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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 meetingTranscript
All councillors first No, no, no Shouldn't councillor Melissa March Thank you very much and welcome Thank you So welcome to returning officers We're a few down tonight Has there been any apologies? So I need to read out the fire drill So we're not expecting a fire drill tonight So if you hear the alarms make your way to the nearest exits and we will congregate at the Ramada Encore Hotel on Charles Street further down Is there anybody in online? No? Okay Lovely Are there any members are there any declarations of interest? Just to turn down to one chair I am a member of the Community Wellbeing Champion and I gave a speech to them recently in my work capacity I am a member of the councillors I have councillors side you agree that the minutes of the previous meeting were a true record Thank you Note the membership of the commission I think there is a few we've got councillors in Jo Howe and councillor Wesley back again and obviously councillor Agath who's new to the scrutiny and I take it that you've all seen the dates for the commission and put them in your diaries and I'll just draw your attention to the terms of reference Number 7 which is the chair's announcements I just want to say that scrutiny is an opportunity to work together and to act as a critical friend where we should respect others' points of view so if we could note that as well and have there been any petitions? None with the chair Number 9 Any questions representations or statements of count? Number 10 Well we are rattling through this Item 10 Rob who's going to lead on public health presentation with Rachna Health protection not presentation Thank you Thank you Rob Are there any questions? Councillor? Councillor? Mark? Close enough Thank you Chair and thank you Rob It's a massive brief I wondered in the context of that what the size of the public health team is maybe in whole town equivalents or in however you count it here at City Council please And then my other question is kind of answered by some of the slides you went on to show but I guess I'm interested in the oral health paper that comes later in the agenda and just how much of an outlier and not in a good way the city seems to be Are there other areas where it's really similar that would be helpful for us to be having a look at please They're my two broad brush questions So that's very helpful because I think that's the health protection side I think I was asking about the kind of public health team more broadly please useful agenda items that you were kind of pulling out these are big streams of work these are things we're worried about that sort of thing but they're more for the chair anyway Councillor Sahu Thank you I'm just interested in the bowel screening Are you able to go back to that? Sorry Sorry Just that with the practices where they had really high instances of people not turning up to the 70-75% on the map to me and I can't see that well from here but it looked like those two practices were in different parts of the city so yeah you know sort of opposite so I you know I suppose what I would have thought about if it was particular communities that you would have had a couple of practices around the same community but if they're in different parts of the city I'm just wondering if it's anything about how those practices are engaging with their patients could you use your mic I haven't done that at all have I sorry amateur I'll be happy to come back with a full report on some of that area of work it's an interesting one it's quite new and again it's partnership work with the NHS England ICB colleagues primary care and ourselves and it's a complex one because I think the rates even when you look at the England rates are pretty low and there is a deprivation gradient as well but it is more complicated than that and I think the GP practices will have a role to play in promoting it and some might be more active than others and that's why it's useful to have that information as well there will probably also become some cultural issues that we need to take on board as well so I think we need further analysis to do that work and then ICB colleagues have already done a lot of work working with primary care identifying low area practices producing materials in different languages and using community organisations to help promote bowel cancer screening as well so it's not like this is new and nothing else has been going on there's been a lot of work going on but we've decided we want to treat this as a priority as well working in partnership but it's a complex one and I think at some point we could come back with a more detailed report but we can all take the work and we don't normally have all the expertise in the room but tonight you've got JIT who's doing some work on the bowel screening piece with certain parts of our population because you were bringing it into the office of the day so we'll actually share that with you out of the meeting if you want to know some of that work that's going on yeah just wanted to add on to that some of the piece of the work what you mentioned was we've taken out certain communities and we took them to the hospital to actually show them some workshops of how bowel screening and the mix so we didn't do any presentation we showed them exactly physically what to do and these people are from taxi drivers to community leaders to all sorts of people in the community it was all knowledge based so we've just taught them and they learned it on the day very briefly and then we as thank you and I believe cash from health watch wanted to ask a question yeah yes chair this is about bowel screening as well and it's a little bit surprising that there's so much incidence of stage 4 diagnosis when in recent years I'm hearing about the fit test someone else can decipher that is it the fecal immunochemical test that there's these innovations and there's automated letters being sent to people especially men certain ages so with all that going on it's a little bit worrying why what can we do more I think we should examine this in more detail with the full report because we can then show some of the data we can work together and do a joint presentation around some of the work that we've been doing where it seems to be working where we need more work and so on because it's quite wide ranging and complex so I think we'd be best bringing that back as a future data for the commission we'd like to see that Councillor Hack yeah sorry I wanted a couple of questions really on bowel cancer I did a programme about 4 or 5 years ago on the radio on bowel cancer and lots of phone calls from different people one of the main things were they wanted to be able to speak on a helpline to somebody just in case of how to use the kit they were sort of confused when they received the kit of how exactly to use it and one of the things that I sort of feedback I got was they were scared to bring the GP and they were on hold for 25 minutes so they didn't really bother in the end they sort of gave up but surely there's a way of using sort of health and wellbeing champions to sort of say when are these kits going out to everybody in the area and then timing it with some kind of sort of helpline or maybe people to contact to say look if you're unsure this is somebody from your community in your area from various different sort of we've got lots of neighbourhood centres we've got lots of sort of Wesley Hall and lots of other places that would be more than happy to say look this is the number you can refer them to us and we'll guide them through the steps in a different language if need to be to able them to actually use the kit and that's the point and what happens is those kits then previously they're just left on a sideboard nobody gets time to do it and it gets forgotten about and that's why the numbers just don't get any better but it just means of being sort of targeting our local sort of residents and in order to help them and I'm sure some of the counsellors would be interested in getting involved to be able to say okay for residents struggling to use this kit and how it operates and what they need to do you know I'd be happy to help that's very kind I'll take that up with Mary and see what we can do and equally with our ICB colleagues as well second question is COVID vaccinations we obviously really struggle all the time to hit anywhere near the county colleagues that we have and the difference is quite huge what's going to happen to these teams because I know there was talk about some of the teams that are going out currently to do the COVID jobs there's going to be a reduction in that is that still happening or has that been now I don't know if our ICB colleagues want to respond to that but the commission for the access and inequality funding which is a loading unit and so on it's been recommissioned and it was commissioned by the ICB but it's now the commission has been taken responsibility for it's been taken by NHS England who are going through that process now we have some concerns with the specification for that and we've been talking to our colleagues in public health in OHID and in NHS England and in the ICB to make sure that what they do is at least as good as what we have now and we want it to be better so we do have some concerns about that but it's all unclear at the moment I don't know if you wanted to add anything Just to add from an ICB perspective which is the vaccine hesitancy with the team as well as the vaccinated and we are having reduced funding in the transformation programme but that's in the entirety and we're not quite sure what that impact will be but if we link that to what's our priorities how do work as partners we can certainly come back and connect that sorry can I just ask quickly yeah sorry very quickly we sort of had a really great targeted team approach of trying to target these people with these roaming teams and everything else it's working incredibly well I don't think any national organisation NHS England or anybody else is going to be able to do that better in actual fact it'll probably be worse and that's a real concern for us all on this committee Councillor Danster sorry thanks it's just a little pet annoyance of mine it's not all about vaccination and hesitancy I'll just give you one little bit of information and that is that I know that I am eligible for the Covid injection because I'm immunosuppressed blah de blah de blah I never get an invite from anybody I don't get any during Covid I used to get sort of letters emails check messages all saying you know or you're going to die don't go out the house that was from me that was from you was it you were just wanting me didn't it but now I get nothing at all so when I do rock up I give my energy I'm like oh yeah yeah you're eligible but nobody ever ever invites me and you know I find it hard to believe that I'm the only person that's not been invited when they should be being invited and I would just be really interested to know how many holes there are in the system and people like me that are falling down numb so I can just respond to that so thanks for flagging that because we look at vaccine uptake in three areas so hesitancy so lip-bursting why are people not taking it convenient and I was just going to add to that that's where I got my information and text from was from the NHS app so that was direct but only if you've got the app cash did you want to speak yeah I just want to add a slight amount to what Councillor Hack was saying about languages the home test kit that you get I think it's complicated enough in English and people have approached me when they received it in English and said what does this mean how do you do it the instructions are not so easy so I just wonder if that's an area that can be looked at at some point the English language version there was a lot of studies done on the language side and I think what we came up with and I think it was Dr. Pavan who works on the East Midland side we produced videos in different languages and it was a very simple way of explaining it and videos are far more stronger than actually translation because you're physically showing them how to do it and when we did that piece of exercise in Glowfield that's the feedback we got from the community saying we know what we're doing now because you've shown it but doing translation actually we might lose them so video and doing it in a simple way actually does help better and that's what we've got already that information available if needed thank you Rob I just want to check in with our youth representatives did you have any questions no okay we well we'll go back one Rob because we went we were supposed to be doing item 10 a brief introduction to public health and health integration scrutiny commission and I know that you've encompassed quite a bit of that within the health protection as well but for our new members it might be a good idea very brief shall we go to item 12 then and we'll put that back on the agenda for next time apologies that's all right so I've got Alice and Yasmin to present the NHS transformation thank you Rob for your presentation thank you chair so in the pack you have got a summary of a briefing from the NHS so I'm just going to provide some further updates and then I'll take some questions rather than a presentation I'm also aware that at joint Harskew you had an update from a financial position so I'm going to do a quick recap and then move on to the transformation as an ICB particularly so just recapping on the NHS budget so last year we had to make savings £150 million that was difficult but we did achieve it this year we have to make savings of £190 million so that's both from inflationary increases increasing demand which means we've got to find us saving £190 million which is about 6.5% of our total target and the plan to achieve our savings is through reducing workforce so reducing corporate services reducing non-patient facing roles reductions in agency and bank spend so using our workforce and pound wisely tackling inefficiencies so removing duplication making and then finally redesign and recommissioning or decommissioning services as we need to decisions regarding redesign and commissioning always look from an impact perspective so we have an impact matrix it's supported by our clinical colleagues and we also look at a number of appraisal criteria so does it achieve equity and equality does it provide value for money is it innovative is it sustainable there's kind of ten blocks that form equality and equality assessment as we walk through decisions for redesign or decommissioning and I think looking at the notes from the last joint husk I'm actually going to talk through some of those big programs so prescribing is a really big area so switches from branded to non-branded as we can for making sure we've got consistent thresholds for high cost drugs particularly and ensuring that we've got the right services for the right population in the right place so care in the right place at the right time for the right value for money so it's a big ask as an NHS and I'm happy to take any questions but I don't want to repeat from the last session do you want me to pause then I can move on Councillor March shall I take it in this part and then I'll go into ICB transition I'm happy to so I don't think I was about the last joint hospital I don't know last time I used to say we used to talk about how we were going to build a new hospital so it's been a while I was really interested in the figures because you've given us some broad brush figures but I guess there's no detail behind them and I think that would be really helpful because 150 million just sounds like we're playing Monopoly and then it's 190 this year and I guess I guess the question is you mentioned prescribing and I get that there would be some savings in there so of your 190 how much million how much are you expecting to save in prescribing and what would the other areas that you would be looking to save money be and what would some broad brush figures be against those I guess I'm really interested in where people are going to feel such significant savings coming in terms of the services that they rely on please great question so there is a public board paper but I'll just walk through some of these details but I can send that paper as well which has got some of the detail behind it so that 190 million is the totality of the NHS budget what the figures I've got in front of me are the 74 million that the ICB is responsible for so you take 190 million a big chunk of that will be from LPT and UHL in terms of their own efficiencies and that's through staffing that's around efficiencies so let me concentrate on the ICB budget so at prescribing we have a total budget of 205 million pounds so again we're talking about big numbers 9 million thank you and that will get 17.9 million from switches optimisation implementation of so let's take the latest nice guidance around weight making sure we've got the thresholds right and it's not open to everybody so we can manage the public spend and so those are the waste programme that I've looked at my colleagues who have been supporting our waste programme so that's a big part the next big chunk is continuing healthcare so that's got a target of 16.1 million now that's let's be really clear that isn't about cautioning that's not about stopping that's about making sure that we have our CHC guidelines it's reviewing care it's reviewing the criteria and making sure we have annual reviews because that's something we've not been particularly good is that care right and that goes up and down in terms of the care the other part which actually is harder and Yasmin and I were talking about this earlier is about managing the market so if you have a CHC really complex care and there's only one provider how do we manage that market so we don't have a monopoly so that's CHC we've then got much smaller chunks of things now when I say small we're still talking millions but so that's around about 8 million will be from the cost of the ICB as our organisation to reducing that head count we've got something called a system development fund that used to be allocated for 5 million for mental health and 10 million for something else and now that's a totality of a pot which we think out of the 36 million pounds we have each year we're going to save 11 million pounds by not doing new pilots etc and including closing some pilots down and then we've got a series of much smaller schemes around efficiencies in smaller programmes and I haven't got that data here but I can certainly make sure we've got the ICB board paper shared thank you Alice any supplementary yeah so broad brush maths apologies so we 74 million pound savings target 17.9 from prescribing 16.1 from CHC 8 million internal and 11 from the system development fund there's still 30 million pounds by my maths there Alice you've not kind of told me where those savings are going to fall please again it might be my maths might be my maths it's not it's because what we've done is pulled that together across lots of different transformation programmes that we have running around parts of pathway redesign so there'll be stuff that we're doing in elective care for example around how we manage the market particularly when it comes to independent sector and there's a whole heap of work that goes around managing that market that provides us with some of those savings as well we've got a whole load of work going around some of the pathway redesign that we do to eliminate duplication and waste as well across a number of different priority pathways that we'll pick up where we feel that there's a further piece of work to do and we review that so at the moment what we've got on some of these things are estimated efficiencies we haven't yet realised those because we've got a piece of work to do to get to that and what we would class as there's risk associated to those because again it's not a done deal that all of this just gets realised there's a whole heap of work that needs to happen to realise those efficiencies and they are significant in their own merits I mean I've been working in the NHS for the last 25 years and the last I'd say 10 years increasingly and increasingly the pressure on budget has got greater and greater and greater and I think in the last three years particularly it has been really significant and this year is no different to that just more and more significant and then when you lay on top of that the transition work that's happening which is out there in the public domain around reduction and reduction of ICBs of NHS England etc etc that makes that a little bit more challenging so there's a whole heap of stuff but if I started the list I've got a list of about 50 60 schemes of work that sits in that 30 million but again we've got that detail we can share it but often what we do is we talk about those things as and when we're starting to review and develop and deliver on those so some of those things will come through different partnerships boards etc as we start to build upon that and see whether or not they are real schemes that we can make savings on other things will be naturally as we deliver stuff during this year sometimes we will naturally have underspend as well so good financial keeping housekeeping helps to save as well so all of those things also make a difference over the course of the year quickly I'll be quick I saw this week that there was a mental health service that was on the chopping block and I guess I'm interested in if that is the service or of those 50 60 schemes of work that sit in that 30 million as a member of the public or a carer for somebody who relies on those services what would be the process to say I really need this you know you think this is duplication but you know how would people kind of make their voice heard if their services are at risk please I'll respond to that and I had a meeting with Robert and Vi to discuss this on Monday morning so some of these services won't reach the threshold for public consultation however we do have partners like colleagues around the table who will use their voice to make sure that we are considering those things so you're right a mental health service that we co-commission we have made a decision to not fund that our proportion of that it's joint funded what we've our view is that we've considered the views and equality impact assessment done by local authority officers and we recognise it's a valued service in the city but actually what we've done and said of those services that we've already got this is where these people will go and so we look at the caseload we get clinical input thank you councillor hack yeah i just wanted to ask how easy was it to save 150 million last year and what is the truth in the amount of money you're actually going to get because the chancellor announced 29 billion pounds and yet you're talking about a cut of 10 10% almost on 200 million a cut of 10% what is the reality because the public out there think there's lots well not lots of money but that the energy services will expand and what we're talking about is some savings i get but then the rest is a really cuts isn't it simple answer it wasn't easy it never is easy it's a lot of hard work and a lot of concerted and continued effort that needs to go into that and we continue to do that and i think we've got a responsibility around that because it's the public money so ensuring value for money ensuring that we're getting what we need out of those is something that is always a focus and priority so it's not easy but it has to be done in terms of the announcements i can't make any specific comments around that because that's just come out a lot of what's been in there is very targeted to certain areas council so for example capital and capital is different and revenue is different when you build something that creates a revenue and often the revenue element is not funded and you've got to then create a way of how you're going to fund those services so these are the complexities that we have to deal with and we also know as part of the 10 year plan one of the three key areas in that 10 year plan and one of them is around analogue to digital so there's quite a big digital element that's invested and we've got to really balance that if you think about the city digital innovation is really good there are tools out there that really work but they work for a certain population it don't work for all so we still have to then balance that out as well so there are challenges around that it's great when they make these announcements the devil is always in the details and my follow up questions were really you saved 150 million last year and it was painful for lots of people you tried to save another 190 million this year of which obviously there's going to be cuts to the services that's going to be inevitable there's no way that you can avoid that and yet we have one of the poorest health outcomes in the country we have one of the worst GP to patient ratios in the country and we also have significant inequalities how does that justify what you're going to do with this 190 million pounds cuts I think that's a really good question and I think it comes back to the point around the settlement is a nationally a big number translating that to locally that doesn't meet our needs on an ongoing basis and I think that's a reality that I'm not going to explain away in this room that is a reality what we have to do is come together to work out how do we use the public pounds so that I mean Rob's already talked around how do we work better together not duplicate and I don't think there is much duplication and waste but it's actually if TB is the thing that we're going after if foul screen is the thing we're going after prevention is that's where we have to put our money and some of that is going to be really challenging so we also think planned care and waiting for operations is really important but actually you can reduce that cost long term if you do prevention right and so I think there is an ongoing challenge because everything you said Councillor Hackey is correct we have got a challenge around outcomes and health inequalities and that's a challenge for all officers to be able to try and balance the books and improve outcomes Councillor Stahil I raised this last time with Rushna about safeguarding because safeguarding is moving down to provider level I have huge concerns about that because often some of the issues around safeguarding actually happen at provider level so you're sort of policing yourself I was told that the RCB would only put that in place when they are confident that it will happen but my concern is of course you're working to quite a tight time scale so how sure can you be that the safeguarding element that will be put in place at provider level will safeguard because we already have issues now and what concerns me is that we may get more so the first thing to say is that absolutely true we will not pass any statutory duties across until we're absolutely certain it can be discharged in a safe way I would group safeguarding with also the SEND provisions of special education needs and continuing health care actually because in the model ICB it talks about all three of those going into another organisation but all three of those are set in statutes so not just the Health and Social Care Act but a numerous other primary and secondary legislation so there is a legal duty to make sure that is still discharged the timeline is around how we get cash out and that is in our total spend not necessarily just safeguarding so if I take our safeguarding team it's two people and actually for them to sit on each of the safeguarding boards and to contribute around the children's agenda you can't reduce that anymore you can't chop off someone's arm and say it's now one and three quarters so actually our challenge is again how to discharge those statutory duties because we are equally worried about making sure we do right for our population I'm going to bring cash in because he's been waiting I don't even know if I need to say this because I think Councillor said it for me but I'll just add a little bit there's a bit in this briefing under the title what does this mean for patients and it says the changes may not impact patients' access to the NHS while this is not a criticism of any department I know you know governments put pressure on and you've got to do the best you can and it's hard as somebody said do we all in this system believe that patients' access to NHS will not be affected I think we have more work to do on the full equality and quality impact assessment of these national changes so there's one thing around the impact of the cash cuts to the NHS but also the impact to the way the ICB is functioning I think we've got further to do around longer term impact I'm going to stop the debate there because I think some of the savings are about efficiency digitalisation and targeting and partnership work but I think the speed of this is unbelievable I really think that we need a more in-depth update brought back in September where we will know more is that okay thank you just tap in with the student reps are you okay have you got any questions you ask away sorry I just wanted to ask thank you how will young people's voices be heard in the NHS changes and are any consultations planned before decisions are made on services affecting children and young people in particular I want to know how you're going to ensure that you're going to be incorporating with voices of STEM and those more in education or employment or in training especially because those people are really difficult to access and reach to brilliant question and you might have been around when the huge amount of engagement took place around the 10-year plan which was a national programme of work where they promoted the input from everybody around the country into what the 10-year plan should be shaped and what it should look like but part of that Jacob and our team did a whole piece of work specifically about involving and engaging the young people across LLR which I will happily share with you and I'm sure Jacob will come and talk to you guys specifically as a board around what was fed in and what came out and also how that has now which is what we're doing since the 10-year plan has been now published which we've just got is now looking at where we can see the influence and where we can see the impact of some of that engagement and what that means now going forward and so we'll happily work with you to talk that through and then start the next part of engagement is now we've got the 10-year plan we've got the feedback what what comes next so we would really like to do that actually and so we'll link in with you guys if that's all right that sounds like a great recommendation for that okay and thank you for your presentation and can I invite Rob to introduce Liz oh sorry go ahead so I've got two questions if that's okay so the first one is regarding working more efficiently and trying to be as productive as possible a lot of SCND young people on the Big Mar forum struggle to get appointments on time and told the appointment won't go ahead I was wondering if the NHS can be a bit more flexible for these SCND or new EDS people and fit an extra 30 minutes before the appointments get cancelled in the budget what would be great to understand is that for all appointments is that particularly hospitals or GPs and then we can work on what might that look like so some of the restrictions we have say GP appointments are different to how we can have in hospitals or community settings but I'd really love to have that feedback and we can build that in and maybe maybe that's one of the topics you could explore when they come to you okay so I would like to go on to item 13 is it I think and invite Rob for oral health so we've slightly covered this under the financial debate but I just think it is worth renouncing around part of that efficiency is the reduction of the integrated care board so integrated care boards were set up in 2022 and we were asked to reduce costs from 2022 to 2024 by 30% and then March this year we were asked to go even further and so for us that's 33% as an organisation and as part of and that is the government's commitment to reinvest cash from the NHS into the front line and just to be clear the savings don't stay in the patch they go back up to government and then are reallocated which is that settlement that Councillor Huck referred to so in order for us to be viable and still deliver our statutory duties we put a proposal into NHS England to cluster with Northamptonshire so cluster in this term means behaving as one organisation but having two statutory organisations to be able to get efficiencies at scale that has been supported now and so we are progressing with our plans for that transition from the 1st of July Toby Sanders is our chief executive officer following Caroline Trevidic's retirement that's an interim arrangement while we wait for some guidance from NHS England around the appointment process for cluster chief executives yes he's the substantive the permanent chief executive yes he used to be in the west of Leicestershire years ago and then just coming back to that pace question which is if we thought the NHS funding was a difficult pace we've got six months to take those costs out of our organisation so that's by the end of December we're expected to do that for every pound we spend there's a person at the end of that so I'm surrounded by colleagues here so recognising that across our two organisations there will be 150 less people doing the work that we are currently doing now so that is about a transformation programme it's around how do we do things differently we have a document called the Model ICB that talks about the transformation of strategic commissioning and we are working at pace to do that around some other NHS funded organisations that will close so the National Guardian's Office that was opened in 2018 as a response to the Midstaff's Inquiry around a place where people can speak up and you can be trained and supported and there's analysis done nationally that will close that doesn't remove people's right to whistleblow or speaker and we're going to have to work out how to do that without that national offer and conditioning support units that have actually been around since 2012 so it's quite a long time in terms of NHS infrastructure and they do a lot of our back office functions on our behalf so we are going to think about how do we do that and then finally Healthwatch so Healthwatch again 2012 2013 commenced again being that independent voice of our population speaking truth to power in a way that when you're in an organisation getting insights is more difficult to do Healthwatch is a part of NHS England it's one of those quangos and I hate that term and so actually what we're talking about is so how would you still maintain that and we don't know the mechanism but as an organisation we've got to think about that transition so that's the update on the transition any questions councillor hack to be honest I don't understand how NHS England is going to run the services here in particular because the numbers of staff the ICB has got to deliver these savings and cuts you need every single person you currently got to deliver that without that there's no accountability on GPs on primary care services and just generally over the whole NHS system and the reality is you need the people to watch what's going on and take away health watch and all the other sort of support mechanisms is really risky and it leaves the public very few places to go and as councillors we have a duty in providing you know holding you guys to account and making sure we do our bit but it means we have to go to the next level to make sure our residents are getting a good quality health service delivered locally and quite frankly that is daunting with the levels of cuts that you're talking about not just to save 190 million but also to the organisations that currently deliver the sort of watchdog element and it includes the ICB because you do the watchdog element on the primary care GP services people frankly at this moment don't know who to complain to without a step further and that's the reality on the ground do you have a question the question is do you think this is going to work I think we have to try and make it work I mean in all honesty it's not going to be easy I've been in the NHS not quite as long as Yasmin this is the fourth reorganisation that I've been to I was there for the Lansley reforms etc etc one thing is certainly NHS is change I think the 10 year plan that was published this week gives us hope the money does not add up though in terms of what we need the current demand and the cash envelope and it's got to come from somewhere and so I think everything you've just said is a risk for us that we're going to have to watch closely any other questions no then can we move on to the next item oral health and Rob will introduce Liz and Shua yeah I'd just like to invite Liz Leverigo and Sherald Ruda to find a space somewhere where can show the presentation and update on oral health in the city just while that's loading out just to introduce ourselves I'm Liz Rodrigo working in public health and Rob's team and this is Sherald Ruda who also works with me and who leads on the public health oral health team who we will talk about in a minute so our presentation is going to be a mixture of good news and not so good news but hopefully it will lighten things a little today so firstly I'm going to present some data so I'm going to just summarise what we're going to talk about we're going to talk about the experience of poorer health in Leicester which unfortunately remains both for children and for adults and some of the outcomes of those are that one in three children aged five who are examined every year of five year olds has some dental decay and when we look at a new indicator which is also enamel decay so this is before it gets to the point that you really need some help it's when your enamel starts to decay it's four in ten children so this is a new indicator that we'll be using ongoing so this is pretty poor oral health for children in the city and we've got some maps as well to show you approximately where they are but it is across the whole city and some areas are worse than others it tends to be more in the east of the city so we are focusing some work on the east of the city and we're also going to provide you with a bit of data about oral cancer which unfortunately Leicester is the third highest rate of oral cancer in the country with regards to mortality so I'm going to do a few slides which are about the data and then Chirag is going to do what actions we are taking so that we follow up on that so with regards to dental decay as you can see here with regards to dental decay if you look at the graph at the top there you can see this is Leicester against its other comparators so these are areas of other cities that are similar to us and England the bit that says F is where those areas are fluoridated and you can see that the fluoridated areas have less decay than the areas that aren't fluoridated so just by assumption you can assume that fluoridation will actually support or reduce the amount of decay that children have in their teeth as you can see one in three children in the city suffer from dental decay and this is from the survey that we do and this is a fall in the last few years we've actually been improving we were worse than this we were at one point the worst in the country I think that was in 2012 and that has gone down so you know we are we are improving but there is still a lot of work to do in the city so this is when we look at enamel decay as well as dental decay so this is before that child actually needs a filling or anything it's when the dentist looks in the mouth and sees that there's something starting and we can see that's four in ten children so that's 40% of all the children in the city age five will have some form of start of decay now that can mean you can stop that if they get some support that might be improving their tooth brushing doing things like that so both these indicators as you can see again with that F are lower in areas where there's fluoridation go on to the next slide and this is a map of the city the darker areas are where there's more dental decay and the lighter areas where there's less now this is of course a quite a small sample that we have every year across the sea of just five year olds but you can see it's higher on the east of the city and some of the more deprived parts of the city where there's more poverty are higher as well strangely Aylston children is quite low so we need to look a little bit more at that because we're not quite sure why that is we go on to the next slide we can see this is emergency extractions from UHL so children that have to go in to see the dentists in UHL and have a tooth pulled and these are under the age of 19 and this as you can see is higher most predominantly in the east of the city and we think this may be because people are not seeking help from the dentist until it gets to the point where they have to have that tooth pulled now having a tooth pulled for a child is a traumatic experience and not something we should be having this data does not include the data that is from our community dental service and they tend to do extractions at an earlier time so this is when a child got to a really poor state of dental health I'm going to move on to oral cancer here sorry that was the slide before can we have the next slide so this is oral cancer and as you can see in Leicester we have a rising rate of oral cancer at a little dip in 1920 the data is quite old this is the only data that we get we have no more recent data but oral cancer is unfortunately rising in the city it's predominantly white males who are the biggest admissions in the ages over 50 however when we look at the rate we can see that amongst our Asian British population and our black British population the rate is higher in the younger group and that is something that we're concerned about because that is rising as well so there's work to do with those two different populations but probably different types of work and there's a different cause for those two things I'm going to let sure I go on now to the public health actions so from that picture I've painted what we're actually doing you want it thank you Liz like Liz said so that's what the picture is in Leicester and these are some of the actions that we're doing as a team as a service but also as a collaborative as well across the city amongst other organisations to try and tackle some of these issues across the life course and so what I'll do is I'll talk through some of the main actions that we're doing at the population level and then we'll also look at across the life course what are those interventions we're doing from a very early age to our most senior colleagues or residents in the city so in terms of the population level so these are some of our actions some of our interventions that we're trying to do that impacts everyone across the whole city equally so we lead on a oral health partnership board meeting and this as it describes on the screen is a multi-agency partnership which brings together partners across various organisations so we have the ICB colleagues attending VCSE organisations health health watch as well and also dental professionals attending this meeting there's an action plan associated with it to tackle health inequalities across Leicester a year ago we brought together a paper to say what our intentions were around water fluoridation we've progressed this and we've actually sent a letter to the Secretary of State requesting that Leicester and Rutland should be considered for water fluoridation we know that this is a scheme a public health scheme that will actually prevent dental decay with anyone with natural teeth another action that we're doing is promotion of health improvement across all populations predominantly through our liberal services so we know what the risk factors are for dental decay and poor oral health and through some of those interventions some of those programmes of work that we have within the local authority we're able to tackle them and then as a service as a team we also support national campaigns making sure that we're getting out there into specific communities and sharing messages around good oral hygiene and oral health and then as a service as well we provide oral health resources across the ages so these are toothbrushes and toothpaste really so the two main things to try and tackle that plaque and that dental decay next slide please so moving on to our early years and our children and what we want to try and do is make sure that behaviours are being implemented as early as possible and so these behaviours once they're we're laying down the foundations so that they can live healthy lives as adults and as senior residents as well within Leicester one of the schemes that we have is called supervised toothbrushing programme and this is predominantly done with earliest children so we're looking at schools and nurseries from 3 to 5 year olds and it's a scheme that we know and it's an evidence based intervention sorry and when we look at our return on investment we know that for every pound that we spend on supervised toothbrushing we'll see a return of £3 in the future so again this is a scheme that we do promote and do implement quite significantly within this level of authority and we do awareness raising through our national campaigns predominantly looking at national smile month and this is a campaign month where we're trying to share good oral health messages with early years and also parents and carers as well we share a number of resources like I mentioned toothbrushes and toothpaste being the main ones through our family hubs colleagues through the food banks as well and then we work really closely with our healthy together team to make sure that every single child has a toothbrush and a toothpaste to go home with as well so that's our public facing stuff but in terms of health professional related things we know that we're quite a more team and so we want to empower health professionals community organisations as well to be able to share key messages so we work very closely with our community well-being champions team making sure that we're delivering training to organisations to any community group anyone that is interested in oral health really or has an influence so that they're sharing the same key messages and then again we are looking at delivering educational sessions for children parents and carers as well and I think I've talked about supervised tooth brushing so you can see from this slide here that this is the overall uptick and I talked a lot about supervised tooth brushing because of the evidence behind it we had a really good uptake pre-COVID and when COVID hit there was a massive dip because we had to cease the programme due to infection control related issues and then we slowly restarted the programme with settings again and you can see that unfortunately but the uptake hasn't been the same as what it has been in the past and so we have developed an action plan to try and tackle this which I'll go on to a bit later on but you can see the number of children the number of settings where we're actually implementing the scheme and in a nutshell what I would like to say is that it's the schools where we want to try and focus on going forward we are looking at our deprived areas and currently we have 33 schools within IMD 1 and 2 so that are most deprived areas within Leicester and currently 10 schools are offering supervised tooth brushing within it so this is a bit of information about our action plan to increase supervised tooth brushing so a few months ago we did a survey with earlier settings and schools and partners as well to try and understand what are the barriers for uptaking supervised tooth brushing what's the key thing that's stopping them from actually taking part in the programme and how can we support them to be part of it because it is a voluntary scheme at the end of the day and what we found was that having insufficient time during the day to actually schedule in this programme of work was one of the main barriers within a school setting but then also concerns about how they can implement it so not knowing enough about the scheme and how it's delivered so there are some myths that teachers are going to be brushing a child's tooth and that's not the case so as a result of that we've developed an action plan and it has three steps strengths to it so we're looking at improving our resources so making sure that people understand the programme a lot better and then also we're able to support schools to fit oral health into the curriculum better we're looking at improving uptake within nurseries and schools within priority areas so looking at our IMD one and two areas in the city but then also extending our offer out to childminders as well because that's another form of childcare that we've not actually accessed in the past before and then moving on to one of the other things that came out of the survey was that whose responsibility is it around oral health is it the parents is it the school so there was a bit of debate about that and what we've found is that schools aren't sure whether it's their responsibility so we're looking at trying to embed a community focused approach to preventing poor dental decay and oral health as well. And the next slide so we're fortunate enough to receive some additional funding through local or central government and what it means in a nutshell for Lesser City is that we've received an additional 119,000 pounds for this financial year and also there's a collaboration with Colgate which means that we will receive a number of resources so a lot more toothbrushes and a lot more toothpaste which we will be distributing out to children. So the money that we've received has been earmarked for supervised toothbrushing scheme and that's what we've been guided to use that money for. So like I mentioned in my previous slide we talked about how we're looking at reallocating staff and actually investing in more staff as well to try and implement the supervised toothbrushing scheme but then also how we look at refreshing our scheme. So yeah we're in a very fortunate position where we're not having to start from scratch with supervised toothbrushing scheme. Moving on to adults and so we focused on oral cancer and so Liz mentioned some alarming statistics and as a result of it there was an action plan that was developed and it had three priorities and that were highlighted and to try and improve and prevent mouth cancers. The first priority was around improving awareness of symptoms and the second priority was to reduce prevalence of risk factors and the third was around increasing access to our medical and dental professionals for advice for those with symptoms as well. So as a result of that action plan we've been collaboratively working with University Hospital of Leicester to understand the risk factors that are affecting the patients within Leicester so nationally we do have an understanding of what those risk factors are but we are doing some audit work with actual patients from Leicester to understand what their risk factors were and who those patients were as well. One of the alarming things that Liz mentioned was the rate of South Asians that have been diagnosed with mouth cancer as well so we're working with a local organisation to help understand what are those barriers what are those risk factors and how can we work with them to prevent mouth cancer in the future. And that is our co-production work that we're going to be doing with our local organisation. And again the math interaction plan has actually helped us deliver some training to pharmacists we've been doing refreshes for GP practices as well and also we've identified where we can make improvements in data collection as well particularly around ethnicity. And then going back oral health we're looking at trying to make sure that residents are aware of how to look after their mouth and working with volunteer organisations and key communities to try and empower them to address oral health needs and prevent poor oral health. And then lastly around care homes so maintaining oral health for everyone is key to quality of life and it's particularly important for those who are living within care homes. Not only does it improve their quality of life it obviously helps them to eat to drink and also to take medication independently as well. So that's why a preventative approach is key to actually making sure that those residents are having a good quality of life whilst residing in a care home setting. And obviously through this we'll be able to relieve pressures on primary and secondary care hopefully as well. So as a result of this we've received some funding to develop and deliver training to care home staff to make sure that they're embedding good or health routine including denture care as well with residents across Leicester City. And as a result of some of that work you can see that we've got 94 care homes currently in Leicester City and of those we've trained 14 of them which includes 132 members of staff ranging from managers to deputies to oral health champions as well. So there are an outstanding 20 care homes that have been booked onto training who haven't received that training yet but we acknowledge that there is still a large portion of the care home staff sorry care homes across Leicester that we do need to work with and we're grateful for our adult social care colleagues who do help us significantly get in front of these colleagues and you can see from some of the feedback as well that it's well received as well. Thank you if you have a good question. Thank you Shirag and Liz. Councillor Singh Johan. Thank you I welcome the report just some observations the first one the school stuff I think you're just endorsing the message of what we've been doing for a long time because I can remember being at school 50 years ago and that same Colgate thing was supplying the toothpaste and the toothbrush and everything else. I think it should be a city wide thing not necessarily just targeting the deprived areas I think that's the basics of what we should be putting out in the schools. My question is a broader question. I welcome your report on the slide on the oral cancer and the oral health for adults and with the changing demographics and the changing communities that live in Leicester it brings its complications. What my question is broader and it's probably for the commission is that the single biggest issue with dental care in this city and probably other cities is accessing NHS treatment. That somebody at some stage has got to intervene and take that up. I can remember when I needed emergency treatment for something not major and it was thousands of pounds. Leicester is not a very affluent city it's a working class city. people of Leicester cannot afford those prices. At some stage somebody I don't know if it's your department or the city council there needs to be intervention. I will give you examples of Marlborough Road. Three dentists have popped up they're all private. You cannot access NHS through there. If you look at the options that we have in the city of NHS dentists they're very few and even those aren't taking on NHS patients. The minute you ring them up they will say we do have appointments but you have to go private. So I'm putting that on the table and that's a genuine concern for the residents of Leicester. Rob? Yeah I'll just say ICB colleagues might want to come in as well on this. We've talked about this many times and have been bored and screw senior commissions. NHS dentistry is in a terrible state. It's broken. And I think there's no getting away from that. The contracts, the way the payments work, everything works against NHS dentistry being a good comprehensive service. What I can say is that again in the NHS 10-year plan for England there's a clear commitment that that's going to be tackled and they're going to look at it through the contractual route and through other routes and they are conscious that it is broken and it needs addressing. We didn't want this whole thing to be about NHS dentistry or the stuff about what we're doing in our own team. But we've got lots of data that shows the poor level of access, the number of dentists that aren't taking any NHS patients on apart from emergencies and so on. So I completely agree with you. I completely agree with you and there's been a programme of work in the ICB2 and NHS England to increase access to dentistry but there's a limited amount that they can do within the current context of their contracts and the finance and the way that it works. We have announced 700,000 new urgent dental appointments across LLR. We were desperately trying to look at the numbers. 14,000. Naturally the number is 700. So 14,000 appointments for urgent treatment and we were just trying to look to say how many of that is left to city which we don't know but I think that is only tackling the tip of the iceberg in terms of actually if you think about the agenda that we've heard today it's about prevention not when it goes really wrong and actually that access is incredibly important and it's a national issue that we will work alongside NHS England to try and tackle. The NHS dental contract is a national contract and that has to be tackled through the national Secretary of State and team. That's why it's part of the 10-year plan and the contract is very old and things have changed and it just hasn't moved on with the times. I think managing expectations that will not be a quick piece of work I'll just want to manage expectations on that. Thank you Councillor March. Thank you Chair. I agree with the Councillor thing that if we could have overlaid a slide of access to dentistry I'm sure that would have chimed with so many of the other figures in there around where people are really struggling with their oral health elsewhere. I think Chair whether we can have a report on NHS dentistry across Leicester specifically because we know that this is an absolute massive challenge and particularly access to that. Last time I sat here I was aghast. I have never felt so incensed on a scrutiny committee because there was somebody that came and told me that the commissioned landscape that will be recorded somewhere was good for dentistry in the city. And that would have been two years. Rob remembers well. I was like what? Because we sat through two of them presentations like that and we were the worst in the country for oral cancer. And then somebody from the NHS told me the commissioned landscape was good. So I think we need to look at them both. So that's my request to yourself and to colleagues here. And then to note that we've gone down two which is brilliant because last time I sat here we'd done that. I guess I'm interested in compliance with this stuff and why that's going down because there's so many strands of work coming out of public health which we've heard about. Is there a fatigue in early years settings because we're asking them to do measles and MMR and vaccination and all this other stuff? How are we packaging that? That's the question. Is there a kind of fatigue in being asked by the council again? Is it Liz? Thank you. And that's one of the main things that we did within the survey was trying to understand what the issue was. Why don't they want to be part of this scheme anymore? Because we had 75% of early years settings participating in the scheme already. A lot of it was potentially lack of awareness and that misconception of having to brush a child's tooth. But then also just an easy answer to potentially say that we don't have the time and we've got plenty of other things to do as well at the same time. We do incentivise the scheme that the resources that we provide are free. So when I say incentivise the resources that we provide are completely free to settings. to answer your early question as well, the offer is universal across schools in the whole city. But as a team we've decided to focus our attention on the most deprived areas and just to make sure that we're able to target those individuals who are at greatest need really. Because we saw the clear links between poor or health and high levels deprivation. Thank you. And I think I agree with Councillor March. I mean in the east where we've got a massive 63% decay it's population density and not enough dentists I think. But yeah we'll take that forward. With Councillor Sahi did you want to? I was basically going to say the same thing about access to dentistry. It would have been helpful to have seen that overlaid to see where those pockets are. And then just some clarification which I might have missed. But when you say about five years were examined and found to have visible signs. Who were they examined by? We commission an organisation called Community Dental Service. So it's a statutory requirement of all local authorities to carry out this national survey. So it's commissioned by us. We commission Community Dental Service, CIC. Sorry I should get them in. Fully correct. Who employ dental professionals so they will have dental nurses going out into settings examining because it is a clinical examination that they're undertaking. And they do provide literature as well. advice on the top ten tips to preventing poor oral health. When they identified that there were signs of decay or poor decay then what happens? Because if they don't have a dental, what happens to the child? Yeah, so with the most severe they will obviously follow it up through the normal protocol. But those with early signs of decay, they will get a letter. And in fact, Lester Lester and Rutland have an agreement. This isn't part of the national protocol to follow it up with a letter to patients or those children who have been examined. so we do go above and beyond from the national protocol to highlight what they can do to prevent the dental decay. So that would be seeking an NHS dentist one of the dentists? And that's a part of a package. So seeing a dentist is one of the things that they can do to prevent poor oral health. So this is the new measure of having some signs of dental decay. It's not at the stage where it needs treatment. Yes, you can correct that with tooth brushing and cleaning and so on. So it's not at the stage where it needs a filling, for example. But that's the new measure that we're looking at, rather than the old one, which was decayed, missing, or filled teeth at the recounting. Cash. Yeah, I was sold on the word fluoridation when I was a child and I'd heard about it, so this is nothing new. And these really quite shocking figures, particularly of children. Anyway, I, because our souls are not there yet, and I probably won't see it as health watch, because we'll be gone, we'll be sacked soon. I'm just wondering, from our knowledge of other areas in Britain, what is the hesitancy of fluoridation in our water like? And I'm asking this because I went to a meeting within the last year where somebody said something about our right to choice. You can't really separate that, can you kind of separate water supplies, can you? But anyway, is there any hesitancy around the country? Yes, there is, and there are some genuine concerns, and there are some that are kind of conspiracy theories that people follow. But the main problem with getting it done at the moment is not that, it's the funding for it. So this is now the responsibility of the Secretary of State. They've just undertaken a huge consultation in the North East, and again, they've made a commitment in the NHS 10-year plan that they're going to get another million people in the North East having access to fluoridated water supply, and then they're going to look at, starting to look at other areas, which is why we wanted to get our letter in to say, have a look at us next, please. But it's probably, the reality is it will take years, because it's a big expensive programme we've put in a new plant, it's, you know, all the capital works that they need to do, the maintenance work. It's a shame that they didn't, that they've stopped like 30 years ago effectively, after they didn't, they stuck in the West Midlands and some of the other areas of the country. It's a shame it stopped at that point, along with the privatisation of water supplies. But that's where we are, and there is a commitment to continue it to some extent, but I think it will, I think it will be longer than the lifespan of Healthwatch, and probably my own lifespan as well, so, but we'll say. Councillor Hack. Yes, just a couple of quick questions I've got actually. You mentioned that the younger group of people from the subcontinent were affected by oral cancer, and the mention is, it's the easing of beetle leaves and tobacco, chewing tobacco. Is shisha also a part of that, or not? Because there's lots of shisha cafes opened up, and lots of people doing shisha more regularly than anything else. And the second part of my question is, you identified 33 schools in particular where you've got high rates of, that are in the areas of high rates of dental decay, in particular, out of which you've done 10. What are the plans to do the other 23? And my final question is, I did visit some of the food banks recently, just to check what they were giving out. I didn't see any toothpaste at any of them recently, at all. And surely there's something we can do with supermarkets and go and approaching them. I know it's not national, but we can do it locally and write to them and say, look, can you do some promotion on toothpaste in particular? Because one of the biggest expenses are, if they're going to try and save money, toothpaste is so far down the list, more important is to get the food in and bread and milk and that's the reality on the ground, because people are struggling to survive with the cost of living crisis. Shurag and I are going to answer these together. So, with regards to Shisha, we actually do have a Shisha working group and we're working collaboratively with the ICB, with other colleagues in the University and with the communities to try and look at what is going on with Shisha. Shisha, we want to know how we could influence young people in particular to not smoke so much Shisha. We don't think the community have a good understanding of the risk of Shisha with regards to oral cancer. Shisha and tobacco and alcohol are the main things. If you do them all, you're a much, much higher risk. And, of course, tobacco and alcohol go hand in hand often. So, we're trying to do some work with the community to understand about Shisha in particular. Our regulatory services have a requirement to speak with Shisha cafes. They're supposed to put in a licence, etc. So, there's that as well. So, working with regulatory services. And, also, we know that there's sales of Shisha pipes and tobacco within various community-based venues. some of that will be legal, some of it will not be legal. So, it's also looking at some of that as well. I think the first thing is to try and raise awareness because I don't think young people understand or believe the statistics that there is about oral cancer and Shisha. And, it is a growing thing and it's across all communities as well. So, I'm going to give Shirad the next bit of that stuff. Thank you. And, yeah, really good point. So, there are 33 schools that have been identified within IMD 1 and 2 that we need to be part of the scheme. Of those, only 10 are participating in totality. So, it is a hard work. I think the main thing to remember is the scheme is a voluntary scheme. And, so schools don't have to unless they choose to participate. And, schools, as you may have seen in our heyday, was at 35% of uptake across the city. So, it is a hard task to try or a hard nut to try and tackle because there are a number of complexities for staffing whose responsibility is trying to convince the heads and trust members as well. So, what we're doing within the team is trying to understand or trying to develop ways of fitting into the curriculum already. So, using, like, the PHE programme, developing curriculum-based educational activities and really facilitating going inside settings as well and delivering educational sessions to children and supporting their parents if needed as well. So, the team have been going out into delivering sessions within parents' evenings as well, trying to highlight the scheme. And, through that, we've seen a small uptake of schools as well. We are developing a mentoring scheme as well. So, where a school within a particular area is developed, is participating in the programme, and they could potentially be a mentor to schools who want to be part of it or help us sell the benefits of this as well. So, we work with our education team as well. So, they have a number of meetings and forums and newsletters as well, which we heavily try and advertise on as well. Schools are aware of it. It's just trying to fit it into the time, the day, really. That's the struggle, when they've got so many different agendas to fit. So, unfortunately, there isn't a one-size-fits-all because each of them have their own issues to try and navigate. So, we do work and work collaboratively with them. And, we know that the evidence suggests that it should be done every day. But, if a school can accommodate a few days a week, we'll work with them and try and build up that rapport to expand it. And, we're also looking at how we work with our libraries as well. So, when the book bus is going out, how can we work with them to go out to these school settings as well? And, you mentioned also a question around toothpaste within food banks and the ones that you went to, you didn't see them. Currently, the number of banks, sorry. So, the resources that we have are being distributed via Reaching People, a commission service within the local authority. They currently support a network of food banks. Now, they're happy to provide a list of the food banks that we are supplying on a regular basis. Yeah, and I appreciate there may be some food banks, unfortunately, that we can't cover through logistics, unfortunately. And, then, you mentioned around supermarkets as well. So, that's something I can take away and try and identify. But, we are getting an influx of resources, so toothbrushes and toothpaste, which we will be distributing to our communities. Very quickly, can I just add, can I, if possible, join the group on the shisha? I'd love to be part of that. And one of the other big issues are that shisha is now being used in people's homes, so they're not in the environment of access to air and airflow, etc. I've recently attended wedding functions and every night there's a couple of dozen people sitting there having shisha for three or four hours every evening during the week of the wedding. And that's going on in Leicester every day now. And the other question I wanted to say is, I'm more than happy to nudge my schools in Evington, and I'm sure if you approach the councillors, they'll be more than happy to nudge their schools in their areas to make sure that we can deal with this problem. We have great sort of relationships with the heads of lots of these schools and happy to play our part in making sure that we can eradicate us down to further down the league if possible. I think that's a good shout. Many of the councillors are governors at the school. Councillor March. Thank you. We're awash with the free toothbrushes and toothpaste from all the events that we go to as a family, so thank you for applying us with extra resources. It doesn't pass us by. What I wanted to say is, again, broad brush maths apologies, but if I look at your oral health sampling thing, and there were less than 400 kids were kind of examined, and 40% roughly had some sort of thing, that's about 150 kids, right? And you've got 14,000 extra appointments. If they're not away, we could just put a number to access those appointments on there, because it just feels like that's less than 1% of all those new appointments, but we've examined a kid, we've seen decay, and we've sent them. I had a five-year-old two years ago. She's not bringing that a lot of homes from school. You know, she's got pictures, she's got everything else, but the risk of that just getting lost in translation, just trying to, we've got them, we know who they are, let's get them, let's prevent rather than cure with those appointments that you've got. Maybe a bit basic. Leave that with us. I just wanted to ask, with oral admission rates, oral cancer admission rates, highest in whites, British men, 55 to 74, how are we targeting prevention? Because it's hard enough to get them to the GPs, so I can imagine that it's quite a feat to get them prevention. So some of the work that we're doing there is specifically about the smoking cessation and alcohol work that we're doing, and that tends to be targeted in the areas where those men are coming from. We also know that HPV is a risk factor, and unfortunately there'll be the age group that didn't get vaccinated. So hopefully over time that will reduce, because the younger age group have been vaccinated, and they will be more protected. But it's the smoking and drinking that we need to address, and we're addressing that through all of our live well services and all the other programmes that we've got in those communities. Our student, let's, did you have a question? Yes, Mohammed. So how come on the map of enamel and dentinal decay, an area like Belgrave and North Eddington is a much darker blue, but then on the map of hospital tooth extractions, it's quite a light shade. So how come there's not a lot of... I like your style, Mohammed, overlapping that. Yeah. Thank you, Mohammed. I'm hoping you're looking forward to a career in public health in the future. So I don't really know the answer to that directly, because we can't link the patients, and we know that the tooth extraction, although the data's there, they will be small numbers of patients. So we can't exactly link it together. My theory would be that those young people are then doing some prevention work or going to their dentist to have their tooth filled, whereas those that are the emergency admissions, those are the people that haven't been to the dentist and have to have that tooth pulled out, because they're in a lot of pain, and there will be, amongst those also, some may be that, you know, their brother kicked them by mistake. It happens in my family that a child got a swing in the face and had to have a tooth out, and they would have appeared in those statistics. So it's those sort of things. Can I ask you a question? And that's maybe about shisha, and whether you were aware shisha was a risk for oral cancer. I don't think it's like, I don't think people know about, like, shisha or smoking, to be honest. People don't really care about the warnings of the packets, they'll just do it anyways. Same for vaping. Thank you. I might be coming to speak to you at some time, and try and work out what we could do to improve that knowledge. It's like the student representatives have got a lot going on. Thank you for your presentation. If there's no more questions, we will try and get NHS dental access. It may be September or November, whichever one, we'll talk to our partners and put whichever one we can onto the work programme. So can I invite Jenny to tell us who will do the same day access, if you can invite them? So really importantly, Yav has just had to go and make sure she's got this car park on, parking on her car park, but there'll be a parking ticket, so she's just run out to do that, so she'll be coming back into the room in a moment to support this presentation. Shall we go on to item 15 then, Community Engagement and Wellbeing Champions Roundup, and then we'll come back. You've got to do your car as well? Well, yeah. Okay. Is that okay? Yes, I think so, otherwise. We'll be right. Thank you. I'm not quite sure where we're going. So we're going on to the Community Engagement and Wellbeing Champions Roundup. Right, yes. Invite Councillor Dumpster then. And Rob and Kate. I'm going to introduce Kate Zarr, who's going to talk about the programme, and give a bit of a round-up about this programme, which we talk about probably at every meeting, because we're really proud of this programme. It's a huge change for us over the last few years of having this network of organisations and individuals who we can use to champion health and wellbeing messages. So we thought we'd do a bit more of an in-depth presentation around the programme or where it's at, and I'll hand over to Kate. Thank you, Rob. I'm Kate Zarr, I'm a programme manager in public health, and it's the responsibility for communities and social inclusion, and the Community Wellbeing Champions sits under my portfolio. Next slide, please, Kate. Thank you, don't worry. Thank you. Okay, so just to give you a bit of background about the Community Wellbeing Champions. This came about during the pandemic, COVID-19. It occurred because two things were happening in the city. There was, assumingly, a non-compliance with some COVID regulations that were happening in the city, and there was also very low vaccine confidence a bit later on amongst some of our communities. So we were really, really trying to understand more about these issues. What was going on within communities? Why were these things happening? And more importantly, how could we use this information to do something about it in a positive way? During this time, we made contact with the community leaders that we were working with across Leicester. We listened to them, we advised, we appealed to them to have access to their communities, to conduct some more conversations, some investigations, and ask more questions about how people felt about things and some of the reasonings for what we were seeing. Through this, we were able to establish some common ground, and we did increase our, through this engagement, we did increase vaccine confidence, and we did increase some of the compliance with regulations in the city. Once this immediate COVID crisis was over, we were really keen to keep and enhance this type of relationship that we have with our VTSC organisations. They really, really care about the people that they support and represent, and obviously they are, they know more about the communities that they're part of than we do. And so we're really, really keen to work with them, and to look at how to address our ongoing health inequalities that are in the city. So the Community Wellbeing Champions was established out of that. So the key to what we do is our, is having a very, very open and honest, trusted dialogue with our VTSC organisations. It's mostly that, and also some individual community-focused people that are on there who aren't part of an organisation, but are still respected and part of their communities. So as you can see from this slide, our current membership is 298 members. It has gone down a little from last year, but that's because we implemented a new sign-up system, where we asked members to sign up to some principals, working principals, that ensure that there's consistency across what we're doing, and it makes sure that information that they're giving out is reliable and reputable, and that we have some sort of commitment both ways towards making the city a better place and working on these inequalities. So it also enables us to collect from the library data, because on our previous system that was born in COVID, we didn't really ask the right questions about the organisations in terms of how many people do they support, what demographics of the people they support, and the areas of the city they work in. So although we were rich in the number of organisations we had, the data we could pull out of that wasn't as good as it could have been. So the new sign-up system will capture more information. So we're now working on the process of encouraging the people that haven't, that fell off the system, to sign back up. So we've got a team that will contact them and try and help them through that process. We have already offered, we've offered a lot of support that we're trying to work out why they haven't signed up, but we will be doing that. What we do have, at the same time as that, we have a number of new organisations that come to see us when we attend events and activities, and they take the opportunity to sign up. So we have new organisations that are joining constantly. So the numbers are still going up, which is quite reassuring. Next slide, please. OK, so what we do, our main method of communication is the Community Wellbeing Champions weekly email that goes out to everybody on the membership list. This contains information to and from the voluntary sector. So they will tell us when they have things that they have organised, events they have on, or information that they want to impart, and we will include that in our newsletter. We also include information from public health, NHS colleagues, and the wider council. It's really well used by social prescribers, voluntary sector organisations themselves, and our internal staff. And it captures what's happening at a very, very easy level. So people have all that to hand in one email. Quite a lot of information. We also include things about cost of living crisis, how to keep your home, where the feed banks are. So there's a lot of information on there, all in one place. Next slide, please. Next slide, please. We also then have a monthly online forum. This meeting is focused around a topic of interest. Often, after mass school advice, the voluntary sector, they might, for instance, say, well, we'd like to know more about TB in the city, or we'd like to know more about vaccinations, and we'll theme it around what people are interested in. So, so far, we've had 27 meetings, 80 speakers, and every month, these are really well attended, and they are valued by the people that attend them. Next slide, please. Okay, so we also have conferences. So, conferences, we often co-produce with the community. We've organised five so far, and out of these, we've had a lot of engagement and joint action and problem solving. One of the ones we had last year was around mental health and social isolation, and we had a lot of roundtable discussions. Just push your mic on again, because it's gone off. So, the next is our annual public health conference in November this year, so have a look out for that one, the invites will be going out. And next slide, please. Thank you. And this year, we've also offered some grants to community organisations as part of our warm welcome. So, we had a number of organisations who would have liked to have opened their doors for longer, or to open different days, to allow people to come in and keep warm, so it's the cost of living crisis. We've found some grant money, and we allowed them to do that. So, we got grants from different sources, that we've got money from different sources, and we issued grants to the organisations. And they were able to decide what they wanted to theme their events around. So, some just did coffee mornings, which was fine. Others had a theme, so people looked at mental health support. They had a menopausal wellness session, and they decided pretty much what they wanted to do. But 32 organisations in the city made that commitment to opening their premises for an extra period of time during the winter months, which was really, really good. This was, again, really successful. We have got an evaluation for that, which is currently being worked up. So, we can look at that and see how many people actually benefited from the schemes and people off the street. But the feedback so far has been that it's very successful. So, we're all very pleased with that, and I hope to repeat it. Next slide, please. We've also run our Community Interns Project pilot for the first time. So, this was an interesting one. This came out of one of our Community Wellbeing Trampolines Forums, because the people that attend the forums are really passionate about public health, and they wanted to learn more, and they wanted to understand how public health is from our perspective, so what it's like on the other side of the fence. So, we took that away, and we developed the pilot project. So, we invited three interns to come, and paid interns, to come and join us. They were here for four months, and they did a few projects between them. So, they were all members of the CWC, and they were all older people. Older than your usual graduate placements, I should say. So, they were all people that had careers, and were working in different arenas. So, they were just for 15 hours a week, and they made really brilliant contributions to several projects. There was a Community Garden and Men's Social Isolation Project, that we were able to suddenly move forward with at quite a good rate of knots, because we had somebody that had excellent contacts and some really good ideas. There was analysing the health and wellbeing strategy. One of our interns was able to look at that with a different pair of eyes that wasn't a part of the council, wasn't part of the NHS, with a very different viewpoint, and that was really interesting to get that insight in a different kind of a way. And then, we had our Let's Get Together week a few weeks ago, and, again, one of our interns for that came to it with a very, very fresh pair of eyes and with a lot of ideas that were really for us out of the box and really sort of like, oh, we've never considered. But, because of that, we had, again, some really innovative engagement with people, and that was absolutely excellent. Okay, so, that's the final slide for me. So, our engagement approach is based on equal participation, very much so, and the need of respect and understanding is built up with our VCSE organisations and the individuals that are on the network. So, we are increasing our community engagement. We do quite a bit of work within our public health team anyway, and we do engagement around our things like the sexual health service. It was noted when we did the JSNA for that, the needs assessment, that Somali women were underrepresented within the sexual health service. So, the community well-being champions, workers and community leaders, and we did some focus groups with translators to find that insight and work out what the barriers were and how we could help small Somali women to be part of the sexual health service. So, we do things like that. We're part of the drugs and alcohol research and bits that go on around community engagement there. So, we do lots of work, but we are looking to broaden what we do across more of the public health sphere. That's on our agenda for the very near future. And then, yeah, helping to bring a little experience into everything that we do in public health, because that's the only way that we get proper information that people feel are relevant to them, and then we get proper engagement, et cetera. So, next slide, please, Katie. It was the last one from me. So, thank you very much. If you want any further information or to sign up to the network, the links will be sent below. So, thank you. Thank you, Kate. Are there any questions? Councillor Sahil. Thank you. I just wondered how you're linking with social prescribers and local area coordinators, because there's a bit you mentioned that some of the areas that they work in. And the other thing is, are they linked into the PPGs running out of GP practices? We have some relationships with our social prescribers across the city. It has been challenging to have that regular interaction with social prescribers, but we have a few very, very motivated, engaged social prescribers that do attend our meetings, and they have access to the information through the email if they can't attend. So, we do have that. Local area coordinators, I don't think we have any in Leicester City, do we? No, no. And the patient participation groups, we're not linked in directly with those at the present time, to my knowledge, but that's something we could possibly explore. We're not at the moment. It might be individuals again, but not as a whip. Councillor March. I know you're tired of time, Chair, and it's a comment, but it will be good. And it really is that we sit often in scrutiny committees, and we hear officers from the local authorities say how they engage with the third sector, and actually, this is genuine engagement, and it's two-way, and that's why I really like it. And I think it's really... They're quite short, the meetings, but you get a lot of information. The emails, it's all in one place, and I think the Wellbeing Champions are doing a great job, because it's quite broad, and it's that broad approach to public health, and it's the diversity of the city represented in there. So, that's what that's all. Thanks. And I would say to sign up to the Community Wellbeing Champions. I mean, I know I'm one, and I've been on to the online forums as well, and you have some fantastic guest speakers, and you learn quite a bit. Are there any other questions? Councillor Hayes. Yeah, I just want to say, actually, it's a fantastic scheme, and how well it's been taken up. And I think it was Richard Morrison, and the team at that time that sort of developed this, which was really inspirational at the time, to try and do something during COVID in particular. And I think also the scheme about giving out these poor pockets of money and actually doing something with that money was really useful as well, because to small organisations, those small amounts of money make a huge, huge difference. Okay. Can I ask what does the current membership tell us about who we are accessing, and more importantly, who we're not? At the moment, we haven't got that data, because we've only recently released the new sign-up process. We are, the only thing that we were, and that probably still stands from the previous sign-up, is that we were underrepresented across the east of the city, and the northwest of the city was slightly, the northwest of the city was underrepresented, the east was slightly lower. So, I think that might be the case still, but we will be able to tell you more once we've had a bit longer to gather the information on the new sign-up system. So, obviously, we've gone down in membership because of the sign-up system. How are we re-engaging those people that were on it before? Okay. So, through a number of different ways. We have done direct emails. We have contacted them by telephone. So, we're trying really quite hard to motivate them to sign back up. My team are quite tenacious. So, if they see people at an event, they will probably corner them until they've actually signed up, and they won't let them out of the corner until they're signed up. So, that's a real possibility going forward. But, I mean, the councillor Dempster put it really well in one of the meetings, and she said the preference would be for quality over quantity. So, if we get a lower number of CWC members that are really engaged and really, really active, as opposed to ones that passively to get the email, then that will be fine. I mean, I've re-signed up, and it is quite a lengthy process, but I imagine that you're going to get some really good data from it. Cash, did you want to say something? No? Are there any other questions? Thank you, Kate. Thank you for your... I'll help. Gina, help. Hi. I'm sorry. You mentioned that young people do, like, short placements there. Is there a way you could include young people in for the long term? Like, within your program? For them... How do you mean that? So, I think you're referring to the internships, were you? Yeah. So, the internships are slightly separate from the membership of the Wellbeing Champions program. So, the internship is just a recognition that we've gone out to communities, and some people are expecting interest in actually becoming... you know, learning more about public health and getting some work experience. So, that's what we've done through that route. I think there's another question about do we get enough young people as members of the Community Wellbeing Network itself? So, I don't know whether we do, actually, but that's a good question that we can take away and certainly look at. Another good question from there. We've got over there. Thank you, Dina. If there are no other questions, we'll go back to item 14 and same-day access. Thank you, and thanks, everybody, for your patience. I'm just going to ask Damien to introduce yourself because you're... because you've gone down the room and you haven't, so I just thought you should introduce yourself first before we continue. Go for it. My name's Damien. I am a paediatrician who works in the emergency departments at the Leicester Royal Infirmary, but my main job is being the system clinical director for adults and children. for urgent and emergency care in Leicester, Lester, Schoen, Rutland. Brilliant. So, I have got the... I'm going to do the introduction. So, essentially, we have got a gender item which is essentially looking over access across services, which is why we've brought Damien, Daz, and our engagement colleagues to talk to you around that work. This is around access in its whole, looking at where we're doing a lot of work around the access into services, be it either in the emergency department, into the GP practices, or into the treatment centres and pharmacies, which we've talked a lot around in this space. So, what we thought would be really helpful is to explain some really key pieces of work that we're about to undertake and working on in all of those areas to support people getting to the right places and getting the right services and then expand on that by working with our engagement team to get into the community and to support that work. So, that's the overarching approach of what we want to take you through this evening. So, I'll hand over to Damien just to talk through the access from an ED perspective and the work we're doing in that space. Yes, so, thank you. Cool. So, ultimately, the pressures on the NHS continue unabated. If we specifically look at the emergency department, the number of patients presenting grows between about 4% to 7% every year. And what we know is is that that produces pressure on the emergency department and also produces pressures on kind of institutions allied to that. There are peaks in demand related to winter viruses. But as you're aware, the heat wave also produces peaks in demand, especially for vulnerable elderly patients. But what we know is out of that 7% growth per year, there is a proportion of patients presenting to the emergency department whose care could have been dealt with in another location. We know that that is not just an emergency department phenomenon. So, for every patient who goes to the GP, they may have been able to go to the pharmacy. For every person who goes to the ED, they may have been able to go to a GP. So, there is a challenge there. And what we also know is this isn't just about the patient being in the wrong place. Meeting people or patients' needs is often done best by someone who is more trained to deal with that specific need. And as I often tell, I'm a paediatrician with very specific skills in emergency paediatrics. But if a child comes to me with a condition that wasn't emergency care, that is actually better dealt with by a general practitioner or a pharmacist. I may over-treat, I may over-investigate, or I may be... put that patient down a path where they didn't need. So, it is better when the patient gets to the right place. Can we go to the next slide? And so, the challenge is really is getting the right patients in the right place. And that ultimately does come down to the right choice. The challenge when we speak about the right choice is it puts a lot of onus on the patient themselves. And what we don't want to do is have a system where people feel admonished, discriminated against for decisions that may have been outside of their control. And so, this is why we're partly here. And we need everyone's help for this change. This is not just the health service going, look, we're not seeing you here, go away. This is about having a broad brush to get everyone on the same page about a direction of travel. Next slide. Am I doing this one and then you coming in, yes? Yeah. So, one of the things is it's highly unfair of a health system to suddenly decide that we're going to put a door down without providing extra capacity for patients to go in. So, we've done a couple of things specifically this year. Despite some of the financial challenges that we face, there are an extra 100 urgent treatment centre appointments a day. That was available from the 30th of June and we have worked on a programme of work that will be getting patients who do present to the emergency department into those urgent treatment centres. And there's been a huge expansion of Pharmacy First and a communications plan in order to enable the public to recognise the difference between minor common illnesses and injuries where you can then have day-to-day medical care moving up to urgent care. That is not without its challenges and even healthcare professionals get confused sometimes. But I think most people have recognised especially since the advent of COVID kind of this green amber and red light system and I think that matches neatly with the programme of work that continues in Leicester City. Next slide. As a practical example, so if you are a patient who presents the emergency department today and you have by our extremely well-trained staff a need that isn't met by the emergency department we will be offering appointments. We're not just saying go away and see someone else. There will be an appointment offered at another location for that patient to get those needs met and that improves patient safety. It might and I'll just be honest it sometimes might not be the best patient experience at that moment for that patient but unless we start doing this we will continue to have an overcrowded emergency department which meets no one's patient experience needs and if we can start to get the right patients in the right place over time I think both healthcare professionals and the public will learn that and then you do start getting some mated improved patient experience because you don't have overcrowded areas where people are waiting for long periods of times and you start to realise where you can get your health needs met in the right way and ultimately then that improves system resilience especially for when we have surges both in the winter and the summer. Next slide. So before we go into the sort of engagement of what David has gone through is around Have you got your mic on? Thank you. If we go back one more slide to the one with the one more that one okay thank you so for the last couple of years we've been doing quite a significant amount of work as health partners with our wider partners in terms of general practice community services our pharmacy colleagues our acute and secondary provider colleagues etc to try and understand and start to really think about how do we right size our services but also how do we ensure that we've got the capacity sitting in the right kind of places because we all talk about access and I've heard about access today as well how access is poor but actually when you look at it in numbers there's lots of stuff happening what we have found is that actually what we need to do is make that access be available in the places that it needs to be we have been working with very historical arrangements so we've had some very old contracts that we've had and people will know about hubs the extended access hubs that we've had for a number of years in the city three hubs for the city population dotted around in three different locations we know that when we put those in it was a solution at a point in time but things have moved on since that was put in so pharmacy first didn't exist the role of community pharmacy in the way that we have got it now didn't exist back then and also things like enhanced access didn't exist and primary care networks didn't exist when we put that contract in so what we've done there is look at that and look at actually doing a clinical audit to see where patients turn up why they're turning up into those places and what their needs are and then look at how we recalibrate that capacity because it's limited it's finite we've not got new money so we've got to work with the money that we've got within the system to recalibrate that and to re-set that across a number of areas urgent care primary care and community pharmacy and that's what we've done here what we've also done as Damien has pointed out we've put some further sort of strengthening of those elements particularly around our urgent treatments and so we've got an integrated urgent treatment offer that currently runs from our ED department we have Merlin VAS which is a UTC without x-ray but it does everything else and then we have ODB as well so what we've done with those is we've looked at their service models as well particularly in Merlin VAS we're also trialing out triage at the front door to support better walking access because we know that that has been challenging there and then we've put some additional appointments because some of what the data has showed particularly for Leicester is where we're getting the most significant footfall into ED where we've got a significant proportion of that population that didn't require an ED type offer so their need was not a life threatening life changing requirement and therefore we needed to look at where best we could place that so we've put that additional capacity in for this year whilst we review and work through what our future urgent treatment centre offer looks like and there are obviously a number of things in the 10 year plan around that particularly around co-located UTCs so we're working around those plans too which are in the pipeline for next year but what we didn't want to do is throw the baby out with the bath water so we're making some big changes but we needed to almost put something in to almost act as a bit of a safety net and a stopgap particularly in the city because we know that that's where our biggest demanding footfall is and that's where we've got our access challenges as well so I just wanted to set the context of what we're working in and the changes that we're making and then Jo and Jit will come in in terms of talking about the engagement work that we are also going to be launching and working through as well over the rest of this year thank you so we'll just move back on to a couple of slides so I want to talk about the engagement that we've got planned with our communities on how we should be accessing services and we know that that can be really complicated so and it's such an important part of this work if we don't particularly in the city if we don't really look at how we engage with our population and how they access services then we're always going to struggle with having too many people potentially in the wrong places that could be seen elsewhere so we've put together a plan so first of all we've had a really good look at our stakeholders we know that city is a very key priority for us and particularly for those people that do go to A&E or to other services or just don't know how to access services at all we're working on methods that we use to engage with the communities and then what we'll do is we'll put together some clear information on how to use services which we're co-designing with them set expectations and we really need to think about our accessible channels and I'll come on to that in a little bit more detail as I go through we then want to be engaging with our populations through lots of different ways but that includes meetings we will have a survey different forums and again I do want to talk about the extra money that we're putting into city to really focus on the voluntary sector work that we need to do here it's very important that we analyse what comes back so that we see if there's any themes about accessing services and that we use it and take action on what we're hearing we will be evaluating as well which I'll come on to at the end a little bit more so you probably will be aware in the city we did some previous hyper local work in the city which really focused on keeping people out of A&E and again it's a similar topic it was all about making sure that people were going to the right place at the right time for the right thing it was a really big success it was a project that JIT managed we had given some money to the voluntary sector we worked really closely with them and their communities and there's a couple of examples there to see just some of the variety that we did we're taking the learnings from that because it was such a successful programme of work and we want to do something similar but on a larger scale I just want to add on to that there was a lot of work with the council as well on there we worked with the adult education one of the pieces of work which we got great feedback was actually new people arriving to Leicester not knowing the system at all and we were simplifying it there's no translation there's no leaflets we literally just showed them what was happening and showed them simplicity and what they got back was just a book with pictures in it just showing them examples of how to use the NHS services and that worked really well that was some of the positive things that we took out from it because we need to work with different audience in different ways you can't just give leaflets our information you have to do different things to engage and understand is the big word because we need to make sure they do understand it rather than them just nodding their head and walk off and they don't know what we're talking about so I think we learnt a lot from this particular engagement piece of work we did sorry so it's very key that we collaborate with our voluntary community sector organisations and we are going to of course focus on those with protective characteristics as we would do with any of our work but we have identified some specific groups I'll go into a little bit more detail on the next slide we want to gather patient feedback on their understanding of services and how to access them also we're going to be talking about those same day access sites and the locations of those and also we are combining our GP service improvement questions so last year we did a really large survey across Westlash and Rutland we're doing the same but in a different way as part of this and we want to know about what's been improved and what still needs to be improved at GP practice level and we're going to be focusing on promoting and educating things like pharmacy first NHS 111 services and there's lots of different ways we can do that so things like first aid courses self-care workshops translation services but not delivered by us and again just on the next slide it just explains a little bit more about the learnings that we learn from the piece of work that JIT did about what was successful and we've directly taken that and said well let's do something very similar so practical workshops delivered by the voluntary sector interactive sessions that are very much tailored to their communities by their communities so we're not telling them what to do we'll make sure that the information they get given is correct but how they deliver that message will be broadly up to them so it really is a partnership piece of work we'll be working with our GPs and PCMs as well they really want to know about the access to their services as well so it's going to be very involved and I'll just show you on the next slide a bit more that I said about the targeted population so we have funded some engagement in the city and only the city for those that live within one mile radius and on the main arterial routes into the city we have had we've not put the map in here but there is a map on how we've done that so we've had a really good look so we're going to be focusing on families with babies and young children under the age of 10 people within the age group of 21 to 30 years so young professionals and then 31 to 40 years old and then because those groups are also more likely to have children 10 years or under homeless refugees and asylum seekers Eastern European and black Asian and minority ethnic groups and communities and I'm not sure what that plus is but it's groups that have got any particular issues with accessing our services we will provide literature and education sessions across Leicestershire and Rutland but our investment is in the city we know that that is where we need to focus our work with our communities people with learning disabilities people with autism people with very specific sometimes needs that are often when you do engagement pieces don't get looking so again this is why this is so important to do this and do it in the variety of ways that we're talking about thank you so as we begin which we would hope that this will be very soon in the next few weeks we've already had our bids in from the voluntary sector and we know now who we're going to be investing in but as we go along we'll be monitoring and evaluating the effectiveness so over a three month period it will be independently analysed and evaluated and there will be a midpoint review to say have we reached everyone we need to reach are there any gaps who aren't we hearing from and we'll be getting regular reports back from our voluntary sector organisations that we're working with to again check that we're really penetrating those communities or what else do we need to do there'll then be a final independent report after the engagement to inform our decision making to just also just to let you know tomorrow we're actually we've got a session with the voluntary sector on this time topic and we're actually working with them on the literature so that's what do you think your communities actually need what do you want to see what works what could you use alongside alongside the education to really help people to understand how to use services so that's the end of the slide I've taken a question thank you Jo councillor March it's a good news is I might be able to help with your continuous monitoring of progress because of your bullet points I'm the first three so I'm half of your bullet points on there and so and I've got I've got what Damien was saying and I got what you were saying and then I got lost in the middle so and perhaps perhaps that's not what I'm clear about so I get that people are perhaps presenting in the less not the best place and I get a big piece of community engagement to really dig into and understand that in the middle I'm not sure what we're consulting on really and what we're trying to achieve but I did pick up somewhere in there some stuff around are the hubs closing and moving to these UTCs instead and that's the big question I guess and and will we still have GP services available in UHL what is the the the bigger plan here and and what what's the savings target attached to it and are we reducing the offers these are the questions that are coming out because obviously we haven't had these in advance right so I can't formulate formulate are we reducing the offer at ED and and perhaps I'm being daft and completely missing the point but I'm not I'm not I'm not clear what we're trying to achieve and sorry the final bit and there's 210,000 extra pharmacy first appointments but the so I was supposed to book one the other day and there's that there's hundreds on there there's nothing within anywhere near certain postcodes so I guess I guess they might be being offered what's the uptake of that and perhaps that's something we ought to carry on following sorry chair there's a lot in there there is a lot in there Jasmine there is a lot so I'm gonna it's really difficult sometimes to try and what is often a very complex jigsaw puzzle that is access to general practice access to urgent emergency care etc and try to simplify that in a way that term is understood so if I unpack the questions in terms of the legacy arrangements the three hubs that we have in the city they will be closing and they are moving to primary care networks so it's not going to urgent treatment centers that is moving to our primary care networks all 10 so we've got 10 primary care networks in the city but if I'm really honest at the moment with those three hubs means that there's the accessibility for quite a lot of people in the city is really poor the DNA rate is about 14 percent on those current services to to be really frank in terms of that it's a legacy arrangement that we had prior to primary care networks and prior to be able to support that through that type of infrastructure which is what we're moving to so we've got 10 primary care networks they will be working together we will have I think there's about eight sites I think it is the primary care networks are just working through that and again they're doing a lot of engagement work within their own populations through their I know you're saying but again I can't comment on what those general practices they they have their ways of what they do in terms of their practice population if you're not getting that then what I would suggest is we'll take that back and we'll pick that up but that's why we're doing the engagement the wider engagement piece as well in addition to that with the pharmacy first we have now got 97 percent of all community pharmacies so assist in the city community pharmacies that are signed up to providing pharmacy first it has been a slow burn and remember we have had this now a year since we had pharmacy first come in to play so it's been a lot of work and hence the reason why we didn't start to have you know make lots of changes last year but we have been working with our community pharmacies and with general practice to work through how we do this and how we do this right and we are increasing the capacity of that and there is plenty of capacity in pharmacy first so it is available and if people are struggling to find one nearby again you need if people let us know we can pick that up with those community pharmacies are signed up to deliver that and if they're not delivering those appointments then we need to be able to address that and monitor that and we will be monitoring that and we're getting coming back here on a regular basis will help us to to pick those issues up so that's be being really simple we've still got the two UTCs that I talked about actually in in essence we have a integrated UTC provision in UHL LRI and then we have ODVI which does is open to all so it does have city patients and it has quite a significant amount of city patients that live that part of the city access that and they will be able to continue to access that without any issues and then we have Merlin VAS now Merlin VAS what we've done is increased the capacity of Merlin VAS and what we've also done with Merlin VAS is look at how they support better triage so that the walking capacity is better used because what we were finding was issues around experience around walking and I know Councillor Hutz you've raised this with us a few times last year as well so we've worked through that and we're testing that what we are doing as part of the engagement work is continue to engage with people to say this is the changes we've made thus far do they work do they not work what else do we need to do and how do we need to do that so we're not making any assumptions in this but we know we needed to make some changes because what we currently what we had up until now was not really delivering for quite a significant proportion of our population. Councillor March did you want to come back? Yeah I think I asked a question about the uptake of those community pharmacy first appointments because it's great that 97 have signed up but if people aren't using them what they're telling us is they're not working so do we know why the uptake might be lower and then secondly and then secondly and if things are moving to the PCN from the UTC the hubs sorry and when and what's the closing down for the hubs please thank you. Yeah so we have seen we're actually one of the best in terms of uptake of pharmacy first in the region and we've seen an increasing uptake I've not got the numbers to hand but I can get the numbers and share them post meeting that's absolutely fine but we've continuously seen an uptake in pharmacy first in Leicester particularly as well as Leicestershire and Rutland so we have seen a positive in terms of that and we've had positive feedback I mean it is always the case we'll never be able to you know not every you know there'll always be some variance in experience but we have seen some positive stuff in that and we continue to working on working on that and we do have a pharmacy first steering group that is led by our pharmacy lead as well and he's doing some really sterling work and that's why any information we get around particular pharmacies we will put that back into that steering group steering group is really working and targeting pharmacies and general practice colleagues in terms of where we're seeing low uptake etc particularly in certain areas to look at understand what those issues are and then work with those pharmacies and with those GP practices to try to try and work around improving the uptake and improving the access from a pharmacy first perspective but I think there is a good news story in that and I will share that back with colleagues as well but we have we definitely have seen an improvement in that and we've continuously seen an improvement in pharmacy first the question around when do the current hubs the three hubs saffron belgrave and westcoats come to an end they will come to an end in end of September early October and the PCNs are the primary care network and remember one of the hubs which is westcoats there is a primary care network that operates out of that and they are looking to continue to use westcoats to support same day access appointments for their populations so it's not this is where it's the hubs in terms of the current operation is closing we're moving to a different way of delivering that type of capacity we've right-sized that capacity as well based on the clinical audit work that's been done and then what we've done in terms of that is the PCNs are also working to utilize because so Leicester City South PCN for example is based at saffron so there will still be safety access at saffron and the same goes for the belgrave area as well which is the other hub Brandon Street yeah so so we so although the hubs in terms of the current contract provider and how they provide is changing what we will still have is a maintenance or service provision from those sites albeit through primary care networks and I think you've mentioned that the eight sites do you know where they will be I can provide that information I'm just waiting for a couple of the PCNs who are just confirming their sites so they're just working through that to confirm back to us what those sites are and it will still be a seven day a week provision 6 30 till 8 30 as as we've got and plus you've got a Saturday provision and Sunday provision too thank you councillor sahu thank you I'm struggling with the comms you're trying to deliver so I think it's interesting you guys and do some comms because it's it's not clear to me one of the comments I put down is what is the message that you're communicating so I saw the the stat where you had urgent minor and something and then day to day and then the first thing under urgent you put GP practice so I just found that intriguing really because I would have thought you'd want people who were you know have an urgent medical issue to contact the GP practice but that's what you've got down along as ED and 999 I think so I'm just wondering why GP practice down for urgent it's a list of um in regards to the one on the screen yeah yeah so it was about places you'd go to first so if you look at the order you'd start in regards to GP practice if you're looking somewhere urgent because what the emphasis on that and it's just a screen grab is that the final place that you would go to would be ED as your final point it's taken out of context because it's part of a um wider detailed piece but it was to demonstrate the point of where we send people to through our communication it's not something we send to people directly okay I wonder about the help from this one of having that up there to GP practice um I think the other bit I'm interested in is about the PCN so you said hubs are closing so I know Westcoats is closing and it's moving to the 10 PCNs um I was at a GP practice today that uses Westcoats a lot so much so that the patients actually ring in and say can I go to Westcoats um now which is the PCN that's running out that's running out of Westcoats Orion right so the practice I was at today wasn't part of Orion so where would they be sending their patients did you tell me which practice and which PCN Groovy Road so they're actually using Orion Orion is going to be providing for Groovy Road as well so although they're formerly not part of that PCN um so Orion Groovy Road is a slightly complex um setup in terms of that practice um set itself up as a PCN with two county practices because geographically located there um but obviously it's a city practice so city provisions still need to be provided so the arrangement on that one is that Orion will cover um that patient population because of its proximity and location to Westcoats and just going back to my first question what is the message well we've got um in regards to everything that Yaz is describing and obviously an incredible amount of detail there is a whole piece of work that's taken place at Sister Hamlet's engagement but we haven't brought that um this evening due to the fact that as Yaz has um sort of said there's still a little bit of work to do with some of the GP practices in regards to the confirmation of the sites that are going forward um so we can share that afterwards which really clearly which has already been worked up with a hell of a lot of work in the background and there's a lot of clear detail in there to like help and support us when we go out and engage with people Cash thank you chair I have two questions um so um some years ago well seems like a long time ago I was involved in um something called the Cue Better campaign which I think in this room Joe Ryder would uh remember um and I haven't seen anything like it and seemed to have had some impact uh where advertising to the public in in in various forms showed uh uh should have the person that should have been at ED uh is the person who actually died um uh and and and somehow whether it was sort of portrayed that you know people are going there for uh the wrong reasons and there are lots of other places of course that's all all this is all about so um is there anything else uh in that sort of uh vein of a publicity company and shall I wait for that um I'll ask in a moment the other question thank you so um yes actually exactly what you're talking about we are actually using some of the imagery tomorrow to discuss with the voluntary sector is that the kind of thing that they want or would they prefer like an algorithm where do we go yes no that kind of thing um or do they want much more information um we're trying to keep the information that we give to different communities very simple you know what do I where do I go GP practice I call NHS 111 the information needs to be provided but we are in danger of really confusing people even more because there's so many different services so if they go to those two points of um first they will hopefully get put into the go to the right place for the right thing um the example of what you were in yes um that's that's one of the examples of what we're going to put forward colour-coded we did some colour-coded work as well which we know is a favourite so we may look at that as well so to just finish that point off actually I I got calls from Cornwall I mean this had gone this post went everywhere um but anyway if that's concluded my my other question is uh if appointments would be appointments for health care hubs would be managed taken up by PCMs is there any risk of losing those appointments within the sort of no um within uh the the whole uh volume of appointments that that those surgeries within those PCMs have and then you don't get access to that same day consultation that's a really good question and that's one of the things that um we worked through um because that was that is a risk and that was a risk um and the work that we've done with regards to that is this is why we've kept it still separate from the core GP practice contract so it doesn't sit as part of the core general practice contract and it doesn't sit as part of the PCM DES but it will sit as a separate contract so that gives us the ability to monitor and view that also the piece of work that we have done because when we did the clinical audit one of the things we found was we had a substantial overuse of those appointments um as overflow or not even overflow by a number of our practices in the city that would often book those appointments up first before they would see the patients in their practice and actually the better thing for a lot of patients is that they're seen especially where their need is general practice to be seen by general practice so what we are doing with those appointments is that the 70% of that that capacity is open to 111 and our ed colleagues to book into and general practice will be able to book into it after 3 p.m so that also means that if a patient calls after 8 o'clock there's better opportunity for an appointment to be available as opposed to what happens at the moment you ring at you know you ring after 8 o'clock they've already booked up the um extended access appointments they've already booked up their own appointments and then there's nothing left or available so this is also one of our ways of tackling that it is testing it and that's why we're saying that we will be testing that and evaluating that and monitoring that and putting that with the engagement work and the comms piece is really important because patient experience around that will be really important to gather so that when we are looking at this formally next year in terms of you know is this a permanent change or you know what further changes do we need to make we've got good information and an engagement piece to back that up with and if i can just finish that point off as well chair the motivation for asking that is because i've said in a number of forums and scrutiny meetings now i actually we get statistics from from pcs or from gps i've been saying we've increased their appointments by 20 25 percent whatever it is but i'm not convinced because no one's given me evidence to say that that's actually um 20 to 25 percent more proper consultations uh and and better health outcomes because some of these are um the telephone conversations and they're converted to face-to-face and then you've got uh apparently more appointments that that a surgery has given to you than um than the actual um um the the health outcome from that from one consultation if you know what i mean what one day i'll ask again this question within hopefully with an answer to uh is are the public being fobbed off with these sort of statistics that surgeries are producing that's what i'm getting at here okay jasmine um there is a real growth in the number of appointments that have been delivered cash so um when the date we look at the data we can break it down so we can see that there's been a one percent it's not it's not massive but a one percent increase in actual gp appointments that have been delivered by general practice um there is um consistently more face-to-face appointments and in fact we're one of the highest i think in the country in terms of um delivering face-to-face appointments so we have delivered more face-to-face appointments and overall growth in appointments that includes other health care professionals that deliver primary care services and remember it's primary care general practice primary care services not just gp services now um is then what we've seen year on year is between three and seven percent growth overall in totality um and that includes the city there is a growth in the city as well and like i said there's about a one percent growth um year on year in terms of the total number of appointments delivered again this comes back to it is numbers um but what we've also got is the local survey that we completed last year around patient experience because we know that the national survey is not representative of llr's population in particular leicester's population it's always a very low um uptake rate in terms of the national survey the gp survey so we undertook our own um survey locally and what we found is that when what patients are saying is when they have their appointment and they go and see the relevant health care professional or gp they are satisfied with the outcome that comes out of that and we've got about 80 to 90 satisfaction rate in terms of that which is really positive so that gives us more confidence in terms of the numbers often because you're right sometimes when you just look at the numbers you think well that's great they're delivering lots of appointments but is it the right thing is it delivering the right type of care and that's why we've done the local work and that's why we want to continue that local survey work because we know that the national survey so even the health in national health insight survey the representative um it's about 0.6 percent of leicester's population that's represented in some of these national surveys nothing so sometimes you can base um quite unilateral decisions on on information that isn't really representative of our local population hence the reason why the local work is really important i'll come back to right why what is the message i think the message is really clear we want you know ed is cannot be the default position and we need to make the other services easier to access for people and that's the work that we want to do through the engagement work to look at how can we do that so that we get people into those services and they're not defaulting into ed ed is an emergency department for emergencies life threatening life-changing emergencies and we need to make sure that we are doing that and i think that is the core of the message that we want to get out thank you jasmine and councillor hack quick um i just wanted to ask you've got 210 000 first pharmacy first appointments how many were actually used roughly and how much do they get paid for those appointments um the 111 service always struggled to put people into the hubs and now you want them to book appointments into the pcns eight of them that's always going to be a challenge for them and how's that going to work you mentioned which i thought is a great move actually that to stop gps gaming the system to ring at 3pm so they can't book their own patients in during the day after 3pm but what happens if they start telling patients can you call us after three o'clock via 111 and we can book you an appointment so it takes up all your appointments of that day in that one practice if they play the system and the other part of my question is how much of the pcns going to actually get financially are they going to get the same money as the hubs distributed amongst the eight and will that be enough for them to operate an efficient service for the times that you're saying because they could say we're only there between 10 and 11 on a saturday rather than being there most of the day which the hubs are and finally i just wanted to say that i'm actually really confident in uh damien and uh his team for delivering what they early meant of and joe and jit in the engagement because i know the way joe and jit work and the engagement will be a proper um sort of thorough piece of work and i would like to see the independent report when it comes out afterwards as well thank you thanks so in terms of the pharmacy first data i'll get that post the meeting um so you can see that and you can see that in terms of the proportion um with regards to the pharmacy first appointments it's part of the national contract um and it's got a set price to it and i think it's about 12 pounds per appointment um delivered um by pharmacy first um and and that's what there's no cap on that they can be delivering lots or less little but um there is there is that um in terms of that um with regards to the um hubs and the pcns so as much as we can do we've what we've tried to do is look at all the unintended consequences but as you know um council there is always going to be some things that will come out and that is why the evaluation piece is so important and we will continue to monitor that but to a certain extent what we've tried to do is look at how we can um address some of those issues the reason why 111 can't book into the hub appointments at the moment is gps get the first preference on those and that's why they struggle to book by switching that around that changes that and therefore it doesn't matter how many hubs they've got to book into they can see that on the schedule that's in information that they can go into very quickly and they will have access to all eight so again although it's now to support better local that localized provision it will not stop another patient say they are registered to um i'm just trying to think of a one that's kind of a bit further away but say if they're registered somewhere in the west side of the city but actually there's an appointment that's available and that actually works for them in the east side of the city at one of the um pcn hubs they'll be able to access that so that again is not restricting access and we've worked really hard on that with our um gps because they were not keen on that as you can imagine but we've worked on that and worked with them to look at that in a very different way and to be there to support the system in terms of the um contracts they aren't like for like contracts with um g general practice so the the value and the pricing is different um and i can provide the information but it is commercially sensitive at the moment because we've not signed off all the contracts so once we have done that we should be able to publish those values um but what it is what's really important is remember we put in enhanced access through pcn so they are not delivering these um in isolation what we've done and this is where the efficiencies come from and the productivity is around bringing this in line with their enhanced access offer so what we know that general practice said is they couldn't deliver that type of volume of um same day access appointments purely through the same day access offer we've taken that on board and we said okay we can bolt on this as part of that wider offer and then what can you deliver and how can you get that to be more productive and that's what they've done the other big difference in this model is that they are all because at the moment through the hubs they're not gp appointments um they are health appointments that could be delivered by an amp or another healthcare professional in the pcn model or the rgp-led appointments and we'll be really clear about that thank you jasmine um i'm just going to wrap that up with a couple of comments really i really agree with what damien said about redirecting people on the day although unpopular it will be it would certainly make me think twice when going next time where i need to be um and it's a really complex um navigation that you're trying to do so thank you both damien yasmin joe and jip for your presentation um i don't think there were any other recommendations other than you look to see the next episode well honestly if well and and as far as the pharmacy is concerned i can't walk past the pharmacy in tesco's without them trying to grab my arm to do a blooming blood pressure or something so i know it is working and i'm refusing i know you've done it twice today already um okay thank you for that so we're i'll just just make a correction we're not actually consulting on this we're going to be going out to engage um so just so that yeah thank you joe now so the pcns will be we'll be working with the pcns and we'll make sure that they engage okay i'm going to go on to item 16 which is the work program um we've already going to look at getting nhs dental access on there if there's nothing else that anybody wants to recommend i know um at the llr um health one um councillor hack you were saying about getting a summary from this group to there um and we've looked at that and i think those those minutes are freely available on the website for people if they want to rather than recreating more work um but um there's any other urgent business any other urgent business um so in january 16th of this year we did the debate about primary care services and the nhs in full full council there were some recommendations made and the uh actual um motion was amended and i agreed to the amendment and there were some actions to be taking place unfortunately the actions were not done and i raised it in a couple of weeks about a week ago why those actions hadn't been done and i had subsequently got the copies of the letter i have sent them to all the the councillors because i had one or two of the councillors ask me what it was all about last week and and i have sent those that email out to everybody just to confirm that uh sir peter soulsby and the assistant uh mayor by demster have written directly to the secretary of state of health asking for what what they're going to do about the current situation of primary care and the levels of uh patient to gp access in the city of leicester okay well we will look at that because i i'm not sure that i quite understand or remember so if we revisit that well given that i actually commented on it at full council i'll just say it again so um not that i like playing groundhog day but there you go so basically um there was a recommendation made um and that fell through the net and sometimes things happen and it wasn't action um as quickly as it should have been um and then cancer hack um reminded us as soon as we were reminded of that action was taken and the letter was sent end of story thank you for clarification so it has been action done thank you all thank you all
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.
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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. ↩
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University Hospitals of Leicester - one of the biggest and busiest NHS teaching trusts in the country. ↩
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Patient Participation Groups - groups of patients, carers and practice staff who meet to discuss practice issues and patient experience to help improve the service. ↩
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