To agree the executive response to the recommendations from the spotlight review into dental health and childhood obesity for children families in Herefordshire.

The leader of the council and cabinet members expressed thanks to all those involved in producing the report, including members of the task and finish group, the children and young people’s scrutiny committee and the representatives of partner organisations.

The cabinet member children and families introduced the report and noted that it covered both the children and families and health and wellbeing portfolios. The review had been undertaken following concern regarding levels of tooth decay and childhood obesity in Herefordshire as evidenced in the joint strategic needs assessment (JSNA) of 2017. The work and resulting report was a fantastic example of the contribution made by scrutiny. The recommendations made were considered and thoughtful, with the result that seven out of the nine recommendations to the executive had been accepted in their entirety, one had been partially accepted and only one rejected. The rejection and partial rejection were due to methodologies that needed to be established rather than any issue with the principles expressed.

The director of public health welcomed the focus on two important issues. She noted that while all individuals could take action and be responsible for their own health, the council was working with partner agencies through the health and wellbeing board, with schools and across the council to encourage positive steps such as improving access to healthy food and restricting access to unhealthy food.

The public health specialist highlighted a pilot project due to commence, working with overweight pregnant women. Other work already taking place included the public health nursing service handing out tooth brushing packs to parents of young children and continuing health advice at every contact with families. Services had excellent relationships with schools and it was hoped that the reintroduction of health education to the curriculum in September 2019 would further increase work with schools.

In discussion of the proposed response to the scrutiny recommendations cabinet members noted that:

·        there were mixed views about introducing fluoridation and how effective this might be in improving dental health;

·        there were two major water suppliers that served the county which could provide an opportunity to compare if one were to introduce fluoridation and the other did not, however as a rural county there were many properties with private water supplies and these would not benefit from fluoridation;

·        there were other ways the council could seek to improve dental health without introducing fluoride to the water supply such as supporting parents to ensure their children brushed their teeth;

·        the potential disbenefits to introducing fluoridation needed to be explored alongside any potential health benefits, it was agreed that the response to the scrutiny committee be amended to reflect this;

·        Herefordshire produced good, healthy food and it was important to educate people on how to prepare it, continuing work with schools was supported;

·        increased childhood obesity was storing up long term problems for the NHS;

·        while individuals were responsible for their own health, the council had a responsibility to promote public health, providing education and support to take positive steps;

·        the responses to the public questions set out those measures to enable safe walking and cycling that had already been delivered and what was planned for the future, consultation on the walking, cycling and public transport measures to be delivered as part of the Hereford Transport Package would start on 29 January 2019.

The chair of the children and young people scrutiny committee spoke on the report. She thanked cabinet for their consideration of the recommendations and was pleased that the majority had been accepted. The reasons for the one rejection and one partial rejection were understood. In her comments on the report she noted that:

·        the review was well attended by a large number of outside organisations;

·        there were 45,000 hospital operations across the country each year to remove teeth from children and teenagers, this was a cost to the NHS and a risk to the patients as the procedures were carried out under general anaesthetic;

·        parents reported difficulty in finding an NHS dentist to take their children to, however figures from the NHS suggested that there were dentists with spare capacity, it was possible that physical access was a barrier to those in more rural areas without own transport and the scrutiny committee had recommended to NHS England that mobile dental services be considered;

·        the matter of fluoridation had been discussed at length and the differences of opinion on its desirability and impact were recognised;

·        with relation to obesity, the council played its part in a number of ways such as encouraging use of its leisure centres for regular exercise;

·        many people did not recognise themselves as being overweight and the council could help to raise awareness;

·        some of the money raised nationally through the tax on fizzy drinks should be made available to councils to spend on public health issues.

Group leaders were invited to express the views of their group. It was stated that:

·        the number of take-away and fast food outlets needed to be looked at;

·        actions to be undertaken should be monitored and some sort of report brought back to ensure things move forward;

·        mobile facilities attending school sites might be more cost effective than attending individual villages;

·        having appropriate routes encouraged cycling which in addition to health benefits for the individual helped to reduce air pollution, benefitting other road users;

·        the public health grant from government was reducing;

·        socio economic factors were touched on in the report, the definition of and differences between poverty and deprivation needed to be understood;

·        reversing the decision to fluoridate the water supply would be difficult so any introduction of this needed to be considered carefully;

·        the important role of parents and the challenge for working parents to prepare healthy meals needed to be recognised;

·        new housing developments should contain more open spaces to encourage outside activity.

In closing the discussion, the leader confirmed that public health remained a priority for the council.

Resolved that:

the response to the children and young people scrutiny committee’s recommendations regarding the spotlight review concerning dental health and childhood obesity in Herefordshire as attached at appendix 1 be agreed, subject to an amendment to the response to recommendation xii that the proposed feasibility study consider both benefits and disbenefits of fluoridation.