KINGSTON HEALTH OVERVIEW AND SCRUTINY PANEL

 

ANNUAL REPORT 2018-19

 

 

Foreword by Councillor Munir Ravalia, Health Overview Panel Chair, 2018-19

 

 

It gives me pleasure to introduce the latest Annual Report for the Health Overview Panel. Health Overview and Scrutiny committees are obliged to produce an annual report on their work and I am pleased to introduce this annual report as Chair of the Panel for last year. The report summarises the areas we considered during 2018/19 includes the introductory meeting we had at the beginning of the Administration’s new four year term of office following the local elections in May 2018.

 

A number of suggestions were put forward by the previous Administration.  We have listened to this and have taken some of these forward during 2018/19 (Child and Adolescent Mental Health Services and Dental Health Services) and others are planned for 2019/20 (Cancer Screening Programmes in Kingston).

 

We also continued the work of the previous year’s panel by inviting senior officers to look at the further progress with the question of Blue Badge Holder parking charges at Kingston Hospital and services for people with Emotionally Unstable Personality Disorders which was originally referred to the Panel by Healthwatch Kingston.

 

The Chair and Vice-Chair of the Panel have participated in the SWL Joint Health Overview and Scrutiny Committee which is continues to consider the developments of the South West London Sustainability and Transformation Partnership and how this will re-shape health services in South West London. 

 

I would particularly like to thank my Vice Chair, Councillor Anita Shaper for her support during the year, plus the contributions of Dr Liz Meerabeau, who took over from Grahame Snelling as Chair of Healthwatch Kingston, Dr Jane D’Souza, GP representative and Kate Dudley, Chief Executive of Kingston Carers’ Network and also the Councillor membership of the Panel.  I would like to take this opportunity to thank all of our partners from Public Health, Adult Social Care, South West London & St George’s Mental Health Trust, Kingston Hospital NHS Foundation Trust the Clinical Commissioning Group, for their co-operation and contributions to the work of the Panel during the past year.

 

 

 

Councillor Munir Ravalia

Deputy Mayor & Chair of the Panel 2018/19

21 June 2019


 

What we did in 2018/19 at a glance: 

                                                                                                                                               

 

JUNE MEETING

 

Introduction to the Health Overview Panel 

 

Update on the Sustainability and Transformation Partnership                            

 

                                     

 

OCTOBER MEETING

 

Update on Kingston Hospital’s Review of Parking for Blue Badge Holders      

Care Quality Commission Inspection of Kingston Hospital                                       

 

 

DECEMBER MEETING

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Improving the Mental Health of Kingston Children and Young People               

 

Referral from Healthwatch Kington – Services for Emotionally Unstable                                  Personality Disorder

 

 

 

APRIL MEETING

 

Dental Services and Oral Health in Kingston

 

 

QUESTIONS FROM MEMBERS OF THE PUBLIC

 

 

 

HEALTH SCRUTINY – what it is  

 

Councils with social care functions can hold all providers and commissioners of publicly funded health and social care to account for the quality of their services through powers to obtain information, request attendance at committee, ask questions in public and make recommendations for improvements which then need to be considered by the relevant health body.   Health and Social Care policies arising from the Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies are also included within the remit.  Where proposals for major changes to health services are not considered to be in the interests of local health service provision, as a last resort these can be referred to the Secretary of State for determination.   Health scrutiny also has a valuable pro-active role in helping to understand communities and tackle health inequalities.

 

1.         JUNE MEETING

 

1.1    Introduction to the Health Overview Panel

 

Following the local elections in May 2018 and the significant change in membership of the Panel our first meeting was introductory and we invited a number of contributions from the Democratic Services, Public Health and Social Care and the Kingston Clinical Commissioning Group (CCG) to give short briefings.

 

Democratic Services – The Team Leader spoke about the concept of health scrutiny which was introduced in 2002,  the objective being to hold the NHS and Local Authorities to account on health and social care with an important focus on health inequalities.  A further aim is to strengthening the voice of local people and ensure voices are taken into account.  Health Scrutiny proactively seeks information about how services operate to enable challenge and it can also be strategic and make recommendations for improvement. It employs constructive engagement rather than confrontational methods.  It does not deal with individual complaints but opens discussion on overall quality.   As a last resort, concerns can be referred to the Secretary of State and there is a need to demonstrate all steps are taken beforehand.   

Public Health – Iona Lidington, Director of Public Health gave a detailed presentation and explained that Public Health’s duty is to improve the health of the population and outcomes are based on the premise that “prevention is better, and cheaper than cure”.  

Mandatory services include sexual and reproductive health services, children’s health visiting services, children’s height and weight measurement, NHS Health Checks, provision of healthcare public health advice to NHS Commissioners (Clinical Commissioning Groups) and provision of advice on health protection, environmental hazards and extreme weather events and protecting the health of the local population.  Public Health also produces a range of borough based statistical information (available by neighbourhood and ward) plus needs assessments including the Joint Strategic Needs Assessment.   

Public Health is funded by a ring fenced government grant totalling just over £10m in 2018/19.  The Public Health grant has a number of conditions attached to it.  LAs must:

·         use it only for meeting eligible expenditure incurred or to be incurred by LAs of the purposes of their public health functions as specified in Section 73B(2) of the National Health Services Act 2016

·         have regard to the need to reduce inequalities between the people in its area with respect of the benefits that they can obtain from the LA’s health service

·         have regard to the need to improve the take up of and outcomes from, its drug and alcohol misuse treatment services.

Public Health produces an Annual Report and the report for 2018 was on Air Quality.

Kingston’s resident population is 176,107 people.  The number of those registered with Kingston GP practices is higher at 209,515 as this includes people living close to the borough boundary.  One third of residents are from Black, Asian and Minority Ethnic communities.  Overall Kingston has a young population with a median age of 36.2 years and almost 22% are aged 0-17.  However, the cohort of people who are very old and frail and who have multiple illnesses is increasing.    Life expectancy is 81.7 years for men and 84.9 for women and the years of good health are 69 years for both men and women.  The main cause of ill health is hypertension and there are four main determinants of health and wellbeing:  socioeconomic factors account for 40%, with health behaviours at 30% followed by clinical care at 20% and the built environment at 10%.  Mental health disorders are the largest burden of disease in England (23%) and affect 1 in 4 of the population at any one time.

Adult Social Care and Community Housing

Stephen Taylor, Director explained that the Directorate has just over half of the Council’s budget and aims to maximum outcomes from it.  He outlined the key stages and actions which are leading to help people to stay independent i.e. new health and social care integration approaches in community teams plus access to information particularly around self-help.  The Directorate has strong links with Public Health on prevention and trying to reduce the increasing needs of those seeking services.  He pointed to the key role the Health Overview Panel can play particularly in challenging the pace of progress of service integration.

There has been much focus on keeping people out of hospital where appropriate, and enabling discharges to be made as quickly as possible.  Kingston is the highest performing Council for reducing delays in transfers from hospital and is also a National Beacon site.  The Council has also in the past 12 to 18 months reduced the number of people in residential care homes by around 25% and this has been achieved by providing increased support to people in their own homes which has a number of benefits.

There are significant challenges for housing; considerable need but very little vacant housing stock.  However, Kingston has strong partnerships and commitment from senior officers in local health and care organisations.

The Connect Well Kingston initiative enables health and care employees to pick up on people’s needs and provide information about self-help, further support or advice.  A cultural shift in staff training is enabling staff to point to the strengths and resources people have within their families, networks and communities.  Initiatives are being planned to help tackle loneliness in a range of ways including within libraries. Some initiatives are local and Kingston based but others will operate across south west London to take advantage of economies of scale.

Kingston Clinical Commissioning Group (KCCG)

Tonia Michaelides Managing Director of Kingston and Richmond CCGs explained that KCCG is a Membership organisation comprising 21 GP practices with 205K registered patients including a proportion of patients from across the boundary.  CCGs are funded on the patient list unlike local authorities which are geographically based.

The CCG’s role is to plan and commission health services (with the exception of Public Health and specialist services) to meet the needs of local residents. The South West London CCG Alliance includes 5 CCGs and whilst most are federated (eg Kingston is paired with Richmond) none are formally merged.    A key priority is to deliver the South West London Plan.

The KCCG has a budget of £255M of which £133M is spend on hospital care, mainly at Kingston Hospital. A key aim is to shift spend away from hospitals to strengthen community services.  Other expenditure includes £30M on GP primary care, £22M on mental health, £22M on community health services, £21M on prescribing and £17M on continuing healthcare.

The CCG has 137 metrics and achieved 105 of these in the last year.  Those which weren’t achieved (in common with other CCGs) were:

·         A&E waiting time > 4 hours (Kingston Hospital)

·         Ambulance handover time (within 15 minutes) – London wide

·         NHS 111 calls answered within 60 seconds

·         Mixed sex accommodation – occasional breaches but clinical care comes first

·         Proportion of patients referred to first outpatient services via e-referral service

·         Proportion of QIPP schemes (Quality Innovation Productivity and Prevention)

Achievements include:

Primary Care

·         Increasing primary care capacity from 8am to 8pm, seven days a week

·         Introduction of the Kingston Medical Services contract which will equalise services across practices

·         Increasing GP access to expert advice to prevent unnecessary outpatient appointments

·         Rollout of the Macmillan social prescribing pilot

Mental Health

·         Faster access to mental health care at Kingston Hospital A&E

·         Developing a single point of access for mental health services

·         Remodelling adult ADHD services

·         Reducing waits for autism services

Kingston Co-ordinated Care – this is a mechanism to identify and support people with complex health and social care needs in Kingston utilising multidisciplinary teams developed around GP practices of approx. 8,000 to 12,000 patients.

Tonia Michaelides confirmed that the CCG had no concerns about care at Kingston Hospital and the performance on A&E is good compared with many other hospitals.  Tonia is the Senior Responsible Officer for Mental Health in South West London and whilst there has been greater investment in SWL mental health services, more investment is needed. Examples of progress include access in A&E to mental health specialists, introduction of the single point of access, the new retreat crisis house in Malden and the remodelling of Attention Deficit Hyperactivity Disorder (ADHD) and Personality Disorder services.    

 

1.2     Update on the Sustainability and Transformation Partnership

 

Tonia Michaelides spoke about the Strategic and Transformation Partnership (STP) which is the strategic plan for healthcare in south west London. The initial version was published in October 2016 and a one year on discussion document was produced and feedback sought via a range of engagement methodologies.  The plan continues to be developed.  It was confirmed that there are now no plans to close hospitals in London but there will be changes to the services which will be provided.  Care is best and most effective when centred around the person not the organisation and work is taking place to change clinical models and the way in which care is accessed.  Twenty years ago most care was delivered in inpatient settings but now this is mainly delivered as day care. The Partnership will develop eventually into a wider care partnership rather than being more strongly focussed on health care.

The STP takes account of clinical standards, clinical sustainability and the financial challenges facing south west London and these factors will change how services are delivered in the future.  It has identified that children and young people’s MH is a key area to progress as this will significantly affect future demand for a range of health and social care.   It is also taking account of what people have said to CCGs e.g. the desire for integrated health care, explaining a single story and independent living.  There has been much grassroots engagement and this has been very positive for senior health managers and enabled a much better understanding of people’s viewpoints.

The most important area locally is the development of the Local Health and Care plan through the Health and Wellbeing Board in the coming months and this will be shared with the Health Overview Panel at a future meeting.

 

 

2.        OCTOBER MEETING

 

2.1   Update on Kingston Hospital’s Review of Parking for Blue Badge Holders       

The Panel considered the question of charging for Blue Badge Holders at Kingston Hospital at its meeting on 21 February 2018.  After that meeting the hospital suspended parking charges for BBHs.  Ann Radmore, Chief Executive of Kingston Hospital, and Sally Brittain, Director of Nursing and Quality, attended the Panel in October 2018 and spoke about the progress with the Hospital’s review. The Panel received Kingston Hospital’s report to its Executive Management Committee held on 8 October 2018 which explained the timeline, the structure of review, the equality duty, the survey outcomes, the options considered and the conclusions.  The recommendations considered and agreed by the EMC were:

a)  introduction of a flat rate charge of £2 for Blue Badge Holder parking (not including staff, who are covered by a separate policy);

b)  to improve communication on how to claim financial support and look at improved mechanisms for claiming; and

c)  to position BBH spaces closest to the locations in most demand.

It was explained that the £2 flat rate charge would be introduced on 7 January 2019 giving enough time for publicity.  This would enable BBHs to park all day and this is the hourly rate for all other users.  Income from these charges would be used for car parking purposes including the introduction of new arrangements to register BBH vehicles.   A number of points were raised in discussion both by people in the gallery and by members.  Whilst the Hospital would prefer not to introduce charges it was explained that the hospital did not have the funds to operate a car park without charging.  The National NHS Refund Scheme covers travel costs, including parking, for people on low incomes and the Hospital administers this on behalf of the NHS for patients attending the hospital.  It was agreed that the hospital would display notices about the scheme more prominently.  She also agreed to provide a further report on implementation and monitoring in due course.

Following discussion the Panel agreed to send a formal letter from the Chair of the Panel to Kingston Hospital requesting that:

·         the hospital reconsiders its intention to introduce a flat rate £2 charge for BBHs and to replace it with a scheme for BBHs of 3 hours free parking followed by a flat rate £2 charge thereafter;

·         further information is provided to the Panel about income estimates supporting the decision to charge BBHs;

·         the Hospital introduces monitoring arrangements for frequency or attendance/charges, those eligible for reimbursement under the NHS

 

The Hospital’s EMC considered the letter and responded in detail to the Chair but upheld the introduction of the £2 flat fee for BBHs.

 

2.2     Care Quality Commission Inspection of Kingston Hospital                       

The report to the Panel prepared by the Democratic Services Officer provided a detailed summary of the key findings set out in the Care Quality Commission’s (CQC) Inspection report published on 30 August 2018 following inspections in May and early June 2018.  The overall rating for the Trust has lifted from “Requires Improvement” in June 2016 to “Outstanding” in August 2018.

Five key areas are pursued in all inspections and aim to identify whether services are:

·         Save – protecting patients from abuse and avoidable harm

·         Effective – care, treatment and support achieves food outcomes, maintaining quality of live and is based on best available evidence

·         Caring – patients are treated with compassion, kindness, dignity and respect

·         Responsive – services are organised to meet the needs of patients

·         Well-led – leadership management and governance enable provision of high quality care based on individual needs and encourages learning and innovation and promotes a fair and open culture.

 

Two “outstanding” scores were received for Caring and Well-led enabling the Trust to be rated as “Outstanding” for quality overall and Ann Radmore, Chief Executive, presented on the main inspection findings which were:

 

·         A consistent and overwhelming focus on safety for patients and their wellbeing

·         Staff going the extra mile every day and using their creativity and initiative to care for patients

·         Staff working effectively, cohesively and happily together in a wide range of teams across the hospital

·         Individuals and teams living our values and respecting patients and each other

·         Staff working within understood and laid out systems to keep services safe and effective.

·         No “Must Do” actions were identified by the CQC

Other positive points made by the CQC were:

·         Clear, strong clinical leadership presence in the emergency department

·         Staff took time to interact with patients and those close to them in a respectful and considerate way.  Patients told the CQC that they valued their relationships with staff and felt they often went the extra mile when providing care and support.

·         Good standards of infection prevention and control.  All areas were visibly clean and staff adhered to bare below the elbow protocols

·         Patient nutrition and hydration needs were assessed and met

A number of “Should Do” actions were identified for outpatients, the Emergency Department (ED) and Medical Wards. 

A Use of Resources Assessment was also undertaken (KHFT was just the fourth trust in the country to undergo this new assessment process).  The Trust has been identified as being efficient with the management of resources in the face of operational demands.  However, the overall rating was “Requires Improvement” because the Trust has been unable to meet its financial plan for the previous financial year 2017/18 (an adverse variance of £6.9m against the agreed control total of £0.9m surplus).   

The Panel and Healthwatch congratulated the Trust on the achievements in the CQC inspection and agreed to send a formal letter of congratulations is send to the Trust.</AI7>

 

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3         DECEMBER MEETING

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3.1    Improving the Mental Health of Kingston Children and Young People

The report from the Kingston Clinical Commissioning Group provided a good range of information about the current services.  The scope included:

·         Present key national and local policies

·         Set out current population needs

·         Local health inequalities and risk factors

·         Outline local responses to the mental health needs of vulnerable groups

·         Map of local system of mental health support

·         Identify current system challenges

·         Focus on place based approaches to addressing mental health needs of children and young people.

It referred the 2017 green paper “Transforming Children and Young People’s Mental Health Provision” which highlights new objectives for mental health support teams in schools, a four week waiting time standard and a senior lead for mental health in schools and colleges.  The Children’s and Young People’s Plan, also published in 2017, focuses on outcomes for wellbeing and resilience which are being taken forward in the local Health and Care Plan 2019/21.

Key statistics for Kingston included:

·         42,144 people aged 0-19 (24% of the local population)

·         4705 children are living in poverty

·         2735 children with special educational needs

·         54% of children living and attending a school in Kingston are from a minority’s ethnic group

·         76% of secondary children achieve 5 or more A* - C GCSEs

·         98% are in employment, education or training at age 16

The “Tiered” model of care was introduce in 1995:

·         Tier 1 - Early intervention and prevention provided by schools, children’s centres, health visitor, school nurses GPs, voluntary and independent services.

·         Tier 2 - early help and targeted services

·         Tier 3 - Specialised CAMHS and eating disorders

·         Tier 4 - inpatient provision. 

The Tier system relates to the “Thrive” Model which was developed in 2014 by the Anna Freud Centre Consortium in consultation with young people and parents.  This promotes coping and self-management before problems become entrenched. It complements the Children and Young People Improving Access to Psychological Therapies Model (CYP IAPTS). 

The Emotional Health Service is a key part of the service offer and is provided by Achieving for Children (AfC).  In the past year referrals have increased by 18%, and rising, and 85% are seen within 8 weeks of the request for an initial appointment.  However, there is a significant wait for treatment following the initial appointment eg:  Psychology - 4-5 months; Art Therapy - 4 months; Family Therapy - 6 months. Information about waiting time data was presented on page A14.

Main challenges facing services locally include:

·         Increasing demand for all services increasing waiting times to access treatment

·         Increasing demand for Autistic Spectrum and Attention Deficit Hyperactivity Disorder neuro developmental assessments

·         Supporting schools to respond to mental health concerns.

The CAMHS Transformation Programme is a 5 year programme to:

·         Build capacity and capability across the system

·         Rollout CYP IAPTS

·         Develop community based eating disorder service

·         Improve perinatal care

·         Work to better integration of education and local CYP mental health services around the needs of individual children.

Key achievements of the programme in the last 3 years are:

·         Provision of training to schools

·         Introduction of online counselling, support and advice

·         Expansion of the Single Point of Access to deliver telephone triage

·         Increased support in A&E

·         Increased staffing

·         Increasing access to support

The Transformation Programme Strategy is a technical document refreshed annually by the Clinical Commissioning Group (CCG) and Achieving for Children (AfC) annually for submission to the NHS England.

During her presentation, Doreen Redwood, Lead Children’s Commissioner introduced a detailed map of the local system of care which explains how people move through the services and information about services and activities across Kingston plus the money and the workforce.

Emotional problems are most prevalent in children aged 2-5 years and one in 8 children aged 5-9 have had a disorder. Rates of disorder increase with age.  Young people aged 17-19 show increased mental health difficulties and there is also an increase in prevalence between aged 5 and 15.  However, behavioural and hyperactivity problems have remained relatively unchanged since 1999.

Diana Cassell, Consultant Child Psychiatrist, South West London and St George’s Mental Health Trust presented information on the South London Mental Health and Community Partnership (SLP) which covers 12 CCGs stretching from Bexley and Bromley to Kingston and Richmond.  It includes Oxleas NHS Foundation Trust, South London and Maudsley NHS Foundation Trust and South West London and St George’s NHS Mental Health Trust, which together deliver services to a population of more than three million.

SLP achievements for children young people include:

·         38% reduction in out of area occupied bed days

·         Decrease in the average out of area distance from home from 73 miles to 44 miles

·         A new CAMHS Psychiatric Intensive Care Unit (PICU) in Beckenham, South London  

·         £4.63M investment in service improvements including in expanded Adolescent Outreach Team in SWL

Details were provided about Kingston use of Tier 4 in patient services which showed that under the new care model there has been a significant reduction in the number of occupied bed days and South West London and St Georges has provided a larger proportion of in-patient care (approx 81%) 

Dr Cassell explained that the SLP is working to improve the experience of those who require hospital admission and to reduce the length of stay and where possible avoid admission.  Admission for young people is disruptive in itself.  The new CAMHS Psychiatric Intensive Care Unit (PICU) is located at the Bethlem Hospital in Beckenham which is a 40 mins drive from Kingston.  Whilst this is not local for everyone, it is important to have a unit in south London and it has helped to reduce occupied bed days. She also outlined the work of the Crisis Team, the CAMHS forensic service and the links being forged with social care to avoid unnecessary residential placement and hospital care.

Whilst the CAMHS Transformation Document provided much information, members pointed to its complexity and it was agreed that the Chair and Vice Chair would meet with Diana Cassell and Doreen Redwood to identify further areas for consideration at a future meeting using a different approach.

 

3.2     Provision of Specialist Personality Disorder Services in Kingston – Progress Report

In December 2017 Healthwatch Kingston submitted a formal written request under statutory powers asking the Panel to consider the specialised provision for people with complex Emotionally Unstable Personality Disorder (EUPD) in Kingston because unlike other nearby boroughs Kingston residents had no access to specialist services. It is estimated that 536 people in Kingston have EUPD. 

 

The Mental Health Lead at Kingston CCG, confirmed that the CCG recognises that this group of people is not well-served and it would be undertaking a three months’ demand and capacity review and expects to be in a position to report in April/May 2018 to enable plans to be made for the future.  Dr Moore added that it would be possible to make some changes in year. It was agreed that there would be a follow up report to the Panel and this took place at the meeting in December 2018.

 

The report stated that the CCG committed funding in the 2018/19 to provide an extension of existing PD services and is working with South West London & St George’s Mental Health Trust (SWLSTG) to implement an interim specialist PD service which will be initially Dialectic Behavioural Therapy (DBT) – a form of Cognitive Behavioural Therapy (CBT) for people who experience intense emotions.  It had not been possible to appoint clinicians trained in DBT to enable the service to be put in place as quickly as anticipated. In the longer term a service will be commissioned in collaboration with Richmond CCG.  SWLSTG is undertaking a review of PD services across SWL and the outcome will inform the final service model.

Current services such as the primary care based Systems Training for Emotional Predictability and Problem Solving (STEPPS) programme and the new Managing Emotions Programme are helpful for people with mild to moderate problems.  There are also existing secondary services including psychotherapy and the SUN project.

The Panel heard that in-patient treatment was not generally suitable for people with PD and whilst patients prefer individual therapy, group therapy is more cost effective although both are offered. 

The Medical Director of SWLSTG pointed out that in the past personality disorder was not treated but views and treatments have now altered.  He explained that whilst personality is difficult to change, interventions can help people to understand the impact of their behaviour on the people around them and people can change as they become older.  People with PD are often frequent attenders at A&E and primary care and the Trust is working with the CCG to shorten the pathway.  The Panel also heard that support can be resource intensive especially for those with severe problems.

The Panel requested confirmation of the date for introduction of the new interim Dialectic Behavioural Therapy service has commenced.

 

4         APRIL MEETING

 

4.1    Dental Services and Oral Health in Kingston

 

Dr Andrew Cross, Corporate Head of Healthy and Resilient Neighbourhoods & Consultant in Public Health gave a presentation on Dental Health Services and Oral Health in Kingston. 

NHS England is responsible for commissioning NHS dental services including, primary dental services, community, specialist and out of hours services to cover both routine and urgent care (private dental services are not covered).  There are 26 NHS dental practices distributed across the borough.  Any treatment that is clinically necessary to protect or maintain good oral health is available on the NHS and whilst most people will pay a contribution, some groups are entitled to free care. 

Levels of access to NHS Dentists vary across Kingston with Tudor ward having the highest access rate (72.6% of children accessing an NHS dentist in the two years up to March 2017) and St Mark’s ward having the lowest access rate (46.7% of children accessing an NHS dentist in the same period).  In terms of age, 63.4% children aged under18 in Kingston have accessed an NHS dentist in the last 24 months, but only 37.7% 0-5 year olds. Variation in uptake of services may be related to many different factors including: fear of the dentist, cost (or perceived cost), socio-economic status, ethnicity and looked after children.

 

Local Authorities i.e. Public Health are primarily responsible for oral health promotion although dentists have an important role to play.  Kingston, along with a number of boroughs across South London, have funded an oral health promotion service which is commissioned by NHS England and is delivered by King’s College Hospital.  This provides oral health promotion interventions targeting those at greatest risk of poor health outcomes.

 

In 2015-16, 1.1% of 5-9 year olds in Kingston had a tooth removed in hospital and this was the 8th highest rate in London.  In 2018 work took place looking specifically at children’s oral health which identified a number of key issues: 

 

·         Kingston has some scope to improve outcomes for children

·         Preventative advice could reach some families earlier and could be more comprehensive

·         The local environment is not always helpful for oral health

·         Important to ensure systems are in place for oral health advice to reach all Kingston’s communities

 

Health Visitors (HVs) have an important role in dental health promotion.  HVs are registered nurses and midwives who have additional training in community public health nursing to provide a proactive, universal service for children aged 0-5 years.  They distribute toothbrush packs at the 1 year and 2½ year health checks and at other appropriate times, for example, during talks on weaning and at drop-in clinics where oral health is discussed.  A particular focus is given to families who are considered to be more vulnerable to health inequalities and where more intensive work is being undertaken. Other recent actions include:

·         Training for the health visiting teams

·         Ensure colleagues in school health are equipped with the skills to deliver messages to schools regarding healthy food and drink policies and lesson plans around this topic

·         Ensure targets around the reduction of tooth decay are introduced into the specifications for school health and health visiting.

 
The Panel heard further information from a number of professionals attending the meeting.  The national programme - Start well - includes a range of initiatives for getting children to see dentist early, even before the teeth arrive, and regular publicity is needed about signposting and dental care being free for children. There is a single pathway across London for paediatric community dental services (CDS).  The CDS filter out what can be done locally and cases where needs are more complex are forwarded onto hospital i.e. King’s College Hospital.  It was reported that there has been a reduction in need for general anaesthetic (GA) during treatment. 

Access by vulnerable groups is good locally and the CDS is accessible by homelessness population however, there is always more work to do for this group of people.  The Panel also heard that there are strategies being developed for people in residential homes and those with impaired movement.  A wide ranging discussion was held  and the Panel raised a number of useful points including about the JSNA survey, why the level of dental extractions in children is relatively high in Kingston whether teaching about teeth needs to  be more about dental health rather than purely biological science and the need to capture information about the use of adult services and that looked after children have access to the community dental service and information is disseminated in a number of different languages.

The Panel requested an update on the Kingston Children’s Oral Health JSNA once a full year’s data is available is brought to a future meeting for noting.

 

QUESTIONS FROM MEMBERS OF THE PUBLIC

 

At the beginning of each meeting we have up to 20 minutes for members of the public to ask questions on items which are not on the agenda.  During the course of the year we received a number of questions:

 

·         Kingston Mental Health Carers’ Forum seeking information on the progress with the Thrive Kingston Mental Health Strategy and especially providing details for people who have experience of mental health and who contributed the development of the strategy.

·         Requests have been made for details of social care provision and performance, similar to what is available in other boroughs and also the process for accessing social care assistance and assessment.

·         Members of the public put forward suggestions for future scrutiny including the work of Crisis Cafes, the use of the NHS111 service and the closer relationship between GPs and Community Pharmacists and also whether the Panel should be undertaking pre-decision scrutiny on important decisions being taken by the Council.

·         The introduction of charges for parking at Kingston Hospital for Blue Badge Holders (a full report was consider at a subsequent meeting of the Panel (see details for the October meeting).

 

 

Link to Health Overview Panel Minutes, Agendas and Reports:

 

https://moderngov.kingston.gov.uk/ieListMeetings.aspx?CommitteeId=233

 

Marian Morrison, Democratic Services Officer

20 June 2019