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Public Health and Health Integration Scrutiny Commission - Tuesday, 8 July 2025 5:30 pm

July 8, 2025 View on council website Watch video of meeting
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Summary

The Public Health and Health Integration Scrutiny Commission met to discuss public health and NHS integration in Leicester, with a focus on NHS transformation, oral health, same-day access to services, and community engagement. Councillors noted the NHS is required to make significant savings, and heard that oral health is poor in the city. They also discussed plans to improve access to services and engage with the community.

NHS Transformation and Financial Savings

The NHS in Leicester, Leicestershire and Rutland (LLR) faces a significant financial challenge and must make savings of around £190 million. Alice, from the NHS, explained that last year the NHS system saved £150 million by improving the efficiency of how services are delivered, but that demand for health and care services is rising, and the pressure to deliver savings this year is even greater.

The plan to achieve these savings involves:

  • Reducing workforce, particularly in corporate services and non-patient facing roles.
  • Tackling inefficiencies by removing duplication.
  • Redesigning and recommissioning or decommissioning services.

Councillor Melissa March asked for more detail behind the broad brush figures, and asked how much of the £190 million saving was expected to come from prescribing. Alice explained that the ICB1 is responsible for £74 million of the £190 million savings target, and that £17.9 million of that will come from prescribing. She added that £16.1 million would come from continuing healthcare, £8 million from internal cost reductions in the ICB, and £11 million from the system development fund.

Alice clarified that the £16.1 million saving from continuing healthcare isn't about cautioning, that's not about stopping, but about reviewing care and criteria. She also noted that managing the market for complex care is a challenge.

Councillor March pointed out that this still left £30 million of savings to be accounted for. Alice explained that this would come from a list of about 50-60 schemes of work, including pathway redesigns and managing the independent sector.

Councillor Haq asked how easy it was to save £150 million last year, and what the reality is given the Chancellor's announcement of £29 billion. Alice responded that it was not easy, and that it requires a lot of hard work. She added that the announcements are often targeted to certain areas, such as capital, and that the revenue element is often not funded.

Councillor Haq followed up by asking how the cuts could be justified given the city's poor health outcomes, GP to patient ratios, and inequalities. Alice acknowledged that the national settlement does not meet local needs, and that there is a challenge around outcomes and health inequalities. She said that the focus needs to be on prevention.

Councillor Sahu raised concerns about safeguarding moving down to provider level, and asked how sure the ICB can be that safeguarding will be effective. Alice responded that the ICB will not pass any statutory duties across until they are absolutely certain it can be discharged in a safe way.

Cash, from Healthwatch, asked whether everyone in the system believes that patients' access to the NHS will not be affected. Alice responded that there is more work to do on the full equality and quality impact assessment of the national changes.

Councillor Pickering suggested that a more in-depth update should be brought back in September.

NHS Integrated Care Board Transition

Alice provided an update on the transition of the Integrated Care Board (ICB). The ICBs were set up in 2022, and were asked to reduce costs from 2022 to 2024 by 30%. In March, they were asked to go even further, to 33%. Alice explained that this is part of the government's commitment to reinvest cash from the NHS into the front line.

In order to be viable and still deliver statutory duties, the ICB has put a proposal into NHS England to cluster with Northamptonshire. Alice explained that cluster in this term means behaving as one organisation, but having two statutory organisations to be able to get efficiencies at scale. This has been supported, and they are progressing with plans for transition from 1 July.

Alice noted that for every pound they spend, there is a person at the end of that. She recognised that across the two organisations, there will be 150 less people doing the work that they are currently doing. She added that the National Guardian's Office, which was opened in 2018 as a response to the Midstaffs Inquiry, will close. She said that this doesn't remove people's right to whistleblow, but they will have to work out how to do that without the national offer. She also noted that commissioning support units, which have been around since 2012 and do a lot of back office functions, will close.

Councillor Haq said he didn't understand how NHS England is going to run the services, and that the ICB needs every single person they currently have to deliver the savings and cuts. He added that taking away Healthwatch and all the other support mechanisms is really risky. Alice responded that they have to try and make it work, and that the 10 year plan gives them hope, but the money does not add up.

Oral Health

Liz Rodrigo and Chirag Ruda gave a presentation on oral health in the city. Liz summarised that poorer oral health remains in Leicester for both children and adults. One in three children aged five have some dental decay, and four in ten children have enamel decay. Leicester has the third highest rate of oral cancer in the country with regards to mortality.

Liz presented data showing that fluoridated areas have less decay than areas that aren't fluoridated. She also presented a map of the city showing that dental decay is higher in the east of the city. She added that emergency extractions from UHL2 are also higher in the east of the city.

Chirag outlined some of the actions being taken to address these issues, including:

  • Leading on an oral health partnership board.
  • Promoting health improvement through the Live Well service.
  • Supporting national campaigns.
  • Providing oral health resources.
  • Supervised toothbrushing programmes in schools and nurseries.
  • Training for health professionals and community organisations.
  • Working with University Hospitals of Leicester to understand the risk factors impacting Leicester.
  • Working with South Asian communities to improve risk factor awareness and behaviour change that are associated with mouth cancer.
  • Delivering training to care home staff.

Chirag noted that the supervised toothbrushing programme had a really good uptake pre-COVID, but there was a massive dip when COVID hit. He added that they have developed an action plan to try and tackle this.

Councillor Singh Johal welcomed the report, but said that accessing NHS treatment is the single biggest issue with dental care in the city. He added that people of Leicester cannot afford private prices. Rob Howard responded that NHS dentistry is in a terrible state, and that the contracts and payments work against NHS dentistry being a good comprehensive service. He added that there is a clear commitment in the NHS 10-year plan for England that this is going to be tackled.

Councillor March agreed that access to dentistry is a massive challenge, and requested a report on NHS dentistry across Leicester specifically. She also asked about compliance with the supervised toothbrushing programme, and whether there is fatigue in early years settings. Liz responded that they did a survey to try and understand what the issue was, and that a lot of it was potentially lack of awareness and that misconception of having to brush a child's tooth.

Cash asked about the hesitancy of fluoridation in the water. Liz responded that there are some genuine concerns, and some conspiracy theories, but the main problem is the funding for it.

Councillor Haq asked about shisha and oral cancer, and what the plans are to do the other 23 schools that have high rates of dental decay. Liz responded that they are working collaboratively with the ICB and the communities to try and look at what is going on with shisha. Chirag added that they are trying to develop ways of fitting the supervised toothbrushing programme into the curriculum, and that they are developing a mentoring scheme.

Councillor March suggested linking the children who have been examined and shown to have decay with the 14,000 extra appointments that are available.

Same Day Access

Damien, a paediatrician, and Yaz, from the ICB, gave a presentation on same day access to services. Damien explained that the pressures on the NHS continue unabated, and that the number of patients presenting to the emergency department grows between about 4% to 7% every year. He added that a proportion of patients presenting to the emergency department could have been dealt with in another location.

Damien said that the challenge is getting the right patients in the right place, and that this comes down to the right choice. He added that it is highly unfair of a health system to suddenly decide that they're going to put a door down without providing extra capacity for patients to go in.

Damien noted that there are an extra 100 urgent treatment centre appointments a day, and that they will be getting patients who present to the emergency department into those urgent treatment centres. He added that there has been a huge expansion of Pharmacy First.

Yaz explained that they have been working with health partners to try and understand and start to really think about how to right size their services, and how to ensure that they've got the capacity sitting in the right kind of places. She added that they have been working with very historical arrangements, and that they are recalibrating that capacity across a number of areas.

Joe and Jit then spoke about the engagement work that they are going to be launching. Joe explained that they have put together a plan to engage with the communities, and that they will be combining their GP service improvement questions.

Councillor March said that she was not clear what they were consulting on, and what they were trying to achieve. She asked whether the hubs are closing and moving to the UTCs instead, and whether they will still have GP services available in UHL. Yaz responded that the three hubs in the city will be closing, and they are moving to primary care networks. She added that there are about eight sites, and that the PCNs are just working through that. She also noted that 97% of all community pharmacies are signed up to providing Pharmacy First.

Councillor Sahu said that she was struggling with the comms they are trying to deliver, and that it was not clear to her. She also asked about the PCNs, and where they would be sending their patients. Yaz responded that Orion will cover that patient population because of its proximity and location to Westcoats.

Cash asked whether there is anything else in the vein of a publicity campaign. Joe responded that they are using some of the imagery to discuss with the voluntary sector, and that they are trying to keep the information that they give to different communities very simple.

Councillor Haq asked how many of the 210,000 Pharmacy First appointments were actually used, and how much they get paid for those appointments. He also asked how the 111 service is going to book appointments into the PCNs. Yaz responded that she would get the Pharmacy First data post the meeting, and that it is part of the national contract and has a set price of about £12 per appointment.

Community Engagement and Wellbeing Champions Round-Up

Kate Zarr gave an overview of workstreams and initiatives currently underway across the Community Engagement and Wellbeing Champions (CWC) project. The CWC project has been underway for over three years, and has developed and delivered a number of initiatives and workstreams aimed at increasing engagement with residents, improving understanding of health needs, and fostering closer working relationships between community organisations, Public Health, and other partners.

Kate noted that the current membership of the network is 298, which represents a reduction from three months ago due to the introduction of a new sign-up system. She added that new members continue to join the network regularly.

Kate outlined some of the work that the CWC does, including:

  • The CWC weekly email.
  • The monthly online forum.
  • The CWC Network conferences.
  • The PH Community Engagement Grants Programme.
  • The PH Community Internships Pilot Project.

Councillor Sahu asked how they are linking with social prescribers and local area coordinators, and whether they are linked into the PPGs3 running out of GP practices. Kate responded that they have some relationships with social prescribers, but that they are not linked in directly with the PPGs.

Councillor March said that this is genuine engagement, and that it is two-way. She added that the Wellbeing Champions are doing a great job, and that it is a broad approach to public health.

Councillor Haq said that it is a fantastic scheme, and that it was really inspirational at the time to try and do something during COVID in particular.

Councillor Pickering asked what the current membership tells them about who they are accessing, and more importantly, who they are not. Kate responded that they haven't got that data at the moment, but that they were underrepresented across the east of the city.

A student representative asked how young people's voices will be heard in the NHS changes, and whether any consultations are planned before decisions are made on services affecting children and young people. Kate responded that they did a whole piece of work specifically about involving and engaging the young people across LLR, and that they will happily work with the student representatives to talk that through.


  1. Integrated Care Board - statutory bodies bringing together NHS organisations and local authorities to plan and deliver joined up health and care services to improve the health of people in their area. 

  2. University Hospitals of Leicester - one of the biggest and busiest NHS teaching trusts in the country. 

  3. Patient Participation Groups - groups of patients, carers and practice staff who meet to discuss practice issues and patient experience to help improve the service. 

Attendees

Gemma Barrow
Profile image for Councillor Nags Agath
Councillor Nags Agath  Independent •  Abbey
Profile image for Councillor Adam Clarke
Councillor Adam Clarke  Labour •  Westcotes
Profile image for Councillor Vi Dempster
Councillor Vi Dempster  Assistant City Mayor - Health, Culture, Libraries and Community Centres •  Labour •  Western
Profile image for Councillor Zuffar Haq
Councillor Zuffar Haq  Liberal Democrat •  Evington
Rob Howard
Katie Jordan
Harsha Kotecha
Profile image for Councillor Melissa March
Councillor Melissa March  Labour •  Knighton
Profile image for Councillor Karen Pickering
Councillor Karen Pickering  Labour •  Eyres Monsell
Profile image for Councillor Liz Sahu
Councillor Liz Sahu  Green Party •  Castle
Governance Services
Profile image for Councillor Kulwinder Singh Johal
Councillor Kulwinder Singh Johal  Labour •  Braunstone Park and Rowley Fields
Profile image for Councillor Paul Westley
Councillor Paul Westley  Conservative •  Beaumont Leys
Kirsty Wootton

Topics

No topics have been identified for this meeting yet.

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