Apologies were received from Cllr Usaama and Dr Sy Ganesaratnam.

There were no declarations of interest.

RESOLVED: That the minutes of the meeting held on 19 March 2024 were agreed as an accurate record.

In response to a question, it was confirmed that the recommissioned sexual health new contract was in place for 2years. There were funds to focus on services in the east of the borough where there were none at present. They recognised that the  east of the borough warranted additional response and as such this has been passed on as part of the service re-procurement.

Russell Styles introduced the presentation with support from Ted Sherman.

The Annual Public Health Report was a statutory duty of Council completed each year which was used as a call of action for partners and stakeholders to work together and deliver solutions in response to identified health and wellbeing needs.

Tackling Drugs together examined the scope and scale of alcohol and other drug problems and encouraged stakeholders to look at challenges including those related to stigma, harm caused by alcohol and other drug use, the need for early support, guides and local partnerships. This was not a full needs assessment and should be read in conjunction with the 2023 needs assessment.

This work was part of a 10yr national strategy ‘From Harm to Hope’ which was introduced to cut crime and save lives by reducing the supply and demand for drugs whilst delivering quality treatment and recovery.

The three priorities of From Harm to Hope was to break the Supply chain, deliver a world class treatment and recovery system and achieve a generational shift in the demand for drugs.

From Harm to Hope was mostly focussed on drugs other than alcohol but due to the significant harm and incidents linked to alcohol they felt compelled to focus the report on alcohol as well as other drugs. In May 2024, the annual cost to Merton caused by harmful alcohol use was estimated at £85.8million and was a leading risk factor in early death and illness linked to heart and respiratory disease and many cancers. The number of alcohol specific deaths increased from 2019, with 791 hospital admissions for alcohol specific conditions in Merton from 2022-23.

Aging could result in the consumption of alcohol becoming more harmful and Merton’s population was aging. It was reported that the amount of alcohol drunk by older age groups had increased, with the younger population drinking less now then in previous generations which was a positive trend.

Wider societal impacts linked with alcohol and violent crime were 39% which included domestic violence.

Merton saw an increase of referrals for people with cocaine, crack and opioid problems. Data showed there were 12 deaths from drug misuse in Merton between 2020 – 2022 that were non-alcohol related. This was the third lowest in London, but numbers had increased since 2017. In 2022 there were 21 alcohol specific deaths in Merton.

The report highlighted emerging areas of concerns with drugs other then alcohol which required immediate attention such as Nitazenes, GHB (gamma hydroxybutrate) and GBL (gamma butyrolactone) along with group sex activity.

Prevention was the golden thread throughout the recommendations in the report.

The Seven R’s framework was created and were Recognise, Respond, Recover, Reintegrate, Reframe, Regulate and Review as detailed within the report.

Next steps included as press release on the Annual Public Health Report within the next couple of weeks and to take the recommendation from the report to create an action plan. 21^st October 2024 was the deadline for the synthetic opioid preparedness plan which  ...  view the full minutes text for item 4.

Rachel Tilford introduced the item with support from Ashlee Mulimba, Anna Huk and Rashid Fagbemi.

In 2023 21% of young people tried vaping which was an increase from 2022. Different messaging between adults and children led to complicated messaging.

Since summer last year there had been considerable progress nationally with the proposed ban of disposable vapes.

Locally, concerns were raised through groups such as the Young Peoples Substance Misuse Group and School’s Mental Health forum. Updates were provided to various groups throughout the project and the final summary slide set was received in July 2024.

The aim was to understand youth vaping in Merton, use this understanding to develop a pilot intervention and to then test that intervention.

This focus of the work came from insights of children and young people. Trading standards were members of the Task and Finish Group and during the initial stages of the project there was additional and national financial support for Trading Standard Teams to address vaping, but this was subsequently withdrawn which shifted the focus more to insights of young people.

The project was delivered over 3 overlapping phases which were Insights, Design and Intervention.

Insights involved 2 stages, the first stage was to understand what young people thought of vaping and the second stage was workshops. In total, over 750 views of young people in the community were gathered and this was used to improve and adapt the approach in Merton.

70% was the most common number given when asking young people to estimate how many young people vape. Young people felt that vaping was normalised and a cool trend which led to them vaping. Other feedback was that vapes were marketed to young people and although some knew the risks of vaping, others did not. Accessing vapes was easy from small chain shops either by sale of theft, family members and dealers.

Insights were mapped against the COM-B model of behaviour change and using behavioural tools they were able to map out best ways to support stopping and not starting vaping. Key topics highlighted were social confidence and saying no to peer pressure, motivation and knowing where to get the right support.

Kick the Cloud workshops were developed for parents and professionals to deliver to young people and included resources such as signposting links, leaflets, slide packs and social media resources. The workshops were delivered with young people and they found that the workshops helped to reduce the desire and motivation to vape, increased knowledge on where to find support and increased confidence to say no to vaping.

60 young people were also engaged in the focus group to test the messaging.

From parents, they learned that they did not know how to have conversations with young people who would challenge parents with their own research. Professionals were given lesson planning with slides and scripts, particularly for those who were new to the topic area as well as a range of options for different age groups.

Next steps included Catch 22,  ...  view the full minutes text for item 5.

Mark Creelman introduced the item.

In March 2023 NHS England were asked to reduce management cost by 30%, which was a cost that mainly related to people. They have embarked on a consultation, restructure and was nearly at the end of the entire process. This had an impact on teams and overall morale, the ICB (Integrated Care Board) commissioned support for staff including a range of support services. Over 550 people have been placed in the new structure with some people facing redundancy. 

The Annual Report was an opportunity to reflect on the work done. In terms of statutory targets and responsibilities, Southwest London ICB fared well compared to others although there was always room for improvement in areas such as mental health.

The ICB was there to be part of the NHS and to focus on NHS services, bringing partnerships together to focus on local residents.

A key focus for the ICB was to improve health outcomes and to tackle inequalities, particularly in East Merton. They needed to ensure that they remained productive and got value for money, this was not just about health as other factors like living conditions had an impact. Some communities did not want to work with NHS, and this was an area that needed to be addressed.

The ICB was a high performing system which did well in regard to waiting times and cancer treatment with the GP survey ranked highly nationally. They met their financial target last year, but this was a deficit target, the same as this year. Finances would always be a challenge in the short-term.

NHS app allowed most people to access care via the app but they acknowledged this was not the case for everyone.

There was an enormous amount of developing services in the east of the borough such as the Together Clinic, Paediatric Clinic, Respiratory Services and Care coordinators for all PCN‘s (Primary Care Network).

Health services were complex so it was important to come up with different ways of developing services and also learn from others by building relationships with families.

They were leading the way in Merton in terms of social prescribing and had wellbeing activities at The Wilson which received great feedback from local residents. The Borough of Sport remained important to promote social and physical activity whilst improving home based support for residents with the right support when discharged.

Due to financial challenges, it was important to ensure that what was done was affordable.

Rowan Park now had a GP practice who were signing the lease, they were now working on finding the right space in the building.

Stakeholders were invited to discuss utilising the rest of the space with the aim of being as creative as possible. The cost would depend on the partners, but it needed to be affordable, sustainable and long term. They already spoke with local Councillors to see what they would like to have and were extending this to others within the Trust.

The Wilsons was planned to  ...  view the full minutes text for item 6.

Mark Creelman introduced the report.

A key objective was for patients to be seen within 4hours when they went to A&E and to not have to wait in ambulances longer then necessary, St Georges Hospital did particularly well with this.

As part of the local schemes across Southwest London, Merton and Wandsworth placed particular focus on frailty with a frailty zone with elderly patients seen by specific team. Additional funding was also allocated to the discharge and personal care hub and into nursing within the ED department.

SDEC (Same Day Emergency Care) was an introduced model that allowed patients to receive a trusted assessment in the ambulance so that patients did not have to be assessed by a nurse.

St Georges Hospital had the Georges Line who tracked people from the front to back door and highlighted some of the pinch points.

Other schemes included the emergency community response and a virtual ward.

With primary care colleagues, additional funding was provided for a Merton residents phoneline which gave access to the GP Hub which, last year, prevented 81% of patients going to emergency departments.

In response to questions, the following was stated:

• Patients often had to wait a long time to receive medication after being told they could go home. Streamlining this process would save money. This was on St Georges line list which tracked in real time.

RESOLVED: That the Board noted the report.

Barry Causer introduced the report with support of Anthony Hopkins.

All forms of physical activity and movement was good. As part of Merton’s aim of being the Borough of Sport by 2026 they aimed to increase access to sport and wellbeing for residents with a particular focus on 5-16yr olds and 65+yr olds.

In order to achieve the ambitions, deeper collaboration was needed by internal and external partners. The report outlined a summary of the Borough of Sport projects and their impact. Programmes ouldl continue to be developed and tracked to measure the impact to improve the health and wellbeing of residents.

Examples of some of the work included being a dementia friendly borough with support from the Alzheimer’s Society, frontline training for social care and staff, family hubs and national pilots.

Merton were chosen by the Health Innovation and The Chartered Institute of Public Finance and Accountancy to pilot an approach to quantify prevention spend.

There were many sports and physical activity offers for youths alongside food programmes. The impact of these programmes would continue to be measured.

In response to questions, the following was stated:

• A press release was completed a few weeks ago which detailed all commissioned projects. Monitoring processes were being put in place so that they could report back on the impact of the projects.
• All 23 projects had started.

RESOLVED: That the Board noted the report.

Russell Styles introduced the report with the support from Kate Lees and Sandra O’Hagan

The report covered the period of 2025 – 2030.

The new strategy would take the marmot approach using the established 8 principles from the Institute of Health Equity on tackling health inequalities.

Reducing health inequalities was seen as socially good morally and ensured that no one was left behind in terms of their health and wellbeing. On average, those living in disadvantaged areas spent a third of their life in poor health compared to those who lived in less deprived areas who spent a sixth of their life in poor health. Health inequalities were systematic, avoidable and unjust.

The Council and ICB had legal duties to improve the health of the population.

The country remained economically challenged and health inequalities created an additional financial burden.

The consultation of the new strategy would take place from now until March and were keen to hear from communities to help form the strategy. The final strategy will be presented to the Health and Wellbeing Board in March 2025. Sandra O’Hagan and Kate Lees from Population Health will support with this.

Population Health would take on a facilitator role pushing things through whilst working alongside Merton, considering the complex Health and Wellbeing strategies.

The project started now would have a completed health and wellbeing strategy and a year 1 action plan to be presented at the Health and Wellbeing Board on 25 March 2025.

The first phased was planning and desk research. The second was engagement and analysis which would take place between November and January. The third phase was report writing.

Four ways that the Health and Wellbeing board could support the project were:

·       Project steering group with 6 meetings over the course of project

·       Speak and hear from all to have meaningful conversations

·       Support with community activities

·       Review and comment on document as they were developed

This would be a Health and Wellbeing Board strategy.

In response to questions, the following was stated:

• No budget was set aside for additional support and activities from smaller voluntary groups. The intention was to utilise existing groups, but they were happy to look into making sure they had the right representation. Insight from the project steering group would also help to address this.
• To represent the patients voice and lived experience it would be good to align with the local health and care plan.
• Keen to hear from all board members with regard to stakeholder recommendations, which could be fed into the Health Partnership Manager.
• The Annual Public Health Report was based on climate change and health. They were aware that climate change had more of an impact on the disadvantaged which would be considered.
• Including the young voice from the beginning by having a young inspector on the project steering group was welcomed.
• The Chief Executive of Merton Connected would be in contact with an invitation to their meeting.

RESOLVED: That the Board noted the report.

Dave Curtis introduced the report.

Healthwatch Merton carried out a needs assessment.

They were aware that Merton had an Eastern European population, mainly in the east of the borough, but did not know the demographic.

When recording data, Eastern Europeans were recorded as white other/non British which made up 22% of the population.

The EU Settlement Scheme showed that in Merton, there were 34,150 settled cases between 2018 – August 2024. These figures did not include Ukraine which were recorded separately. 25,695 cases were approved and settled with 20,000 pre settled applications.

176 people from the community were engaged for the needs assessment, with five focus groups and two one-to-one interviews. Topics covered within the assessment were access to healthcare, utilisation of health services and preventative care.

Key findings from the needs assessment showed low engagement from mainstream NHS services, overuse of A&E, mental health concerns, vaccine hesitancy and preventative care gaps.

Reasons given were language barriers and a poor understanding of how the system worked. 94.3% sought healthcare in their home countries, 88.6% chose to use private clinics in Merton, of those who used the NHS 68.2% reported difficulties with booking appointments and 67% were unaware of how to engage with the NHS.

92.6% visited A&E at least once, 42.6% would use A&E outside of hours for non-emergencies, 34.7% would call 111 for out of hours assistance and 22.7% were unsure what to do.

The assessment showed that 49.4% experienced mild depression or anxiety since moving to UK. Many within the community did not access the available support due to language barriers and the stigma of mental health within the community.

There was an alarming rate of vaccine hesitancy with only 10.8% staying up to date with vaccinations. 32% felt that they were poorly informed. Mistrust in the institution was recorded which could come from their home country.

49.4% reported no engagement in physical activity and 58.5% felt poorly informed on lifestyle factors which affected health. Healthcare promotional material which was more culturally sensitive could help with this.

In summary there were significant gaps in engagement, communication and trust.

There were six recommendations provided which were:

• Sustainable community engagement within the NHS centred around a two way dialogue approach.
• Design targeted interventions whilst preserving background and cultural identity.
• Culturally sensitive healthcare promotional material.
• Training and capacity building.
• Implementation and Evaluation.
• Policy changes to bring better representation for the community.

Although recording as ‘white/other’ may work in other areas of the country, it did not work for Merton due to the increasing population year on year.

In response to questions, the following was stated:

• The Local Executive Director invited Healthwatch Merton to the Borough Committee.
• It was important to create a space which looked at the impact on children, particularly suggestions from GPs around children who were brough to A&E as opposed to being registered with a GP.
• The voluntary sector wanted to develop growth in terms of groups that developed locally. Healthwatch Merton looked to  ...  view the full minutes text for item 10.