Report of the Head of Legal and Governance
Alison Challenger, Director of Public Health, attended to update Councillors on the progress in implementing the changes to Targeted Intervention services agreed as part of the Council’s budget in March 2018 and on the strategic approach to fulfilling Public Health responsibilities and improving the wellbeing of citizens, highlighting the following points:
(a) LAs have been given a statutory responsibility for improving the health of the local population and reducing health inequalities for the last 6 years (including delivering the National Child Measurement Programme, universal health visitor reviews, sexual health services, NHS Health checks, drug and alcohol treatment services, health protection and public health advice for NHS commissioners), with the aim of achieving healthier local populations;
(b) the ring-fenced Public Health Grant for delivery has reduced by 2.6% per year since 2015/16, resulting in a £32,937m budget for 2019/20. As such, ensuring that NHS services are commissioned for best value and delivered to the areas of greatest local need is of primary importance, and it is vital to also invest in other areas to increase the potential for good health, such as parks, good quality safe housing and better air quality. The main health and wellbeing priorities are to engage with obesity, smoking, alcohol related harm, mental health, dementia, loneliness, sexual health and teenage pregnancy, support in the early years, and dental health;
(c) a system-wide approach (with a major focus on the most vulnerable) is being built, in partnership with the GP Alliance, to help people stop smoking. This includes creating smoke-free hospitals, with specialist advisors and services available on site – particularly to those people most at risk. A weight management app has been developed and a weight-loss programme commissioned from a major provider, but current funding levels are extremely limited. It is hoped that the NHS Long Term Plan will make engaging with these issues much more routine for clinicians;
(d) NHS Health check invites saw a 64% increase in quarters 1-3 of 2018/19 (compared to the same period in 2017/18). External funding was secured (in conjunction with partners) to reduce physical inactivity, Nottingham’s Time to Change Hub was launched with more than 70 local champions recruited, and arrangements have been made with the CCG to sustain the Knowledge & Resource function;
(e) the City’s policies aim to maximise the contribution to public health outcomes across its wider services and functions, incorporate health considerations into decision-making across sectors and policy areas, and utilise the unique position of LAs to address the social determinants of health, with an initial focus on training the wider Council workforce to talk to citizens about healthy lifestyle behaviours. This supports the national November 2018 policy context of positive recognition of the importance of prevention, the NHS Long Term Plan and the upcoming Spring 2019 Prevention Green Paper – though further reductions to the Public Health grant will still be implemented.
Some further information was provided, following questions and comments from the Committee:
(f) the current flu season has not yet concluded, but that there have been more vaccinations and fewer flu cases than in previous years. Practices are advertising the vaccinations and take-up rates are growing, but there is still capacity for improvement;
(g) Public Health is committed to achieving a 95% coverage rate for vaccinations to achieve herd immunity, with a major focus on improving the uptake of the MMR vaccine, which is currently at around 90-91%. It is hoped that the distribution of evidence-based information on the benefits and safety of vaccines will help to address citizens’ concerns, but this can be an emotionally contentious topic – particularly on social media. Some cases of measles have started to appear, so it is important for GPs to promote vaccines and keep take-up records;
(h) there is no legal requirement for care home staff to receive an annual flu vaccine, but policy is that they should be vaccinated as part of their duty of care to residents;
(i) there are a number of specialist staff available, but a more universal approach is being developed. In the context of stopping smoking, many people now approach their GP or try to quit by themselves rather than seeking specialist services, so new online, group and one-to-one support structures are being established. As smoking has such a large impact on a person’s health throughout their life, it needs to be addressed by medical staff as routinely as possible;
(j) every effort is made to assess a patient as a full person and arrive at the right diagnosis, and alcohol-related issues will not prevent a patient from also having full access to mental health support services;
(k) early investment in the health of children has a huge benefit and there are substantial expectations on Health Visitors, who provide a strong, early intervention service. Nottingham City has a relatively high number of Health Visitors, who receive assistance from support officers and practitioners with other skills on the team. A reduction in Health Visitors is not proposed, but recruitment has proved to be difficult. A minimum required number of visits from a Health Visitor is in place, with additional visits at the professional judgement of the Health Visitor;
(l) statistics on the number of women drinking during pregnancy can be compiled from the data gathered by Midwives and Health Visitors. The guidance is that women should not drink alcohol while pregnant, but there is always some difficulty in clearly diagnosing foetal alcohol syndrome;
(m)ideally, free full health checks should be delivered to all adults over 40 in a rolling 5-year period, with a particular focus on people with a family history of certain diseases. Health checks are often carried out by nurses at a GP practice.
1) thank the Director of Public Health for the progress report on Targeted Intervention services and to note the contents;
2) acknowledge the progress made in the context of the need for efficiencies following challenging cuts to the Public Health grant; and
3) request a further update on the progress of Targeted Intervention services in 6 months’ time, in the context of the developing NHS Long Term Plan and upcoming Green Papers on Social Care and prevention.