The Health and Wellbeing Board met on Thursday 27 May 2021 to discuss a range of important public health matters, including the recovery of cancer screening services, the refresh of the health and wellbeing strategy, and the structure and priorities of the Integrated Care Partnership (ICP). Key decisions included noting the proposed continuation of the current health and wellbeing strategy for the Royal Borough of Kensington and Chelsea (RBKC) pending the launch of a joint strategy with Westminster City Council.

Health and Wellbeing Strategy Refresh

Chanel Arcutt, Director of Health Partnerships for RBKC and Westminster City Council, provided an update on the refresh of the health and wellbeing strategy. The current strategy for RBKC expires this year, with Westminster's due in 2022. The ongoing pandemic has increased demand on services and resources, while the NHS undergoes significant restructuring. The role of the Health and Wellbeing Board is evolving to oversee local health and care delivery and shape future services through a more strategic and integrated approach. The board was asked to note the proposed continuation of the current RBKC strategy until the new joint strategy is presented in the coming weeks. Olivia Clymer welcomed the update and asked about the board's role within the Integrated Care Partnership (ICP), to which Chanel Arcutt responded that the Health and Wellbeing Board is the only statutory board remaining locally post-NHS transformation and serves as the platform for partnership working, aiming for integrated, outcome-focused, and patient-centred services.

Integrated Care Partnership (ICP) Structure and Priorities

James Benson, Chief Operating Officer for CLCH and ICP Director for the Royal Borough and Westminster, presented an update on the ICP's structure, priorities, and relationship with the joint Health and Wellbeing Board. He outlined the ICP's focus on neighbourhoods, integrated care partnerships, and the North West London Integrated Care System. The board's existing health and wellbeing strategies already identify areas for improvement, such as supporting children and families, reducing risk factors for long-term conditions, and increasing the sustainability of the health and care system. The ICP will review these strategies, drawing on rich public health data to address challenges like obesity, diabetes, hypertension, and severe and enduring illness. Key principles for the ICP include managing public health, developing primary care networks, improving diabetes care, and enhancing community and mental health services. The ICP also aims to manage vaccinations and address vaccine hesitancy.

Councillor Tim Mitchell raised a question about how population health management approaches are being applied to identify priorities, specifically mentioning obesity. Dr Andrew Steedon explained that obesity was identified through Joint Strategic Needs Assessment (JSNA) work that informed the health and wellbeing strategy, particularly concerning children. Bernie Flaherty emphasised the importance of tackling health inequalities, noting that obesity is a significant outlier in the boroughs. Olivia Clymer inquired about how local people's voices would be heard in shaping priorities, and James Benson stated this would be a key discussion for the partnership board, aiming to coalesce patient voices within Primary Care Networks (PCNs) and wards. Detective Inspector Iain Keating asked about the ICP's influence on wider determinants of health, to which James Benson responded that the ICP would involve a variety of partners to drive collective change. Dominic Condon, a representative from Westminster, expressed enthusiasm for the partnership and highlighted the potential for end-to-end work and the application of principles from the Anchor Institute. Lena Choudary-Salter raised concerns about the under-resourcing of GPs and the impact on access, particularly for BME communities. Dr Mona Vaidya and Dr Andrew Steedon acknowledged the importance of GPs and discussed ongoing work to support primary care, including the deployment of additional roles and the learnings from the vaccine hesitancy programme. Councillor Tim Mitchell raised concerns about the WISIC data's accuracy and the overlap between having two ICPs, to which James Benson agreed that data quality needs improvement and that the decision on one or two ICPs would be a partner discussion. Dr Mona Vaidya noted that PCNs are at different levels of maturity across the boroughs, and Andrew Steedon highlighted that three of the four ICP partners are already joint partners across both boroughs.

Cancer Screening Recovery Update

Anna Riley, Director of Public Health, introduced an update on cancer screening recovery, noting the significant impact of the COVID-19 pandemic on NHS services. Dr Cathy Banesh, NHS England Screening Lead, reported that bowel and cervical screening programmes have largely recovered, with breast screening anticipated to be fully recovered by March 2022. Dr Banesh confirmed that initiatives are planned to address inequalities in screening uptake, particularly among BME groups, and to map these inequalities across all screening programmes. Olivia Clymer raised concerns about historical lower uptake of cervical smear testing, and Dr Banesh acknowledged this remains a challenge, potentially linked to changes in programme methodology and confusion among vaccinated women about the need for screening. Clare Barry, Senior Delivery Manager for Screening and Early Diagnosis at the RM Partners Cancer Alliance, assured the board that reducing inequalities and variations in screening uptake are central to their interventions. Councillor Tim Mitchell questioned whether the eligible patient numbers were based on WISIC data, which Dr Banesh confirmed, while acknowledging potential data inaccuracies.

Children's Annual Safeguarding Report

Emma Biskupski, who manages the local safeguarding children partnership, and Angela Flowerhive, Head of Safeguarding Children's Services for the borough, presented the annual report for the local safeguarding children partnership. The report covered the period from September 2019 to September 2020 and detailed referral numbers for Kensington and Chelsea and Westminster, noting a systems issue in Westminster's reporting. Police were identified as the major source of referrals, followed by education and health. The most common age group for involvement with families and those under a child protection plan was 10 to 15 year olds. The report highlighted concerns about lower referral rates during the pandemic due to school closures and the potential for hidden harm. The partnership responded by developing multi-agency guidance, holding regular meetings, and utilising online platforms.

The new by-borough partnership for RBKC and Westminster has appointed Aileen Buckton as its independent chair. Key priorities for the new partnership include recovery from the COVID-19 pandemic with a focus on mental health and wellbeing for children, young people, and their families; transitional safeguarding for young people moving into adulthood; maintaining safer communities by addressing serious violence and child exploitation; and reducing the harm of domestic abuse and coercive control. New subgroups are being established for case reviews, best practice and development, and engagement and accountability. A question was raised about where local children would be treated for residential mental health problems, and it was noted that while local children and adolescent mental health services (CAMHS) and systemic clinician services are in place, there are ongoing challenges in meeting the needs of the most vulnerable children requiring residential care, with joint packages of care in place with health colleagues. Councillor Tim Rendell thanked Angela and Emma for the report, commending the excellent services provided.

Any Other Business (AOB)

Chanel Arcutt informed the board about an upcoming consultation questionnaire from NHS England regarding the effectiveness of the CCG's working relationship with statutory bodies and its contribution to the delivery of the joint health and wellbeing strategy. The board members will receive this questionnaire soon, with a tight deadline for responses.