The minutes of the meeting held on 8 June were agreed as an accurate record.

There were none.

There was no urgent business.

Councillor Maggie Mansell attended an event on survivors of cancer - looking after health. She was a keynote speaker. Other speakers were survivors. It was an excellent initiative run by McMillan nursing - working with Croydon University Hospital (CUH) and other partner agencies.

AGM CUH - good initiatives are taking place, bringing together a number of departments. There is now a good process in place, making it faster from A&E to where treatment is provided.

There were none.

Paula Swann introduced the item and Dr Tony Brzezicki gave a presentation.

Cancer causes one in four deaths in the UK and kills around 945 Croydon residents each year. Despite this toll, cancer care is improving significantly and currently around half of those diagnosed with the disease survive for 10 years or more. Incidence of cancer and cancer deaths are lower than England averages but Croydon does have challenges, in particular around breast and bowel screening.

There is evidence that cancer diagnosis is lower than in other parts of Europe/the world and this is being investigated.

Screening has increased and this is improving with data being looked at earlier.

The New Addington letterbox survey, looking at lung cancer, enabled pharmacists to identify and refer patients to GPs. This proved very effective.

John Goulston thanked Dr Tony Brzezicki for his exceptional work, being the local lead for cancer, making Croydon ahead of other London boroughs in this area.
 

The following issues were raised:

• Croydon has a very different population to other boroughs. With high levels of BME, it is very diverse. This makes it difficult to make comparisons in the 6 nations study, where other participants have very different populations.
• Afro-Caribbean work - health inequalities have not been investigated in depth, particularly regarding the variation in cancer care and outcomes
• Smoking, neglect, poverty, housing - wider determinants of health contribute significantly to smoking rates
• Targeted focus in identified areas of high risk - services and intervention campaigns need to be highly targeted to reach group of highest risk of disease and mortality rates
• Bowel screening is a difficult area - done nationally so pharmacies don't know who has been sent screening kits in order to follow up - wasted opportunity as GPs can only get kits from the central hub
• Pharmacies are useful for identifying symptoms (coughing, excessive purchases of antacids etc) and referring to GPs - Be Clear on Cancer Campaign - needs more aligned communications strategy so pharmacies are tied in.

For further information on the government's Be Clear on Cancer campaign, read the press release here - http://news.croydon.gov.uk/cancer-prevention-work-set-to-increase/
 

Rachel Flowers gave a presentation.

• Rate of people presenting with HIV at a late stage is increasing
• There have been a few cases of measles in Croydon but we are keeping an eye on it
• Vaccinations for 5 year olds - now 3rd lowest in London
• Request HWB to give delegated authority to sign off JSNA ready for commissioning cycle - to CEO of CCG, Director of Public Health, and Executive Director of People

The following issues were raised:

• HIV testing - it is the responsibility of the local authority as part of sexual health commissioning - working on new ways of benchmarking
• Contraception for all women - need to address contraception and pregnancy to reduce impact on abortion services
• Croydon has unique problems due to its population diversity
• Dedicated multi-partner agency working to address low vaccinations
• Task and finish group being set up to identify where problems are and to come up with an action plan - will present to the Health & Wellbeing Board in a few months.
• Need to change how the JSNA works around trends.  All 3 statutory officers will identify and highlight areas of concern every quarter

The Board RESOLVED to agree delegation for signing off the JSNA as above.

Paula Swann introduced the item and Stephen Warren (Director of Commission CCG) summarised the report.

Mental Health day care services were previously re-commissioned in 2009. The report provides an overview of the Voluntary & Community Sector (VACS) Services, specifically those that are currently jointly commissioned by NHS Croydon CCG & Croydon Council, and have an impact on social isolation. 

The report identifies that there is a clear need to engage more with service users to determine people's views on service provision.

The following issues were raised:

• To what extent are services planned in a strategic way?  The current provision is based on the historical pattern 
• Crucial for future direction to determine the need for specialist services, by identifying the user profiles
• Recent reduction in funding for the voluntary sector has had a great impact in Croydon, particularly in mental health.  There are particular concerns about in-patients from BME groups
• Demand in Croydon has increased dramatically - 2 evenings in last week 7 or more people with serious mental health issues were seen in CUH
• Need to return to mental health adult issues at a future meeting 
• Are people able to get to day centres?
• Not just about services but about communities at different times of life and across diversity.
• Needs more emphasis on prevention, support and emotional wellbeing
• Croydon Drop In Service only covers those up to 18 years.  There are many people with substance and mental health issues but where can they go when they are over 18 years?
• Mental Health Strategy exists - update to be brought to the Health & Wellbeing Board
• Voluntary sector - health champions encourage gardening, art etc - focusing on emotional health and wellbeing

The Board NOTED the report.

Bernadette Alves (Consultant in Public Health) summarised the report.

Tobacco control in Croydon has two main strands: a stop smoking service (SSS) that is commissioned by public health; and broader tobacco control activities that are undertaken by several services within the council.

By the end of 2016/17, Stop Smoking Services will be delivered through the Councils‟ Live Well Programme, an integrated, holistic, health behaviour change service that aims to help people to stop smoking, maintain a healthy weight, drink alcohol sensibly, be physically active and be happy.

The following issues were raised:

• Smoking cessation services - concern about shut down of primary care network - will lose a lot of expertise.
• 70% of quitters represent a health danger
• How to encourage people not to start smoking?  Children of smokers are much more likely to become smokers
• Croydon College - there does not seem to be any work going on there to discourage students
• Need focus on keeping well programmes but concern about being able to get into schools which are not managed by the Council
• New post recently appointed to work on the healthy schools programme.  Half of the schools have signed up to it but those not signed up tend to be the ones with higher need - looking at how they can be reached more effectively
• Tobacco control - more strategic approach
• E-cigarettes - increase in use but tends to be those trying to give up, not new smokers
  • Some health concerns about some lung diseases, as no one really knows what the risks and benefits are.
  • In the short term they appear to be highly effective.
  • 95% safer than tobacco
  • Addiction is to nicotine and tar in cigarettes causes the problems but there is no tar in e-cigarettes
• Need to commission things differently - many people give up smoking without the cessation service
• Smoking cessation is one pillar in tobacco control - need a website for those trying self help
• Must recognise people who need support have other issues - obesity, poverty, drinking etc.
• Pharmacists are only being informed - they could be used more proactively - lack of consultation
• CCG does not know where services are located - current method of paying for outcomes is not best practice. 
• Looking at commissioning differently - model being developed with many components involving many agencies.
• Shisha bars - 14 in Croydon - tobacco with flavouring, smoked through a pipe - hoping new tobacco control strategy (from government in next couple of months) will include shisha
• Needs to be engagement and consultation about how diff future services will be from currently.

The Board NOTED the report and supported the proposed wider tobacco control approach.

Rachel Flowers introduced the item.  Ellen Schwartz (Consultant in Public Health) gave a brief summary of the report.

One of the four domains of public health practice is health protection, which includes infectious diseases, chemicals and poisons, radiation, emergency response and environmental health hazards.

• Work plan to ensure correct partners are around the table
• Addressed pandemic influenza

Issues to be covered at meetings:

• Screening (yesterday)
• TB in January 2017
• Child immunisation in May

There were no questions.

The Board NOTED the report.

The work plan for 2016/17 was agreed at the meeting on 13 April 2016. The work plan is regularly reviewed by the executive group and the chair. This paper includes the most recent update of the board work plan at appendix 2.

The Board RESOLVED to:

• Note the planned review of the local strategic partnership including the health and wellbeing board.
• Note risks identified at appendix 1.
• Agree revisions to the board work plan for 2016/17 at appendix 2.

The following reports were for information only:

Carers of over 65s - Experiences
Mental health - local perspective
Both reports can be accessed on the Healthwatch Croydon website here: www.healthwatchcroydon.co.uk/impact

The Annual Report 2015-16 can be accessed here:
www.healthwatchcroydon.co.uk/annual-report-business-plan

There were no public questions.