Agenda item

(HOSC member Councillor Frances Smith was not present for this item.)

As part of the Council's development of the 2017/18 budget, the Cabinet Member with Responsibility (CMR) for Health and Well-being, and the Director of Public Health have been invited to discuss the budget challenges facing services in 2017/18 and how these are being addressed. The CMR explained that the proposal relating to public health was one of a list which would be looked at by the Cabinet at its meeting the following day.

The Director of Public Health talked through the concepts behind the Futurefit proposal 'Demand Management: Improving Public Health – Optimising the Use of the Public Health Ring-fenced Grant (PHRFG)". 

The Council took on new duties for population health improvement, and from April 2015 new duties for prevention and wellbeing. The inheritance of public health duties was complex, including the new duties to improve population health having regard to health inequalities. A ring-fenced grant could only be spent on local authority public health functions, and could be spent in four different ways:

·         Mandated, for example sexual health, NHS health checks

·         Non-mandated inheritance, for example substance misuse

·         Non-mandated NHS inheritance, for example primary mental health

·         Non-mandated use in former base adult services budget since 2013, for example housing related support, advice and information.

There had already been cuts to the PHRFG, initially in 2015/16, with further cuts in 2020/21. A managed process of reduction was in place, and corporate strategy planning proposed reductions of £1million in 2017/18 and £0.5million in 2018/19. Currently there was national consultation on the future of specific grants, and further consultation expected on mandated areas.

From a £30.6million 2016/17 budget, approximate spend was 20% to adult social care services, 30% on children's services, 15% on drug and alcohol services, 15% on sexual health services, 10% on strategic direction, 2% on health checks, and 8% on prevention/initiatives such as health walks and social impact bonds.

The Futurefit concept paper would review all PHRFG spend systematically, ensuring statutory compliance, a systematic approach to prevention, preventing the escalation of problems and ensuring evidence based work which has an impact on the Council's public health duties – the key duties being to improve health and well-being, have regard to health inequalities and to co-operate on community safety. 

In reviewing spend on public health, a series of key questions would be asked, for example to assess a service's effectiveness, contribution to prevention and value for money. It was important to remember that there was an appetite for change and innovation and a question to be asked was how might public health work with other directorates to re-design services so as to maximise the health impact of spend and a one-council approach.

It was clarified that whilst Worcestershire's spend per head on public health may have compared very well with other areas previously, at the time when duties were transferred from the NHS, this was no longer the case.

In discussing the concept proposal, a HOSC member made a plea for the Cabinet to maintain public health, which he saw as one of the Council's main responsibilities; yes it was important to embed public health into all areas, and for residents to be self-reliant, but the public needed support to do so, and direct action was still needed.

The Cabinet Member for Health and Well-Being cautioned that the public purse had been reducing over a long time, but the Cabinet was committed to reaching those families and children most in need.

Summing up, the Chairman said that he was confident that Cllr Smith, the Portfolio holder, would fight "public health's" corner hard in his discussions on the budget.

The Chairman thanked everyone for their contribution.

The next HOSC meeting would take place on 13 December 2016, and an additional meeting had been arranged for 11 January 2017, to facilitate a discussion with West Midlands Ambulance Service.