Agenda item

The Board is requested to note the report and to discuss performance.

Tracey Cogan, Head of Public Health, NHS England, East Anglia and Dr Shylaja Thomas, Screening and Immunisation Lead, NHS England, East Anglia and Public Health England introduced a report and gave a presentation to the Board which provided an update on screening and immunisation. Key points highlighted included:

·         The presentation followed a recommendation from the Peer Review that the Board should be assured and informed of the performance around screening and immunisation in Peterborough;

·         It was agreed that exception reporting would be undertaken going forward to each meeting of the Health and Wellbeing Board;

·         The report was vital and it needed to outline the progress made in each area. Improvements needed to be made in screening rates;

·         The presentation highlighted the commissioning arrangements, the delivery arrangements and the current picture for Peterborough;

·         There were a number of programmes currently commissioned by NHS England East Anglia  for the population of Peterborough;

·         There were a number of delivery arrangements including GPs, the Cambridgeshire and Peterborough Foundation Trust and Cambridgeshire Community Services, amongst others;

·         An overview of the Abdominal Aortic Aneurysm Screening Programme was provided. This screening programme was based on lowering mortality rates in men;

·         Community Pharmacies had been commissioned for the first time in 2013 to support GPs for the delivery of flu immunisation programmes within at risk groups;

·         Performance processes were outlined, including quarterly Screening Programme Boards and the inspection of the screening service on a three yearly basis amongst others;

·         The Childhood Flu Programme had been rolled out in a pilot programme 2013, this being a nasal spray vaccine licensed for use of children between the ages of 2 and 16. The main benefit of giving the vaccine to children was to ensure the illness was not passed on to adults within the family. It was to be piloted in secondary schools in 2014;

·         The Performance and Quality Monitoring Group met monthly, with a number of Boards feeding into it. Performance could be monitored and actions identified in order to bring performance back on track if required;

·         The majority of immunisation and screening programs were doing well in Peterborough including breast screening uptake rates and diabetic eye screening uptake rates;

·         Across the programme, 25% of those booked in for abdominal aortic aneurysm screening appointments failed to attend. Further work needed to be undertaken in order to highlight the importance of this screening;

·         Improvements needed to be made in relation to uptake for some other screening programmes, such as bowel cancer and cervical screening in younger women, and improvements also needed to be made in relation to the uptake for some immunisation programmes, particularly flu immunisation programs; and

·         A number of recommendations were highlighted within the presentation in order to progress the issues forward, these being:

i.      For the Board and individual member organisations to work collaboratively with NHS England and Public Health England to promote screening and immunisation in Peterborough;

ii.    For the Board and individual member organisations to work in partnership with NHS England and Public Health England to address the lower uptake by particular groups, including those from deprived and ethnic communities;

•      Cervical screening in younger women

•      Bowel screening

•      Childhood immunisations to achieve 95%

•      Flu vaccinations for ‘at risk’ groups and pregnant women to achieve 75%

iii. To agree the setting up of a task and finish group with multi agency membership to implement recommendations 1 and 2 above

Members were invited to comment on the presentation and points raised and responses to questions included:

·         Further work needed to be undertaken as to the reasons behind people not attending their screening sessions;

·         Younger women were becoming increasingly less likely to undergo cervical screening, and this was a trend seen across the country, not just in Peterborough;

·         Extended hours or evening clinics may be a solution to the problem of low uptake of cervical screening;

·         The Cambridge and Peterborough bowel cancer screening programme had low uptake in comparison to other authorities;

·         It needed to be identified where the health promotion budget sat;

·         There appeared to be little in the way of clear strategy outlined within the presentation;

·         A further presentation was needed with more locality-specific analysis to be able to analyse problems and present data in a way more suitable to the Health and Wellbeing Board’s remit;

·         The decisions around age limits for screenings were made by the National Screening Committee, a body of Public Health England, all decisions being backed by evidence before being implemented as policy;

·         If at risk people were identified early, such as those at risk of flu, this would improve outcomes in the long term;

·         There needed to be a more proactive approach to screening and immunisation in order to provide greater value for money and greater uptake. If evidence could be gathered as to the savings that proactive improvements would make, this could make obtaining future finances easier;

·         It was suggested that in the first instance, further work be undertaken via the Health Enquiry Group, which was led by Cathy Mitchell, CCG, and Dr Henrietta Ewart, Interim Director of Public Health. This work would identify whether there were opportunities to work differently and how to achieve better engagement. It was further suggested that Healthwatch be involved in this initial work as they had recently won an award in engaging hard to reach groups;

·         The implementation of a task and finish group could not be supported at the current time. The situation was extremely complex and the research needed to be clearer, as did the methodology, membership and terms of reference of any proposed group;

·         The rationale behind the report being presented to the Board in the first instance had been to address the levels of screening, as there had been concerns aired. However, it was to be noted that screening levels were performing better than expected and no worse than the rest of England;

·         The level of interest from the Board around the subject matter was to be commended and support for Peterborough being better than average going forward was important. An initial piece of work did need to be undertaken to scope issues;

·         A small focus group consisting of experts, lay people and Healthwatch etc. should be convened and tasked with providing an overview of the issues and where the priorities lay. This would assist the commissioners of these services;

·         The issues needed to be identified prior to the implementation of a task and finish group;

·         There was an issue around the lack of analytical support, hence the lack of clear data for Peterborough. A solution to this issue would be would be explored; 

·         Providers were held to account for performance, however they could not be made to work outside of their remit; and

·         It was positive that the Board was so engaged with the issue and suggestions of how to progress the task and finish group forward were welcomed.

RESOLVED

The Board noted the report and presentation and agreed for further work to be undertaken around the establishment of a fit for purpose task and finish group.