A presentation from the Director of Health and Care detailing changes to the Healthy Communities Service from April 2023 will be provided at the meeting.
The Lead Commissioner Public Health and Prevention provided a report and presentation about proposals for the integrated lifestyle services from April 2023.
Committee was advised that the service contract had focussed on residents with most need in 148 super output areas, for a range of issues:
The services were reported to be good overall and had surpassed outcome targets in all areas, but the take up of services had been low due to the eligibility criteria which had made access restrictive. A third of adults in Staffordshire were classed as overweight or obese and additional Government funding for weight management last year had enabled the eligibility criteria to be opened up to anyone over 18 years which had increased take up.
Other programmes and initiatives such as the Supportive Communities Programme and Better Health Staffordshire had been developed. Communities and the voluntary sector provided support for physical activities, fall prevention and social isolation prevention. Public Health has also developed a Mental Wellbeing Programme and a range of self-help approaches including APPs and use of social media to reach out to members of the public. The range of support in communities provides opportunity for the Healthy Community Services to focus on fewer issues, therefore increase funding for the key priorities. It can remove the eligibility restrictions to make access to services easier.
The Lead commissioner advised that proposals stemmed from recent consultation. He outlined the proposals for the new contract from April 2023 and invited members to consider what was the most effective and efficient use of resource.
Committee noted the following comments and responses to questions:
· A key issue was the eligibility criteria which had impacted on take up of some services. Members welcomed the removal of the eligibility criteria, the focus on fewer intervention activities, and considering the alternative approaches available to address the issues.
· Members endorsed the ‘less is more ethos’ moving forward, the need to reserve services for those that need them most and find alternative ways to promote services for all through other programmes, to achieve outcomes.
· There was concern that the weight management programme had not reached the people it needed to. Members were assured that in addition to doctor referrals community engagement officers were promoting the service and reaching out to people in the community to build the message and increase referrals to services from other sources. Many referrals were self-referrals from social media and campaigns.
· In terms of funding allocated to each service it was questioned if there had been a cost benefit analysis of smoking cessation services in terms of preventing hospital spend due to people quitting smoking. Members were assured that smoking cessation services had been very well evaluated and were cost effective locally and nationally.
· The cost of services: £500k in targeted weight management (approx. 50%) and non-targeted, £800k stop smoking services and £200k for targeted NHS health checks.
· It was noted that there was separate system in place for drug and alcohol service - the Staffordshire Treatment and Recovery Service (STAR). The Government had recently invested in drugs and alcohol services however the funding allocation had not directly benefitted Staffordshire yet, it would receive funding in the third funding cycle. The CQC inspection earlier this year had resulted in a good rating. There were gaps across the service, but it was felt that Government funding would help close the gaps. Members raised concerns about the lack of support for people with alcohol and drug problems and that they need face to face sessions to help with mental health relating to drugs and alcohol problems. Members were invited to talk to officers outside of the meeting to feed in their comments and concerns in relation to the Draft Mental Health Strategy.
· Mental Wellbeing - Members were assured that there was a process of engaging partners across Staffordshire to focus on key priorities and to help to engage with public and raise awareness of services.Mental Wellbeing was not part of Healthy Community Services discussion today.
· A concern was raised about weight management reaching minority communities in BurtonEast Staffordshire, where there was a high risk of obesity in ethnic minority communities. Members were reassured where communities were at greater risk eligibility criteria had been lowered. The service was embedded and reaching out to communities and workplaces to talk about weight management and other services available. Officers agreed to meet with East Staffordshire Members to discuss the specific needs of that area to be reflected in the tender.
· It was clarified that the reference to diabetes in the presentation should specify type 2 diabetes.
· In terms of pathways into schools, members were advised that there was a separate Families Health & Wellbeing (0-19) Service tender which included weight management and other services for young people.
· A member highlighted the need to encourage residents to focus on nutrition, and weight management, all related to their diet. There was concern that people opted for fast food rather than cook for themselves.
· District and Borough Councils (DC/BC) have a key role to play, Chief Executives from DC/BC had been asked to nominate a link officer.
County and District Council officers were developing good relationships.
· It was clarified that the outcome targets were set having regard to data research, benchmarks, and good practice experience of partners in other areas, and that the key measure of quality was feedback from clients which had been built into the programme.
· It was confirmed that the Joint Strategic Needs Assessment contained data for all Districts and Boroughs and that when requested it would be possible for officers to provide ward data for Tamworth area.
· Service commissioning – It was clarified that the Council used a prime provider model rather than have several specialists working together. The prime provider was commissioned to have contractual arrangements with the Council and could sub-contract to specialist providers e.g. weight management commissioner could sub-contractors to specialist provider such as slimming world or weight watchers. The Chairman questioned the commissioning model, indicating there may be some specialist providers that may not sub-contract and suggested that officers could re-look at the commissioning model. It was explained that the 7 year contract allowed relationships to form between contractor, sub-contractors and partners overtime to create stability.
· Better Health Staffordshire, focus was on weight management and obesity. Historically there had been a lack of coordination and collaboration to communicate what information, guidance and advice was available to the public about services and how to access them. Mapping demonstrated that the public had many opportunities and options to exercise and eat well, sports clubs, community activities etc., as such there would not be a requirement for specialist providers in this area.
· The role for the ICS relating to obesity. Public health and ICS work in partnership. Prevention is public health role under the public health funding arrangements, where intervention is failing or people have not been picked up through the prevention pathway, the ICS provide bariatric services and some specialist nutritional services.
The Chairman thanked the Lead Commissioner Public Health and Prevention for the presentation and responses to questions. He welcomed the increased focus on priority service, the focus on outcomes, improved impact in communities and he highlighted the importance of starting prevention early in schools.
1) That Health and Care Overview and Scrutiny Committee note the report detailing the changes to Healthy Communities Service from April 2023.