To review Herefordshire’s Joint Strategic Needs Assessment (JSNA) and neighbourhood health profiles.

The committee considered a report on Herefordshire’s Joint Strategic Needs Assessment and Neighbourhood Profiles.

The principal points of the subsequent discussion are summarised below:

1. The Director of Public Health introduced the item and explained that the Joint Strategic Needs Assessment (JSNA) is a statutory, ongoing assessment of the health, care and wellbeing needs of Herefordshire’s population. It was noted that, alongside the countywide summary published on a three-year cycle, the JSNA included themed needs assessments, dashboards and other products to inform strategic planning, commissioning, monitoring and evaluation.

2. The committee heard that the JSNA considers the wider determinants of health and wellbeing, including housing, employment, transport, social connections and the local environment, rather than health services alone. It was noted that health services accounted for only part of the factors influencing health outcomes.

3. The Lead Public Health Intelligence Analyst reported that the neighbourhood profiles had been developed to provide an area-based understanding of need, complementing the countywide and topic-based JSNA products. The profiles are intended to support the national neighbourhood health agenda, with Herefordshire identified as one of the first-wave neighbourhood health sites.

4. The committee was advised that the profiles were designed to be accessible to a wide range of users, including primary care networks, commissioners, council and partnership services, voluntary-sector organisations and other stakeholders. Their purpose is to identify opportunities for prevention and reducing inequalities.

5. It was explained that four neighbourhood areas had been defined using existing localities and primary care network footprints: Hereford City, East, South and West, and North and West. The two Hereford City primary care networks had been combined because their registered populations overlapped, while the profiles would also enable analysis of differences within each wider neighbourhood area.

6. The committee heard that the profiles had been developed as narrative and graphic products, interpreting and triangulating available evidence rather than presenting a comprehensive list of data points. A full North and West profile and draft summary profiles for all four areas had been included in the agenda papers, with members invited to comment on whether the profiles accurately reflected the story of each area.

7. In relation to Hereford City, it was noted that the area has the highest population density and contains both some of the most and least deprived areas in the county. Significant inequalities exist within the city, including a difference of around five years in male life expectancy between some areas, alongside higher smoking rates and avoidable mortality than elsewhere in Herefordshire.

8. The East neighbourhood was reported to have generally positive outcomes, including higher life expectancy, healthier lifestyles and strong communities. However, members heard that area-wide outcomes could mask local need, with Bromyard Central and Ledbury Central identified as areas experiencing deprivation and higher emergency hospital admissions.

9. It was noted that South and West is geographically diverse, encompassing better-connected locations such as Ross-on-Wye as well as remote rural areas including the Golden Valley and the Black Mountains. While health outcomes were generally positive, the profile identified barriers to physical and digital access to services, housing-related issues including fuel poverty and excess cold, and particular health challenges in parts of Ross-on-Wye.

10. The committee heard that North and West also contained significant internal variation. Particular communities in Leominster appeared repeatedly across measures of need affecting children, families and working-age residents, while Ridgemoor and Grange were identified as the two most deprived local areas in Herefordshire, with Ridgemoor among the 10% most deprived areas nationally. It was also noted that six of the county’s ten areas with the greatest geographical barriers to services were located in North and West.

11. The Cabinet Member Adults, Health and Wellbeing highlighted the limitations of national deprivation measures in rural areas, particularly where car ownership could be essential because of limited public transport. It was suggested that this could obscure the financial pressures experienced by residents who needed to maintain a vehicle in order to access employment, services and everyday necessities.

12. It was emphasised that the purpose of the profiles is not to compare neighbourhoods against one another but to understand each area in its own context. It was noted that variation within the four neighbourhood areas, including urban-rural differences and concentrated pockets of need, is often more significant than the difference between neighbourhoods.

13. The committee considered an example concerning digital exclusion in Leominster Grange. The area had been identified as being at high risk of digital exclusion, principally because of skills and confidence rather than broadband availability; analysis of deprivation, working-age need and social and private rented housing had helped identify opportunities for targeted action.

14. The Consultant in Public Health explained that the profiles would provide an evidence base for partners to identify local priorities and develop appropriate interventions. The profiles remained in draft and would be developed further, shared with wider stakeholders and updated as further intelligence became available, including local analysis relating to falls.

15. In response to a question about changes since the last JSNA, it was noted that life expectancy has stalled in comparison with the national position, healthy life expectancy has declined, health inequalities remain significant, and the prevalence of multiple long-term conditions is increasing. Officers identified smoking, immunisation uptake and falls prevention as three immediate countywide prevention priorities, to be considered further at neighbourhood level.

16. Members discussed the importance of sustained smoking cessation support, including reducing inequalities in smoking prevalence, and welcomed the focus on falls prevention. The committee heard that smoking prevalence was around 10% and that Herefordshire was on track towards the target of reducing this to below 5% by 2030. A newly established Falls Network, jointly chaired by adult social care and public health representatives, was reported to be considering partnership work on falls prevention.

17. In response to questions about the geography used for the profiles, officers explained that the four areas followed existing primary care network footprints and had been selected pragmatically to support neighbourhood health planning. It was acknowledged that the profiles must continue to distinguish between the differing needs of market towns, rural areas and smaller communities within each neighbourhood.

18. The committee highlighted the potential value of the profiles in informing discussion on transport, access to services and neighbourhood health planning. Officers confirmed that the profiles are intended to begin conversations at primary care network level about local priorities and service design.

19. It was also agreed that officers would provide further information on the One Herefordshire Partnership.

20. A committee member identified the need for targeted health information and prevention activity for communities with different language needs, particularly in relation to smoking. Obesity and late dementia diagnosis were also raised as important issues. Officers confirmed that, while these were not among the three initial neighbourhood health prevention priorities, both remained significant longer-term priorities for the county.

21. The committee discussed the interpretation of deprivation data. It was explained that the Index of Multiple Deprivation used nationally produced measures across seven domains. It was noted that the profiles would first be shared through primary care networks but should subsequently be made available to a wider range of partners.