Agenda and minutes

The Democratic Governance and Scrutiny Manager explained that as Apologies had been received from both the Chairman and Vice Chairman, a Chairman for the meeting would have to be elected from those present.

Mr G R Brookes was elected as Chairman for this meeting.

Apologies had been received from Mr P A Tuthill, Mr P Grove, Mrs M A Rayner, Mr C Rogers, Mr C B Taylor, Mr M Chalk, Ms C Edginton-White and Mrs F Smith. 

None.

Members of the public wishing to take part should notify the Head of Legal and Democratic Services in writing or by email indicating the nature and content of their proposed participation no later than 9.00am on the working day before the meeting (in this case 22 November 2019). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

The Minutes of the meetings held on 18 September and 8 October 2019 were agreed as a correct record and signed by the Chairman.

Attending for this Item from Worcestershire Acute Hospitals NHS Trust were:

Amanda Markall, Director of Operations Surgical Division

Mel Collins, Countywide Audiology Services Manager

The Audiology Services Manager referred to the Presentation attached to the Agenda and the following main points were highlighted:

·         1 in 6 people had a hearing impairment in the UK and it took on average 7 years for people to realise there was a problem and seek help

·         Only 60% of people with hearing difficulties wore hearing aids

·         The affect of hearing loss included isolation, depression and general acceptance that they will ‘miss out’.  There was also a possible link to dementia, although this was not proven

·         Patient numbers in Worcestershire had been fairly stable in recent years, with around 48,000 adult consultations and around 14,000 paediatric consultations taking place in 2018

·         Reception aged children were routinely tested in Schools by Worcestershire Health and Care Trust and if necessary referred to the Audiology Service

·         Alongside the main hospital sites, the Service had a number of satellite sites around the County ensuring that patients did not have to travel for long periods for routine appointments or aftercare

·         A recent initiative, where hearing aid batteries were distributed through Charity Shops in Worcester and Droitwich, had been well received by patients as these outlets were often more accessible than the main or satellite sites

·         The service was nearly fully resourced, with 29 Clinical Audiologists amongst others, with 3 vacant posts being recruited to currently

·         Performance was generally positive against the key indicators, although equipment failures at the Alexander Hospital in Redditch meant that some patients who would have had to travel further declined their appointments, thus affecting the performance figures

·         An increasing number of GP surgeries were no longer removing ear wax, which was having an impact on the service as patients were arriving with wax and could therefore not have their hearing test performed

·         Advances in technology was having a positive impact for patients with hearing loss.

In the ensuing discussion, the following main points were made:

·         In response to a query as to whether the Audiology Service was proactive in reaching out to organisations which had hearing loop systems, to offer advice or support, it was reported that although some work had been done in the past, it would need to be revisited

·         Members were extremely concerned to hear that GP surgeries were no longer removing ear wax which was having an impact on both the patient and Audiology Service.  HOSC agreed to write to the Worcestershire Clinical Commissioning Groups to urge them to encourage GP surgeries to undertake ear wax removal before referral

·         When asked whether a build up of ear wax could cause an infection later, it was suggested that there was no evidence to suggest this was the case

·         In relation to current vacancies, these were part of the base budget and there were no new positions

·         Members were interested to hear about the initiative whereby hearing aid batteries were being distributed through  ...  view the full minutes text for item 949.

Attending for this Item from Worcestershire County Council were:

John Smith, Cabinet Member with Responsibility for Health and Well-being

Kath Cobain, Interim Director of Public Health

Steph Simcox, Head of Finance

HOSC Members were reminded that Public Health had transferred from the NHS to Worcestershire County Council in April 2013 and there was a duty on local authorities to take appropriate steps to improve the health of the people living in their areas.

The Public Health Ring-fenced Grant (PHRFG) was also created in 2013 and was payable to upper tier authorities to deliver public health duties under the Health and Social Care Act 2012.

The PHRFG for Worcestershire was £28,360m in 2019/20 but had reduced year on year since its introduction.  The PHRFG had been cash limited for the last two years but was due to increase by 1% in 2020-21.

The Agenda Papers outlined the statutory duties, mainly to improve population health and well-being and have regard to narrowing health inequalities, the role of the Director of Public Health and the structure of the Public Health specialist team.

The Vision of Public Health in Worcestershire was ‘that Worcestershire residents are healthier, live longer, and have a better quality of life, especially those communities and groups whose health is currently poorest’. 

The Agenda Papers also provided a comprehensive overview of a number of performance metrics around public health, including health visitor activity, school nurses and the national child measurement programme, sexual health, drugs and alcohol and the NHS Healthcheck programme.

In comparison to other local authorities across England, Worcestershire generally performed well and on the individual indicators there was nothing of concern.

Public Health in Worcestershire generally spent less than its CIPFA neighbours but achieved better weighted outcomes.

In the ensuing discussion, the following key points were made:

·         Members were disappointed to hear that the Government PHRFG funding was only available on an annual basis, which did not allow for long term planning, however, the Committee was encouraged to note that centrally there was a commitment to prevention services, although there was some uncertainty beyond 2020-21

·         The Director clarified that the PHRFG was the total spend of the Team

·         The Committee noted that the % of children, both at age 4-5 (Reception Year) and age 10-11 (Year 6) who were classified as being overweight or obese was around 22% in Reception and 33% in Year 6, which was concerning

·         Oral decay was highlighted as a health inequality as only certain areas of the County were in water fluoridation schemes

·         A Member asked about the relationship between the County Council and District Councils in relation to Public Health, to be informed that on occasion there was a disconnect and further work could be done to engage further for the benefit of residents

·         Relationships with Worcestershire Health and Care NHS Trust in relation to sexual health were positive 

·         The Director was asked about the Joint Strategic Needs Assessment (JSNA) and the Committee was informed that although it was a statutory duty to  ...  view the full minutes text for item 950.

Attending for this Item from Worcestershire County Council were:

John Smith, Cabinet Member with Responsibility for Health and Well-being

Kath Cobain, Interim Director of Public Health

Lucy Chick, Senior Public Health Practitioner

HOSC Members were reminded that as part of reductions to Public Health Ring-fenced Grant (PHRFG) funding, the Council had discontinued commissioning of smoking cessation services, except for pregnant women.

Nationally, smoking prevalence in England had fallen to 14.4% and in Worcestershire, for adults, this figure was 11.7%, although there were District variances.  Redditch Borough Council had the highest estimated proportion of current smokers at 20.5%, compared to the lowest in Wychavon with 6.8%.

There was a national vision to create a smokefree generation, which would be achieved when smoking prevalence was at 5% or below.  The Government had set out a series of ambitions which would help focus tobacco control across the system, including reducing the prevalence of smoking in young people, parity of esteem for those with mental health conditions and a smokefree pregnancy for all.

In Worcestershire, 13.1% of pregnant women still smoked at the time of delivery, equating to more than 600 babies born each year.  As part of the new Tobacco Control Plan, the Government had set an ambitious goal to reduce smoking in this group to 6% by the end of 2022.

The NHS Long Term Plan had also highlighted that smoking was in the top five of various risk factors that caused premature death in England, along with poor diet, high blood pressure, obesity and alcohol and drug use.  By 2023/24, all people admitted to hospital who smoked would be offered NHS funded tobacco treatment services.  Furthermore, a universal smoking cessation service would be available for users of long-term specialist mental health services and learning disability services.

E cigarettes had been regulated for use since 2016 and delivered nicotine in a vapour rather than in smoke.  It was estimated that they were 95% less harmful than ordinary cigarettes but public understanding of their relative harm had worsened over time and was often inaccurate.  In Britain, almost all users were either ex or current smokers and there was no evidence that they had led to an increase in smoking in young people.

In the discussion that followed, Members raised the following points:

·         Research was ongoing to determine what the long term side effects of vaping were and further trials would need to be undertaken

·         In the USA, some States had introduced bans on either flavours or products, which could be counter productive as it would make the activity potentially more illicit

·         Smoking activity in Redditch and Wyre Forest was reported to be at a higher rate, although it was noted that the data was not always accurate.  However, the data associated with the number of pregnant women still smoking at time of delivery was accurate as that was recorded by the NHS

·         When asked whether there was any evidence to suggest that if an individual smoked, would they also drink or take drugs,  ...  view the full minutes text for item 951.

Members had nothing to report at this time.

The Cabinet Member recommended, and HOSC agreed, to add a visit to the Worcestershire Integrated Sexual Health (WISH) service, which had recently relocated to Aconbury North on the Worcestershire Royal Hospital site.