To present to the committee firstly, a review of the consultation process and responses received.  Secondly, present some conclusions and high level proposals on priorities for consideration in the strategy and thirdly, update the committee in regard to the timeline for the development of the draft strategy and its final version.

Further to consideration of the ‘Health and Wellbeing Strategy’ item at the 25 November 2022 meeting (minute 28 of 2022/23 refers), the purpose of this item was to present to the committee: a review of the consultation process and responses received; some conclusions and high level proposals on priorities for consideration in the strategy; and the timeline for the development of the draft strategy and its final version.

The Cabinet Member - Health and Adult Wellbeing (and Chairperson of the Health and Wellbeing Board) made opening comments about the substantial work being undertaken by the Public Health team on the strategy.

The Director of Public Health and the Public Health Programme Manager provided a brief presentation, with attention drawn to:

i.             The papers provided a high level summary of the findings of the public engagement exercise; the findings were also to be discussed at a Health and Wellbeing Board workshop following this committee meeting.

ii.            The public engagement exercise, involving an online survey in relation to twelve proposed priorities, was undertaken between the end of October and mid-December 2022.  This had produced 960 responses.

iii.          The top three priorities were identified as ‘Every child has the best start’, ‘Support good mental wellbeing’, and ‘Protect the natural environment’.

iv.          The common themes from qualitative data from the online survey responses (agenda page 23) and from face-to-face engagement sessions with community groups and partners (agenda page 24) were outlined.

The main points of the debate included:

1.           The similarities in the common themes that had emerged from the online survey and from the engagement sessions.

2.           The Community Partnership workshop had placed ‘Every child has the best start in life’ as second in the ranking of priorities but ‘Improve education outcomes for disadvantaged children and young people’ was at the end.  Noting the explanation provided that the workshop considered that one would feed into the other, the Chairperson commented on the need to avoid umbrella topics which could squeeze out consideration of specific priorities.

3.           The Chairperson suggested that, in addition to percentages, it would be helpful to include actual numbers of people and benchmark figures with comparable authorities in tables such Appendix 1 -‘Summary of areas of concern informed by the Public Health Outcomes Framework’.

4.           It was noted that 41% of respondents were aged 45 to 64 but only 4% were aged 16 to 24.

5.           With reference to Appendix 1, a committee member commented on the importance of screening for prostate and bowel cancer, in addition to screening for breast cancer.  The Director of Public Health said that prioritisation for the purposes of the strategy and partnership effort would not limit activity on other population health matters.  It was reported that screening would be delegated by NHS England to the Integrated Care Board from April 2024 and that conversations had commenced about increasing screening uptake.

Later in the meeting, it was suggested that the topic of screening services could be considered by the scrutiny committee at a future date.

6.           The statement ‘49.3% of children and young people are physically active’ related to the aim of completing at least an hour of physical activity a day.

7.           The Director of Public Health commented that there were three different levels of prevention: primary prevention which involved upstream measures before problems emerged; secondary prevention when there was early signs of disease or illness; and tertiary prevention where there was disease or illness present.

A committee member recognised that work was being undertaken on prevention but felt that communications about this activity could be improved.

It was recommended that clarity be provided about the proportion of the strategy that was focussed on each level of prevention.

8.           The Director of Public Health commented on the importance of ‘Every child has the best start’ and ‘Support good mental wellbeing’ to achieving outcomes; the next steps would be to explore the evidence, what was being done, and where the gaps were in order to inform the multi-agency approach.

9.           The Director of Public Health also commented on the need to map work being undertaken on ‘Protect the natural environment’ and on other determinants of health.

There was a brief discussion about the death of a child in Rochdale ‘as a result of a severe respiratory condition due to prolonged exposure to mould in his home environment’.

10.        The current pressures in primary care and the implications for prevention were explored, with the Director of Public Health commenting on potential opportunities to deliver health checks and clinical services in new and innovative ways.

11.        Representatives of Impact Consultancy and Research advised that the fact that Herefordshire Children’s Services had been rated inadequate by Ofsted had not been a recurring issue in the face-to-face engagement sessions.

12.        In view of the transportation challenges for rural communities, a committee member suggested that consideration should be given to mobile outreach services (e.g. for audiology, dentistry and ophthalmology), particularly to identify conditions in children under compulsory school age.  The Director of Public Health said that overarching themes were likely to include access and inequalities.  The Director added that the recommissioning of health visiting and school nursing services may provide opportunities to deliver different models, subject to cost and outcomes effectiveness.

With input from the Democratic Services Manager, the committee discussed potential recommendations to the Health and Wellbeing Board and agreed the following resolution.

Resolved:

That the following recommendations be submitted to the Health and Wellbeing Board:

a)           The strategy presents clearly how the priorities covered by other directorates / health partners and boards will be monitored and promoted;

b)          Clarity is provided about the proportion of the strategy that is focused on primary, secondary and tertiary prevention; and

c)           Considerations are given to providing mobile outreach services (dental care, screening etc) to ensure all children can be provided with the best possible start in life.