To receive a presentation on the Annual Report of the Director of Public Health and consider issues arising from it.

The Committee received a presentation from Dr Frances Howie, Associate Director of Health Improvement, on the Annual Report of the Director of Public Health 2006.

 

The presentation contained a health profile of the county, progress against priorities in the “Choosing Health” White Paper and Health protection activity.  The main points made in the presentation are summarised below.

 

Health Profile

 

It was reported that people in Herefordshire are generally healthy and see themselves as healthy.  However, the following areas for concern were listed:

 

·          Whilst overall mortality rates dealt with small numbers, so caution were needed, there was remarkable consistency over recent years.  Standard Mortality Ratios (SMRs) were higher than expected for: malignant melanoma of skin; Stroke (especially female); and land transport accidents among men.

 

·          Poor dental health.

 

·          Health inequalities between different areas, depending on levels of social deprivation.

 

·          Life expectancy differences at ward level.

 

·          SMRs are highest in the most deprived areas.

 

·          Hospital admissions are highest in the most deprived areas.

 

·          Differences between socio-economic groups within different categories of admissions: eg. injury and alcohol related admissions.

 

Recommendations

 

The recommendations to address these concerns were:

 

·          Development of a sun safe health promotion programme with focus on men

·          A scoping study on falls prevention

·          Work with partners to improve cycling safety

·          Increased provision of primary health services in South Wye

·          Working with partners to identify health needs of ethnic minorities

 

 

CHOOSING HEALTH

 

Priorities were sexual health, smoking, sensible drinking, and obesity.  It was noted that investment had not been ringfenced and the financial pressures in the NHS had led to a reduction in the budget for these initiatives.

 

Sexual health

 

In terms of sexual health it was reported that the 2008 target of a 48-hour wait for genitor-urinary medicine services would be challenging, as would the 2007 target for Chlamydia screening.  Teenage pregnancy was low so it would be hard to reduce this to meet targets.

 

Smoking

 

The PCT service met targets.  However, the health equity audit showed lower quit rates in the most deprived areas.  The Regional Lifestyles Survey (RLS) showed the highest smoking rate to be among 35-44 years and significantly above the regional average.  The PCT had joined with the Council to form a Smoke-Free Herefordshire Group.  The aim was to bring together partners from across the County to co-ordinate and develop a programme of work to reduce smoking and meet the requirements of forthcoming legislation.

 

Sensible Drinking

 

Statistics were presented on the percentage of people drinking more than the recommended level, and on binge drinking.  It was noted that there had been a steady rise in alcohol related emergency admissions.  A multi-agency group was in place which linked to the national alcohol strategy.

 

Obesity

 

The effects of obesity on health and the current position in Herefordshire were set out, noting that as a consequence this would be the first generation whose life expectancy would be shorter than their parents.  A number of initiatives being taken to reduce obesity were described.

 

Recommendations

 

The recommendations to address these issues were:

 

·          Introduce NAAT system of testing for Chlamydia.

·          Encourage brief interventions around sensible alcohol consumption.

·          Encourage the use of brief interventions around smoking.

·          Develop dedicated capacity for work programme to challenge obesity.

 

HEALTH PROTECTION

 

Screening

 

Statistics were presented showing good coverage for cervical screening, with a huge improvement in the length of time people had to wait for results.  There was also good coverage for breast screening and again an improvement in the length of time waited for results. 

 

Immunisation

 

The uptake of the MMR vaccine showed a slight improvement but was still only 81.5%, well below the required 95% level.  A new childhood immunisation programme vaccine was to be introduced in September adding a pneumococcal vaccination for babies, together with a catch-up programme for all children up to the age of two.  There was some concern about its impact and that MMR uptake rates may begin to fall again because of parents becoming anxious about the number of vaccinations being given and the difficulties of attending more clinic appointments.

 

There was no longer a universal school-based vaccination programme for Tuberculosis.  Herefordshire had the lowest rate of notification in the West Midlands and the policy of withdrawing routine vaccination was therefore appropriate.  Screening systems were in place to identify high risk people who would then be offered vaccination.

 

The uptake of the Flu vaccine was above the national target.

 

The uptake of the Pneumococcal vaccine, targeted at those aged under 2 and over 65, was just above the national average for those aged over 65.  Vaccination was being introduced for babies together with a catch-up programme for those aged under 2.

 

Recommendations

 

The recommendations on health protection were:

 

·          Focus attention and activity on increasing uptake of flu and pneumococcal immunisations

·          Maintain other programmes of work on MMR and screening.

 

In summary the annual report concluded that Herefordshire was healthier than other places but that health could be significantly improved in key areas.  This could only be achieved with continued new investment and a wider shift of NHS resources into prevention.  There was a need to accept short-term investment for a long-term gain.  Improvement could only be achieved with the support of partners.

 

Dr Howie then responded to a number of questions as summarised below.

 

·          In relation to fluoridation Dr Howie assured the Committee that she would continue to monitor progress by the Strategic Health Authority on the matter and again thanked the Committee for its support for a feasibility study.

 

·          Asked about investment in the South Wye area to reduce health inequalities,  Dr Howie said that investment did not come from the public health budget alone.  The public health team was small and sought to draw attention to the inequalities and influence others to prioritise this issue.  Her expectation was that there would be increased allocations from both mainstream budgets and the public health budget to reduce inequalities in the area.  She gave a number of examples of initiatives that were underway and commented on health promotion publicity.

 

·          It was noted that whilst statistics on alcohol consumption by people below the age of 18 were not currently available, work was in hand to gather the information for the current year and future years.

 

·          Dr Howie reported that no difficulties with supplies of flu vaccine were expected in the County at this point.

 

·          Clarification was provided on the action being taken to improve Chlamydia screening.

 

·          Dr Howie commented on the continuing efforts to improve uptake of the MMR vaccine but advised that the issue continued to be of concern.

 

·          The number of cycling accidents resulting in hospital admissions and the need for improved road safety was discussed.

 

The Chairman thanked Dr Howie for her presentation.