Apologies were received from Sarah Goad and Mark Creelman. Apologies were also received from Jane McSherry with Elizabeth Fitzpatrick as substitute, Jon Morgan with Graham Terry as substitute and Anna Huk with Rachel Tilford as substitute.

The Chair agreed that item 6 of the agenda would be heard first.

There were no declarations of interest.

RESOLVED: That the minutes of the meeting held on 23 January 2024 were agreed as an accurate record.

A verbal update to be provided at the meeting.

Russel Styles introduced the item.

Measles was a serious disease caused by a virus which could spread rapidly, one case could infect 9/10 unvaccinated people. It could be debilitating, and certain cohorts were more likely to develop complications and require hospitalisation.

Measles was transmitted through the respiratory route and had an incubation period of 10-12 days from exposure to the onset of symptoms but could vary from 7-21 days. The infectious period was 4 days before and after the onset of the rash.

Common signs and symptoms were fever, conjunctivitis, cough, runny nose, white spots in the mouth and a rash which started on the face and neck that spreaded to limbs. Out of 100 people, 90 would catch measles, 7 of which would have complications and in some cases death.

Children were offered the MMR vaccine as part of their routine vaccines with the first MMR dose given at 12/13 months of age, the second dose given at approximately 3years and 4 months of age. Those with an incomplete or uncertain immunisation history should be brought up to date at the earliest opportunity. There were no negative effects of vaccinating those who were already immune. Those born before 1970 were likely to have immunity from natural infection.

There was a rise of measles in 2023/24 and in London a rise in the last 2-3 months. Coverage for MMR in the UK had fallen to the lowest level in a decade. London historically had a lower uptake compared to the rest of the country and was therefore at risk of an outbreak. 95% uptake would be needed to avoid an outbreak, with two doses of MMR by the time a child turned 5 years old.

Merton performed higher than Southwest London and the London average for MMR 1, with an increase to 88.4% in the last quarter, MMR 2 was at 73.1%.

The Public Health Team worked closely with the UK Health Security Agency (UKHSA), who was responsible for protecting residents from the impact of infectious diseases like Measles.

Up until 8^th March in London, of 113 cases over 1 year of age, 81.4% was unvaccinated, 10.6% had received one dose and 8% received two doses.

The highest rate of Measles reported was in deprivation quintile one and the lowest in quintile 5. Of 129 cases of known hospitalisation status, 31% were recorded as having attended or being admitted to hospital.

Merton has had 6 confirmed cases since the start of the year, all of which were contained.

London Health Protection Teams continued to see an increase in overall notifications of Measle cases which resulted in an increased workload.

Merton established an MMR Task and Finish Group, developed comms plans, circulated key information to help and encourage stakeholders to share messages, contacted education settings, wrote to parents and carers via schools, shared content on social media, supported bespoke clinics in children centres, contacted outreach teams with targeted demographics and set up a landing page on the Merton Council website  ...  view the full minutes text for item 4.

Samina Sheikh introduced the item.

Merton Story was an annual high-level assessment of Merton’s population that provided a snapshot of local health, social care needs and priorities of residents including living and place of work.

Samina provided an overview of the type of information which would be found in the assessment and confirmed the approximate timeline which aimed to update the Health and Wellbeing Board in October and for publication to take place in January 2025.

In response to questions, the following was stated:

• The assessment was previously in word format, but they aimed to make it more digestible for readers and have moved towards PowerPoint slides.
• Cancer was mentioned as a subchapter for adults, but it was not a separate chapter for Start Well which was perhaps something that they could include in the updates.
• School attendance was not included in Start Well but was something that they could think about including as a subchapter.
• The assessment was used by commissioners of services within the Council and the NHS but agreed that they could look at having more graphics within the information, 

RESOLVED: That the Board noted the report

A verbal update to be provided at the meeting.

Graham Terry introduced the presentation with support from Elain Hill.

The Section 75 presentation followed on from a council’s savings proposal to end the section 75 Mental Health Agreement with the Southwest London St Georges Mental Health Trust and deliver a £8000 saving in 2024/25, alongside a savings proposal to put back commissioning brokerage of mental health placements.

To enact such savings, papers were submitted to Cabinet.

The borough operated integrated arrangements under Section 75 of the NHS Act 2006 since 2014 which, as part of the agreement, covered workforce, employment liabilities, legal responsibilities and defined pool budgets for health and social care related functions. 32–35fte London Borough of Merton staff were seconded into the trust but remained Council employees.

Five out of the Six London Boroughs had already ended their Section 75 arrangements and took responsibilities back into their Councils. Merton Council had cited similar reasons for their decision to also end the agreement in keeping with the other 5 Councils. Nationally, other Council were also considering ending the agreement for similar reasons to Merton Council such as organisational change, financial considerations and pressures and governance issues. As Section 75 was developed a number of years ago it, to some extent, no longer addressed some of the wider preventative community transformation agenda and modern service models for mental health social work. This was a main concern for Merton as it was felt that it did not address principal duties and core requirements of the Care Act 2014 and did not fully enable Merton Council to have a strength based approach or to work more closely with Primary Care and the Prevention Agenda.

Merton did not want to lose the benefits of shared ambitions with the Mental Health Trust. Other boroughs who have left the Section 75 agreement have said that there were advantages to no longer working to a Section 75 agreement and was working in a more coordinated way. There was various research cited in the report which went to Cabinet that showed you could have many of the benefits of integrated work if you were delivering coordinated working in conjunction as equal partners around Mental Health. Some of this would be obtained from clarity of role and responsibility.

The shared ambition with the Mental Health Trust was to have the best of both worlds and where possible, have staff co-located and have access to shared records to help address current duplication.

London Borough of Merton was the only Southwest London trust to have the Section 75 in place which resulted in the Trust working in a different way with Merton to the other 5 London Boroughs. Merton would be able to learn from the other 5 boroughs on how they have preserved integrated working.

A key drive to implement the decision was to transform the model of mental health social work. It was agreed with the Trust that the aim was to leave the Section 75 agreement on 1^st October 2024 and to have an operating  ...  view the full minutes text for item 6.

To Follow

Hilina Asrress and Kate Milsted introduced the report.

There were strong links between deprivation and higher rates in areas such as sexually transmitted infection and abortions with certain groups impacted more than others.

Through the Local Authority and Director of Public Health, there was a statutory responsibility to commission and provide open access sexual and reproduction health services.

Across Local Authority, ICB (Integrated Care Board) and NHS England Commissioners it was important to make sure that services were arranged appropriately to meet needs. Figure 1 in the agenda showed the commissioning arrangements.

Covid impacted access to integrated sexual health services and the Monkey Pox outbreak caused closure in services and reductions in the number of people being able to access services. Due to this some services were able to move online to ensure people still had access to services.

Hilina highlighted information from 3.2 of the agenda and noted that the figures were a comparison to England, but London did have a higher burden of STI’s and poor sexual health outcomes then elsewhere in England.

Merton had an integrated sexual health service provided by Central London Community Healthcare (CLCH).

3.6 of the report highlighted the wider framework with sexual and reproductive health. Through Public Health, they commissioned emergency hormonal contraception through pharmacies, commissioned GP practices to provide long natural reversable contraception, self-sample online STI testing, prevention support through spectra, condom distribution schemes, testing and treatment provided under the national chlamydia screening programme.

The Integrated Sexual Health Service contract was due to end in September 2024, they were reviewing and considering their specification model based on feedback received whilst exploring the short and long term options.

Services were paid for through the Public Health Grant, funding was limited and they were trying the manage the challenges around budget. They continued to explore opportunities aimed at increasing access to sexual health services and reducing inequalities and improving health outcomes.

In response to questions, the following was stated:

• They continued to explore how they expanded and enhanced services within primary care whilst ensuring that resident were aware of how to access services. Access to out of area services remained fairly the same since pre covid and was often due to wanting to be anonymous when accessing services. Resident feedback showed that certain services were wanted closer to home, so they were looking at resources and funding available to meet that need.
• They were not aware of grooming gangs at the Clapham site and would look into this further and took this seriously.
• Spectra specifically worked with young people and covered areas of sexual exploitation. There was a risk and resilient service which supported work around sexual exploitation, and they commission a piece of work that went into schools that looked at consent and grooming. Within the integrated sexual health service, they have health advisors who picked up on issues which could be linked with other services.

RESOLVED: That the Board agreed recommendations A,B and C