Transcript

Transcript

Good evening members, thanks for coming on such a cold night. I was in Waitrose the other day and it was colder in the store than it was outside, so that was not just the refrigerated part. So, welcome to this meeting of the health of Addison Health's scrutiny. Thanks for attending. Please note that the meetings may be recorded and broadcast by people present. You may be picked up on recordings. Council recordings are covered by our privacy notice, which can be found at barnet.gov.uk. Please note, we are currently in the pre-election period in advance of the Burntoke by-election on the 13th of February, 2025. During this time, ordinary Council business can continue, but members are reminded not to refer to candidates or parties in relation to the upcoming election. Thank you for your support in ensuring that these principles are respected at all times. Can I remind members to use the microphones, which is a message to me as well. Yesterday I had the sad news about passing of Councillor Eva Greenspan, which is very sad for a long-standing member of the Council. I wasn't on the Council when she was the Mayor, etc., but I have sat on strategic training with her. She's obviously very experienced. She was a very respected member of the Council, so I no doubt there will be questions after the Council. I don't know if there are any other questions briefly. I know lots of people have already asked to speak at the main Council meeting, and certainly it's just very, very sad. She was a huge character, and she will be very sorely missed. But thank you for mentioning it, and hopefully she was an amazing lady today at her funeral, you realise, I think, Councillor Sargent. I mean, she really was an architect, and she had a psychology degree. You never know, we all sit here, and you never quite know what people are. Then she had decided to become a concert pianist. She suddenly learned how to learn the piano, and then not went to grade seven or whatever the kids normally do, eight, sorry. You know, she became a concert star. So it seems like she's now just doing a PhD at the moment, so there you go. And she said there's never anything. You must always go for more. So there you go. I think that's the message. Thank you, though. Can I agree those as a record? Did I get it? Sorry. Okay, do we have any absentees? Okay, update from cabinet members. I don't know if I know that Councillor Law is there, would like to speak briefly on that. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. I think it's a good thing that we're having a meeting. We had a lot of inspectors all around the council over those three days, and I think some of us in this room were interviewed, and the results of that inspection were public as of Friday morning, and I'm pleased to say that one of them got a good inspection. Now we need to take into account there are only three words that they can use. One is need for improvement. The other is good. And the third one is outstanding. Sorry? Inadequate. Okay, well, we didn't get inadequate, and we got a good inspection. That's a belief that nobody in the country has had outstanding, so we did really well, and I want to take this opportunity to thank Dawn and all her staff who worked very hard over at least 12 months to prepare just for this inspection. Bearing in mind there was no extra resources for doing that, so the day job also had to be done, and so I'm really, really pleased, and if there's any detailed questions, I'm sure Dawn can answer them, but I think everybody in the room should be proud that the London Borough of Barnet did well. We have an interesting demographic change occurring in our country, and particularly in Barnet. I think it might have been yesterday in The Times that in 2003 we had 7,000 in England and Wales, 7,000 people who were centenarians. 20 years later, that's more than doubled, and there's now 15,000 people who are over 100 years old in England and Wales, and I remember when I was a child that that was something that, when someone reached 100, that was something that was on the TV, and people got a telegram from the Queen, and it was a big, you know, good news story at the end of all, bad news that we got, and news at 10. So it's an interesting demographic change, and it's particularly prevalent here, I think, in Barnet, and that presents us with huge challenges in terms of our service delivery. So it's a positive thing that people are living so long, but also we know that in the last 20 years of a person's life, they're more likely to get ill and in need of support, both from the health services and from other social care. So I'm sure you'll join me in congratulating Dawn and all their staff for this excellent result that we received on Friday morning, after a long wait, because it was in the end of August, so it took till Friday morning before we got the final outcome. So I'll try to answer any questions that people have, but also defer to Dawn as well if there's any specific questions that I can't respond to. So thank you. Dawn, is there anything specific, apart from positive results, that you would point out? I think you said the staff, the comments on the attitudes of the staff and that kind of thing would be particularly specific. Yes, and they're definitely, I would say, things that could improve their methodology. But they were, and the process actually lasted 10 months. So it was quite a long, and the report is like well over 50 pages, a lot of narrative. So the things that I'm personally very proud of are that uniformly we've got a really strong desire for continuous improvement. So in a way, I think probably if we hadn't said that we had areas for improvement, we may inspection the active process, if you'll remember Mr. Monday. But we were already taking action in the areas for improvement that they identify. So they report, although it's different from the information that we have, that some of them are successful. And we know that they have, because we can check records. We're slightly confused about that, but we should do more to improve the uptake of direct payments. And that's something that all councils should be trying to do, because it's a tool for in the prevalence of young black people in mental health services. Now that's, we're not alone, that's a national issue. You know, I suppose if you're thinking about this in terms, like Ofsted, we told them the things that we wanted to do better at, and they did. But yes, that's probably. Thank you. Staff should be congratulated for that outcome. Yeah, you want to come back on this point before we ask for any other questions? Yeah, I just wanted to add, because I know Don won't say that necessarily, but I think the report was also very complimentary of the senior management leadership style, and that, you know, staff appreciated the support that came from senior management. And I think it's important to say that, because as we all know, adult social care is a challenge for all authorities, and increasingly so today. So I knew she wouldn't say it, but it was clearly there in the report, and I wanted to say it publicly, and thank Don and her management team for the brilliant job that they do every day for our residents. So thank you. The other thing is CQC are very interested in scrutiny, and for them, and in fact, actually, scrutiny comes over really well. So you came over well as well. Yeah, no, it does. It doesn't really, you know, so just a little pat on the back for the committee, because it doesn't always. So first of all, I'd also like to put on record, you know, it looks like a very encouraging performance with regards to the social care report. So a sort of dual question. Part one is what are you the most proud of in terms of best practice that we might be able to impart to other local authorities differently that works particularly well? And the second question is what do you think might be the biggest challenges that we face in the medium term? Well, I think that the thing that comes out for me is something to be proud of is the approach that our staff have to strength-based assessments. It's quite clearly an approach which says what can't you do? It's about what you can do, and, you know, empowering people to recognize their own strengths. And this is really part of the success that I think that our staff have been working with, people with increasingly complex needs as the population gets older, and it's not in the report necessarily, but we already know this, that in Bona we have a particularly large cohort of people with learning disabilities as opposed to other local authorities, and this presents us with challenges, not only because many of them are working age and wanting to live independently, and that's a big challenge for us, but because the staff adopt a strength-based approach, they work with people about enhancing their strengths and encouraging people to recognize their own strengths, to be as independent as possible. So that's what I think is a really marked part of our practice, which I'm impressed with in the way our staff do that in a very meaningful way with the people that come to us for support. I forgot the second part of your question, sorry. What do you think might be the biggest challenges that we face in the medium term? There are a number of challenges, and I think the challenge for us is a demographic one. So I think the statistic I gave you before is something which in Bona, as we know, we have a larger older population than many boroughs in London, and that's a growing population, and that will be a big challenge for us going forward, whether we will have sufficient resources to meet that demand will be a challenge in the coming years. And I think I also, because I mentioned the demographic figure earlier on about the growing population of people who are over 100. So if you think about that today, that's people who were born in the 1920s who are still here, still living, and still, for the most part, trying to live a good, quality and dignified life, and that number is growing. And as you get older, you will need more support to live a dignified life. So that's going to be the biggest challenge, but not just here, but in most authorities around the country. So the thing I'm proud of is how our staff work to enhance and help people understand that they have their own strengths as well, and they should be proud of it. And that's the first thing. And the second thing is the growing elderly population, which will continue to rise and be a challenge for us, but also all the local authorities up and down the country. And I think, you know, the government's setting up some commission, which is looking at the future of adult social care, and that's for another day. Because due to the increasing demand on our services, and we did have a discussion, you know. As you know, the government's announced 600 million pounds for local authority adult social care services. And I think I said it at the last meeting, it's not a panacea to the challenges that we face, but we welcome, I think, somewhere in the region of 2 million pounds extra. That's got to be confirmed yet. And yes, the budget will go through its normal screwed decision-making process in February, next month, really. But, you know, there are challenges for us, and there's no question about it, but we do welcome the additional resources that's coming. We know that, you know, the spending on social care is actually going up, you know, is increasing. It's not, I think, obviously concerned that any cost pressures or savings don't impact on residents' assessments. But I think it's been circling, but to show thinking that goes on behind each cost. I don't know if that was a question or a statement, really. Okay, any other questions to cabinet member? Thanks very much. Thank you, everybody. Councillor Moore, is there anything that you particularly want to add from your perspective, just, you know, on your portfolio? Yes, thank you. Just some brief comments, if I may, Chair. Can you hear me effectively? I can. Lovely. Okay, thank you. So, I mean, the first thing, of course, is to reiterate my thanks to staff and senior officers for the positive CQC outcome and their ongoing work in social care and health and how important that is. The second point I wanted to make briefly was Councillor Edwards started his remarks talking about the numbers of the rise in the number of centurions over the last several decades. And I think the point that I would make there is in light of both our growing older population, but also the fact that a proportion of older people live their later years with one or more ongoing health issues, you're going to take two reports on vaccinations during this meeting. And I just wanted to reinforce the real importance of vaccine uptake. And I don't know whether others picked up from some of the reports on the numbers of people being to hospital with flu over the last several weeks. And I think the genuine frustration on the part of some of the clinicians that they were seeing people coming into hospital with severe complications from flu who were eligible for a vaccination but had not taken that up. And so when you're looking at your reports, you're taking these reports around the vaccine programmes, really understanding the potential impact that that is having on the health system in general. We have the same thing applies, of course, to our younger adults with complex needs and our children in schools and their ability to engage with school and go through their education effectively if they're not taking up vaccination opportunities and are becoming ill. And so I just wanted to put that on the table as it can look quite academic when you're looking at vaccine uptake levels. But actually, these are the real impacts of that not happening. And it's particularly important in a borough where we do have that older population. The only other comment I would make is the joint health and wellbeing strategy is reaching its next stage of development at the health and wellbeing board on the 23rd of January, where we will be agreeing the priorities that will then go out to wider public consultation and to thank all those who put in comments thus far. So thank you very much. I'm happy to answer any questions, but I wanted to keep that report brief. Thank you, Councillor Moore. Any questions to Councillor Moore on health and wellbeing generally? Councillor Cornelius. Sorry, Councillor Moore mentioned encouraging people, obviously, to have the vaccines and that it's interesting how many people in hospital don't have, haven't had it. But do they also count the people who do we have a note who end up still with COVID please? I think it was an anecdotal comment that was made by clinicians, and I think it was part of their concern that they were seeing people who hadn't had, not everybody that they were seeing had had the opportunity to take up the vaccine. Of course, people will have different strengths, different immune systems. Some will have taken up the vaccine, may not have good inherent immunity. They may have other complicating factors. But I think the point I was I think the point they were making was that where people did take up the vaccine, it protected them and reduced the chance of them being admitted with severe complications. I don't have the figures for those who have and have not had vaccine, have not have have and have not been vaccinated. But it was it was really reinforcing how important encouraging people to take up vaccine opportunities is. And the implications in that case, because we are seeing quite a significant number, had been seeing quite a significant number of people coming in and having to be admitted to hospital. And the challenge, additional challenge that presented, particularly given that the influenza wave was happening earlier than has happened in some previous years. And so it was merely an anecdotal comment, but reinforcing the important vaccination. And when you and when you've looked at the papers, you'll realize that the it for some of those vaccines, the percentage uptake is not as good as we would ideally like. Thank you. I think the public health would like to comment. Reminds me of when I was in the department, we we use Henry Cooper, the boxer, to use the slogan, get your job in now, get your job out to and to improve the uptake for all the people. It was quite successful. Any other questions? Details to Councillor Moore. Thank you, Councillor Moore. Pleasure. And that leads us on to. I believe they will be on the third of February. So we're going on to the vaccination program, and this is the updated item, isn't it? The updated report that was tabled as opposed to the original one. Well, I believe we've got the. The shrimp from public health. And the gentleman would like to introduce yourself. OK. Sorry about that. I'm Daniel people. I'm the prevention and vaccination project manager from North Central London Integrated Care Board. So are you going to make a short introduction? You know, you can be brief in terms of hopefully members of the report. Just a brief introduction to. And then we can have questions you're taking for this coming year, but also some achievements in the past year. And immunizations really require the collaborative effort because there are different responsibilities across the different system partners. And it just didn't are responsible for commissioning of the vaccination programs and integrated care systems have a duty of quality improvement. And we as a council deliver population health initiatives, including promotion and in get of vaccinations. And I just wanted to also highlight that. Colleen Kavanagh is here from Vaccination UK. Vaccination UK are a new school immunization provider that took over the contract from CLCH in September twenty twenty four. I welcome that we can see you on the screen. Thank you for joining. And just kind of. Colleen. I think it's just. Yeah, I don't think Hannah's able to join us this evening. Sorry. Okay. That's fine. Thank you. This is a comprehensive report going through the different stages of the vaccination program from children to school age to pregnancy, et cetera. I don't know if people have got questions. I wonder if we could have it talks about there's been a decline in the terms of naught to five. There's been a decline at age five. Of take up and GP practices have been alerted to this. I don't know if there's any more figures or any background to that particular decline. We we noticed this decline for the paleo. Preschool abuse to the data a couple of months ago and three work and GP practices. We understood that in late twenty twenty two, there was an additional polio booster vaccination campaign that took place across London. And what seems to have transpired through that is that parents took that child when they were between two and three years for an additional paleo booster vaccination and then believe that that was the detail preschool booster. So it didn't come forward for the detail booster, even though they received invitations from their GP practice. So all bonded GP practices have now contacted all of those missing immunizations to remind them that that is one of their required donations to in the terms to obviously bring up the decline that we've seen in recent months. That just motivates to polio to that particular vaccine. We've been able to conclude that that because of because the detail vaccination is includes polio and of the polio campaign, that that was what the link for why it's declined. Other questions from members about the report. Sergeant. Yes. Thank you very much. That's the two main feedback that we get when we're talking to our residents about flu. It's always that they make it easier. I think that that's an unfortunate example that you can give, because I think the reason that now pharmacies, GPs and doctors and a whole wide variety of different organizations can give the flu vaccine to try and make it easier for patients. And that's unfortunate, actually, because different organizations are providing it, that it did make it more difficult. But that's something that definitely we can look into and make sure that any patient and public communications regarding where you can get the flu is much easier for everyone. And you don't have to book an appointment, you can walk in and get a flu vaccine. On the one hand, it's been positive. On the other hand, I can understand it can be quite for care home residents, people in care, but also for care staff. So when we are talking about protecting. I just think it is getting quite complicated. You've got your COVID vaccine, you've got your flu vaccine, then there's another vaccine and people aren't sure which one they're supposed to have. And if you've got a cold, you can't. This is that for eligible groups, co-administration still remains the go to method for where people are eligible, just really to try to reduce the complication whenever possible. And we do have assets that we have. Thank you. Councillor Stock. There are a couple of things. In care homes, do you know what the uptake is of the staff that actually work? Because that would be really important to people, obviously, going to care homes. The other thing is you were saying about suggestions. You've got 63 Councillors who really do. I don't know if you ever think of somehow giving us something that when we see people, we can say, have you done? Have you taken your different populations? It's just a suggestion. I was going to follow up from that. The reporters talk about variation coverage across groups in the bone. Particularly certain ethnic groups have gotten lower coverage. Just wondering, you know, and it also talks about you've got some funding to appoint two health ambassadors. Hosted by ground work, I think, presumably to work with different communities. Could you say a bit more about that work and how worried are we by low coverage in some communities? I will hand over to Vibhita. We had some funding from the Department of Leveling Up Housing and Communities. And we were able to have about six health ambassadors across VCS organizations and individual health ambassadors. That funding has since run out. But we have, you may have met Farrah Josephs, who is a health ambassador who initially started out working with the Jewish community. But has now expanded to different groups. She works with asylum seekers, refugees, women's groups. She has now become the senior ambassador through the cancer screening program. And we are now two health ambassadors that will work underneath her and utilize her experience. So the aim is, although the main aim is cancer screening, they will also be engaging with other health topics that are relevant to those communities. Because if we go, you know, just in with cancer screening, they'll switch off. You know, diabetes, long-term conditions, physical activity. So it will be a health focus, holistic approach to health ambassadors. Okay. Perhaps they could come back at a future time in a bit more detail about how they work and how they're reaching out. Hi there. So first of all, thanks for the report. Very interesting read. Going to the other end of the age spectrum. So I was actually quite intrigued by the routine childhood immunization. And on figure one, the first graph that's in the routine childhood immunization section, if you look at most of the vaccinations, I think they're color coded. But I don't know which ones they actually refer to. There are five different colors. And they all seem to be going on an upwards trend, which is quite encouraging, from January 2020 till basically the first quarter of 2024. And then there's this dip in 2024. So I just wondered whether you think from the analysis that you've done, whether this is the beginning of a trend that we haven't seen before. Or is this actually just a peculiar quirk that is specific to 2024, while the prevailing long-term trend is actually moving in quite a positive direction? So the dip that we can see in that graph is related to what I spoke about regarding the polio campaign. So the vaccinations that have gone down are the four in one booster at five. And then that's also impacted all vaccinations at five. So because the children who are now approaching five would have been those that were eligible for a polio booster from two to three and then not come forward for their four in one booster. That's why we see this dip, but we are engaging with practices and the public to rectify that. So we see this as a quirk that will be fixed in the short term rather than a start of a downward trend in uptake in vaccination. As a follow up, how can you rule out that it isn't the start of a trend where possibly, so if you think of it as numerator over denominator where the denominator is like the total population of the given demographic and the numerator is the total number of people that have taken the vaccine that's available. Is this because the numerator has decreased or is it because the denominator has increased? Because I think one of the strengths of this report actually is that there seems to be a bit of a hyper local recognition of different community groups like asylum seekers and homeless people who we might not have featured in the same quantity in previous reports. I just wonder whether, you know, how you know whether this is a short term or a long term trend. The MMR2 data hasn't been impacted in any way compared to the data. And historically, the MMR is the more difficult vaccination for parents to vaccinate their child against. And that is saying to be continued on a steady trend and upward trajectory, and that's given at the same appointment as the detailed vaccination, which is at three years, four months. So we don't see the trend of MMR uptake links more closely with the general trend of vaccination uptake than what we see through the DAP. Any other questions? Yes, I was just going to ask. Second paragraph since May 2024. North central London, and I presume when you give it a colour in the graph. You actually call it the booster. The D-TAP with a foreign vaccine protects against diphtheria, tetanus, pertussis and polio. So the small a is for a cellular pertussis. And, yeah, Googled it, it says D-TAP is diphtheria, tetanus, and the a is a small a, and it's and. Emma Waters, we'd like to, sorry, I should have introduced you before, did you want to say something? No, no, no, it's just to say I think it's a small a because it's a cellular and then pertussis. But I think that's a small a as opposed to being the and. But that's my understanding anyway. Yeah, just to clarify. We should have put it in brackets to make it clear on the report. So apologies. I didn't know that. Thank you. Could you just repeat that as to what it should be? We didn't quite hear what you said. You must be mute. Can you hear me now? Apologies. You're muted. Sorry, Emma. Can you hear me now? I mean, anyone else can correct me, but I believe it's diphtheria, tetanus, acellular, pertussis and polio. Does that work? Is that the thing that's correct? Daniel, Janet or Bhavita, please correct me. Perhaps we will reply to you. Just explain why it's called a foreign. To this council. Sorry, this is not a question, but I was just going to say in reference to the point that was just made, I could be. But my understanding was that the foreign one is quite a standard definition in most health literature. So even though it was written as detailed in the report, it's quite clear what it actually is, if that health literature is understood. But, yeah, perhaps there's no confusion as far as I'm aware. Any more questions on the report, Councillor Sargent? Got an icon. I missed that. So page thirty seven. Yeah, pregnancy. There's an appendix A on vaccinations and pregnancy. Just have to email it to you to make sure that you see it. I didn't have a problem. And just a quick extra one. Could we see the teddy bear vaccination? Could we see the teddy bear vaccination adventure? When it's done, it just will be like relief from everything else. I'll make sure you get a copy of that. OK, thank you very much. This is anything else? Thank you for your contribution. Going on to the HPV vaccination, which is related. So you might want to stay there. We're welcoming you to talk about aiming, is that right? Public health, specifically with HPV, is that your main concern? Yes, that's the project I'm leading on. Would you like to say a few words on that particular vaccine? Yeah, so the report that we submitted provides a project overview of the of our vaccination project aims to improve vaccination uptake in Barnet and our neighbouring North Central London bars. It was a bit about the program. So the HPV stands for the human papillomid virus. And this vaccine has been part of our school immunisations programme as of 2008. So initially, this programme was introduced to girls in year eight that attend secondary schools. And this was a two-dose programme for in year eight and nine. And then in 2019, it was also used for all school-aged children. So both girls and boys in year eight. And then in 2023, the vaccination dose was switched to a two-dose programme to a single dose, which is offered in year eight for both girls and boys. The HIV vaccine is known to protect against a variety of cancers that are linked to the HIV virus. This includes the cervical cancer. It has up to a 90% effective rate and other cancers include the mouth cancer, head and neck cancers and also genital warts. And so in Barnet, the HIV vaccination uptake has experienced a significant drop. So in 2018-2019, uptake amongst girls in year eight was at 80% and 60% for boys in 2019-2020 respectively. And currently from our recent data, so this is the academic year of 2022-2023, hating like 45% in boys. And so the report, what we're looking to do is deliver some engagement work to hopefully gather some insight into the barriers and attitudes, current barriers and attitudes towards vaccines and hopefully look to create health promotion aspects which can be shared and directed for parents and carers and school-aged children. And this will also be used both in Barnet and also be shared with our neighbouring North Central London boroughs. Thank you, Pat. Thanks for the report. It obviously was an alarming drop, which affected a lot of other programmes, you know, from the pandemic. And you obviously tried to get back to pre-pandemic levels. I know you're working on health promotion and you've got talks about an online survey. I just wondered what are you finding? Do you believe are the barriers to take up? Because that is quite alarming. It is a big drop and it puts young people at risk, does it not? Yes, definitely. So we have identified that there are multiple reasons that are linked to this drop in uptake. Firstly, the disruptions that were caused by the pandemic. And you also believe there's an increase in vaccincy, which has also come up with other vaccination programmes as well, such as our childhood immunisations programme. We believe this might be linked to a potential increase in misinformation. So there are various communication channels that community groups use, specifically community groups that are on the lower end of uptake, that are our target groups for this type of work. And also, we believe there's a link in operation delivery. So across London, there has been a vaccine. In London, there are various school-age immunisation providers. We do currently work with Vaccination UK as of September 2024 as a provider for a number of years before this. There's also a varied engagement with schools. So there was also a variation in the uptake within different schools in Barnet. And billions might be linked to various levels of engagement. Parent care is understanding of HIV uptake, linking to an increase in the number of consent forms, which varies among schools as well, which also links to our ability to deliver the programme, doing the HIV program, considering that the vaccination is delivered up. Schools must be key to reach young people, to comprehensively work with schools. I think Carleen may be the best person to respond to this, engages with the schools and delivers vaccination programmes in schools. Hi. So we've just been taken over to Vaccination UK. So we've just completed the flu programme, although we're going back into schools and trying to catch more children due to the uptake in A&E services. But what we are doing is we're really making engagements to try and go into schools and discuss with senior leadership teams, just explain what the HPV and the DTP and meningitis programmes are all about and try and get into assemblies and just explain to the children as well what it is. And we meet a lot of barriers, including, you know, parents just won't accept their children are or they think they have to be sexually active at 13, which isn't the case at all to break down those barriers and explain to parents exactly what it is and how it can protect the children going forward. So we're doing the same when we reach our HPV campaign, which will start after Easter. But at the moment, we're kind of we send the school, send out information, we send text messages, our nurses are calling parents if they haven't returned a consent form and answering questions. If parents have any queries as to what it's about. So we really are trying to push to get those numbers up. We initially go in. So when we go in to do our HPV, we'll be targeting year rates, but we'll do children who are out of cohort and we'll do them as well at school. When we go into visiting school, which saves them coming to clinics at weekends, but we will also offer weekend and after school appointments at various clinics around the borough. So we are trying various things to try and catch those and increase the uptake. Thank you. That's helpful. Any questions on the HPV? We do focus groups with communities across the lower uptake communities across Barnet and North Central London. So they are interviewing, they met with year seven children and some of the language that we use, some of them didn't even know what a cervix was. So when we use cervical cancer, we have to be really careful about language and how we help promotion athletes towards young people so they understand what they are getting. And if they can understand, they can be influencers to their parents and parents. That's enough for you. Questions, any other points? Okay. Thank you. I actually was a little bit curious reading this report about the degree of causality and how much can be attributed to the pandemic disruption. Because my understanding is that this is not a situation where or maybe it is a situation. Does the analysis show that it's a case of some vaccines were sort of disrupted because of pandemic delay and then there was a backlog and that's caused a decline in the uptake rate? Or is it a case where we actually have oversupply of the vaccines and people are just not coming forward because there are fewer people attending schools compared to pre-pandemic trends? So I'm just trying to establish what degree of causality can be attributed given the evidence available to pandemic disruption versus other non-pandemic related factors. I think it's hard to put it down to just the pandemic. We have had schools where they had great uptake in a deprived area. And then after the pandemic, it's just not recovered. And we are still trying to figure out what the exact reasons are. I think maybe Colleen may be able to add to this a little bit more because for us, it's a mixture of reasons. But I think through the focus groups, through the online survey, we're trying to understand is it due to operational deliveries in schools? Are some schools more engaged at a certain school, more educated than others that they can understand and sign consent forms? So it's hard to know, but I think the whole process of doing this HV project will help us lead to those answers. I don't know if Colleen wanted to add anything to that. Yeah, thank you. We do have an issue because obviously all our consent forms are online and some parents have digital poverty. They just don't understand or they just sort of, you know, put it on their to do list and it just doesn't get done. We've tried giving paper. And as I said, our nurses do call them and try and do verbal consents with them over the phone to help to complete the form. And people have just lost a lot of trust. I know when we call people and say, you know, we need this vaccine. They go, oh, no, no, no. They just say Covid. And when we try to explain to them it's not Covid, it's something else. They really do need kind of winning around. It's getting better as the years are going on. But there has been a lot of damage, if you like. And people just think, well, they're kind of backing off vaccines, thinking they'll just use, you know, oh, I'll just chance my luck or I don't know. But there's a lot of distrust, I think, around vaccines, unfortunately, so we need to work on that and try and change people's attitudes. Thanks for that. So when looking at it operationally, it's a bit of an eye opening revelation because I get the impression that maybe there's too many communication channels that actually causes confusion. Like I'd never heard of a system where you receive a phone call and you might think, you know, these days with the level of sort of cyber crime and scams that go on, you know, it can be quite difficult to distinguish a genuine sort of vaccinate from a fraudster. I don't know. So there's always that tradeoff, I think, between using as many communication channels as possible to expand coverage, but then also making sure that each of those channels are effective enough to actually have a material impact on uptake. So to see actually how this helps, how you take this. Yes. Sorry. It just sounds like we bombard people. But let me just quickly just go through our process. So we obviously send our communication to the school, the school send out on our behalf to those parents and those year groups. And it just explains about the vaccine. And there's various questions like an information sheet and a link to complete the consent form. And we ask the school to sort of send reminders regularly about three weeks before we go in. And they also give us a list of contact details. We also take parents initially just to say, you know, please complete the form. We haven't if we haven't had one back from them, we we take out the ones that we've received a yes or no consent from the ones that we haven't heard of from the non returners that we may, you know, we'll send two or three text messages, then we may call them if we have time and staff availability just to say, look, go through it. A lot of our schools have got maybe more cultural needs or language barriers. And it's those really that we try and put a bit more help and we'll send text messages in different languages and information links in different languages so they can see what it's about. Then when we get school, we're trying to get the schools to onboard to help us. So they'll bring the children down that perhaps haven't consented or we haven't heard a yes or no from. So the staff will do the children that we've had yes consents from the no consents we won't even see. And the children, which we haven't heard either way from, we will try and contact the parents then using the child's phone because they typically answer from the child's phone. And we'll just say, look, we've got your child here. Would you like this vaccine? Sometimes a child will interpret and tell the parent or they'll say, yes, I do want it, but we do call the parents and try and get their consent first. Well, we do get their consent first or they'll say, no, I don't want it. That's fine. That child goes back to school. So we don't just hit them straight with cold calling. They're kind of given warnings. And it does say on our literature, we will call you if we do not hear yes or no back from you. Sorry. Thank you. Just picking up on your point about there's a lack of trust. You know, the damage has been done by the during the pandemic years and, you know, skepticism among, say, parents. Do you think it needs a bigger push from government and from state bodies to reinforce the importance would be needed, would be helpful? Do you feel we're getting that anyway? I don't know. You mostly feel like you want these influences on TikTok. You just need somebody to promote it. And I think they're hesitant also is that because the parents aren't with the children when they're given the vaccinations in school. So they're worried what we are giving their child. They don't trust. You know, they said they've signed up for something, but you'll just give them a covid because you have them there. They they you know, we really struggle trying to say we wouldn't. We can't. And we don't even have the fact we don't do that. Covid vaccines at school at all. So but that's they really do. Don't trust them because they're not with their child. They can't be sure that you're not going to give it to them. But it is good luck this year, particularly with flu. We've just taken over the Barnet team and we've been offering flu injections in school, whereas previous years. And if child wanted a flu, I.M. injection, they've been going to clinics. So that's been quite an insight going into schools this year doing the I.M.'s uptake was good, actually. We do Barnet and Enfield and Barnet have had a forty six forty six percent uptake for primary schools and thirty six percent for secondary schools, considering Enfield have got like twenty three and twenty four. So it's been good. We've had a lot of engagement, actually, with head teachers and rabbis who've really kind of pushed for the children to have this. And that's made a big impact. You know, if they've been on board, then the consensus really go up and the engagement goes up. Yeah. But as regards to how to get people's trust, I'm not sure. The bigger problem, isn't it? Interesting. Council Probert. Yeah. Thank you so much for the reports and also thank you for providing us a description of how you notify students and also parents with regards to the vaccine. So my question is in relation to the notification periods and the process itself, I just want to understand. You mentioned that it goes directly through the students and the parents. They usually answer the phone, whether it be through the students or they'll get an email from the school or maybe they'll get a letter. I wondered whether you do anything related to coming into the school. Like, you know, when it's parents evening and you meet with the student and you also meet with the parent individually and you explain the importance of the vaccine. Yeah, that is something we said we've only just come into Barnet and we are working on that. I know having been with Enfield for a number of years now, that's it's always tricky or just, you know, they were just asking for five minutes of a year group assembly or a parents evening. We have done some of that. But when you do the parents evening, typically the parents that are compliant and engaged will come and talk to you. The others kind of just skirt around you. It's it's really just trying to give the information to the students and the parents. But we're open to doing any of that. And we are looking forward trying to get in and giving them plenty of time. So not hitting them just before we come and do the vaccine, giving the parents, you know, a few months notice in order to go and do their research and, you know, answer their questions before they sign up and consent to that. Thank you. It's obviously very, you know, difficult work in a way with parents and schools. It's going to take some time to get the rates back up again. First of all, I think it's worth acknowledging as well as a committee that it's very encouraging that this project is taking place with a specific focus on HPV, because otherwise half the analysis here might never have come to light. And in the identified risks and challenges, there was something I read that was quite interesting around accessing school immunization data, which includes HPV vaccination coverage. You said that there had been some difficulties in attaining that data from NHS England's commissioners. It's only available upon request. I'm just wondering, could you comment on that a little bit more like what precisely is the difficulty in accessing data? So I've been asked to present full-level uptake data at our quarterly meetings. And then at the end of the year, when they do an audit, they'll provide us some more detailed ethnicity or any of those protected characteristics. I was going to ask the panel, do you think this is counterproductive? I mean, the speakers, is that state of affairs that you described, is it counterproductive? I mean, it's very difficult. Things may change, and they may have a relaxed view on sharing school-level data. But I think at the moment, we have access to particularly HPV-level data, and we can see which schools have lower levels. Thank you. Very interesting report. I wish you well in your work. Thanks very much indeed. To the adult social care next item, the adult social care performance report. Paul, thank you. I know you've been waiting patiently. I don't know if you just want to make any a few points on what this particular report is, anything new that's come out of it. I know you talk about some measures that are going up and a few that are going down, as is the way. Anything you wish to note before we ask some questions? Yes, that would be helpful. So the performance report we've provided to overview and scrutiny is an update on performance in adult social care. And it's using indicators that we monitor as part of a national adult social care framework, or ASCOF, as we refer to it. And it's a set of indicators used by all local authorities in England to measure outcomes. It's a collection of data that we submit, both as part of our annual statutory returns to NHS Digital, as well as data that we gather from surveys we conduct on behalf of NHS Digital with our long term service users, as well as our carers. So the data was published in December, and that's the information we've provided in the report. And really, you can think of the data in respect of two parts. There's the data that comes from our core systems data and the data that comes from our surveys at a really high level. The data that comes from our case information is 5,715 individuals, just for some context. And overall performance across all of those measures would be considered good. And four measures improved from last year, three stayed the same, and three reduced slightly. But overall, we would consider all of them good. So for context, our performance was better than national London averages in seven out of the 10 measures and better than national averages in nine out of 10. With regards to the data that comes from our surveys, so we do two surveys on behalf of NHS Digital, a users survey, so that's all of our long term service users, so we do that annually. Also a carer survey, which we conduct every two years. So it's important to know that the surveys are conducted on a small proportion of our residents, so that they represent about 7% of our overall kind of service user group. And again, at quite a high level, there are seven measures that come from our users, and in those seven, we saw an improvement in five and a reduction in two. And again, we tend to compare the surveys against London rather than national averages, just because of the kind of the statistical differences between London and the rest of the country. So comparing to London, our averages were better in two measures and then marginally below for the remaining five. In the survey of adult carers, there were five measures in that group and with three of them improving and two reducing. And again, comparing ourselves to London, we were better in three measures and marginally below for the remaining two. So, you know, there's a lot more information in the report, a lot more detail, but that's just a high level description of how we performed. Thank you for that. It's welcome, isn't it, that you've got an increase in people independent after 91 days, I mean, quite a big increase after discharge. And also people who feel satisfied with the services that they get, which is probably, you know, is in line with what the CQC has said. And also people feel safe and secure, etc. I just wanted to ask about the paragraph where you talk about a reduction in the individuals offered a preventive reable service following discharge, which is reduced by 15.3 percent. As the service looks to focus preventive service to those who benefit them, you probably are going to say that this has people become more independent. Therefore, they don't need, you know, they need the service less and less. But on the surface, it looks like quite a big reduction in people offered this service. So I'm just wondering if you could just explain a bit more about refocusing the work, which is what you're implying in this paragraph. Is it all right if I pick that one up? You will remember, because we've told you before, we have one of the highest rates of hospital discharge in London and often the highest numbers. Part of our overspend has been driven by the demand coming from for care post hospital discharge. And 80 percent of our reable activity historically has originated from hospital discharge. We have been working with our NHS colleagues to promote more independence in hospital. So there are a number of things I think that have happened since the pandemic. One is a culture has developed in the wards where things that used to happen on the wards, like people getting dressed in the daytime, starting to do kind of the things that would support you to do day to day activities has not been happening so much. And we've been working with Barnet Hospital over the last, gosh, that's nearly a year now with therapists to make to do that. So we've been making sure that people are more active before they leave. We've also been more robust with our NHS colleagues where they would, and at the height of the pandemic, I think it's fair to say that most councils gave reablement to pretty much everybody. So it's not, to manage that demand, our reablement in one year, which I think was 22, 23, a really, really big increase. So it's not, we are absolutely giving reablement to anybody who would benefit from it, understand, and are giving the right messages to patients about who actually needs reablement and doesn't. Is there any risk attached to this at all? No. I mean, if there were any need for somebody to, if somebody, how can I, sorry, I'll start again. So nobody would go home if it was not safe for them to do so, if that's what you're getting at. And if somebody needs reablement and they, i.e. they're appropriate. Thank you very much. I couldn't agree with you more about the getting elderly people moving. I so agree with that policy. It really, really, very quickly, someone who can be very able, as soon as they go into hospital, can be done there to improve that figure. Sorry, did you say what have we done to improve the figure? I said what can be done? What can be done? What is being done then? Because that's the disappointing one in red, isn't it? Yes. And so, yes, it is disappointing. I suppose I would reiterate or remind the committee about what Paul said about the limitations of the survey. And what we are doing is working with the carers about how we improve the experience of carers. And it involves five main areas. Bear with me if I'm doing this from memory and I get to four and I can't remember which is, I think. And I think the other, just another thing that we are doing across North Central London, the five carers centres will be working together. So, you know, you could be, you could live in Barnet but get admitted to, I don't know, University College London and they will, with permission, say can I give your information? They're the biggest part of the social care workforce so they're really, really important. But I share the disappointment but I also know there are issues with the survey. And it does make me think that we started our own local survey of people who draw on care and support and maybe we... Council Sargent. Yes, first of all, thank you for that. Would you like to say a little bit more? I think, Paul, that is definitely one for Paul. Yes, so certainly the surveys, we're always thinking about how we can improve, I suppose, both the responses we get but as well as the response rates we get. So we do quite a bit of work with our kind of colleagues across London to understand kind of how our response rates compare to others. So although it's the views of quite a small proportion, that's just how the design of the surveys work with NHS Digital, our response rate for our user survey is actually slightly better than when we compare ourselves to other London boroughs and for our carer survey slightly below. So we're roughly in the middle but we do slightly better with one, slightly better with the other. Some of the things we're doing to try and improve take-up, so we're looking at the quality of our own data. So obviously the surveys go out based on the information we have in our own system. So if we have the wrong address because the surveys are paper-based surveys, so we're not allowed to do anything digital at the moment. It's all very much a paper-based survey and that's directed by NHS Digital. So if our address information has been updated, obviously the survey won't go to the right location. So the first thing we do is making sure our data is as accurate as it can be. We make sure the layout of the materials is aimed at the particular individual, so make sure they're easy to read. There are multiple versions of the surveys as well, so we can offer surveys in various different languages, easy-to-read versions, so large print. We also offer a lot of support for individuals perhaps who need some assistance with the completion of the survey. So we offer a telephone number that residents can contact if they would like some support with completion of the survey. We also encourage our staff to promote it, so obviously our staff are speaking with residents regularly. So we ask them to promote the return, make sure they're aware that they may receive one, and if they do, to please complete it and to return it. We also work with our providers, so similarly with our staff, we work with providers to make sure they're supporting the residents that might be in their residential units. To look out for the surveys and make sure that they're passed on to the occupants, and then also support them with the completion of the return. As well as simple things like we provide a page for return, so residents don't have to pay for the return of the survey back to the local authority. But we're always considering kind of other things that we could do to try and, I suppose, improve both take-up and response to the survey as well as the actual responses we get to the questions included. Yes, I do appreciate the challenges. I think it's very difficult. I just wondered if there are any locations where the carer centre does it all together. I don't know, but I do think it's going to be very difficult. Having the carer's action plan, I think. Yes, we look forward to seeing that. We will go into more detail in these. And the other point I wanted to make was about the risk management. Particularly because I see a trust pilot survey that shows how bad the equipment providers were. And one of them said, Councillors doing anything about this. Trust pilot was why aren't our Councillors doing something about the appalling service. I do realize the difficulties because you did mention it before, that there are very few providers now. And I just wondered if you could have a review of this. You're probably stuck with it. Dealing with the service that people are very unhappy with. It does say performance remains below expectations in that. I don't know. It's an ongoing issue that we've raised before. Are you looking for some current state, you know, is there any prospect that it will improve? I don't see that. We've got these four providers, haven't they? And I think three who offer the service. And they all, when I looked at the trust, they all were equally bad. Whereas I remember the old survey, you know, mediquipped, the old mediquipped. And I looked at those, it got very good. It's just something, you know, that I do feel very concerned about. And I can't see it improving. So I wonder if we could have a report about what we can do on that. Any comments? So we can certainly bring either a separate report or include a section in the next report. There was some further improvement in quarter three, because obviously this says quarter two. And we are still working with the others. I wonder if we could have one of the, we could question our providers. Because they just need to feel that there is a real concern about this. So are we, should we ask for a separate report on this issue for the, you know, for a future meeting on equipment? As you were talking about asking the providers to give evidence, you mean? Yes. And then the feasibility of that, given if it's a contractual arrangement, I don't know. Let me look into that. I also don't know if scrutiny would have, like scrutiny has the power to require an NHS register with CQC. Because they do not provide, so therefore they fall outside. We can certainly ask if one of them, if a representative from the provider will follow along. But I suppose one of the things I would say about our current provider is that they, in the previous income, so there are some things that, and then they had a cyber attack. So those two things happened to the current provider in a public committee meeting for obvious reasons. And obviously cyber attacks can take an awful lot to recover from. And that, you know, obviously if NRS are a national provider, so that affected their operations. Potential opportunities, alternatives are, which are limited. You know, the cost to us is quite difficult. The cost could be covered with any report, but that would be helpful, I think, you know, to show, you know. Anything more on the social care performance report? Thank you, Paul and Dawn. Having a forward plan, another forward plan, obviously we've got the next meeting. We didn't realise it was not until May, it seems a long time from now. But we will be taking in the Carers Action Plan. Can you just shoot? Quality accounts from the three trusts. Performance report. Additional roles in primary care. There are three items from NCL ICB. So additional roles in primary care. NCL primary care access recovery plan. GP registrations in bar net. Implementation of Carers Action Plan. Full agenda for the next. For the business. Yes. Just going back to the minutes. And we didn't. There wasn't an opportunity. And I don't remember seeing the draft letter. And the next meeting, as you said, is going to be May. And I thought we were going to discuss the letter. So could you give us an update? Yes, of course. Apologies, there must have been a misunderstanding. I thought it was about circulating to the committee rather than discuss and approve it publicly here. I thought it would be dealt with in the committee. Unfortunately, I have the letter drafted. I meant to circulate it ahead of the meeting. I wasn't working today. That's why I didn't get to do it. I'll send it around first thing tomorrow. I do have the. I was thinking about the timings as well. It would be prudent to wait. Because we are awaiting the announcement of the public health grant. If it would give perhaps more substance to respond. But regardless, I'm happy to share on the draft. Because I had it already. I was unsure about presenting it in public. That's the reason why I didn't. But the committee that is definitely. You're right to raise that one. Are you okay for the letter to be circulated? And we can give our comments. We don't have to wait until the next meeting to send them. If it wants us to agree. If it can be agreed via correspondence within the committee. I think that's potentially mentioned. Obviously, the information being available pretty soon. Do we have a date for that? That's the promise. Obviously, there is no guarantee. But we were said that the grant would be in mid January. In case we do get a better funding. Or if we're not expecting better funding. That's what I was thinking the last day. How far to go into the details. We can have. I have a core draft. And then there are options on how the conclusion. Perhaps you can circulate the draft. And then we have to amend it at the last minute. If there's any. If we get some wonderful new funding. I am not overly optimistic that we would get a grant. That we wouldn't have to comment on. I would say it that way. And perhaps wait for the exact amount. For the letter. Exactly. If everyone can comment and agree on the actual. We can then finalize it once we get the actual information. And if we could be sent the actual. Thank you. Okay. Any other business? At nine o'clock. I declare this meeting closed. Thank you. And I hope you all keep warm tonight.