The Health & Wellbeing Board and ICB Sub-Committee (Committees in Common) met on Tuesday 12 March 2024 to discuss a range of critical public health issues. Key decisions included approving a new strategic approach to tackling healthy weight in Barking and Dagenham and extending contracts for adult and young people's substance misuse services.

Resident's Story: Jamie Postendorfen

Jamie Postendorfen, Chair of the Just Say Forum, shared her personal experiences as a carer and a resident navigating local services. She highlighted the significant challenges faced by carers, particularly in supporting young people with complex needs through the transition into adulthood. Ms Postendorfen emphasised the difficulties in accessing timely and appropriate support, often having to undertake extensive personal research due to a perceived lack of knowledge within local authority services. She stressed the importance of better communication and a more integrated approach between health and social care services, especially for parents new to the Special Educational Needs and Disabilities (SEND) system. Her experience as a carer for her father with Alzheimer's and her mother's mental health struggles also underscored the need for more comprehensive support for carers.

London Ambulance Service Update

Patrick Brooks from the London Ambulance Service (LAS) provided an update on the service's performance, particularly in North East London. He detailed the pressures faced during the winter period, including a 7,000 increase in call demand, and outlined strategies implemented to manage this, such as procuring additional vehicles and utilising specialist resources like mental health clinicians. Mr Brooks highlighted improvements in hospital handover times, with a new 45-minute release policy significantly reducing delays. He also discussed the importance of alternative care pathways to minimise unnecessary conveyances to emergency departments, noting that less than 50% of patients attended by LAS in North East London now end up in hospital.

During the discussion, concerns were raised about the availability of community services to avoid hospital escalation and the evaluation of harm caused by ambulance delays. Questions were also posed about the number of individuals self-presenting to hospitals who might have benefited from an ambulance response. Mr Brooks explained the role of GPs as a primary pathway for referrals and acknowledged that while many community pathways exist, they can reach capacity. He also detailed efforts to improve response times, including the introduction of a direct line to mental health clinicians via NHS 111 press 2. Ann Hepworth from Barking, Havering and Redbridge University Hospitals NHS Trust commended the LAS's partnership working but noted the continued growth in demand. Councillor Jane Jones raised concerns about patients being taken to hospitals outside their usual care area, such as Newham General instead of King George's or Queen's Hospital, impacting social care relationships and aftercare. Mr Brooks apologised for any such instances and stated that patients should generally be conveyed to their nearest hospital, especially if they have ongoing care needs. The potential reintroduction of a successful Duty Doctor Scheme was also discussed. Healthwatch reported that 50% of respondents to a recent survey had been deterred from calling an ambulance due to waiting times, highlighting the need for better communication of recent improvements. Mr Brooks confirmed that the 45-minute handover policy, a national mandate, had led to significant improvements and that the next goal was to reduce this to 30 minutes.

A New Strategic Approach to Healthy Weight in Barking & Dagenham

Philip Williams, Head of Localities Commissioning, presented a new strategic approach to tackling the significant issue of overweight and obesity in Barking and Dagenham. He highlighted the borough's high rates of overweight and obese adults and children, leading to increased risks of serious health conditions. Mr Williams explained that the current reliance on individualised weight management programmes is insufficient, estimating it would take over 150 years to support all eligible adults. He proposed a shift towards a whole system approach, focusing on preventative measures at a population and community level, addressing interconnected factors such as environment, social, economic, and cultural influences.

The proposed strategy involves building a borough-wide partnership around food, activity, and the environment that supports healthy weight. This will be facilitated by commissioning a provider to act as an enabler, engaging communities and partners to develop new models of support. The plan includes phases for design and implementation, focusing on co-produced community activities, building a network of healthy weight champions, and improving digital support and communications. Mr Williams acknowledged the inherent risks and challenges, including the difficulty of measuring impact and the need for sustained effort, but stressed that this systemic approach is essential for long-term change. The Forum members largely supported this new direction, recognising the current strategy's limitations and the need for a more holistic, community-led approach. Dr Ramneek Hara highlighted the need for wider membership and engagement with supermarkets, while Craig Nikolic noted the availability of more granular data for targeted interventions. Fiona Taylor, Chief Executive, emphasised the need for definable outcomes and a focus on what system leaders can truly impact. Concerns were also raised about the safety of green spaces for physical activity and the impact of fuel poverty on healthy eating. The Health and Wellbeing Board and Committees in Common agreed to recognise the urgent need for change and adopt this new strategic way forward.

Adult Substance Misuse (Drug and Alcohol) Integrated Service - Contract Variation

Claire Brutton, Head of Disabilities' Commissioning, presented a report seeking approval for a five-month contract variation for the Adult Substance Misuse Service with CGL. This extension, from 1 April to 31 August 2024, is necessary due to delays in the procurement of a new contract, ensuring continuity of critical specialist interventions for adults with substance misuse problems. The Health and Wellbeing Board approved the contract variation and delegated authority to the Strategic Director, Children and Adults, to extend the contract and related agreements.

Young People Substance Misuse (Drug and Alcohol) Integrated Service - Contract Variation

Claire Brutton also presented a similar report regarding the Young People Substance Misuse Service, provided by V-I-A (formally WDP). Due to procurement delays, a five-month contract variation was sought, extending the service from 1 April to 31 August 2024. This ensures the continuation of specialist interventions for young people facing substance misuse issues. The Health and Wellbeing Board approved this contract variation and delegated authority for its extension.