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Reports may be downloaded, free of charge, in PDF and RTF formats - the site help page provides information about these formats.
For further information on any of the reports below, please contact Sarah Hurcombe, Assistant Scrutiny Manager, email: firstname.lastname@example.org.
Boris Johnson’s vision for tackling health inequalities in the capital is at risk of being sidelined unless he clearly sets out his priorities and the initiatives he will take forward to help achieve them. While Health and Public Services Committee welcomes the publication of the Mayor’s draft health inequalities strategy, it warns in its response that partners will find it hard to determine their own priorities when it is unclear what the Mayor and the GLA group will be doing.
The Committee says the Mayor should also provide details of how he will bring together local partners and break down organisational ‘silos’ as part of the strategy delivery plan.
The Committee makes recommendations to maximise the impact and effectiveness of the draft strategy:
Our report reveals that young Londoners' sexual health is still among the worst in the country, despite innovative projects and improvements to the way services work. It finds that teenage pregnancy rates in 18 London boroughs are higher than the national average.
The Committee makes specific recommendations to address the barriers to improving young people's sexual health in London:
This report follows up on the Committee's 2005 investigation into the sexual health of young Londoners
Written submissions received by the Committee during the investigation is also available.
Our response calls on the Mayor to give greater clarity on his plans to tackle violence against women in the capital. It asks for more information about costs, the partners involved, their responsibilities and timeframes for implementation. The response welcomes the Mayor's commitment to tackling violence against women but makes recommendations to maximise the impact and effectiveness of the draft strategy.
Our report reveals that the capitalís 11-15 year olds now drink the equivalent of 180,000 bottles of lager every week Ė and the amount they drink is on the rise. The investigation found a lack of senior leadership both locally and regionally means efforts to tackle the problem are not always effectively prioritised or co-ordinated. To address this, the Committee believes the Mayor and local leaders need to focus more effort on tackling alcohol.
As part of the investigation, the Committee commissioned a report by the Institute of Alcohol Studies, which is available to view below:
The Committee also conducted a series of workshops with young Londoners.
Written submissions received by the Committee during the investigation is also available.
Responses to our report are available to download
The Health and Public Services Committee response to Post Office Ltdís consultation on the London Area Plan Proposal
The Health and Public Services Committee submitted a response to Post Office Ltdís consultation on its proposal for Londonís network of post offices, as part of the Network Change Programme.
Response from the Health and Public Services Committee
The Health and Public Services Committee submitted its views on the Mayor's draft Health Inequalities Strategy.
The Health and Public Services Committee submitted further views as part of this stage of consultation on the development of the Healthcare for London Framework.
More than a third of women in London who are invited to be screened for breast cancer are failing to take up the offer, our report found. London has the lowest uptake of breast cancer screening in the country – 13 percent below the national average of 75 percent. The report shows large disparities in the uptake of screening across London boroughs. Havering and Bexley have the highest uptake, while Westminster, Kensington & Chelsea, and Tower Hamlets have the lowest.
The report recommends a London-wide call and recall service, which offers appointments to women outside working hours and at a location of their choice. It calls for NHS London to sponsor an incentive scheme to encourage GPs to promote the screening programme using an electronic flagging and letter system. Other recommendations include:
The following letter(s) was/were received in response to this report:
The capital has more NHS dentists than most other parts of the country, but only half of Londoners are using them according to our report. Only 51 percent of Londoners and just under two-thirds of children went to an NHS dentist in the two years to March 2007, and our survey found around 205,000 adults in the capital may never visit a dentist. This is despite there being 51 NHS dentists per 100,000 Londoners, compared to a national average of 42 dentists to every 100,000 people elsewhere in England.
The report makes a number of recommendations:
The full results of a survey undertaken as part of this investigation are also available to download:
The following letter(s) was/were received in response to this report (please note that the following PDF files contain scanned documents):
The Committee met with representatives of the GLA’s Policy and Partnerships Directorate in October 2007 to discuss the consultation draft of the Mayor’s Refugee Integration Strategy. The Mayor is taking strategic leadership of refugee integration work for London and the strategy aims to tackle the social exclusion faced by refugees and to move towards equality of opportunity for refugees in London.
The Committee’s response to the consultation on the strategy recommends that: the strategy team engages with PCTs and other NHS Trusts as soon as possible to secure their support for the strategy. The strategy includes proposals for improving refugee and asylum seeker women’s knowledge of and access to antenatal and other maternity services the strategy emphasises the importance of developing a comprehensive, community based TB screening in London for refugees and asylum seekers a survey is conducted of London’s refugees and asylum seekers as soon as possible to provide baseline information to help monitor and evaluate the strategy.
Our report reveals Londonís infant immunisation rates are so low that the chance of a serious outbreak of measles is worryingly high. It warns just over half (52 percent) of the capitalís children are fully immunised against measles, mumps and rubella. This compares to a national average of 74 percent, and is well below the level required to prevent a severe outbreak. The report also identifies significant variation in the immunisation rates across London boroughs.
The report makes recommendations to help bring the capitalís immunisation rates up to population immunity levels, which would make a serious outbreak unlikely.
Every year, around 6,000 Londoners die from a cardiac arrest before they reach hospital. Yet our report reveals the capital has one of the lowest levels of people trained in emergency life support (ELS) in the country.
Find out where to get emergency life support training.
The following letters were received in response to this report:
Post Offices in London: future directions
Post offices play a crucial role in their communities, not least because in some neighbourhoods they might be the only place where people can get free access to cash and claim their pensions and benefits. In the past few years, more than 300 branches have closed across the capital, and a growing number of branches have been franchised. The Health and Public Services Committee therefore decided to investigate the impact of closures and franchising, and the future role of post offices in our communities. This investigation also provided an opportunity to follow up on a previous (2004) report on post offices.
As a part of this investigation, the Committee submitted a response to the government's consultation on the post office network.
More than a million Londoners have a mental health problem, yet accessing the right treatment and support can be difficult because of long waiting lists, confusing referral procedures, and a lack of information about what is available. This report sets out recommendations to improve access to mental health services in the capital, including the need to agree a single pan-London referral system for specialist mental health services.
As part of our investigation, we conducted a survey among users of mental health services in London. The full results of this survey are also available to download:
At its meeting on 1 November 2006, the Committee questioned the Chair and Chief Executive of NHS London, the new Strategic Health Authority. Following this meeting, a letter was sent to Ruth Carnall, the Chief Executive, to follow up on key issues. This letter together with her response are available below.
The 2012 Olympic Games: benefiting Londoners health
A strategy for maximising the health benefits of the 2012 Olympic and Paralympic Games is under development. The Committee met with representatives of the Regional Public Health Group in July 2006 to discuss this strategy. The Committee also responded to a consultation on the draft strategy in September 2006. The Committee's consultation response and the draft strategy are available for download.
Some of the key points of the Committee's response are:
Provision of Youth Services
During 2005 the Health and Public Services Committee looked at activities for young people aged 13-19 in London including sport clubs, youth centres, arts workshops, parks, etc. The Committee investigated what there is at present and how to make this better, and also what money is available, how things are organised, how this is changing and what people think. As part of this work the Committee held a public meeting on youth provision in October 2005.
The Committee conducted some follow-up work in autumn 2006 around youth opportunity cards - a kind of a type of smartcard for young people, one of the Government's proposals outlined in the discussion document Youth matters. These cards are designed to hold credits that can be spent on positive activities such as youth and sports clubs. The Committee met with representatives of Camden and Tower Hamlets Councils in November 2006 to discuss the pilots for youth opportunity cards, and the reasons why these pilots had been delayed.
For further information see the following Health and Public Services Committee agendas:
London is currently experiencing a drought following many months of below average rainfall. Water shortages caused by the lack of rainfall have been compounded by massive amounts of leakage from the capital’s water pipes, and increasing demand on our limited supplies.
The Health and Public Services Committee therefore decided to investigate what water companies and others are doing to tackle water shortages in the capital, and what impacts these efforts are having. The Committee found that although water companies, Ofwat and other agencies are working to improve the security of London’s water supply, more must be done, particularly to reduce leakage, increase water metering, and improve the information being given to customers.
Around 11,000 babies born every year in London need the extra care provided in neonatal units, and this number is on the increase. Our report examines how neonatal care services in the capital are coping with the growing pressure put on them and also looks at parents’ experiences of the care their babies received, and their involvement in that care.
The Committee found that neonatal services in London are generally working well, thanks to recent investment and committed, experienced staff. However, neonatal units across the capital are understaffed and are working at much higher occupancy levels than is recommended. Cot shortages mean that babies regularly have to be transferred to hospitals far from their homes. Parents’ experiences are mixed. Although happy with the medical care their babies received, many felt that staff needed to do more to involve parents in their babies’ care. Our report makes several recommendations that we believe will ensure neonatal care services in London continue to improve, and cope with the increasing demands put upon them.
The following letter(s) was/were received in response to this report (please note that the following PDF files contain scanned documents):
The Government announced that the NHS must change how it delivers and commissions primary care services in order to meet proposals in Commissioning a Patient-led NHS. The Health and Public Services Committee investigated the impacts of these proposals on London, and in March 2006 submitted a response to the Government's consultation on the changes. The response and covering letter are available to download.
There is a real concern about the declining quantity and quality of public toilet provision in the city – a shortage that causes problems for those who live and work here as well as visitors to London. It impacts on public health and environmental issues, in terms of street cleanliness, social disorder and infections.
London has experienced the highest decline in the number of local authority owned and run public toilets in the country. Things can be done to change this around. There needs to be a complete rethink about the role that this public service has in a 21st century world city. The report’s recommendations include:
Response to the Mayor’s Draft Older People’s Strategy
This report is the London Assembly’s response to the consultation draft of the Mayor of London’s Older People’s Strategy entitled: “Towards an older people’s strategy for London, a draft Mayoral strategy for consultation”, published in November 2005.
The London Assembly's Safer London Committee has published its report 'Street Prostitution in London', a review of prostitution and community safety in London. The aim of the review was to examine the impact of prostitution on London’s local communities, in particular local residents, and to keep a community safety focus.
The report recommends that the Home Office should fund more drug referrals and exit programmes to help tackle London’s prostitution problems. It also calls for a common strategy across London to help prevent vulnerable women and young people from prostituting themselves.
The rate of sexually transmitted infections are increasing across the country, with the highest rates of increase in London. Our young people have been particularly affected, with 16 - 25 years olds displaying the largest increases in rates of infection. The Committee focused on young people’s access to services, and their access to information and advice on sexually transmitted diseases.
The Committee were concerned at the level of knowledge that young people have about the risks to themselves and others of unprotected sex and believed that the single most important step to improve all young peoples’ sexual health over the long-term is to implement a more comprehensive programme of sex and relationships education in secondary schools. The committee also found that as tackling sexual health is not a priority target, it is still not given the importance or resources it deserves. This is not acceptable and needs to change.
Secretary of State's response to the sexual health report:
The construction industry accounts for half of all fatal injuries in the workplace and on average two people are seriously injured every working day. The industry and Government have successfully introduced a range of schemes to improve workers' safety, but the report finds that there are still areas for improvement. With 40% of new building funded by public bodies we urge the public sector to use this purchasing power more effectively. In particular, construction for the London 2012 Olympic Games should set new standards in safe working.
London has hospitals with worldwide reputations, but also some with the highest rates of MRSA in England. The report looks at MRSA, what it is, how it can be acquired and what factors influence its spread. The Committee makes a number of recommendations on improving record keeping and what other actions are required to reduce MRSA. Examples of good practice show that MRSA infection can be reduced but this practice must become commonplace.
The majority of the Health and Public Services Committee agreed to recommend that smoking should be banned in enclosed public places in response to a recent Government consultation on health protection. They believed that workers should be protected from the harmful effective of passive smoking regardless of their place of work. The Committee found that a partial ban would be ineffective at preventing health inequalities, would be harder to enforce and was unpopular, including amongst publicans. The Conservative Member, Angie Bray, did not agree with the response.
The largely unseen 32,000 kilometres of piping delivers fresh water daily on demand to London’s seven and half million people. Thames Water is in charge of much of this vast and complex network. Maintaining and managing this system, much of it a hundred years old and in need of replacement or total overhaul, is a challenging and resource intensive task. The Health and Public Services Committee focuses on a number of serious concerns over the impact of a possible reduction in water pressure if Thames Water goes ahead with plans to lower water pressure across London with the aim of reducing leakage levels. In particular, the Committee highlights the following concerns:
The Committee made a series of recommendation to Thames Water and looks forward to a response within a two-month period.
Dublin's Smoke Free Pubs
Jennette Arnold AM, Rapporteur for the London Assembly’s Health Committee, visited Dublin to investigate the Irish Smoke-Free at work policy. The objective of the visit was to see how the ban was devised and implemented, how well it is being complied with and what the costs and benefits have been.
Key Findings: The Irish Government kept the focus of the debate around the proposals on eradicating the harmful effects of second-hand smoke (or environment tobacco smoke, ETS) and on it being a public health issue aimed at protecting workers;
The Government refused to be side-tracked by the issue of the civil liberties of smokers; safeguarding the health of workers “trumped” the “right” to smoke. Pubs were first and foremost places of work. The Government reasoned that if bank workers and hairdressers had the protection of law why shouldn’t pub and bar workers enjoy the same protections?
Sexual health - forum for young people
On 10 March more than sixty teenagers came to City Hall to take part in a ground-breaking event to explore young people's views about sexual health. The day-long forum, part of the Committee's investigation into sexual health in the capital, sought to find out how young people would like to be taught about these issues and what services should be available to them. During workshops young people and health care professionals discussed sexual health education and treatment in some depth.
Why does sewage end up in the Thames?
On 3 August 2004, after torrential downpours in London, up to one million tons of so-called combined sewer outflows (rain, street detritus and sewage) went into the river Thames. Oxygen levels in the river fell and thousands of fish were killed.
At its hearing on 14 September 2004, the Health and Public Services Committee discussed with Thames Water and the Environment Agency the reasons why sewage can still end up in the Thames. The Committee heard that such sewage outflows were routine, happening some 50-60 times a year often after modest levels of rainfall. The main reason for these events is that the system of drains, most of which date back to Victorian times, cannot cope with the volume of material that flows through them when it rains over London. To avoid raw sewage backing up into the streets, it is directed to flow into the river.
A series of proposed solutions to this long-standing problem was set out in Thames Water's presentation to the Committee (PDF).
For a full record of the discussion between the Committee and Thames Water and the Environment Agency, please see the minutes of the Health and Public Services Committee.
In response to this session, the Committee wrote to Elliott Morley,
Minister of State at the Department for Environment, Food and Rural Affairs:
DoH response to report on fluoridation
The Department of Health has responded to the Health Committee's report on fluoridation, Should Fluoride be added to London's Water?
This is the first joint scrutiny between the London Assembly, Association of London Government, and the London Boroughs. Enormous improvements have been made to the service, including the time taken to respond to potentially life threatening calls and the protection of children and vulnerable adults. Working in partnership with other agencies, the London Ambulance Service continues to ensure their preparedness for major emergencies. Improvements still need to be made to the Patient Transport Service and more work is needed to support patients with mental health needs. This report aims to stimulate debate and influence the future development of this important service.
The Post Office Limited’s programme of closures could see between 400 to 500 post offices closing in London by the end of 2004. This means that around 35% to 45% of London’s 1,100 post offices could close. The Post Office has seen a fall in revenues since the Government changed the way benefits and pensions were paid. The Post Office has moved into some areas of banking, which we believe should be extended to include access to all the major high street banks, and so help raise social inclusion. The Committee recommends that the possible sale of travelcards and the congestion charge should be reviewed again. We also called for the Post Office to improve disabled access facilities at its branches. The Committee was concerned that the closure of a local post office, especially when coupled with the closure of a local bank or a food store moving out of town, can lead to the death of a high street. We recommend that the Post Office should engage with local businesses to consider relocations and new openings.
London has a higher proportion of people living with HIV than any other city in the UK. A third of people living with HIV do not know that they are infected. Although there are drugs that prevent the progression of HIV, there is no cure and no vaccine to prevent its spread. HIV is no longer seen as an issue of concern for the public and the level of HIV continues to rise. It is expected that the total number of new diagnoses for 2003 will be the highest ever.
There is an acute need for the Government and health service to refocus their priorities and embark on a wide ranging educational programme to raise awareness of the HIV pandemic. The experience of living with HIV in London is a challenging one, not only in terms of living with a long-term, life threatening condition, but also in overcoming barriers and learning to negotiate access to appropriate services and support. The report outlines ways in which these services could be better provided.
On the 28 August 2003 at 6.20pm London suffered a major power cut. The power cut was caused by a safety circuit with a wrong protection relay, which had been fitted by contractors. Power was restored in 30 minutes, but chaos reigned for the evening. Many commuters were stuck as only a reduced rail service was restored and most of the underground was out of action until the next day, due to the antiquated signalling systems used on the tube. The communication flow to the Mayor, transport staff and public was slow and limited. The Committee recommended that the utilities and other public service providers improve their external communications and that the plan for tube signals improvements under the PPP should be monitored.
After a century in decline, tuberculosis is making a worrying comeback in London. While rates of infection have flattened out or dipped across the rest of the country, increasing numbers of Londoners are contracting the disease. Fifteen years ago, the capital accounted for three out of twenty cases in England and Wales; now, almost half of them are in London. This report looks into the implications of the resurgence of disease in the capital and explores some of the measures which are being adopted to tackle it.
On the long running debate as to whether adding fluoride to drinking water is beneficial or harmful to people's health, Committee members were divided. But the Committee highlighted two key issues of concern for London - is it technically feasible to add fluoride to all London's water? And how will the Government ensure that there is a full consultation of Londoners?
Thames Water has the highest level of water leakage in the United Kingdom. Since privatisation the rest of the country has been gradually improving its water leakage figures. However, Thames Waters figures have actually worsened since 2000. We heard from the Environment Agency that the level of leakage is such that continuity of water supply for London cannot be guaranteed. If there is a moderate drought for the next two years, there is unlikely to be sufficient water to meet all Thames Water requirements. The way to limit the need for new water resources is to tackle leakage levels and so reduce overall consumption, in conjunction with consumer efficiency drives.
The current average GP vacancy rate in London is 7%, a shortfall of about 350 GPs, which is equivalent to all the GPs working in Harrow and Wandsworth. With a large number of GPs either resigning or retiring in the next five years the situation is likely to get worse. The Health Committee believes there is much that could be done now to recruit more GPs and retain existing GPs, and has made positive recommendations to key health organisations to try and assist them in tackling this major problem in London. These include:
This report looks at the planned mothballing of the Mail Rail underground mail delivery operation. It calls on Royal Mail and the Mayor's Transport for London to take swift action to bring the line back into profitability so this important asset is not left to gather dust.
Every day tens of thousands of Londoners have contact with dentists, GPs, health visitors, high street chemists and opticians. London is a city experiencing highly complex health needs and the role primary care services play in maintaining and promoting the health of Londoners cannot be overemphasised. The recent reorganisation of the NHS has involved changes in the structure for the delivery of primary care. The Mayor of London and the London Assembly have undertaken the first London-wide consideration of access to primary care in the capital and how access might be improved. At the heart of this scrutiny is the consideration of whether the new NHS structures will deliver the improved primary care that London so desperately needs. The report brings together a wealth of best practice and data from all over London and beyond, and makes recommendations to health services on how they might improve access for Londoners.
London's falling levels of infant immunisation cover present a real threat to the health of young (and not so young) Londoners, and are a grave threat to health professionals and families alike. Our scrutiny sets out the evidence in a clear and systematic fashion to show how London underperforms other UK and world cities. The report reveals that there is a significant gap in our understanding of why the level of infant immunisation cover has fallen through the late 1990s. Further, the report seeks to stimulate a national debate on a number of areas where radical action may be needed to deliver a service more suited to the 21st century.
This is the London Assembly's report on smoking in public places. The Investigative Committee examined the scientific research on the damage to health from passive smoking and the particular vulnerability of children. The report finds that there has been relatively little research into the effects of short term exposure to passive smoke, for example people who visit a smoky pub or restaurant a couple of times per week. A need for more public education on the risks of passive smoking is also identified. The report looks at the availability of non-smoking areas in public places such as trains, buses, taxis, pubs and restaurants, and argues for the provision of more smoke free areas. The report makes detailed recommendations to the Government, the Mayor, the London Health Observatory, the London Health Commission, the Strategic Rail Authority and the hospitality industry.
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