Apologies were received from Sarah Goad (Chief Executive Officer of Age UK Merton).

There were no declarations of interest.

RESOLVED: That the minutes of the meeting held on 2 October 2024 were agreed as an accurate record.

The Interim Director of Public Health and Principal Public Health Intelligence Specialist introduced the item and confirmed that the report was a progress update from the Health and Wellbeing Board meeting held in March.

JSNA (Joint Strategic Needs Assessment) was a high level data assessment of health needs in Merton and a statutory requirement which informed the development of the Health and Wellbeing Board strategy. The report was also used by Council ICP, NHS England and Stakeholders.

This was not an exhaustive database; vast amounts of information were available elsewhere. Following feedback from the Board, the report now included a more visual way to look at core data and allowed users to drill down on more specific areas.

The Merton Story informed commissioning intentions, decision making and formed part of the JSNA but was not a review of services or series of service recommendations.

Each of the six chapters were made up of three PowerPoint slides and consisted of infographics as recommended.

The Merton Story went through consultations with the Health and Wellbeing Board in March, Adult Social Care, Integrated Care and Public Health DMT, Children, Lifelong Learning and Families DMT and the Corporate Leadership Team.

A demonstration of the dashboard was given by the Principal Public Health Intelligence Specialist.

In response to questions, the following was stated:

• Available data was included in the dashboard and showed mapped data from reception to year 6 of those who were overweight or obese. At present they were in consultation for the Health and Wellbeing Board Strategy and hoped that alongside the Oral Health Dashboard, these would help to inform the strategy moving forward to address concerns raised around childhood obesity. The Borough of Sport and free swimming aimed to help with childhood obesity. Dieticians have worked directly with schools to try and help with the nutrition of school meals, but more work was needed which the Health and Wellbeing Board Strategy was hoped to help with. Dental care had a massive impact on children’s health, ICB recently held a day focussed on dentistry with plans to respond to those needs.
• It was mainly children from poorer backgrounds that missed dental checkups.
• ICB took responsibility of dental services last year and alongside public health colleagues, looked at activity and capacity within the system. They currently worked on a project which targeted local schools determined by colleagues in education and the Local Authority which involved dentists going into the schools to identify those in need, who would be referred to the practice for consultation and treatment. The plans in place would initially target children and older people in care homes oral health, plans could be shared with the board.
• The team hoped to publish the JSNA in February.
• Linking the ICS dashboard data could be explored.
• Adult scrutiny had a topic for oral health for 18 years plus, but it would be good to do the same for children to link the whole life journey.
• 6-8 week checks were one of the mandatory health  ...  view the full minutes text for item 4.

Vanessa Ford introduced the item.

The service served 1.2m people with 87% of patients recommended. They continued to work on health inequalities and highlighted that there was a 20 year mortality gap for those with mental health conditions.

The recent Mental Health Act reform created an opportunity to improve race disparity. They had a strong CQC rating and in the last year saw a 20% reduction of staff vacancy rates, which was below the London benchmark.

Southwest London ICS was the first to introduce an integrated Mental Health Strategy.

The Springfield development was something to be proud of as it brought greater care for patients and was more than just a hospital. The site brought more the 400 new homes, half were for social value homes and over half of those for social rent.

Despite only receiving 10% of the health budget against a 14% average spend they broke even.

As a result of moving forensic services back into the hospital there was over a 36% reduction in patient safety instances.

94% of patients were treated within 18 weeks, with a 14.3% increase in demand for adult services.

There were long waiting times for ADHD services, which although more efficient than many of the national services, it was an area for improvement.

In relation to health inequalities, there were higher access rates for black/mixed/other ethnic cases then the population size, but the higher access rate did not translate to  improved treatment, outcome and experience which needed to be corrected. The Asian population had the lowest access rates which was an area to focus on. There was an overrepresentation in the black/brown community within the inpatient setting which was another area of focus.

S75 was disaggregated in October which was positive. A 6 month evaluation was due in January/February but there had been no immediate risk challenges, and they now worked out arrangements in The Wilson.

The Merton Integrated Hub was now live, and they saw an increase in tailored treatment with over 22 different organisations working effectively together alongside the voluntary sector.

Next steps included 2 key annual deliver plans; Improving our Adult Patient Journey and Making the Trust a Great Place to Work.

The slides were silent around the ambition on children. This was due to Southwest London ICS Mental Health Strategy delineating the ambition around children’s mental health and the need for the team to invest in a different way in children’s mental health services.

The environments in Richmond, Barnes and Tolworth were being transformed, with Merton residents benefitting from the site in Tolworth.

In response to questions, the following was stated:

• For adult services, via the integrated recovery hubs, people were signposted to support whilst waiting for care and treatment. For children, they had a waiting well programme of work with virtual waiting rooms. Wait times were too long, a real challenge was the volume of referrals for ADHD services. current wait times should not be accepted, continued advocacy for children was needed.
• The institutions run were  ...  view the full minutes text for item 5.

Tony Molloy introduced the report.

Merton Connected employed 2 community Health and Wellbeing workers whose role were to visit 150-200 properties per month to provide a permanent point of contact to help support people.

The model came from Brazil who, over the first 4 years of the project saw a massive decline in hospitalisations across many areas. The aims of the project were to provide education, to navigate health services, provide support and research. Anticipated outcomes included reduced workloads for those in the health service, uptake of screening and immunisations, to meet unmet demands, to have early uptake on maternity care and breastfeeding, reduce social isolation, increase health and literacy empowerment and increase trust.

The model started in Wandsworth in 2023. The areas for planned delivery were Pollards Hill and Phibbs Bridge Estate based on health inequalities.

Recruitment was based on individuals who had the right characteristics with no medical background, extensive training was provided. 

The approach worked as they dealt with issues in real time, non-clinical people were able to engage with residents on clinical issues well, actively social prescribe and had knowledge of the local area.

Success created success, in time there was better uptake, and collaborative working was successful.

In response to questions, the following was stated:

• Wandsworth’s pilot ran for approximately 1.5 years and was not yet made permanent. To measure success in Merton they would use a system called Elemental to record health outcomes. The real challenge was not whether this would be a success but how to get people involved and tenure types.
• The pilot was funded by ICB. Fortnightly meetings took place with Southwest London to assess performance. The work carried out was preventative and the downstream health outcomes were radical.
• Westminster was the first to do this pilot and produced hard facts such as a 10% increase in immunisation rates and a 15% increase in flu vaccinations. The benefits outweighed the relative low costs. In Wandsworth, they found that the community workers had to develop trust which took time. There were many other outcomes other than health.
• The Wandsworth pilot ends in April 2025.
• Details from the Westminster pilot could be shared with members.
• Wandsworth presented the Brazilian Project at the at Southwest London Integrated Neighbourhood Teams Summitt and highlighted that it took a lot of time due to working with an entire household. The impact was hard to see straight away which made it hard to quantify as you could not know how much more productive the household would become in society in the years to come.
• The team worked with everyone on all local levels such as churches.

RESOLVED: That the Board noted the report.

Julie Kelsi introduced the report and noted an error in the report in relation to dates which should state 2025 – 2030.

Merton’s smoking prevalence in 2023 was approximately 14.7% which was slightly higher than London and England. There was a higher prevalence rate for those who worked in manual roles, those with long term mental health conditions and adults with anxiety or depression.

Fewer than 1% of 11-15 year olds regularly smoked but children with parents who smoked were 3 times more likely to start smoking.

Smoking in pregnancy was reasonably low. In 2022/23 104 women in Merton smoked during pregnancy. There was support from regional and national services.

One New Merton primarily delivered most of the stop smoking services and offered tiered stop smoking support. These services were going through procurement and would be in place from April 2025.

In 2023/24 1500 residents set a quit day, 557 successfully stopped smoking.

The Swap to Stop national scheme began in December 2023 and offered those who smoked the opportunity to swap cigarettes to vapes. In Merton, 90 vape kits were redeemed.

Forthcoming national stop smoking schemes included one to help pregnant women. There was an NHS long term stop smoking plan for inpatients.

Clarion Housing was part of the Local Smoking, Tobacco and Vaping Steering Group which linked smoking with cost of living to help residents make savings. 97% of residents identified as smokers were motivated to quite after their session with Clarion Housing. The pilot was being evaluated, with a final report due in December.

There were some changes to the Tobacco and Vapes Bill which could stop young people from ever being able to legally buy cigarettes. The legislation also addressed vaping.

It was announced last month that there would be a ban on the use of single use vapes in England effective from June 2025.

The Local Stop Smoking Service Support Fund Grant was £270,000 for Merton and was a 5 year commitment of funding, of which they were 8 months into with targets detailed within the report. Some of the funding was used for comms, Catch 22 and a planned pilot with GP’s and community pharmacies to create stop smoking champions.

A new London Stop Smoking App will launch on 18 December 2025 with limited licenses available. Additional funding was available for One New Merton to extend their stop smoking services.

Last year, Trading Standards prosecuted someone selling vapes to a 15 year old and were also able to remove over 4000 illegal vapes from stores in Merton.

In response to questions, the following was stated:

• A priority target group for One New Merton were pregnant women, they worked with maternity services on patient discharge. The new pregnancy incentive scheme was coming where they could get shopping vouchers. They were currently 8 months into a 5 year scheme.
• The community outreach team and One New Merton will be attending the Cost of Living event on Saturday.
• The drug recently mentioned on the news was withdrawn  ...  view the full minutes text for item 7.

Barry Causer introduced the report.

A Joint Pharmaceutical Needs Assessment (JSNA) had to be published every 3 years as a statutory requirement.

The current PNA for Merton was published on 1 October 2022, Public Health Merton commissioned this on behalf of the Health and Wellbeing Board. A new PNA needed to be published by October 2025.

The team planned to work with other local authorities and public health teams across Southwest London to review options of joint working.

The team worked as part of a steering group set up with by Wandsworth and Richmond, who were procuring the PNA so that Merton could publish by October 2025.

In response to questions, the following was stated:

• The ICB did not make the decision on where new pharmacies went, it was a national process and decision. The ICB commissioned the service.

RESOLVED: That the Board agreed to the recommendations.