To receive apologies for absence.

Apologies were received from Councillor G.W. Davis, P.E. Harling, T.M. James and Brigadier P.Jones C.B.E.

To receive details of any Member nominated to attend the meeting in place of a Member of the Committee.

There were no named substitutes.

To receive any declarations of interest by Members in respect of items on this agenda.

There were no declarations of interest.

To approve and sign the Minutes of the meeting held on 16th March, 2006.

RESOLVED:  that the Minutes of the meeting held on 16th March, 2006 be confirmed as a correct record and signed by the Chairman.

To consider suggestions from members of the public on issues the Committee could scrutinise in the future.

There were no suggestions.

To consider the specific issues of fluoridation and take up of the MMR vaccine and the progression of the Public Health Agenda.

The Committee considered the specific issues of fluoridation and take up of the MMR vaccine and the progression of the Public Health Agenda.

On 30th January the Committee had considered the Director of Public Health’s Annual Report 2004/05.  It had requested further reports on fluoridation and MMR immunisation, identified as two key issues affecting the health of children in Herefordshire, to enable it to reach an informed view as to what action it could and should take on both these issues.

Dr Howie, Associate Director of Public Health, had prepared a report on MMR vaccination which was included with the agenda papers and gave a presentation on fluoridation.

Fluoridation

Key points of Dr Howie’s presentation were:

·          That fluoride occurred naturally in all water supplies but there was an optimum level at which it reduced tooth decay.  The natural level was usually lower than the optimum level but could be safely topped up through the fluoridation process.

·          That there were clear dental benefits of fluoridation.  A child living in a fluoridated area had up to four fewer teeth affected by decay than a child living in a non-fluoridated area, the average difference being just over two teeth.  Fluoridation also reduced inequalities between social groups making it an effective method of intervention.  In the Redditch and Bomsgrove PCT area where 91% of the population received fluoridated water the average 5 year old had three times fewer teeth affected by decay than in the Herefordshire PCT area where there was no fluoridated water supply.  There were also benefits for adults.   A study in the Irish Republic had shown that people aged 45-65 who had lived mainly in fluoridated areas had between 40%-50% more of their natural teeth than those who had lived mainly in non-fluoridated areas.  People aged 65 and over who had lived mainly in fluoridated areas had 50% less root decay than those who had lived mainly in non-fluoridated areas.

·          That there was plentiful expert evidence that fluoridation was safe.  One of the concerns had been that the process might increase osteoporotic fractures.  In fact there appeared to be some protective effect.  The Medical Research Council had also concluded that fluoridation did not cause birth defects.  Cosmetic concern relating to dental fluorosis was not considered significant.

·          That Professional support for fluoridation was overwhelming.  Attention was drawn to the National Alliance of Equity in Dental Health and the statement by the British Medical Association (BMA) issued in March 2004:  “The BMA has for many years been in favour of fluoridation of mains water supplies.  We support this policy on the grounds of effectiveness, safety and equity…..The BMA believes there is no convincing evidence of any adverse risk to human health by the introduction of water fluoridation.”  The British Dental Association had issued a Statement in July 2003 that: “Water fluoridation is a simple measure that dramatically improves dental health by reducing tooth decay.  Comparisons of fluoridated and non-fluoridated areas reveal significant discrepancies in oral health.”

·          A MORI survey of opinion in the  ...  view the full minutes text for item 47.

To consider proposals for the development of stroke services in Herefordshire.

The Committee considered proposals for the development of stroke services in Herefordshire.

It was noted that a review of stroke service provision had been commissioned in the autumn of 2005 and a consultation paper had then been developed on potential ways of improving Stroke Services within current resources.  Reports by the Primary Care Trust to the Hillside Section 31 Board and the PCT Provider Committee had been included in the agenda papers. 

Trish Jay, the PCT’s Director of Clinical Development and Lead Executive Nurse, gave a presentation explaining how the proposals had been developed, the proposed future measures for stroke prevention, acute stroke care, stroke rehabilitation and long term support.  In relation to stroke rehabilitation it was noted that the proposal was that this all took place at one unit: Hillside.  The impact on current activity at Hillside was outlined.

She noted that discussions in Herefordshire on the need to develop stroke services had been ongoing for some five years.  However, there had been no progress because the proposals made during that period had been too expensive.  The view had now been taken that action should be taken in specific areas by reorganising existing resources as a pragmatic, incremental step towards developing an ideal service and the current proposals had been put forward on that basis.  Mortality rates as a result of strokes were too high in Herefordshire and action needed to be taken.

The Committee’s principal concern about the proposals related to the implications of for some patients from Hereford City and Golden Valley requiring general intermediate care, but not specialist stroke rehabilitation, who would need to be treated in other Intermediate Care/Community Hospital Units.  The evidence suggested that 6 beds would cease to be available for this general intermediate care.

In reply Trish Jay explained that the intention was that any impact would be mitigated by full use of all 22 beds at Hillside, access to community hospital beds and a review of access arrangements to the 126 community hospital/intermediate care beds, with proposals for using them differently.  She reiterated that a new Unit might be more ideal but that was not a practical option at this time.  If progress were to be made an incremental approach was the best way forward.   She emphasised that whilst a bed at Hillside might no longer be available to some patients those patients would still receive the care they required.

It was noted that the Patient and Advice Liaison Service would consider provision of travel information for those affected by the proposals.

Members acknowledged the importance of making some progress in developing stroke services and that the proposals should accordingly be supported.  However, it was requested that the implementation of the proposals should be carefully monitored.

RESOLVED:  That the proposals for the development of stroke services be supported, with their implementation being carefully monitored.

To advise Members of key messages emerging from the new White Paper “Our Health, Our Care, Our Say: A new direction for Community Services”. 

The Committee was informed of key messages emerging from the new White Paper “Our Health, Our Care, Our Say: A new direction for Community Services”. 

The report summarised the key areas for change identified in the White Paper.  It was noted that the detailed implications would emerge as the Government issued detailed guidance to implement the proposals over what was expected to be a two year period.