The consultant in public health presented the report and asked the board to consider the robustness of the joint strategic needs assessment (JSNA) and whether any adjustments were required in the health and wellbeing strategy.  

In presenting the report, it was explained that a working group had been overseeing the development of the JSNA and as a result of that work, which included consultation with stakeholders, a number of priorities had emerged:

·         Supporting the health needs of the working-age population, noting the plans for a new university in Hereford

·         Preventing road deaths in the county, ensuring safer roads

·         Fuel poverty and reducing winter deaths

·         Childhood dental health: it was noted that the situation in the county was severe, with the worst figure nationally for dental decay.  This had been addressed through fluoride treatment but had not been consistently applied across the county’s dentists, and a position was needed on water fluoridation.

·         Obesity: comparative figures were poor, with contributory factors being poor diets and physical inactivity.

·         Long term medical conditions: there was a higher prevalence than the national average, particularly with regard to high blood pressure for which 20,000 undiagnosed cases were estimated, despite the potential to control the risk factors. 

·         Life expectancy gap: addressing risk factors such as coronary heart disease, cancer, respiratory diseases.

·         Falls: there were around 244 hip fractures per year and simple mobility tests could be used within primary care to ease the falls response service.

·         Young people’s mental health and wellbeing: there were increasing needs, hospital admissions and suicide numbers were higher than average. A suicide prevention strategy was under development and but there was a need to review provision of community mental health services.

Board members made the following comments in response:

·         The matter of fluoridation had been raised periodically for some years and although it was considered to be a good solution in general, it was believed to be difficult to achieve within the county.  This was seen to be due to a number of factors which included numerous water supplies in the county and high set-up costs. There were pros and cons to alternatives such as fluoride varnish. In the meantime, work had begun with schools on nutrition but there was recognition that parents’ behaviour also needed to change.

·         In addressing falls, a simple test known as ‘get up and go’ was a quick assessment of someone’s physical stability, which could be carried out by a GP, or community pharmacist when dispensing medicines that could cause drowsiness for example.

·         There was intelligence being developed regarding possible correlation between wellness and accessibility to services, for example, a person’s proximity to a GP.

·         Perinatal mortality rates were based on relatively small numbers. Findings were that there were both congenital and circumstantial causative factors. 

·         The data presented in the JSNA were informative and a suggested development was to make connections between data and evidence of effective approaches to address them in the local context to inform commissioning decisions.  It was noted that there were some areas where there were common factors and approaches, such as in relation to hypertension, but with, say, road traffic deaths, there were more individual factors. It was therefore necessary to focus on factors that the health and wellbeing board could have direct influence over. 

·         In presenting the JSNA to the governing body of the CCG, the focus needed to be on the areas that the CCG had the remit to address, in order to assess impact in a year’s time and inform refreshed commissioning plans.  This could be supported by showing how ownership of the different elements were apportioned between the CCG and the council. 

·         The veterans’ needs assessment was welcomed in the JSNA work programme as this had been requested as an area of focus, although it was felt that the 2019 timescale needed to be sooner.

RESOLVED

That:

(a)    the 2017 joint strategic needs assessment (at appendix 1) be approved;

(b)   the areas of concern noted above, where not already included, be built into the appropriate priorities of the joint health and wellbeing strategy. In particular, these being identified as:

-        establishing the most appropriate approach to increasing fluoride uptake as part of the strategy to improve dental health in children, including further investigation into the feasibility and desirability of water fluoridation

-        promoting the ‘get up and go’ test with clinicians as part of falls prevention work

-        bringing forward the work on a veterans’ needs assessment for earlier completion; 

(c)    the analysis of data be developed in order to provide a demonstrable evidence base for the approaches used in order to inform commissioning plans; and

(d)   stakeholders be asked to take into account the priorities identified by the JSNA when refreshing their commissioning plans, showing clear ownership of actions.