borough faces significant inequalities across the life course, from obesity in pregnancy to lower healthy life expectancy compared to London and England averages.
• Evidence-based Interventions: Presentations highlighted the principles of effective interventions for reducing health inequalities, emphasising evidence-based, outcomes-oriented, and sustainable approaches.
• Partnership Working: A strong emphasis was placed on collaboration between health partners, local authorities, and the voluntary and community sector. The establishment of Community Locality Leads and PCN Health Inequality Leads was noted as a crucial step in co-designing initiatives with residents.
• Community Power and Agency: The importance of empowering residents and fostering community agency was highlighted as vital for preventing ill-health. Initiatives like participatory grant-making and community-led co-production were discussed.
• Localities Approach: The programme is moving away from single-organisation service delivery towards a networked approach, focusing on building connection, trust, and belonging within communities.
• Achievements: Notable achievements included improved place-based working, targeted case finding for undiagnosed conditions, and community-led initiatives such as participatory grant-making for young people's mental health.
• Funding and Formula Issues: Concerns were raised about the funding formula used by NEL ICB, which is based on older census data and does not adequately reflect the borough's demographics, particularly its younger population. This has resulted in Barking and Dagenham losing out on significant funding. Despite this, provisions have been made to continue projects, and there is a commitment to lobby for fairer allocations.
• GP Funding Discrepancies: It was noted that GP practices in Barking and Dagenham receive funding for fewer patients than they actually serve due to the national weighting formula, which does not account for the borough's younger demographic.
• Workforce Retention: Challenges in recruiting and retaining staff, particularly GPs, were discussed, with issues such as the lack of inner London weighting pay contributing to GPs moving elsewhere.
• Community Hubs and Pop-up Clinics: The successful use of community hubs and pop-up clinics for health checks and other services was highlighted, with a focus on making health services more accessible and proactive.
• Long-term Planning: The programme is focused on changing infrastructure and working practices to ensure sustained benefits for residents. A six-month update was requested to monitor progress.

Mental Health Transformation Programme Update - One Year On

The committee received an update on the Mental Health Transformation Programme, which aims to create a new framework for community mental health services.

Key points discussed included:

• Programme Background: The programme, initiated in 2019, is a three-year commitment to transform community mental health services, with NELFT's bid being recognised as highly positive.
• Vision and Principles: The transformation focuses on developing community mental health and wellness teams that work collaboratively with primary care networks, social care, and the voluntary sector, adopting a holistic approach to care.
• Progress and Achievements:
  • Team Integration: Mental health services are being brought together into cohesive teams across three localities in Barking and Dagenham, with the borough being ahead of other areas in this integration.
  • Workforce Development: There has been an expansion of the mental health workforce, including the introduction of Peer Support Workers employed by MIND, who are embedded within the teams.
  • Trauma-Informed Care and Open Dialogue: All staff are trained in trauma-informed approaches and open dialogue, which involves engaging with individuals' support networks.
  • Point-of-Care Testing: Increased point-of-care testing has been introduced to monitor physical health, recognising the correlation between mental and physical health conditions.
  • Partnership Working: Strong engagement with the voluntary and community sector, including Barking and Dagenham Collective, has been a significant aspect of the programme.
• Next Steps: Future plans include developing services for young adults (18-25), enhancing access to intensive psychological support, and expanding peer support across the life course.
• Caseloads and Demand: Caseloads have doubled, and while the workforce has increased, there are ongoing challenges with recruitment and retention, leading to increased waiting lists for certain services, such as specialist ASD assessments.
• Interface with Social Care: While not physically co-located, there is strong collaborative working between mental health teams and adult social care, with joint planning and care plans. This partnership has been praised for its effectiveness in supporting timely discharges from hospital.
• Domestic Abuse and Police Liaison: NELFT works closely with the police through a Mental Health Liaison Officer, sharing information, undertaking DASH risk assessments, and participating in the Violence Against Women and Girls' group. This collaboration aims to reduce risk and support individuals who may present with aggressive behaviour.
• Preventative Approaches: Staff are trained in smoking cessation, and approaches to healthy eating and physical activity are integrated into support.
• Risks to Delivery: Key risks identified include workforce recruitment and retention, population growth outpacing funding, and the potential long-term impact of events like the COVID-19 pandemic.
• GP Referrals and Talking Therapies: The model aims to improve the interface between GPs and mental health services. Talking Therapies (formerly IAPT) allows for self-referrals, while PCN mental health workers can support those presenting at their GP, ensuring appropriate referral pathways to different levels of care.

The committee also noted the minutes from the Joint Health Overview and Scrutiny Committee and the Barking and Dagenham Partnership Board.