Apologies were received from Chris Lee (Director of Environment and Regeneration) and Dr Andrew Otley.

There were no declarations of interest.

RESOLVED: That the minutes of the meeting held on 23 November 2021 were agreed as a correct record.

4a) Situation Assessment Report

4b) Vaccination update

The Director of Public Health presented the report and gave an overview of the most up to date Covid-19 statistics within Merton and London.   The main message was good news, the infection rate was down, and the pandemic was declining.  Although the volume of infection was still high, it was moving in the right direction.  Despite the spread of Omicron, the impact on hospitals was much lower than previously.  There have been large outbreaks in schools, particularly in primary schools where the children are not vaccinated, but the health impact on children is generally mild and is not translating into severe illness or hospitalisation.  No significant difference in infection ratios between East and West Merton or by ethnicity.  Although there had been concerns over testing supplies over Christmas and New Year, tests did not run out in Merton.  Fatalities due to the Omicron wave have been low. 

In response to further questions the Interim Director for Community and Housing reported that mandatory vaccination of Health and Social care staff comes into force by 1 April, requiring first doses of vaccination to be administered by 3 February.  100% of directly employed staff have been vaccinated.  Of around 350 care staff working for external providers, 18 are firm refusers, although none of the 30 home care providers are reporting problems.

The Locality Executive Director Merton and Wandsworth CCG, reported that the data on NHS as was still being collected, but around 90% of staff in trusts were vaccinated or fully vaccinated. Of 22 medical practices in the borough, five have requested additional support.  We have on our website information for employers on vaccination and we have introduced an overseas vaccination verification process, so that where employees have been vaccinated overseas, we can validate them.

The Director of Public Health reported that although there was a cohort of firm refusers, it was believed that if we were able to answer their questions and concerns, we would be able to encourage some of them to take the vaccine.  We have a hotline that will cater for bespoke questions for those concerned about the vaccine.

The Director of Public Health also reported that while education may be impacted by staff who are unvaccinated, we are increasing opportunities to get the vaccine, including in schools, and reducing barriers where we can, and increasing communications to encourage further uptake of vaccination amongst teaching staff and reduce the impact of unvaccinated teachers having to isolate following a close contact.

In response to concerns about low vaccination rate in private care providers, the Interim Director for Community and Housing reported that although some of the private care providers in Merton covered an area larger than Merton itself and that might affect their overall statistics, the figures for staff in Merton were not a cause for concern.

The Chair of the Safeguarding Adults Board presented their annual report.  Two significant points to note were that importance of being able to maintain high safeguarding standards during the pandemic, working in a different way and responding in a different way.  There were also a lot of new members of the Board, which meant ensuring that they had robust methods of working in partnerships in place.  The report highlights that there was an increase in the number of referrals during the pandemic, not just from partner agencies, but from the public as well.  Not all concerns raised became full cases, but the increase in referrals demonstrated that the work and processes of the Board were trusted. 

There has been a focus on increasing partnerships and working with care home managers, particularly as COVID restrictions have prevented families from visiting relatives in care homes and that work is now fully established.

For the first time we are beginning to look at the impact of protected characteristics on safeguarding referrals.  The data show some differences in the referrals between the various ethnicities across the borough, which will inform future efforts in communicating what safeguarding is.

In response to questions the Chair of the Safeguarding Adults Board reported that in the future they would like to see a continuation of the partnership work with a focus on what the Board can give over and above the work of each individual agency. To provide an overview in a wider safeguarding arena and to look at capturing vulnerable people who don’t fit into the traditional categories of those needing assistance. Working towards a greater emphasis on preventative work through multi-agency working.  There was also more work to do across the different communities within the borough to promote the role of safeguarding. 

The Chair of the Safeguarding Adults Board also confirmed that adult serious case reviews are published, at least in part. None were published last year, but there were some in process that will publish in 2022.

The Chair of the Safeguarding Adults Board confirmed that while the number of referrals were increased, this wasn’t in itself of concern as the previous reporting numbers had been quite low relative to the wider region. She commented that this represented a greater level of awareness and prevention of safeguarding issues, with an appropriate conversion level reported of referrals to signposting and further action.  The Chair agreed that more work needs to be done to ensure that the understanding of safeguarding does translate into the cultural and linguistic understanding within all the communities and contexts across the borough.

The Public Health Consultant presented the report.  In addition to the focus on healthy weight and diabetes action plans, the report also highlighted the impact of the COVID pandemic.  We have seen significant increases, although they are comparable with wider London levels, notably a 7% increase in overweight/obese levels in 10-11 year olds.  This is exacerbated by the closure of leisure facilities and the challenges around affordable food and the increase in food poverty. There is also a link between mental health issues, stigma and the increase in eating disorders.

The priorities for the future are to focus on communications and training to embed a family approach to providing support for children including the development of a children’s social prescribing pilot which will focus on healthy weight and low level mental health issues. 

The burden of diabetes has increased across the borough. The pandemic has had an impact on access to services, so there has been a reduction in new diagnoses, but there has been an increase in obesity among adults, which increases the risk factors for diabetes. 

Future work will emphasise increased access to education programmes and particularly target South Asian communities. 

The third focus is on healthy place – how the environment shapes opportunities for physical activity and our food choices.  Priorities for the future include refreshing our health policies and looking at how we can embed a sustainable food environment with a focus on sugar and sugar reduction, physical activity and active travel.

Both child healthy weight and diabetes are health equality issues, we know there are much higher rates in the east of the borough and in minority communities.

In response to comments, the Public Health Consultant acknowledged recently published links between breastfeeding and obesity and confirmed that although not highlighted in the summary, the more detailed plan did include detail of the ongoing work on promoting breastfeeding support.

The Public Health Consultant also highlighted the work the Family Start Service, delivered by the school nursing service, based on a successful pilot in Richmond, which works beyond diet and exercise to remove stigma, accessed through the NCMP (National Child Measurement Programme), administered by CLCH (Central London Community Healthcare).  One You Merton also offers support to adults. 

RESOLVED: 

1. That the Board Considered and endorsed the Health and Wellbeing Board’s refreshed Child Healthy Weight Action Plan (2022-2025) and noted the update on the Tackling Diabetes Action Plan (2019-2024).

2. The Board championed the priority for ‘healthy place’

3. The Board considered how Board members could champion and support the priority for making child healthy weight everyone’s business and in particular the implementation of the communication and engagement plan.

4. The Board agreed to retain the current governance structures for the oversight of the action plans.

The Locality Executive Director for Merton and Wandsworth CCG, presented the report, highlighting the planning guidance that came out on Christmas Eve changing the ICS (Integrated Care Systems) implementation date from 1 April to 1 July 2022.

The Director outlined the membership of the Merton Borough Committee and expected to have all members confirmed by the next meeting of the HWBB.  The Committee will sit alongside Merton Health and Care Together Board (MHCT) and the two will work closely in partnership together

The questions for the HWBB to answer were whether they felt anyone was missing from the membership and how they would the HWBB like to be assured that the Committee is integrating and aligning to the priorities of the HWBB.

In response to questions the Locality Executive Director confirmed that the HWBB will continue to provide strategy and priorities for health and wellbeing, with Merton Health and Care Together reporting to it which, along with the new Borough Committee will drive forward projects.

The Senior Child and Adolescent Mental Health Service (CAMHS) Transformation Manager presented the report.  The plan has been published in draft.  Although the CCG is now across the six boroughs of SW London, there is still a local approach.  The aim is to make it easier for children and young people to access support and improve the organisation of services to complement that ease of access.  The aim is to provide equity rather than equality, as treating everyone the same assumes that all users are starting from the same place, this won’t provide appropriate assistance to every person, and we need to recognise that different people need different elements of support.

By the end of February, all public schools in Merton will have access to Emotional and Mental Health Support.  We are now seeing more complex referrals coming into the CAMHS pathway, and the service is increasing its capacity to help schools manage the challenge they experience whilst young people are on waiting lists, where brief interventions may be helpful.

Work is ongoing to fully staff services to Youth Justice and Learning Difficulty sectors.  Although funding is coming through the system, there is a challenge in recruitment, and this is a national problem, not just for SW London. 

In response to questions the Transformation Manager highlighted the work of the talking therapies which have worked in the barber shops of Mitcham to engage with young people in a non-clinical environment. They have also promoted Emotional and Mental Health leads in Schools and Kooth, an online talking therapy forum which is anonymised so young people can log on and seek help.  There is more work to do, Young Inspectors will play a part and this is an area of focus for the future.

The Transformation Manager also informed the Board they are speaking with schools and other interested parties to improve step up and step down support, so there are no sudden holes in support and this work is ongoing.

RESOLVED:

1.         The Board considered how members can support delivery of the priorities of the Local Transformation Plan

2.         Agreed the South West London Local Transformation Plan refresh.