Agenda item

The Cabinet Member with Responsibility (CMR) for Health and Well-being introduced the report on the public health ring-fenced grant and reminded everyone that the allocated funds were very much predicated on outcomes with great emphasis on prevention.

The Interim Director of Public Health (the Director) provided a summary of the Agenda report, including public health statutory duties, the purpose of the PHRFG allocation and the related mandatory public health functions.  The confirmed PHRFG allocation for 2023/24 was awaited, however the report included a financial update as at period 6, with the main explanations for budget variations. The fairly large sum of reserves was in part due to Covid-19, since the Plan already drawn to utilise reserves which had been gradually accumulating, had been stalled during the pandemic – this would now be implemented and was targeted towards health and well-being, reducing inequalities and the impact of the pandemic.

Attention was also drawn to the additional sheet with further detail on expenditure of the PHRFG which had been circulated in advance of the meeting (attached to Minutes).

The Chairman invited discussion and the following main points were made:

·         A HOSC member asked about expectations for the level of PHRFG allocation, referring to the fact that in real terms, grants had been gradually decreasing over recent years. The CMR and Deputy Chief Finance Officer pointed out that Worcestershire did very well compared to other areas, although it was acknowledged that while the grant had not been decreased, recent increases in the PHRFG of 1-2% did not match inflation increases.

·         The reason for the £0.8m underspend of the PHRFG in 2022/23  was questioned. The CMR explained that this underspend was partly due to services needing to stall during Covid rather than any withdrawal of public health service.

·         HOSC members were keen to see the PHRFG fully made use of and were therefore pleased that the 3 year plan in place for the use of the reserves which had been paused during the COVID pandemic, was now underway.

·         A Committee member questioned whether there was any monitoring in place to ensure that the NHS Health Checks Programme for everyone aged between 40-74 were offered to everyone who was eligible, once every five years (funded by Public Health).  Some members of the Committee stated that they had never been offered a health check despite being eligible. It was explained that such checks would not be extended to anyone already being treated for a long-term condition, but that Public Health managed the programme and monitored GP practices’ related work. The CMR added that the main concern was around people who did not see a GP especially those who were not registered with a GP.

·         A HOSC member also pointed out that not everyone who would benefit from a health check would have any symptoms and the importance of health checks in tackling issues such as rising levels of obesity was agreed, as well as learning from the pandemic about how to identify pockets of people not in contact with the health system. 

·         The data presented on NHS Health Checks was clarified and thought would be given to a clearer layout for future reports.

·         It was explained that the £268,000 allocated to fluoridation in 2022/23 was related to specific areas across Worcestershire and further detail about which areas would be provided. For the coming year fluoridation would be a nationally paid for programme.

·         When asked whether Sexual Health Services including emergency contraception and walk-in provision in Worcester had been restored to pre-pandemic levels, the HOSC was advised that a survey was being carried out, which HOSC members were encouraged to highlight. The Officers would verify whether the walk-in clinic in Worcester had reopened, however explained that sexual health services were fully operational – some elements had been tweaked as a result of learning during the pandemic and the online and outreach aspects had been very successful with service users.

·         In respect of feedback from a HOSC member that crime against sex workers had increased significantly, reassurances were sought that the level of funding and support would be sufficient to provide for their health. It was confirmed that a service was being provided to sex workers as part of the service specification for Sexual Health.

·         Everyone agreed the great importance of falls prevention work, and further figures for 2022/23 post Covid were requested so that members could appreciate the full impact. The Director advised that variances in figures could be attributed to Covid, since high numbers of staff were recruited and commenced this work during Quarter 1 of 2021/22.

·         In respect of auditing the Council’s public health activity, the Director confirmed that information had to be submitted to NHSE and the Joint Strategic Needs Assessment for Worcestershire was fundamental.

·         It was explained that the £70,000 spent on the Planning Service under wider determinants of health and well-being had helped develop a system to ensure planning decisions reflected public health priorities.

·         In response to a member’s comment that the public felt access to GPs had declined and was not working due to lack of face-to-face care, the CMR pointed out that GP numbers for the population of Worcestershire were very high, however she suggested the Committee scrutinise this view if it could be evidenced.

·         The Director clarified that the health checks referred to in the report were provided for a specific age group and were a duty of Public Health – these checks were aimed primarily at checking cardiovascular health and were not generic health checks.

·         A HOSC member asked why the Council’s webpage (about NHS Health Checks, screening and vaccinations) did not refer to prostrate cancer, and commented that GPs were more receptive to requests for checks for cancers such as breast, than they were for others such as prostrate. The Officers explained that the website referred to nationally mandated screening such as for breast and cervical cancer, which had very strong evidence of success, whereas the national body which considered such evidence had not recommended national screening for prostrate cancer, although checks could be requested to your GP. One issue around screening was the need for the benefits to be balanced with the potential for harm.

·         Following further discussion about the lack of a national screening programme for prostrate cancer and the information on the Council’s website, the CMR concluded she would request a piece of work on what could and could not be done and consideration be given to signposting about prostrate cancer checks.

·         Regarding treatment for alcohol misuse, it was clarified that the graph to show hospital admission rate for alcoholic liver disease for 2020/21 related to any Worcestershire resident being admitted to any hospital, not just hospitals within Worcestershire.

·         The mandated function of ‘protecting the health of the local population’ related mainly to arrangements and services against threats such as infectious diseases eg Covid-19 for example outbreaks in schools.

·         Recruitment of school nurses had improved, although not all posts were filled and an upskilling initiative was underway.

·         Regarding public health funding for adults, the Director clarified that this did not include specific funding of Day Centres, but did include £150,000 forthe Loneliness Service, which worked with those identified as isolated and also on encouraging connections within communities.

·         The CMR referred to the key role played by district councils and collaboratives, for example in enabling the success of falls prevention.

·         The Director clarified that the figures for people attending a series of falls prevention sessions rather than just one session were misleading because quarter 1 of 2021/22 was when the service had started back after the pandemic.

·         Clarification was provided on two areas listed on the Plan for use of reserves. The BRR agreed schemes referred to Business Rates Retention, and the relevant schemes being funded by use of Reserves (page 12 of the report) included a scheme targeting lonely, vulnerable, disadvantaged women (JOY) and another scheme for domestic abuse. 

The QI project would have been around infection control and prevention but would no longer run, with funding instead being directed to arts projects.

·         The Officers highlighted the success of a project to promote resistance bands, with over 30,000 distributed, with some people who had used walking sticks now walking unaided.

·         The Deputy Chief Finance Officer clarified that the current commitment for funding of the Arts and Health was for two years however there may be potential for this to be recurring and the CMR agreed that arts were important for mental health.

·         A member referred to the 2023/34 Draft Budget report considered by Cabinet on 5 January (Appendix 3 – Savings, reforms, efficiencies) and queried whether the one-off eligible use of £1.6m of PHRFG to further support prevention and demand reduction with adults was the same use of underspend queried earlier by HOSC members, which the Deputy Chief Finance Officer confirmed it was – and were listed on the additional information sheet (Promoting Independent Living Service, Adult social care commissioners and quality team-covid response and mental health reablement and vocation contract). For 2023/24 the recommendation was to use public health funding for these services and this was another area which may have potential to be recurring, subject to the level of the PHRFG allocation.

·         The public health role and funding of Trading Standards related to areas such as counterfeit goods including e-cigarettes.

·         Funding of Occupational Health (Employee Wellbeing) included costs of vaccinating staff for example those working with vulnerable adults.

·         When asked if there were any areas of response which had not achieved, the CMR felt that Disabled Facilities Grants, administered by district councils, could be more efficiently used, which was a personal aim.

The Chairman asked the Scrutiny Officers to draft a summary of the main discussion points related to the 2023/24 Draft Budget, which he would then highlight to the Overview and Scrutiny Performance Board at its meeting on 30 January, comments from which would feed into the Cabinet meeting of 2 February.

The Chairman suggested a future update on the PHRFG in six months’ time, and a specific update on NHS Health Checks, in view of HOSC members’ queries.