The Health and Wellbeing Board met on Monday 22 April 2024 to discuss a range of public health updates, adult social care and community health, hospital performance, and the crucial issue of carers and mental health. The Board noted updates on various health services, reviewed progress on responding to a coroner's report regarding CAMHS investment, and dedicated a significant portion of the meeting to understanding the challenges faced by carers and exploring ways to improve mental health support for them.

Public Health Updates

Gladys Xavier, Director of Public Health, provided an update on several key public health matters. Covid-19 cases were reported as decreasing, with a spring vaccination campaign targeting those over 75 and immunosuppressed individuals. Flu season had concluded with low virus activity, though some under-5s were experiencing illness. An initiative to eliminate Hepatitis C was underway, with targeted scanning and treatment for individuals with substance abuse issues and the homeless. Travel health advice was being promoted, with the UK Health Security Agency's online tool, travel.prohealth, highlighted for checking health advice for different countries. The Board was also informed about ongoing efforts to address confirmed measles cases, with Redbridge recording its first case in months, and work with primary care providers and communities showing positive results. Discussions during this update included concerns about long Covid, the targeting approach for the Hepatitis C programme, and the importance of proactive messaging for measles vaccination uptake. The Board resolved to note the Public Health update.

Adult Social Care and Community Health

Sanjiv Luckhea, Integrated Care Director for NELFT, reported on positive developments in Adult Social Care, including key appointments for Strategic Lead and Safeguarding Managers, and ongoing recruitment of social workers to fill vacancies. A pilot for assistive technology across adult social care and community health teams was also mentioned. Challenges were noted in children's services due to recruitment difficulties, leading to a review of the staffing structure to implement a multidisciplinary team approach. Pressure on the CAMHS service was acknowledged, with work underway with the ICB to address the backlog of routine referrals. The Community Children Nursing Team was described as fragile, with efforts to find a sustainable model. In contrast, recruitment to the district nursing service had improved due to an overseas recruitment campaign. The success of the BHR respiratory transformation and its virtual ward model was highlighted, earning an award for outstanding service. For adult mental health, physical health checks had been introduced to address inequalities, with 75% completion to date. The Chair congratulated the team on the award and progress in adult safeguarding. The Board resolved to note the update.

Barking, Havering and Redbridge University Hospitals (BHRUT) and Whipps Cross Hospitals

Louise Dark, Managing Director of King George Hospital (KGH), presented an update on BHRUT's performance. The Trust had met its urgent emergency care target of 76% by the end of March, with KGH achieving 78.5%. A new same-day emergency care unit at KGH had opened, aiming to reduce admissions and improve patient length of stay. Two new elective theatres had also opened, with an official opening planned for 17 May, expected to increase the number of elective cases. The faster diagnostic standard for cancer was met in March, and while slightly outside the DMO1 target, it was expected to return to track. The challenging 62-day cancer performance target was met in March, showing significant improvement, though it would be monitored. Louise Dark was leaving BHRUT, and a Redbridge Place Based Lead was to be announced in May. Clarity was sought on the interface work between primary and secondary care, with an update to be circulated. The Chair congratulated BHRUT on its progress. The Board resolved to note the update.

Redbridge Borough Partnership

Adrian Loades, Corporate Director of People, reported on the Borough Partnership's recent meeting. A diagnostic exercise on mental health, disability, and autism spending across North East London (NEL) revealed that NEL, and Redbridge specifically, had lower spending in these areas. There was agreement to address this funding disparity. The partnership also considered a proposal for a mental health offer for domestic abuse victims, agreeing to form a task and finish group. A review of a difficult discharge case involving a young person from KGH led to an agreement for more bespoke discharge and escalation arrangements for young people. An update on Health Inequality funding showed positive benefits, with a measured approach to assessing its use agreed upon. The Chair requested that the diagnostic exercise on mental health, disability, and autism spending be shared with the Board. The Board resolved to note the update and that the diagnostic exercise would be shared.

Response to Regulation 28 Prevention of Future Death Around CAMHS Investment

Portia Kumalo from the Integrated Care Board (ICB) presented the ICB's response to a Regulation 28 notice issued by His Majesty's Coroner for East London following the inquest of a 12-year-old who died by suicide. The notice highlighted failings in care within an under-resourced Emotional Wellbeing Mental Health Service (EWMHS). The ICB had formed a multi-agency Task and Finish Group to review service provision and develop a business case. System actions taken included understanding needs through various stakeholders and case studies. Discussions covered the impact of a revised Neglect Tool Kit, Redbridge's Pathfinder Status for child protection arrangements, increased investment in Tier 2 services and voluntary sector organisations, the need for Clinical Psychologists, and the funding for new services, with assurances that new funding would be sought. The Chair requested regular updates on progress. The Board resolved to note the actions taken to date and agreed to receive subsequent updates.

Carers and Mental Health

This themed session focused on the role of carers and their mental health. Individual carers, along with representatives from NELFT, One Place East, and Redbridge Carers Support Service (RCSS), shared their experiences and highlighted issues such as insufficient promotion of carer services, the need for better information sharing between services, and the continuation of support for young people beyond the age of 18. Concerns were raised about the availability and accessibility of respite care, particularly for working carers, and the need for activities to prevent carers' mental health from impacting those in their care. The importance of addressing carers' physical health through activities was also mentioned. The long waiting times for CAMHS communication were described as unacceptable, causing anxiety. The decommissioning of Barnardo's was seen as a mistake, and the need for schools to promote young carers clubs was emphasised.

RCSS highlighted the complexity of the First Contact Centre's system and the need for a clear navigation system for carers. They also pointed out issues with the application process for health care assessments and the efficiency of emergency alert card processing.

One Place East, which supports people with disabilities and their carers, offers mental health services, trauma and falls recovery groups, and a user network meeting. They noted the importance of safe spaces and a holistic approach linking physical and mental health, but also the difficulty in obtaining the right support for the right length of time.

NELFT's Redbridge Community Mental Health Team discussed barriers faced by carers and confirmed that social workers are integrated into their teams. They outlined services for early intervention psychosis, older adults, and specialist secondary psychological services, including a monthly carers support group. While acknowledging limitations in adult mental health services, they committed to exploring ways to support access to mainstream services. Carers of those accessing secondary mental health services are entitled to a carers assessment.

Primary Care representatives noted that more could be done, with NHS England's framework for carers requiring GP practices to implement. They suggested utilising link workers within Primary Care Networks (PCNs), appointing clinical psychologists to PCNs, and providing GP practices with a directory of services, including a carers' register.

The Board acknowledged the importance of the carers' submissions and the need to report back on the issues raised. Accessibility and information sharing were identified as consistent themes, with a digital discovery exercise underway. The gaps in service provision and the need for better pathways and feedback were also highlighted. The anxiety surrounding what happens when parents can no longer provide care was a significant concern, with a need for a network of support. The Chair thanked those who shared their experiences and stated that the next steps would involve translating insights into action.

Forward Plan

The Board noted the Forward Plan, which included upcoming meetings and a focus on themed sessions to strengthen engagement with communities.

Dates of Future Meetings

The dates for future Health and Wellbeing Board meetings for the Municipal Year 2024-25 were noted: 24 June 2024, 16 September 2024, 18 November 2024, 24 February 2025, and 28 April 2025.

The Board resolved to note the dates of future meetings.