Agenda item

Members are asked to consider the information presented within the report and note the key issues described.

Dr Bruce Laurence addressed the Select Committee, a copy of the update can be found on their Minute Book and as an online appendix to these minutes, a summary is set out below.

Improving access to childhood immunisations for Gypsy, Roma and Traveller (GRT) families temporarily residing in ‘unauthorised’ encampments

Gypsy, Roma & Traveller (GRT) children are identified as being at higher risk for missing immunisations, in particular those communities that travel more frequently. The aim was to improve access to childhood immunisations for GRT families temporarily residing in ‘unauthorised’ encampments through implementation of a new pathway. 

The new pathway was tested in autumn 2018 at the Lansdown Park and Ride encampment. The multiagency team accessed the site, HNA was completed and all eligible children received immunisations. GRT experience significantly poorer health yet despite this greater health need, there is low uptake of health services, including preventative health care. When the new pathway was tested the local GP practice prioritised the children as a vulnerable group to ensure immunisations were received and the multiagency team were able to make recommendations to the Environmental Protection Team regarding the length of stay.

Female Boaters and Access to Cervical Screening

A focus group was delivered with female boaters to examine the barriers to accessing cervical screening.

The waterways are managed by the Canal and River Trust and the current guidance states that boats that do not have a fixed mooring must ‘bonafide navigate’ the waterway. The guidance means a boat must make a progressive journey from point A to point B, (A and B must be a minimum of 20 miles apart) staying up to 14 days in each place before continuing on their journey. The potential impact on boaters complying with the guidance is vast. In order to comply a boater will potentially be more than 20 miles away from their GP, school, place of work and social networks for part of the year. The cruising guidance therefore has a potential negative impact on access to healthcare, education, employment and there are increasing reports that the isolation from social networks is impacting mental wellbeing. In addition to the complexities of distance, the most populated areas to cruise (Bath – Devizes) span two counties making referrals across local authorities challenging. 

Findings from the focus groups

• The participants had either not attended or were overdue their cervical screen
• General lack of knowledge around screening programme from the focus group participants.
• The majority of the barriers were practical. They were related to priorities, being too busy, simply putting it off and ‘meant to go but didn’t get round to it’
• Difficulties registering with GPs and not being registered with a GP was another barrier for not receiving invites. The pressure to keep moving along the canal made registering with GPs difficult.
• The boaters felt that often GPs were not supportive in terms of registering and using alternative addresses. There was a sense from the group that there was stigma and discrimination once they had disclosed they didn’t have a permanent address and there was a lack of understanding of the boating community.

Barriers and facilitators to access and completion of cervical screening for younger women

•  Focus groups and interviews delivered across BaNES, Swindon and Wiltshire with women aged 25-36

•  The sample had a high proportion of participants from areas of deprivation - 35% of participants were from areas among the 20% most deprived small areas in the country.

•  Two-thirds (66%) of participants self-reported that they had historically either put off, missed or chosen not to attend a screening appointment

Cervical cancer is the most common cancer in women under the age of 35 in the UK and evidence shows that younger women are less likely to attend their cervical screening appointment.

Barriers: Four themes were identified: 1) competing priorities; 2) emotional barriers; 3) practical barriers; and 4) previous negative experiences.

Facilitators: It was suggested that talking about screening more openly and positively would help to address emotional barriers (discussion with friends and family, discussion groups and peer support). Pre-appointments may be useful to alleviate first-time fears and women consistently wanted reassurance of a female sample taker.

Facilitators to tackle practical barriers included timed appointments, alternate ways of booking and text reminders. An accommodating service with flexible hours, alternate settings was deemed to be essential in helping women to attend their screening around work and childcare commitments.

Women felt strongly that education for both sexes around cervical screening needs to start as early as possible, with PSHE or HPV vaccinations as the opportune moment.

Recommendations:

• Utilise a community based assets approach to improve cervical screening uptake through discussion groups, locally led campaigns and peer support.
• Identify opportunities to signpost women to alternative sources of information and support, particularly services provided by Jo’s cervical cancer trust
• Disseminate local feedback to primary care staff and regularly remind sample takers of the influence of their role on future screening attendance. Ensure staff are trained to improve communication and understanding for patients who have experienced sexual abuse. 
• Expand the screening programme into all sexual health settings
• Delivery of education sessions on HPV, the vaccination programme and cervical screening within the school must be included within the specification when commissioning the HPV vaccination programme. 
• Encourage employers to recognise the importance of cervical screening; through work based campaigns and health workplace awards.
• Service providers to ensure appointments are offered on multiple days and at a range of different times.
• If not available already, offer alternative ways for patients to book appointments such as online booking systems
• Review the current reminder letter sent by the GP practice to assess the language used and to include reassurance of female sample taker and include the Jo’s Trust website
• Send text messages to patients who have missed a screen with a link to either the online booking system or surgery telephone number
• Introduce a flagging system where patients can be reminded to make an appointment for cervical screening either when making or attending other appointments
• Practices to consider trialling or implementing a targeted approach to offering pre-appointments for those who have not yet attended their first screen, and a timed appointment system or drop-in clinic for repeat non-attenders. Review if this improves uptake.

Councillor Lin Patterson asked for his view on funding for Public Health.

Dr Laurence replied that the Council’s support for the role of the department has been acknowledged and that the Public Health Grant would now be linked to Business Rate Retention.

He added that as the Council was coming to the end of its four year cycle that he was hopeful of similar support from May 2019 onwards. He stated that he was committed to work within the grant made available to him.

Councillor Geoff Ward said that he welcomed the work that had been highlighted and asked if travellers or refugees were cause for concern in terms of passing on diseases such as measles.

Dr Laurence replied that there was no evidence to support such a problem. He added that there was in general a push for immunisations to be carried out and that more of a worry would be those that don’t take up the option to have them.

The Chair thanked Dr Laurence for his update on behalf of the Select Committee.