Apologies were received from Dr Doug Hing and Dr Andrew Otley.

 There were no declarations of interest.

RESOLVED: That the minutes of the meeting held on 28 January 2020 are agreed as an accurate record.

Prior to starting the formal business of the Board, the Chair noted the thanks of the Board to all involved in Covid assistance particularly in the health and care sector, in voluntary services and within Schools.

The Chair also advised that there had been a number of changes to the board including the resignation of Councillor Kelly Braund and Councillor Eleanor Stringer had joined the Board. The Board noted their thanks for her work during her time on the Board.

The Chair particularly welcomed Dr Vasa Gnanapragasam to the Board as the new Vice Chair replacing Dr Andrew Murray who has stepped down from the Board as he becomes Chair of the new South West London CCG. The Chair thanked Dr Murray for his years of valued support in the work of the Board.  He also welcomed Drs Mohan Sekeram, Aditi Shah, Karen Worthington to this meeting.

James Blythe, Managing Director for the Merton Borough Committee presented the report, advising that the Merton CCG had now ceased to exist and as of 1 April 2020, the six South London CCGs had merged to become the South West London CCG. There is now also a Merton Borough Committee, Chaired by Dr Vasa Gnanapragam and led by Merton GPs which has significant CCG budgets delegated to them.

Also on the 1^st April, the South West London Sustainability and Transformation Partnership was granted ICS (Integrated Care System) status, meaning that the NHS has confidence in the partnership arrangements in place.

The Chair noted that the terms of reference for the Board would need to be updated in due course to reflect the changes.

The Director of Public Health presented the report. The slides used during the presentation are available here: https://democracy.merton.gov.uk/ieListDocuments.aspx?CId=184&MId=3720&Ver=4

It was noted that the peak excess death rates were in the middle of April, both for Covid-related deaths and others deaths likely partially due to the under-reporting of Covid. The total deaths are now lower than at the same time last year.  

In Merton most deaths occurred in hospital, with the 2^nd most common place of death being in care homes, however Merton was not standing out as an outlier with the increase death in care homes, with numbers being around average.

There was a particular differential in the first data from the ONS (Office for National Statistics) and whilst this was now evening out, there still remained a difference with more deaths occurring in the East of the Borough.

There were a number of underlying issues including housing and overcrowding contributing to this, as well as vulnerability, with diabetes being a particular issue.

It was noted that the underlying causes were mostly socially patterned.  

The Director of Public Health gave an overview of the ecological studies which noted higher incidences of Covid deaths in the East of the Borough, in high risk occupations and associated with BAME communities. It was noted that these figures were based on modelling, as the Council does not currently have the data on the deaths that have occurred in the borough.

There would also be some work to look at the indirect impact of Covid for example the impact on mental health, and the Council will be working with the NHS to understand the emerging evidence relating to these issues, as well as looking at engagement with the volunteer sector to gain more insight of ‘lived experience’.   

James Blythe stated that they were trying to get as much data as possible. Initial data shows a marked variations from area to area within East Merton and this needed to be reconciled clearly back to risk factors.  

Dr Karen Worthington requested that the effects on children were not overlooked and suggested that there was a need to have a focus on rehabilitation type services for people who have been seriously ill with Covid.

The Director of Public Health assured colleagues that they were particularly interested in relation to children and their lived experience will form part of the work to engage with communities.

Members of the Board raised concerns around health inequalities and the inequality gap which has increased due to Covid.

The Director of Community and Housing presented the report (the slides shown have been published on Merton’s website here: https://democracy.merton.gov.uk/ieListDocuments.aspx?CId=184&MId=3720&Ver=4).

Covid19 had led to unprecedented challenges and the Director thanked colleagues and care homes across Merton for everything they had done so far during the pandemic.  

The Director of Public Health advised that this had been a traumatic episode and she wanted, through dialogue and engagement with the Care Homes, to understand the key issues, including the issue of sustainability of care homes in the future. It was noted that Covid was still around and the Council would continue to protect our care homes. The Director of Public Health commented that the pandemic has highlighted an area of health and care which hasn’t been previously valued and she hoped that the focus on the need for good care in care homes will continue be taken seriously.  

The Chair echoed the thanks to the staff and their teams.

Simon Shimmens and Rob Clarke presented the report and gave an overview of the statistics shown on the slides (published on Merton Council website here https://democracy.merton.gov.uk/ieListDocuments.aspx?CId=184&MId=3720&Ver=4).

Rob Clarke praised the work of the London Borough of Merton staff who had been running the Community Hub, which would now be continued by the voluntary sector going forward as Council staff were required to go back to their usual roles.

The Chair and others on the Board echoed the thanks and the Chair thanked Simon and Rob particularly for their hard work.

The Director of Public Health gave a verbal update on the Council’s plans for outbreak control. This would involve supporting the NHS testing and contact tracing service as would be one of the tools to manage any future outbreaks of Covid and to prevent spread of infection. The Council would need to build awareness and connectivity so that when anyone developed symptoms they engaged with the service and self-isolated. 

One big insight was that during the peak of Covid, the communications messages didn’t land equally and the Council were very keen to engage and understand this working with the voluntary sector. The Local Authority would have an important role to play and the Health and Wellbeing Board will be a part of this. Contact tracing is a protection tool and the Council was proposing a sub-group of the Board be set up with community representatives that mirror the diversity of the community to oversee the outbreak plan and to also double up as an oversight group to look at the impact of Covid on vulnerable communities.

The Chair emphasised that it was really important get people on the sub-group who have links in the community. The composition of the group would be looked at shortly and the sub-group would meet more regularly than the Health and Wellbeing Board.

All members of the Board gave a brief update about the work ongoing in their areas and any upcoming work.

Dr Karen Worthington advised that in the NHS in relation to primary care, the NHS had tried to embrace a ‘triage first’ approach to patients. The NHS had deployed and expanded digital initiatives, ensuring patients were able to contact the NHS via phone, online and all GPs were now also offering video consultations. The NHS had rolled out remote working supporting workforce resilience. No GP practices were unable to offer services even during the peak of the pandemic. There were two hubs running for suspected Covid assessments and as numbers of infections are falling, the NHS are revising services and looking at learning from them so they could plan for future waves. The NHS were now looking at resetting primary care and restarting some of the services which had been paused including those focusing on long term conditions, screening and immunisations.

James Blythe advised that all of their structures were working on recovery and there was a South West London Recovery Board now set up. There had been a campaign called ‘NHS is here for you’ aimed at those not presenting at health settings, particularly those who had symptoms of or incidents of heart attacks, strokes and cancer to ensure they were presenting. Referral rates are now increasing, however, rates are still not where they need to be and the NHS has seen some impacts from late presentation.  

Simon Shimmens advised that they were now focusing on how they might re-establish services. The MVSC work with organisations including a focus on BAME organisations on recovery and sustainability. Simon stated that they did support 19 organisations in May to achieve £104,000 of funding and had also had the support of a huge number of volunteers.

Rob Clarke reiterated that members of the Health and Social Care Forum were looking at recovery planning as they move forwards and would also do some analysis of the gaps particularly on preventative services. Rob advised that they needed to think about the issue of digital exclusion as those who struggle to access services usually will continue to be and potentially more so if services become more of a digital by default model. The Chair noted that this should be revisited with the Board.

Dave Curtis (Healthwatch) advised they had paused the majority of activity in March and asked how they can support the BAME work planned.   

Brian Dillon (Healthwatch Chair and Treasurer of MVSC) stated there was a concern for budgets and with any new demand going forward he was concerned about budgets and resources declining at a point when they would need to draw more resources.

The Director of Children Schools and Families advised that schools had been open for keyworker children and vulnerable children throughout the pandemic, including over the Easter holidays, and over the end of May half term. Since the beginning of June schools had opened more widely  ...  view the full minutes text for item 9.

The Health and Wellbeing Board is asked to note that this has been postponed to April 2021.

It was noted that the Pharmaceutical Needs Analysis, which is usually refreshed every three years, would now be extended with publication now required by Government for April 2022.