Agenda item

Report and presentation of the Director of Health and Care

The Interim Assistant Director for Public Health and Preventionand Lead Commissioners for Public Health and Supportive Communities provided a detailed report and presentation on public health performance, outcomes and services in Staffordshire relating to the following areas:

• Health and wellbeing in Staffordshire
• Covid Response and adaptations
• Drugs and alcohol
• Sexual health
• Healthy Lifestyles
• Supportive Communities
• Outcomes
• Staffordshire warmer homes

The following comments and responses to members questions were noted:

Sexual Health

·       It was considered that many service users may lead a chaotic lifestyle and an appointment system would not suit all of the user group. From April 2022 the new contract would look to maintaining and increasing walk in clinics.

·        Risks and misinformation: concerns were raised about misinformation about the risk of blood clots relating to the contraceptive pill and Covid vaccine. It was confirmed that the National Institute for Health and Care Excellence (NICE) guidelines were followed, and that people should be directed to GP or sexual health clinic for information, members also felt this would be an opportunity to talk to people about long-term contraceptive advice Long acting reversable contraception (LARCs). It was agreed that possible communication options/need to counteract the misinformation would be explored.

·        Termination of pregnancy: sexual health commissioning. Members requested clarification that mental health support and information about terminations was available for individuals.  It was confirmed that CCG commissioned termination service so a query would be posed to the CCG.

Drugs and alcohol:

·        A query was raised re. the extent of joining up between drugs and alcohol and criminal justice systems.  AB confirmed that a robust partnership was well-established with police and other criminal justice agencies. Funding had been provided from the Police and Crime Commissioner to provide drug and alcohol workers in prisons, courts etc. – although the pandemic has impacted on progress.

·        Drugs and HIV: Transmission of HIV through shared needles was potentially a risk, however rates of transmission in Staffordshirewere very low. There was a successful needle exchange programme in operation through specialist services and pharmacies.

·        Cllr C Atkins requested a breakdown of new monies obtained for drug/alcohol services.

Healthy Lifestyles:

·       Diabetes and obesity: Committee considered that there was a need for more support groups and information about early diabetes and obesity to help individuals. It was also identified that the approach varied across Staffordshire. It was acknowledged that treatment was the responsibility of CCGs and NHS, and Public Health role related to   prevention, to reduce obesity and diabetes before it became a problem for individuals.  Officers confirmed that local delivery of the National Diabetes Prevention programme was very successful and held as good practice nationally.

·     The weight management programme was targeted at specific lower super output areas (LSOA) reaching people in communities where issues such as overweight and obesity tend to be more prevalent. There was a pilot scheme in East Staffordshire PCN working with GPs to advise people and it was expected to roll out this work as soon as possible.

·       Members requested more information and an explanation relating to the change in location of lifestyle sessions in Leek - a written response would be circulated. It was confirmed that the challenge of obesity and weight management was a priority for public health for all age groups in Staffordshire.

·       It was recognised that Borough and District Councils were better placed to consider and influence the whole system place-based approach to support individuals on upstream approaches and wider-determinants such as healthy environments, planning, access to green space etc.

·       Smoking Cessation.  Smoking was considered to be a success story for public health and partners - this approach would be taken for obesity and other areas. It was reported that fewer young people were smoking, and this was a reflection of concentrated effort across a whole system for over 20 years or more, using a range of tools in a whole system approach such as policy change, legislation change, taxation, advertising bans, point of sales restriction over a number of years, accessibility and availability of it, this type of model is what we need to aspire to in relation to obesity and diabetes.

·       The stop smoking service offered both pharmaceutical medications support and Nicotine replacement therapy in line with NICE guidelines. A mix of counselling and medication was considered more likely to help an individual to stop smoking.

·       Vaping: Concerns were raised about vaping.  It was considered that vaping was safer than smoking but not risk free, and there was a need to recognise the difference between using vaping as a quitting aid as opposed to young people taking up vaping from scratch. Members requested available data on vaping to be circulated to evaluate if there was a need to bring the issue to committee at a future date.

Whole Systems Approach on wider determinants of Health:

·       Members welcomed earlier interventions and a whole family approach to make healthier lifestyle choices but had concern that they were not well co-ordinated and partnership working was inconsistent across Staffordshire. They were advised that Better Health Staffordshire was a whole system approach to healthy weights i.e., working with partners in a more joined up, coordinated way on a shared outcome. It covered all age groups and a multi-faceted approach.

·       Public Health was a partnership between a statutory body and the individual; the organisation can inform and support, but it was largely up to the individual that had to want to change lifestyle.

·       A strategic approach was required to bring everyone involved together to work across our organisation and with partners on matters that strengthen healthier lifestyle choices. The greater impact would be through tackling wider determinants of health to look at the wider issues. It was considered there would be a significant role for District, Borough and Parish Councils in this work.

Supportive Communities:

·       The Supportive Communities Programme was about developing prevention and early intervention for adult social care. Committee voiced concerns that support for healthy lifestyles, activity levels and social prescribing was not consistent, and resource would not reach across all of the County.

·       There was recognition of the need to work with the voluntary sector and train volunteers to be able to reach across all of the County.  It was explained that it was not just about place, it needed to be a whole system place-based approach and to make impact there was a need to focus on the hotspots initially and a good understanding already of the target areas (e.g. lower super output areas). Systems and the environment had to be in place, and it would take time to change. There was a dual approach - population area advice and guidance and information about how we engage with some of the groups, including Parish Councils.

·       Social Care Assessments waiting list – Members voiced concern that demand for home care assessment was rising and were advised that this was being addressed through successful partnership working. Many were people seeking low level support and the supportive communities programme looked to advise digitally by telephone and finding help and support through the voluntary sector.

·       The wait for Homecare – Information about the number of calls was not available at the meeting, however it was said to be unprecedented. Work was underway to meet the assessments and to support through programmes of lower-level support such as food and clean houses.

·       It was noted that fewer people were going into care homes.

·       Workforce – There was a need to address staffing levels and to encourage people into the care role as a career opportunity. A written response would be circulated to members in relation to increasing care hours and the resource implications to pay carers £1 an hour more.

·       The approach recognises the post Covid impact in communities, health disparities and strength-based working, in terms of confident trained staff, recognising skills and wider voluntary and community sector training.

·        Public health funding –£6.3m new investment brought into Staffordshire - funds were secured for drugs and alcohol from a variety of sources, including a large amount from central government and some from Intensive Prevention Service IPS supporting people into work and supporting them in work.

·        Warmer homes – Assurance was given that communication with the elderly who may not have access to the internet was given and families and carers of individuals were also targeted. In terms of funding received to fit boilers there was criteria to access the grant and targeted leaflet drops for the most vulnerable. Winter pressures communications were going out at the same time.

·       Healthy Schools – A Member raised that only 9 schools engaged and discussed issues such as school nursing, it had previously been 200 or more. It was agreed to ask Children’s and Young People’s Cabinet Member about healthy school’s agenda and school engagement when he attends a meeting with Children’s Services early in 2022.

Health and Wellbeing Board - Health in all Policies (HIAP):

·     Driving behavioural change was everyone’s responsibility, it was not possible for public health to achieve or progress on its own, but everyone can benefit. Committee understood the importance of intelligence sharing for public health to find out about and support initiatives.

·     Members were assured that public health had begun to have conversations with relevant people and planning early stages of local plans and planning process. They emphasised the need to consider health impact assessments in planning consideration and to thinking health in everything we do.  Emphasise the importance of thinking ‘health’ in all that we do, and the role of districts and boroughs in this e.g. planning, licensing.

The Committee understood that the County held the statutory public health role and that District, and Borough Councils held the remit to look at wider determinants of health. It was agreed that focus of future work relating to Wider Determinants of Health should consider the role of District and Borough Councils to look at local plans and consider the ‘health in all approach’ across the whole system. 

The Committee agreed to look at diabetes and obesity as topic for future scrutiny and to invite the Senior Partnership & Commissioning Manager from Children and Families Health and Wellbeing Team, who had not been able to attend the meeting due to illness, to attend a meeting early next year to present her report.  He confirmed requests for further information on public health funding, backlog of social care assessments and information on vaping risk.

The Chairman thanked presenters for a clear presentation and report.

Resolved:

1. That Committee receive and note the report and presentation.
2. That Committee request additional information identified in the meeting to be circulated to Members.
3. The Cabinet Member for Children and Young People and Senior Partnership & Commissioning Manager from Children and Families, Health and Wellbeing Team be invited to attend a meeting to present their report on public health outcomes and services in February 2022. 
4. Heath and Care O&S Committee include scrutiny of obesity and diabetes in the Work Programme for 2022 -23.