To consider the Director of Public Health’s Annual Report 2004/05.

The Committee considered the Director of Public Health’s Annual Report 2004/05.

Dr Frances Howie, Associate Director of Public Health attended the meeting to present the Annual Report and to answer questions, together with Mr Simon Hairsnape, Deputy Chief Executive of the Primary Care Trust.

Dr Howie gave a presentation on the report reminding the Committee that the Director of Public Health was statutorily required to produce an independent Annual Report on health in Herefordshire.

Her report focused on priorities in the White Paper published at the end of 2004: Choosing Health.  She commented in turn on each of the following priority areas: smoking, sensible drinking, mental health and well-being and obesity and the recommendations made in the Annual Report in these areas. 

Health Inequalities had been identified as a theme in its own right.  She outlined the inequalities between geographic areas in the County, in particular the inequalities in the South Wye Area, the inequalities between social groups and between households and what factors should be taken into account in devising interventions to limit these inequalities.  She drew particular attention to the poor dental health in Herefordshire and the potential benefits of fluoridation and to the continuing need to increase MMR immunisation rates.

In conclusion she stated that Herefordshire was healthy relative to the rest of the Country.  However, health inequalities did exist which action could be taken to narrow.   Long-term health improvement could be achieved by implementing the health prevention agenda set out in the Choosing Health White Paper, focusing both on both prevention and improvement.  She noted the extent to which delivery of the White Paper relied on Joint Working between Health Services and the Local Authority in particular.

Mr Hairsnape commented on the importance of the Annual Report in informing the strategic decision making of the Primary Care Trust.  The Trust’s approach had to be driven in large part by National Targets and where Government chose to direct its funding.  However, the aim each year was that the Annual Report would be produced in time for its findings and recommendations to feed into discussions on commissioning and be built into the Local Delivery Plan.  One of the difficulties was that success could not be measured in the short term.  However, whilst the emphasis might change, the key issues such as the benefits of reducing smoking did not.  He too emphasised the role of partners of the health service, in particular the Council in implementing the public health agenda.

The Director of Children’s Services reinforced the importance of the links between partners and the extent to which the public health agenda was a joint agenda.

The Committee then questioned Dr Howie and Mr Hairsnape on the report.  The following principal points were made:

·          The Annual Report had identified that Herefordshire had the lowest percentage of 5 year olds in the West Midlands (South) Strategic Health Authority Area free from tooth decay.  The Committee was advised of the effectiveness of fluoridation in reducing dental health inequalities and that an ever growing body of research had demonstrated that it was safe. 

·          The lengthy process for approving fluoridation was explained.  It was noted that the Primary Care Trust had agreed to begin the process by asking the Strategic Health Authority (SHA) to work with the Water Company to carry out a feasibility study.  It was acknowledged that a minority of people were strongly opposed to fluoridation and that this would doubtless become apparent in the consultation period.  It was noted that the Primary Care Trust would welcome the support of the Committee and the Council for fluoridation.

In response the Committee proposed that Dr Howie should prepare a report for the Committee, supplemented by a pack of more detailed supporting evidence, to allow the Committee to reach an informed view as to what action it could and should take.  In the meantime the Committee gave its qualified support to the request for a feasibility study, whose findings would form an important part of the final decisions.

·          The Committee was also advised of the continuing, relatively low MMR immunisation rates, with take up in parts of the County below 60% whereas the national target was 95%.  Outbreaks of Mumps and Measles were now being experienced and there was the ever growing risk of an epidemic.  There was a suspicion that, having been relatively free from these diseases for a generation, people had simply forgotten their devastating effect.  The Committee was informed of measures being taken to remind people of the effects of these diseases and to seek to increase take up of the vaccine.  It was noted that schools were being very co-operative in helping to try to address the problem.

It was again proposed that Dr Howie should prepare a report for the Committee supplemented by a briefing pack of supporting evidence to allow the Committee to reach an informed view as to what action it could and should take.

·          It was confirmed that the PCT was mindful of the changing ethnic profile of the County and the new health challenges this could present.

·          The PCT acknowledged that the provision of sexual health services to young people of school age was particularly sensitive.  The PCT was mindful of this and sought to balance the various views on this subject and how advice could best be provided.  Ultimately, however, the PCT’s view was that the responsibility not to fail the young people affected had to prevail over other considerations. 

·          A Member suggested that people still did not fully understand the damaging consequences of an unhealthy lifestyle and the contrasting benefits of a healthy one.  The message still needed to be more effectively communicated.

·          The PCT recognised that it had to bear in mind that education alone was not the whole solution.  For various complex reasons many people smoked and drank more than they should even though fully aware of the harmful consequences.  In devising a strategy for public health improvement the PCT was aware that it needed to address this fact.

·          The Committee noted that there were a number of reasons for the poor health outcomes in the South Wye area of Hereford City and that a range of measures needed to be deployed in response.  This was reflected in the Report’s recommendations that further work be carried out to identify actions that were most likely to challenge poor health outcomes in South Wye and that an Inequalities Strategy should be developed.

·          The Committee recognised the need to give further consideration to its potential Community Leadership role.

·          A question was asked about the impact of changes facing the NHS on efforts to improve public health.  In reply it was stated that in the case of structural change the NHS had faced frequent such changes in recent years and public health had improved during this time.  The current reconfiguration proposals could improve co-terminosity bringing benefits in terms of co-ordinating housing and regeneration policies to the benefit of public health.  In terms of other initiatives practice based commissioning related directly to improving the public health agenda.

·          It was suggested that in future years the PCT should give further consideration to producing a clear, concise summary of the Director of Public Health’s report to try to ensure that its key messages reached as many people as possible.

·          A question was asked about dentistry provision.  In reply it was stated that the position in Herefordshire was now considered broadly satisfactory.  The PCT would continue to allocate resources to dentistry and had a responsibility to ensure care was available, if not with an NHS dentist then with an alternative provider.

·          In terms of the Committee’s future work the Chairman suggested that it would be important to maintain focus on the public health agenda, contribute to consideration of how inequalities in the South Wye Area could be addressed, and examine how effectively those involved in delivering the priorities in the Choosing Health White Paper were working together.

·          On being asked where he thought the Committee might add value Mr Hairsnape reinforced his previous advice to the Committee that in his view it could contribute most effectively by focusing on areas which were not already strictly regulated and monitored.  The public health agenda which determined life expectancy and quality of health was one such area.  The importance of joint working to deliver public health improvement had been emphasised during the meeting and the effectiveness of partnership working also tended to fall outside many of the monitoring systems.

·          It was suggested to the Committee that it was important that it maintained its focus on Public Health and did not simply return to it annually upon publication of the Director of Public Health’s report.

RESOLVED:

That    (a)        a report on fluoridation with a briefing pack of supporting evidence be made to the Committee to allow the Committee to reach an informed view as to what action it could and should take;

            (b)       a report on MMR immunisation with a briefing pack of supporting evidence be made to the Committee to allow the Committee to reach an informed view as to what action it could and should take;

                        and

            (c)        the PCT be asked to give further consideration to producing a clear, concise summary of the Director of Public Health’s report next year.

(The meeting adjourned at this point, reconvening at 2.00 pm)