The Health Scrutiny Committee met on Monday 30 September 2024 to discuss stroke prevention and rehabilitation, the Joint Local Forward Plan, and learning from winter pressures. Key discussions included improving stroke detection rates, the challenges faced by homeless individuals in accessing healthcare, and the effectiveness of winter health initiatives.

Stroke Neurorehabilitation and Prevention

The committee received an update on stroke neurorehabilitation and prevention efforts in North East London (NEL). It was highlighted that Barking and Dagenham has seen a concerning trend of declining healthy life expectancy, with a higher prevalence of risk factors for stroke, such as unhealthy lifestyles and specific ethnic communities being at increased risk. To address this, the borough has lowered the age for health checks to 36. Challenges remain in ensuring timely GP access, leading to discussions about pop-up cardio-metabolic clinics and adapting prevention literature for better accessibility. The interconnectedness of stroke with other long-term conditions was also a focus, with a framework being developed to address this. While the current health check uptake is considered good, a more ambitious target of 80% was proposed to improve early detection. The committee also noted the high number of residents living with sickle cell disease, a condition that increases stroke risk, and the ongoing work with Barts and Homerton Hospitals to mitigate this. Performance in Transient Ischaemic Attack (TIA) services has improved, with Barking, Havering and Redbridge University Trust (BHRUT) now meeting the 24-hour assessment target for most patients, although weekend services remain a gap. Workforce challenges in stroke and rehabilitation services are being addressed through apprenticeships and investment in the non-registered workforce.

Joint Local Forward Plan

The committee reviewed the Barking and Dagenham Joint Local Forward Plan, which outlines priority areas for the partnership to deliver on the Joint Local Health and Wellbeing Strategy. The three overarching priorities are: improving health and wellbeing for all ages with a focus on early intervention and reducing inequalities; adopting a preventative, asset-based approach to health and wellbeing close to home; and enabling residents with learning disabilities or autism to lead independent lives. Engagement with homeless individuals was identified as particularly challenging, with efforts underway to incorporate their views through working with clinical teams, voluntary organisations, and health needs assessments. A new facility offering showering and washing facilities for street homeless people is set to open in Barking. The plan also addresses tackling obesity through a system-wide approach, with a new service being tendered that will be community-led. Concerns were raised about the impact of increased GP costs for text message reminders on flu jab uptake. Funding for the plan largely relies on existing resources, with a particular challenge anticipated due to projected population growth.

Learning from Winter Pressures

An update was provided on the Barking and Dagenham Place Winter Plan, highlighting progress made in supporting residents and staff during the winter period. The plan focused on supporting people in the community and taking a proactive approach to health management. Despite pressures, performance in urgent and emergency care improved across hospital sites and community urgent treatment centres, with reductions in ambulance handover waits. The plan's priority groups were children (0-4) and families, people with respiratory disease, and those with multi-morbidities accessing integrated case management. The committee noted the correlation between A&E attendance and flu vaccination uptake, with efforts being made to increase vaccination rates, particularly in the under-65 population and the health and social care workforce, through pop-up clinics and community projects. Concerns were raised about the influence of anti-vaccination views on social media. The committee also discussed the challenges faced by homeless individuals during winter, with additional pop-up clinics and a new outreach service planned. Funding for winter pressures was largely met through existing resources, as NHS NEL had not received specific winter funding. The committee was informed about an increase in A&E attendances by children and young people experiencing mental health crises, and work is underway to improve A&E waiting times. Access to a directory of services, MiDos, was discussed for Healthwatch and voluntary sector partners to improve signposting. The performance on hospital discharge for Barking and Dagenham was noted as excellent, partly due to a smaller older population, but efforts are ongoing to further improve discharge rates, including through the reablement service.