Agenda and minutes

The Committee is asked to approve as a correct record the minutes of the last meeting held on 8 September 2016

The minutes of the meeting held on 8 September 2016 were agreed as a correct record.

Report of the Director of Public Health

The Committee received a presentation from Stuart Youngman, Primary Care Contract Manager for NHS England . The presentation aimed to clarify the position in terms of commissioning and highlight the current arrangements.

It was reported that since 2012 the local authority has become responsible for oral health improvement, and NHS England is responsible for primary and secondary dental care.  General dental services are commissioned by the primary care dental commissioners, the service can be accessed through NHS 111, NHS Choices, self-directed contact and professional sign-posting.  That general service may not be able to meet all the needs for each individual and therefore referrals can be made to special care dental services. This special care can offer discreet community dental service where high street services cannot meet needs, for example for people with learning difficulties or bariatric patients, and can be accessed through professional sign-posting.  Specialist dentistry, including orthodontics, minor oral surgery and sedation services is commissioned by the primary care dental specialist referral service. This service supports the general high street dental practices.  In terms of the secondary care services this is consultant led and commissioned by secondary care commissioners.  Overarching all of these services is Public Health’s oral health improvement programmes commissioned by Local Authority Commissioners.

It was noted that patient preference dictates that a number of patients will choose to access private dental care rather than NHS services. In addition a number of patients will be unscheduled dental health seekers who will only access services when they have a specific need. It was noted that private dental care regulation is undertaken by the Care Quality Commission and the General Dental Council.

Primary Care Dental Services must operate in accordance with National Dental Regulation. This stipulates what should be provided, there is no requirement for patients to be registered, it is a demand led system and the practice has direct responsibility for patients only during the course of treatment. It was acknowledged that patients will perceive that they are registered with a particular practice, although practices only send out appointment reminders etc in order to manage their system.  Secondary Care Dental Services do not fall under the same regulation and are commissioned under separate Standard NHS Contracting arrangements and funded through Payment by Result tariffs.

It was reported that the regulations set the contract currency and is measured in units of dental activity (UDA’s) and ‘banded’ to courses of treatment.  Band 1 equates to one UDA and is for a routine visit, scale and polish, Band 2 is for fillings and extractions and is 3 UDA’s, Band 3 is 12 UDA’s and is for laboratory work. The regulations require the collection of patient charges, which are nationally derived charges which vary year on year.  It was noted that there are certain groups of people who are exempt from paying for treatment, it was acknowledged that there are gaps in terms of getting this message out to those who are exempt.

In terms of national statistics it was reported that  ...  view the full minutes text for item F17

Report of the Director of Public Health

The Committee received a report on the self-harm hospital admissions during 2014/15. National research shows that self-harm rates are higher among children and young people and are four times higher for girls than boys. It was noted that certain groups of young people are more vulnerable to self-harm, including; children and young people in residential settings, lesbian, gay, bisexual and transgender young people, Asian young women and children and young people with learning disabilities.

The Child Health Profile shows that in 2014/15 179 young people aged 10-24 years were admitted to hospital as a result of self-harm. This is a reduction from 2013/14 where the figure was 214. It was reported that Gateshead is higher than the Newcastle and the North East in terms of self-harm rates.

An analysis of data from North East Commissioning Support showed that in 2015/16 overall the admission rates for females is higher than males, however the trend for female admissions is down in  this year. During 2015/16 there was an increase in the number of male admissions in the age group 10-24, however it was pointed out that within that group there were two males who had over 10 admissions each which may have skewed the data

In relation to the intentional self-harm during 2014/15 and 2015/16 the majority of female admissions were coded by the hospital as self-poisoning with medicine. There was also 37 females coded as self-harm by sharp object. In the same period for males the majority of admissions were coded as self-poisoning by exposure to drugs used to treat epilepsy, tranquilisers or medicines that alter chemical levels in the brain. There was also six male admissions coded as self-harm by sharp object. It must be noted that the 2015/16 data from North East Commissioning support has not yet been validated so must be treated with caution at this time.

It was reported that the causes for concern forms passed from the Queen Elizabeth Hospital to children’s services are low compared to the number of hospital admissions. In 2014/15 there were 77 forms passed to children’s services, against a total of 179 admissions, in 2015/16 there were 83 forms passed over against a potential total of 223 admissions. It was acknowledged that  there are potential  issues around coding and work is ongoing to improve this for the future.

It was noted that there is a full review ongoing in the Child and Adolescent Mental Health Service and work is underway with the CCG to cross reference hospital data.

In order to address the issue of self-harm, training has been delivered to schools over three sessions and has been well attended by all secondary schools. It was pointed out that schools had previously raised the issue of how to support young people who are self-harming. It was reported that the Gateshead Self-Harm Protocol has been developed to help professionals identify and support children and young people who are self-harming.  It is anticipated that this will be rolled out to GP’s, School Nurses  ...  view the full minutes text for item F18

Report of Gateshead Hospitals NHS Foundation Trust

The Committee received a report and case study on the harmful effects of alcohol in pregnancy, with a focus on the situation in Gateshead.

A detailed case study was provided to the Committee which identified the circumstances around a child in Gateshead who has been diagnosed with Foetal Alcohol Spectrum Disorder.

It was reported that 1-2% of children and young people in Gateshead are affected by alcohol consumption during pregnancy, but it was acknowledged that this could actually be as high as 2-5%. It was also noted that within the looked after children population there is a high concentration of children and young people diagnosed with foetal alcohol spectrum disorder.

It was noted that this can often be misdiagnosed as autism or attention deficit disorder. It was also suggested that often there will not be a diagnosis of foetal alcohol spectrum disorder because of the stigma attached. A study undertaken by SCOPE found that 75% of women in the UK reported drinking alcohol at some point in pregnancy.

Clinical features of children with foetal alcohol spectrum disorder can include neurodevelopmental difficulties in areas of; attention, adaptive behaviour, language, memory, motor skills, social communication and sensory integration.

It was questioned as to what evidence has been published to prove foetal alcohol spectrum disorder is a recognised disorder. It was clarified that this is recognised by the Royal College of Paediatricians and is known both nationally and internationally and is a validated condition. The British Medical Association published information in 2007 and updated in 2016 around the disorder. It was confirmed that this exists within neurodevelopmental disorder DSM5 and can be evidenced. It was noted that there is no test for it but there are diagnostic tools which are also used in other countries. It was reported that the Royal Holloway in London recently held a conference around this issue.  It was acknowledged that there is an overlap between foetal alcohol spectrum disorder and other disorders, for example it is probable that 50% of children with ADHD will be due to exposure to alcohol.

The point was made that many women would not admit to drinking during pregnancy therefore how can there be a proven link if there is no certainty as to whether the mother has consumed alcohol. It was acknowledged that the disorder cannot be diagnosed with a test, however children affected all display the same characteristics. It was also noted that within foetal alcohol spectrum disorder there is widespread damage and all children can vary within that, for example ADHD is one of the features. However, by just recognising a child having ADHD ignores a wider range of issues in children with foetal alcohol spectrum disorder, such as learning difficulties and expressive language disorder.  Foetal alcohol spectrum disorder was likened to autism spectrum disorder which had a huge surge in the 1990’s when the diagnosis widened.

It was queried as to how many of the clinical features identified would a child need to have in order to be diagnosed  ...  view the full minutes text for item F19

Report of the Director of Public Health

The Committee received a report on performance of the Healthy Schools Programme.  It was reported that in early 2015 the decision was made to move the Healthy Schools Programme to a traded service.

The programme was launched as a traded service on 1 September 2016 and last year was included in the brochure to schools for services that schools can choose to buy into.

The new offer will give schools access to a Health Coordinator to provide roll out of the programme in schools, including support to training for staff. There will also be a Mental Health Liaison Worker to support the promotion of social skills and resilience of pupils and also to identify and support those pupils at risk of mental health problems.  The programme also provides access to an online community to allow schools to access information and resources.

It was noted that the programme is open to all schools and offers a much more comprehensive breakdown of findings in relation to their school population. The cost of the programme is £500 for Primary Schools and £700 for Secondary Schools.  It was reported that 44 schools within Gateshead have bought in, 37 primaries, six special schools and one secondary school.

The next steps will be to continue to promote the programme following the publication of the Government’s Child Obesity Strategy, which offers an important role for the programme.

It was questioned why not all schools have bought into the programme. It was confirmed that the schools who did not buy in were contacted for feedback and only five or six responses were received, four of these responses stated that cost was the reason for not buying in.

It was also questioned whether some schools provide the mental health element without buying into the programme. It was confirmed that some schools already offer this support and therefore do not feel the need to buy in.

RESOLVED    -           (i)         That the comments of the Committee and the contents

of the report be noted.

                                    (ii)        That the Committee agreed to receive an update in 12

months in relation to;

·         Continuing performance of schools and updates on the health priorities they will be focusing on

·         Update on the number of schools agreeing to engage in the Healthy Schools Programme for 2017/18.