To approve as a correct record the minutes of the Health and Wellbeing Overview and Scrutiny Committee meeting held on 5 September 2019.

The minutes of the meeting held on 5 September 2019 were approved as a true and correct record.

To receive additional items that the Chair is of the opinion should be considered as a matter of urgency, in accordance with Section 100B (4) (b) of the Local Government Act 1972.

No urgent items were raised.

Councillor Ralph declared a non-pecuniary interest as he was a self-employed mental health tutor, and worked for Thurrock Mind.

The HealthWatch Representative stated that she had no updates.

The Chair announced that the order of the agenda had been changed to hear Item 10 first, and that Item 8 had been removed from the agenda.

The Library Services Manager introduced the report and stated that the Peer Review team had received many positive comments about the staff, volunteers and stakeholder that they had met during their visit. She explained that the report focussed on the library service, and the team had been impressed with the developing library and hub programme. She then outlined the six recommendations that were included at point 3.1 of the report. She summarised and stated that there would be a review of library delivery, but they were happy at this stage of the programme.

Councillor Redsell opened discussion and described how Blackshots Library within her ward was one of the most well used libraries in the borough, and welcomed the report. She felt that some libraries needed some attention to help them work better, as people benefitted from the services provided. She hoped to see more work on libraries come before the committee, as she wished to see libraries become self-sustaining in regards to funding. Councillor Muldowney added that it was good to see support for libraries and plans to develop them into hubs. She highlighted recommendation four and felt it was good to see a new ‘Friends Network’ being proposed. She added that libraries held numerous events and asked if an increased social media presence could enhance footfall. The Library Services Manager replied that a meeting had been held recently between the libraries and communications teams to develop a social media presence, as libraries currently only had a Twitter feed. She stated that the communications team were keen to put library and hub events on the Council’s Facebook page, and there was work on an annual library social media plan to increase support.

The Chair felt it was good to see positive comments come back as part of the report, and felt that libraries were an important investment. She queried the number of hours libraries were open, as some were only open for fifteen hours per week. She asked what could be done to ensure longer opening hours for libraries. The Library Services Manager responded that the smaller libraries were open for fifteen hours per week, but other libraries were open a variety of hours, with Grays Central Library being open 48 hours per week. She added that new technology was being implemented by Christmas, such as self-service machines, which were being introduced next week in East Tilbury library, and this would ensure that volunteers could open libraries when staff were not available.

The Chair felt this would be a good addition, and felt that smaller libraries should be open for longer. She added that a Libraries Strategy had recently come before the Committee and asked if an updated on this strategy could be bought back to Committee. The Director Adults, Housing, Health/Interim Children’s Director replied that although libraries has not seen significant investment in previous years, this had recently changed, for example the new library in East Tilbury had recently been opened; the library in Aveley would be opened  ...  view the full minutes text for item 24.

The Programme Manager – Targeted Lung Health Checks introduced the report and began by recapping the national programme of work that had been completed by the National Cancer Alliance. She stated that a successful trial of the Targeted Lung Health Checks had been completed in Manchester, so ten new trials were being started across the country, based on factors such as demographics, instances of lung cancer, and survival rates of lung cancers. She explained that since Thurrock had been chosen for the trial, Thurrock CCG had identified practices and the criteria for eligible patients had been decided. She explained that eligible patients would be those between 55 and 74 years old that were either current or ex-smokers, and everyone that met this criteria would be invited to participate in the trial. The Programme Manager – Targeted Lung Health Checks added that the public health team had worked hard to ensure practice records were up-to-date regarding residents smoking status, and the communications team had also raised public awareness. She clarified that this service was opt-in and it was up to the patient to decide whether they would like to take part in the targeted lung health check, but the trial had been very successful in Manchester. She thanked HealthWatch, Thurrock CCG and the public health team for their hard work on the trial, and explained how a number of public awareness events had been held, such as the ‘Mega Lungs’ which had been set-up in Asda car park and Blackshots and had gained lots of interest. She clarified that as the trial was run in partnership with Luton CCG, there would be two teams, with one based in Thurrock and the other in Luton, and described how the recruitment had already started for both of these teams. The Programme Manager – Targeted Lung Health Checks went on to mention that the team were currently in negotiations with the CT scanner mobile van, and they had chosen a supplier that was based in Thurrock as they would be able to identify suitable sites which had easy access. She described how the vans were being specially created and would each have a reception room, four private consultation rooms and would be connected to a mobile CT scanner, which would be offered to patients straight after their consultation if needed. She added that the vans would be placed in areas such as supermarket car parks, as during the consultation event in March, this is where the majority of residents had wanted them. She stated that Thurrock CCG were also working closely with Basildon Hospital for this trial as patients who were found to have lung issues would be referred there to see specialists or the primary care team.

The Accountable Officer Thurrock CCG added that there would be a soft launch at one practice in Thurrock, as although the targeted lung health checks were being rolled out equally across the borough, rates of lung cancer differed across Thurrock. Councillor Ralph began the debate and  ...  view the full minutes text for item 25.

The Director Public Health introduced the report and described how sexual violence was an emotive topic, and could cause both physical and mental harm to survivors. He stated that the Joint Strategic Needs Assessment (JSNA) had been developed out of a need to view the topic objectively and give victims a voice. He thanked HealthWatch for surveying residents who had experienced sexual violence. He described how the JSNA had discovered fragmented services for survivors, and how this piece of work would try to bring services together. He stated that this report was a proposal and would be up for consultation with stakeholders, and then revised based on their comments. He added it would then go to the Health and Wellbeing Board and spoke of plans to hold a Thurrock Sexual Violence Summit in the New Year to launch the JSNA. He summarised and thanked the Public Health Programme Manager and the Strategic Lead – Public Mental Health for their hard work as this report had taken one year to put together, and was not an easy topic to work with.

The Public Health Programme Manager gave some context around the report and described how the JSNA provided further understanding regarding the prevalence of sexual violence. She stated that this report had engaged with 83 local survivors, six of whom had been interviewed, and 128 professionals. She clarified the definition of sexual violence that included any unwanted sexual acts, trafficking, or unwanted sexual comments, and added that these could have a wide range of impacts, which could occur at any point in life. She stated that sexual violence could make survivors turn to harmful behaviour, and 56% of sexual violence survivors turned to self-harm, and one third had common mental health issues. She added that sexual violence could impact on the survivors ability to parent, work, study, or form relationships, and this meant that a survivor might need to access lots of different services to help them cope and recover. The Public Health Programme Manager added that different organisations had responsibility for commissioning services to support survivors, and these services had different criteria for eligibility to access services, which made the system fragmented and could make it difficult for survivors to navigate. She summarised and described the range of services available locally for survivors to access, such as the Sexual Assault Referral Centre (SARC) and the South Essex Rape and Incest Crisis Centre (SERICC).

The Strategic Lead – Public Mental Health added that the JSNA worked to identify local victims, and hypothesised that there was a large data gap between the number of estimated victims, and the number of victims known. She described how there were likely to be over 10,000 victims in Thurrock who had experienced sexual violence and abuse since the age of 16 (10,116 females and 1,985 males), however only 316 Thurrock victims were reported in police data for 2018/19, with the majority of these victims being young and female. She added that there was also a data  ...  view the full minutes text for item 26.

The Pharmacy Lead Mid and South Essex (MSE) CCG introduced the report and stated that though this report, the CCG would be liaising with the three main providers of FreeStyle Libra, and other independent providers. He stated that this report had been driven by a mandate from the NHS to make the technology available to eligible patients, and the CCG had been engaging with local service providers to determine whether the scheme was clinically cost-effective. He stated that so far the team had determined the patient cohorts who would be eligible, and these were categorised into Type 1, who were diabetic controlled and had mental health issues so could not use finger pricks, and Type 2 which included pregnant women and people with mental and physical disabilities. He stated that these patient cohorts had been agreed by the CCG and they were currently working to identify patients who fit into these categories. The Pharmacy Lead MSE CCG moved onto describe how the Flash Glucose Monitoring System worked and how it identified blood glucose levels. He stated that eligible patients would be assessed and trained in how to use the system, which would then be monitored by GPs who proved the sensors. He clarified that after six months the GP would determine whether the new system was working for the patient, based on how many traditional testing strips had been used, compared to the new lancet system. He then drew the Committee’s attention to section 3.2 and 3.3 of the report which had shown, that although the project was still in the early phases, the number of traditional test strips being used by eligible patients had decreased. He stated that funding had been received from NHS England for the project for two years and 20% of Type 1 patients, and Thurrock CCG were under the expected target.

The Chair began the debate and stated that a number of Thurrock residents had emailed Councillors asking why they were not eligible for the new system, and asked for clarification. The Pharmacy Lead MSE CCG replied that not all diabetic patients met the NHS’ criteria for the FreeStyle Libra system, and even the people using the new system still had to revert back to traditional testing strips when they become ill. He stated that there was not a lot of outcome data regarding the use of FreeStyle Libra, as there was no central government guidance.

Councillor Ralph expressed his concern that patients might become over-dependent on the new FreeStyle Libra system, and asked what training was given to patients to identify over-dependence. The Pharmacy Lead MSE CCG replied that when a patient was identified as suitable for the programme, they were booked in to a training session to determine whether they were capable of using the device. He described how the system involved using a laptop to input blood glucose level results, so the clinic could constantly monitor whether the service was working for the patient. He mentioned that guidance and advice  ...  view the full minutes text for item 27.

The Accountable Officer Thurrock CCG described how the four Accountable Officers were being merged into one role, and this proposed job role was going through the two week consultation process, before being signed off by NHS England. She stated that this new role would lead on ICS development and would be a huge job. She explained that recruitment was taking place through a headhunting company, and all four Accountable Officers had now received their ‘at risk’ letters. She stated that recruitment was also underway on the NHS jobs website and through the recruitment agency, and the interviews had been scheduled for the beginning of December. She explained the three outcomes from the interviews, which would be either an internal candidate would receive the role and would start the job immediately; an external candidate would receive the role and would start the job within six months; or no appointment would be made.

The Director Adults, Housing, Health/Interim Director Children’s Services added that Council did not support the merger of the CCGs and this view had been expressed directly at the last HOSC meeting with NHS England. He added that since then a letter had also been sent to NHS England, which made the case against merger of the CCGs, including reasons such as geography, footprint, loss of local partnerships, and safeguarding. He felt that NHS England had already made up their mind and the Council were now trying to mitigate the issues that CCG merger would cause. He described how an MOU had been written to ensure decision-making would remain at a local level as much as possible, and a governance working group had been established to also ensure local level decision-making. He added that a structure was emerging for the new merged CCG, which included one Managing Director for Thurrock, and had requested that this post was jointly accountable to the Local Authority.

The Chair stated that the merger of the CCG had been discussed at length during HOSC meetings and at Full Council, and all Members and senior officers were unhappy with the merger. She felt that NHS England had decided the merger, and had ignored Thurrock Council’s recommendations. She asked if the HOSC voice could be added to the Cabinet voice to reiterate the dissatisfaction that all Members felt with the merger, and asked if a letter could be drafted to reiterate the Council’s position.

The Chair asked if an update on the Libraries Strategy could be included in the March meeting, and if a verbal update could be provided in January regarding the targeted lung health checks.