Agenda item

Frances Howie urged district Councils to be aware of the wealth of data in the JSNA which was available on the website. The Director of Public Health Report focussed on prevention being better than cure; an idea which hadn't been taken seriously enough in recent years despite warnings from the health industry that things would not be sustainable by about 2020. Monetary investment was needed but also working better with our communities to ensure people took ownership of their own health.

Matthew Fung presented the JSNA Annual Summary:

·       The JSNA was a tool to reduce inequalities in the local population

·       Women in richer areas of the County live 6 years longer

·       Generally healthy life expectancy was better in Worcestershire than nationally

·       By 2033 it was expected that the numbers of people over 65 would increase by almost 30%. Action was needed to make services sustainable

·       The positive mortality gap between Worcestershire and England had been narrowing in 2017 but more recent data suggested the trend may be changing in a positive direction and had begun to widen again

·       There was a declining trend in the use of antibiotics but the decline had not kept pace with national trends

·       Air pollution was rising but 0.3% of Worcestershire residents lived in air quality management areas compared to national figures of 0.2%. There would be fewer deaths if people moved from areas with high pollution to low, fewer deaths would result and millions could be saved in primary and secondary care in medication costs and social care costs

·       School readiness in children who received free school meals was lower than in England

·       Educational outcomes at KS2 were worse that England.

Frances Howie stated that Worcestershire was generally above average for most health outcomes however we should not be complacent as there were risks to future health. There were risks to children's future health due to excess weight, school readiness, smoking in pregnancy and breastfeeding rates leading to the current generation being the least healthy in recent times. Middle aged people were also following lifestyles which would lead to them living longer in poor health and there were persistent inequalities.

The report suggested how these problems could be approached:

·       Creating healthy places – it was accepted that more could be achieved and not all opportunities had been grasped. System leaders could do more

·       Supporting people to help themselves – there were lots of places to go for help and information but more systematic signposting was required with organisations working together. Progress was being made on social prescribing through the STP but that work needed to be scaled up. The fact that there was less money available could not be ignored so organisations needed to work together with what was available.

·       Effective prevention services – small, hard to reach services were still being missed. Universal staff training was required and more done with midwifery, health visiting and school nursing. The targeting of services such as mental health, parenting services, diabetes prevention, falls prevention and weight management for those who needed them most was also required.

The report had four overall recommendations:

1)     A system approach to prevention would be an investment for a healthier future and would reduce demand

2)     Working with communities to enable people to help themselves and each other

3)     To work better together

4)     To set up a Worcestershire Prevention Board to drive a community assets approach.

During discussion the following main points were made:

·       The Director of Children's Services welcomed the timely report and information about school readiness and concerns about KS2 results, which were improving but were still behind the national average, and also social care concerns. She believed that Services were intervening too late and were then trying to solve problems rather than preventing them. She hoped more would have been included in the report about mental health and well-being as it was believed ¼ of all teenage girls were self-harming. At present services were not easy to access and it was unfair to ask schools to act as mental health professionals. Looked After Children would all have suffered some sort of trauma in their life and work was needed to prevent later, lifelong problems. She also wished to mention that more should be done to improve the health and opportunities for people with learning disabilities

·       A complete JSNA on mental health was being produced and would hopefully be available in early 2019

·       Prevention and self-care were important concepts in the Five Year Forward View and the NHS 10 Year Plan but it was queried how Public Health could deliver that with financial cuts to services such as health visiting. A document claimed that 85% of Local Authorities were cutting funding to public health. The Director clarified that she was referring to the general climate of austerity rather than any specific cuts to the Public Health Ring Fenced Grant. Spending needed to be on areas where there would be a high impact. A process of prioritisation had begun and questions needed to be asked about how things could be done differently. 12% had been taken out of the Health Visiting budget but transformation work was positive. The problem would come if the ring fence came off the grant and the money became part of the general Local Authority funding. The Chairman added that at the end of the day Local Authorities had to balance their books

·       Sue Ibbotson from Public Health England, supported the focus on prevention and health inequalities, especially in early years. She agreed that the work needed a whole system approach. Similar work was on-going at a national level with NHS England and Public Health England. The focus of the report mirrored the founding principles of the NHS which were 'Healthcare for all' and 'Preventing ill health'

·       It was suggested that one way to reach the right people and increase take up of different services was by co-production

·       It was clarified that the Prevention Board would be different from the HIG in that one worked at an operational level while one would be working at the strategic leadership level

·       14 Neighbourhood teams had been established across Worcestershire with each one having a lead GP, nurse and social worker and were aligned to public health. They were a delivery units which could act on the information in the JSNA

·       It was felt that it was time for a radical approach as previous approaches had not proved successful; there needed to be earlier intervention and a cultural shift was needed as the time certain professionals such as health visitors had for prevention work was limited.

RESOLVED: that the Health and Well-being Board

a)      Noted and discussed the content of the 2016-2018 Report of the Director of Public Health (DPH),

b)      Considered how organisations represented on the Board might best respond to the recommendations of the DPH Report,

c)      Agreed to note and use the contents of the JSNA Annual Summary and compendium of indicators in service planning and commissioning.