The Chair noted her disappointment in the lack of detail in the following two items and apologised to new Members on the unusual standard of reports being presented this evening. With the Target Lung Health Check Programme and the Primary Care Networks being two of the most important areas to Thurrock the reports should have been more specific based and relevant to Thurrock. The Chair requested that both reports be brought back to the 5 September 2019 committee. Mandy Ansell, Accountable Officer for Clinical Commissioning Group, apologised to Members and agreed to present the reports at the 5 September 2019 committee.
Mandy Ansell presented the report by stating that NHS England had confirmed it was to invest in 14 targeted lung health checks across England with Thurrock being twinned with the Luton Clinical Commissioning Group. The checks were being undertaken due to high lung cancer mortality, the high incident of smoking and high incidence of lung cancer rates. Those people in selected areas who were aged between 55 and 74 and 364 days who had a smoking history would be invited to attend a lung health check by their general practitioner. Where results would be calculated and those patients identified at being high risk would be invited to have a low dose Computerised Tomography Scan. Comparisons display that Thurrock had poor outcomes due to a high level of smokers, obesity and air population. Mandy Ansell identified that engagement had already taken place with stakeholder events and workshops in Thurrock alongside the enthusiastic engagement with Healthwatch and Luton. That the early testing of those risk groups started in Manchester followed very quickly by the Yorkshire lung trial. The programme staff had been identified with Patient Lead for Thurrock being Barbara Rice from Healthwatch and the strong medical leadership, patient safety and deliverables being governed alongside the Risk Register.
Mandy Ansell concluded some of the next steps being the procurement of lorries, where a one stop check would be carried out including the low dose Computerised Tomography Scans and deciding on the best locations. It was agreed by Members that this report be brought back for regular updates on the progression.
The Chair thanked Mandy Ansell for the update.
Councillor Muldowney questioned why over 75’s were not being screened. Mandy Ansell stated the age bracket had been based on the research on trials undertaken in Manchester and Leeds. Although the study should raise the profile of lung cancer, increase awareness and encourage patients to present earlier to general practitioners. Ian Wake, Director of Public Health, stated that consideration had to be taken into account on the benefit verses harm. That in these types of trials it had been calculated that over 75s could potentially die before lung cancer developed.
Councillor Redsell questioned why screening was not being undertaken for under 55s and to ensure the right location be made for the positioning of the treatment lorries. Mandy Ansell stated that the lorries would be placed on public sites, probably starting in Tilbury but would be placed where the need was. Ian Wake stated the increase of cancer increased as you aged and it was very rare for someone under 40 to get lung cancer with the risk of screening those in their 20s could provide false positives in this age bracket and consideration should be given on risk verses reward.
Ian Evans, Thurrock Coalition, questioned what the timescales were on the Rapid Access Clinic from referral to getting an appointment and asked what treatments would look like. Mandy Ansell stated these were part of the pathway to be developed although the structure and engagement had started but patients would not be seen until the end of the year.
Ian Wake stated that this was incredibly good news for Thurrock with lung cancer being one of the most common cancers in Thurrock. That the recording of patient smoking status was relevantly poor with only 33% patient status being recorded at SystmOne and questioned how the system would be used to improve the recording of patient smoker status. Rahul Chaudhari recognised that digitalisation had to be improved in the NHS service. Mandy Ansell stated that other forms of communication would need to be used for those hard to reach groups to encourage residents to come forward to get registered. Ian wake stated that 95% of resident access a general practitioner once a year so smoking status could be flagged up and completed at this time. Ian Wake also stated that letters could also be sent to those that had no completed smoking status on their records. The Chair agreed that this was a commitment that should be made with Mandy Ansell agreeing to look into this. Kim James agreed that this was a great opportunity but to ensure the right people were not being missed and communications would be undertaken by Healthwatch to make residents aware.
Kim James also stated concerns to ensure that with the sudden influx of people that this did not have detrimental effect on those residents already being missed from this service because of waiting times for all other cancer treatments. Healthwatch would continue to monitor and challenge as required.
Mandy Ansell stated that each area was being supported by the Cancer Network who had an overview of all the services, deliverables and outcomes. With 14 Clinical Commissioning Groups working as a group alongside experts from Manchester, Leeds and Nottingham who had designed the service and answered all relevant questions. Mandy Ansell also stated that the risk register would also highlight any concerns.
The Chair thanked Mandy Ansell for the report but to note those concerns raised this evening should form part of the report to be presented at the September committee.
Councillor Ralph questioned whether the completion of the smoking status could form part of the Over 40s health checks and stated that there would probably be a potential increase in lung cancer as young people denied they smoked and had concerns with the amount of cannabis being smoked which was being mixed with tobacco. Ian Wake stated he would take the suggestion away that lung checks could form part of the NHS Health Check Programme and had concerns over the high use of cannabis and how this could affect those suffering from mental health.
The Chair questioned what was being done, from an environmental point of view, to prevent residents from getting lung cancer in the first place. Ian Wake stated that the greatest risk was smoking with 85% of lung cancer incidents being contributed by smoking. That the tobacco programme was key and vital that it was incorporated into the promoting of the screening programme, education in schools and working alongside Trading Standards.
The Chair stated that air pollution was another contributing factor with Thurrock being an industrial borough and with huge plans to change the infrastructure and questioned what the impact this was likely to have on the health of residents. Ian Wake stated that with regards to the Lower Thames Crossing no one knew at this time what the impacts would be but stated that air pollution levels were falling nationally and locally but not at the rate we would like it to fall. Ian Wake stated that a difficult issue for Thurrock to tackle was that 50% of pollution was background pollution coming in from London or even from France. That work would also be undertaken with haulage companies and to look at when engines could be turned off with idle.
Councillor Redsell stated the river was being used more for the movement of containers to alleviate road usage.
Councillor Redsell questioned the use of e-cigarettes and asked whether they contained nicotine. Ian Wake stated he was a huge fan of e-cigarettes in preventing lung cancer as although they contained nicotine they did not contain any of the lung cancer tars and were the most effective way for smokers to quit.
Councillor Ralph stated he was aware that some general practitioners were already referring patients to vape shops but questioned the air monitoring being undertaken in Stanford le Hope and asked whether there was a breakdown of stats on cancer and asthma rates by local area. Ian Wake stated that stats could be obtained at general practitioner level but would not possibly show the entire picture. Councillor Ralph questioned why Stanford le Hope’s air pollution was not being monitored. Ian Wake stated he was unsure but would supply a response from the Environment Health Team.
The Chair thanked Officers and Members for their questions and looked forward to receiving an update at the September committee.
That the Health and Wellbeing Overview and Scrutiny Committee noted and supported the delivery plan for the Targeted Lung Health Checks Programme and the later commencement of the programme for the people of Thurrock.