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 raised concern that there would be ‘unseen smokers’ across the borough as not everybody was honest with their doctor regarding their smoking status. He also asked if the criteria could be changed to include people over 40, as he felt that it could be too late to catch issues by the time residents reached 55. The Director Public Health responded that cancer tended to be a disease that affected older people, and the screening programme had to balance risk with harm. He stated that there was harm associated with CT scans as it could detect nodules on the lungs that were not cancerous, which could create mental distress, particularly if a biopsy of the nodules was needed. He added that rates of lung cancers increased dramatically after people reached the age of 55.

The Chair raised concern as residents under the age of 55 may still be concerned regarding their lung health, and asked if they could request to access the service. The Accountable Officer Thurrock CCG replied that any resident with concerns regarding their lung health could access their GP, and would enter the two-week cancer pathway if necessary, but would not be eligible for the targeted lung health check.

Councillor Redsell felt that this was good work being undertaken, but raised concern that Council employees were still smoking outside the Council building, and college students were smoking outside the college. She felt that the prevalence of smoking should be tackled, starting with outside Council buildings. The Director Public Health drew the Committee’s attention to page 32 and the figure quoted that only 9.8% of Thurrock’s population smoked, as he believed the actual figure was nearer to 20%. He felt that if Thurrock’s prevalence of smoking was that low, it would be one of the lowest in the country, which was not true. He also raised concern that only 52% of the eligible cohort had had their smoking status recorded, as this could mean almost half of eligible patients would be excluded from the trial. The Programme Manager – Targeted Lung Health Checks stated that this data came from the East of England Cancer Alliance and were the figures for the eligible age range. The Accountable Officer Thurrock CCG added that residents could not be forced into being honest regarding their smoking status, and the communications team were working to raise awareness that residents should be honest with their GP.

The Chair raised concern that only 52% of eligible patients had had their status recorded, and felt that even if people were not honest with their GP, they would still have a smoking status. She asked if data was missing from the dataset. The Accountable Officer Thurrock CCG replied that the smoking status could be left blank by GP’s, as the question was sometimes not asked. She added that the trials in Manchester had worked hard to identify patients, and then persuaded them to come to the trials by sending three attendance letters. She felt it was a two-prong approach, as it needed people to be honest with their smoking status, but also enticed to come to the trials. The Director Public Health added that people could only be honest with their GP if their GP asked them the question regarding their smoking status. He felt that 48% not recorded was high, and asked if patients could be written too or texted to ask them what their smoking status was, as he felt 95% status recorded would be a better figure. The Accountable Officer Thurrock CCG explained that she would go back and clarify the figures regarding smoker status and prevalence of smoking in Thurrock.

Councillor Muldowney felt that the work being undertaken was good, but highlighted Appendix One, as she felt there were problems around the procurement process. The Programme Manager – Targeted Lung Health Checks responded that these issues had been identified a while ago as there was an issue regarding how quickly the units could be produced. She stated that they had now received assurances from the company producing the units that this would not be an issue anymore. She added the Trust were awaiting a Memorandum of Understanding (MOU) to ensure funding, and then contracts could be signed.

The Chair questioned the resources based approach, as funding was based on the prevalence of smoking. The Accountable Officer Thurrock CCG replied that revenue funding was also received from the number of scans provided, so if the number of scans increased then so would funding. The Chair asked if a verbal update on the programme could be bought back before Committee in January to see how the programme was developing, and again in March.

RESOLVED:

1. The Health and Wellbeing Overview and Scrutiny Committee noted the report and championed the rationale for the criteria population to participate in lung health checks.