To hold a public accountability session to discuss the performance of the public health service in Herefordshire.

The Committee received a presentation on public health.  The director of public health provided the presentation and highlighted the following areas:

·         That according to Public Health England’s (PHE) healthier lives table, Herefordshire was one of the healthiest places in England to live. Out of the 150 local authorities Herefordshire was ranked 21^st in terms of its premature mortality rates. PHE defined premature mortality as a death before the age of 75 years. Within this overall ranking there were variations for particular diseases that were the causes of death.

In reply to a question from a member, the director said that there was a national change in drinking patterns, and that as more women were binge drinking it was likely that figures would remain static.  Work on the relative risk of those drinking to excess not being treated by their GP was in hand, and targeted work was underway to encourage people to attend their local surgery.

In reply to a further question, the director said that the focus for the Home Office in this area was on cities and large towns, but that there was little appreciation of the needs of rural areas.  HE agreed with another member that better education in alcohol use could lead to less alcohol abuse.  National initiatives were underway with pubs and clubs to change their happy hour promotions.

·         That whilst the government was advocating the need for preventative measure to improve health, austerity measures had meant that the treasury had reduced the public health grant nationally in 2015/16 by £200 million which equated to a 6.2% cut in the national and local grant. This meant a cut of £571k in the council’s budget.  A further cut was being made by the treasury for 2016/17 which was equivalent to an 8.5% cut in the grant, a loss of over £720k. The treasury was proposing an additional cut in 2017/18 of a further £200k. As the council received less than the national average per capita allocation, cuts would mean a reduction in the council’s ability to invest in prevention services. Whilst it had been acknowledged nationally that rural councils receive less funding than their urban counterparts, national government had yet to take steps to allocate a fairer funding formula to address the needs of rural areas.

·         That social isolation was a significant issue for poor health and that greater engagement with communities was an area that the council would have to be able to promote.

In reply to a question regarding the impact of cuts on the council’s public health duties, the director said that cuts were already affecting the council, and that whilst it had the same responsibilities as all other local authorities, it was significantly underfunded compared to others.  Public health funding in Kensington and Chelsea was £13k per Km², compared to £86 per km² in Herefordshire.

In reply to a comment from a member concerning the possibility of lobbying MP’s and the Leader to consider redressing the negative funding gap, the cabinet member, health and wellbeing, said that whilst she was happy that the committee should write out to express its concerns, she would like to be assured that such a move would have an effect and that the right levers of power were being pulled in the most appropriate was in order to have a demonstrable effect.

The director said that better use could be made of the funds that were available to the council.  An asset assessment would provide better understanding of what was available, and there was an opportunity to make better use of pre-existing networks within the county, such as the WI or school communications to parents.

In reply to a comment from a member, the director undertook to provide a briefing note that outlined to the committee what the council’s public health responsibilities were.

A member commented that the county did not perform well in the area of breast feeding, and that the indicators were getting worse.  She was concerned that money was being inappropriately spent in this area.  The director said that work was underway with the Herefordshire Clinical Commission Group (HCCG) and the midwives at the Wye Valley NHS Trust to provide education and encouragement toward taking up breast feeding in the local community.

·         That child health performance was generally around the national performance rates for the west midlands region and the figures for England. Immunisation rates for children were slightly below the regional average, although progress had been made in this area.  Rates of dental caries were higher than the regional average, as were the number of children within the county who were clinically obese or over.  Rates of physical activity amongst children and young people were low and there was concern that without changes to lifestyles, children and young people would be at greater risk of health problems such as heart disease and diabetes in later life.

The director undertook to provide a briefing report to members in their role as corporate parents with data regarding the levels of immunisation and GCSE attainments of children in care.

Resolved that

a)    The report be noted;

b)    briefing notes be provided that:

                   i.    outlined to the committee what the council’s public health responsibilities were

                  ii.    and the levels of immunisation and GCSE attainments of children in care and;

c)    a report on young people and mental health issues be provided to the committee.

d)    an updated report on public health be provided to the committee in six month’s time.