Agenda item

To provide members of the Health and Wellbeing Board with an update on progress in the development of the Healthwatch Brent work service.

Jo Kay (HealthWatch Brent) introduced the report, which asked the Health and Wellbeing Board to note and recognise the key themes and achievements in the development of the HealthWatch service over the past year. In introducing the report, she advised the Board that she felt HealthWatch had been successful in laying the foundations of the service and had worked hard to raise its profile in Brent through engagement with various community groups, including in deprived wards and with voluntary sector organisations. She highlighted that HealthWatch took community views and concerns into consideration and amplified those voices at various meetings to various partners and statutory bodies. In addition, HealthWatch had partnered on a few consultations and strategies through the year and communicated the need for improvements where services should be engaging with the public to either co-design services or be part of the consultation process. In her introduction, Jo Kay highlighted the following key points:

·         Within the report, sample sizes were very small and HealthWatch were working hard to increase the number of people who were engaged through their engagement strategy. Although sample sizes were small, feedback helped HealthWatch ensure providers were assessing and addressing existing concerns.

·         Local health and care services should be returning to pre-pandemic activity, but HealthWatch saw residual and potentially long term problems due to lack of funding and staff shortages.

·         Paragraphs 3.7 and 3.8 of the report detailed the work HealthWatch were prioritising on access to GP services, which remained a top priority for Brent residents, particularly those who faced barriers to care such as those with disabilities. HealthWatch welcomed the investment put into primary care to address these issues, particularly the renewed focus on personalised care, however recognised that many patients were still unable to access their GP practice in a timely or efficient way.

·         Over the coming months, HealthWatch hoped to see that primary care systems were understanding communities and addressing disparities in access. GPs were a vital first point of contact, so it was important general practice worked for everyone.

·         HealthWatch were currently independently evaluating the alternate Saturday inequality clinics being held across Brent which were offering routine services such as health screenings, checks and immunisations. They had heard good feedback from patients regarding Saturday appointments and seen excellent approaches from certain GP practices to ensure they were meeting the individual needs of vulnerable and elderly patients. The evaluation report would be submitted to primary care in late August 2022 with the final outcomes.

·         HealthWatch welcomed NHS England’s focus on ensuring better dental support for people with complex problems and improvements in information for those trying to find an NHS dentist. They hoped the focus would improve the issues they heard about in Brent in relation to dentist access and information. As oral health was one of the priorities for children and young people’s health, HealthWatch queried what was being done to address concerns around lack of dentists signing up new patients in Brent.

·         In relation to Child and Adolescent Mental Health Services (CAMHS), HealthWatch fully supported the development of a mental health priority within the Integrated Care Partnership (ICP) and the solutions being put in place to improve access to CAMHS, which had seen a 53% reduction in the number of children waiting for assessments since March 2022. HealthWatch strongly recommended all providers worked with the voluntary and community sector to ensure the right intervention strategies were in place, and over the next year HealthWatch would focus on adult and children’s mental health, particularly in the more deprived areas of Brent.

The Chair thanked Jo Kay for the introduction, and invited contributions from those present. The following issues were raised:

• The Chair reminded the Board that the work HealthWatch were doing on GP access followed on from the work undertaken by the Community and Wellbeing Scrutiny Committee GP Access Task Group in 2021. The Health and Wellbeing Board had received an update at the last meeting on how the NHS was implementing the recommendations from the task group, which had clear asks around improvement for access to GP provision. Tom Shakespeare (Integrated Care Partnership (ICP) Director) had heard from the ICP and Borough Team about the challenges raised in both the Scrutiny report and the work HealthWatch had been doing, and there was an update on the agenda about the work being done to improve GP access. The Board were advised that this work would be improved if councillors could provide feedback about particular GPs that residents were having difficulties accessing.
• The Board queried how many GPs there were in Brent where the only way to book an appointment was via telephone, as there was the potential this excluded patients with hearing conditions. Fana Hussain (Assistant Director Primary Care, NWL ICS) advised that Brent was a digital innovator and the first borough to implement online access over 4 years ago. During the pandemic, due to the work already undertaken around digital services, Brent had transitioned very easily to the digital model and every practice in Brent had access to online services. Booking appointments did not have to be through the telephone as it could be done online, or through other providers including 111 who could directly book a patient into a GP appointment slot. All GPs in Brent were required to reserve a number of slots for patients booking through 111 and all practices had been funded and commissioned to provide an online platform. NWL was now moving to a new online system known as ‘Patches’, which was more patient friendly and less lengthy than the previous ‘e-consult’. In response to whether these changes would be communicated to residents, Fana Hussain confirmed it was the intention to do that once it was embedded into practices and they were confident in the utilisation of that platform.
• The Board queried how HealthWatch agreed its work programme, as some of the work being done overlapped with work being done in the Council such as vaccination hesitancy and GP access. The Board highlighted the need for discussion with the Council and other partners prior to implementing a work programme in order to avoid duplication of work. Jo Kay confirmed that the work programme was set by the advisory group which was made up of public members, volunteers and the HealthWatch Chair, and the Contract Manager then signed that off. She advised that HealthWatch had worked alongside the scrutiny committee the previous year collecting feedback for the GP access task group, and going forward wanted to do ‘enter and view’ visits to particular GP practices.
• It was highlighted that some of the sample sizes in the report were as small as one person, and the Board felt that one person feeding back that a GP was poor could not be seen as a valid condemnation of services based on the opinion of one individual. Jo Kay took the feedback on board and agreed to consider how that type of data could be presented in the most meaningful way in the future.
• In response to whether HealthWatch held data on the number of GP practices in Brent and how many appointments were being offered face to face or online, Jo Kay advised that HealthWatch did not hold that type of data, but heard the themes of what patients experienced within their GP practices. Jonathan Turner (Borough Lead Director – Brent, NWL ICS) advised that he could share the information with HealthWatch for analysis.
• In relation to dentistry, members highlighted that they received many approaches from residents about dentistry. They queried what HealthWatch was doing nationally or across London to apply pressure on the government to improve dental services locally. Jo Kay advised that HealthWatch England had been campaigning for NHSE to improve access across the nation, and HealthWatch Brent was hearing across the 7 other HealthWatch services in NWL that there was a problem in NWL around access to NHS dentists. Some patients were travelling to other boroughs or outside of London to access dentists. HealthWatch Brent were speaking with HealthWatch England to ensure they continued to lobby NHSE to improve dental services.
• Dentistry for children and young people was also discussed, as HealthWatch was hearing from parents and carers that they could not register children at local dentists. Melanie Smith (Director of Public Health, Brent Council) advised that the public health team had been running outreach sessions, with the vaccination bus repurposed as an oral health bus, and working in conjunction with primary schools to address dental decay in children. She advised that there was enthusiasm amongst parents for addressing children’s oral health as there was an awareness from past data of the issues with the number of children with dental decay and the very clear inequalities issues with that. Children were being offered fluoride varnishing through that initiative, but the long term benefit would be if they were able to see a dentist to receive those varnishes regularly. Public health were working on an evaluation of the work later during the year. Anecdotal feedback to date was that parents were finding it very difficult to get NHS appointments for children, and there were clear structural disincentives within national contracts for dentists, which was why lobbying nationally was useful. In the meantime, work was being done to get children’s oral health recognised by the ICS as a priority in order to have a bigger influence on NHSE.

RESOLVED: To note the report.