Agenda and minutes

To issue a welcome to those present, and to confirm if there are any apologies for absence.

Apologies for absence were received from Councillor Zaman.

Members will be asked to declare any interests they may have in the business to be discussed.

The Chair asked members of the commission to declare any interests in the proceedings for which there was none.

The minutes of the meeting of the Public Health and Health Integration Scrutiny Commission which was held on 21^st January 2025 have been circulated, and Members will be asked to confirm them as a correct record.

The Chair noted that the minutes of the meeting held on 21 January 2025 were included within the agenda pack and asked members to confirm that they could be agreed as an correct record. 

AGREED:

·       Members confirmed that the minutes for the meeting on 21 January 2025 were a correct record.

The Chair is invited to make any announcements as they see fit.

The Chair invited Councillor Sahu to update the commission on her meeting with the Integrated Care Board. This meeting was organised to discuss disabled women’s access for smear tests and mammograms. Councillor Sahu informed the commission that further information was being sought following the meeting.

Any questions, representations and statements of case submitted in accordance with the Council’s procedures will be reported.

It was noted that none had been received.

Any petitions received in accordance with Council procedures will be reported.

It was noted that none had been received.

The Director of Public Health will provide the Commission with a verbal update on TB rates in Leicester and the ongoing work by the Leicester, Leicestershire and Rutland TB Strategy Group.

The Director of Public Health and the Public Health Consultant gave a verbal update of the latest position of health protection, focusing on TB. It was noted that:

·       There was no significant change in the other areas of health protection usually covered in this item.

·       A TB update was provided 6 months ago at this scrutiny commission. The key points were that it is a disease of poverty, but it is curable and preventable.

·       TB mainly affects the lungs, but it can affect any other part of the body. It is only infectious when in the lungs however.

·       10% of cases of latent TB, developed into active TB.

·       The symptoms experienced depend on the location of the disease in the body.

·       TB rates peaked in the UK in 2011, England had the highest rates due to the highest population level in the UK. In the period after this, there was a reduction in cases.

·       Last year saw a sharp rise in rates of TB in Leicester, whilst the England average had decreased. This was the first time in over 10 years that there had been an increase.

·       The measured rates only considered active TB and do not account for latent TB.

·       Leicester was now the highest rates of TB in England. This was previously Newham, but their rates reduced following financial help that enabled resources to tackle the disease.

·       Leicester would like to see similar financial help to ensure appropriate resources can be targeted.

·       The disease had impacted primary care services – between 2016/17 and 2023/24, 10111 inpatient days were attributed to TB and 82% of these were emergency admissions.

·       There was increased numbers of cases with antibiotic resistance which had increased the complexity of cases, but this had not been a huge issue in Leicester.

·       Post Brexit, changes in economic migratory patterns had seen increased migrations from different areas of high incidence. Country of origin had been identified as the single biggest contributor to case numbers.

·       There were ongoing budgetary pressures. More resources were required for further case identification.

·       Leicester has a TB strategy. This received input from national services and the UKHSA. The key points of the strategy were:

o   Increase detection and control of active and latent TB.

o   Ensuring a skilled workforce and building on successes as well as working within capacity and resources.

o   Raise awareness and reduce stigma around TB.

o   Prepare for the future and plan for need.

·       The strategy fed into the Health and Wellbeing Board, East Midlands TB Board and the Leicester, Leicester and Rutland TB Strategy and Network.

·       A TB JSNA was being finalised. This was going to help identify gaps in services and where and who the cases were.

·       A business case had been made to increase TB staffing resources and recruitment was taking place.

·       There had been successful lobbying of NHS England for further resources to increase the number of tests performed.

·       A research group had been collecting data on the variation found across GP practises in the  ...  view the full minutes text for item 114.

An overview of health research will be provided to the Commission by representatives from De Montfort University and Public Health to consider how research benefits the communities of Leicester and addresses health inequalities. 

Representatives from De Montfort University and Public Health provided the commission with an overview of how research benefits the communities of Leicester and addressed health inequalities. It was noted that:

• Health research entails systematic collection or analysis of data with the intent to develop generalisable knowledge to understand health challenges and mount an improved response to them.
• To be generalisable, research had to be completed in a population that would allow researchers to understand the wider population.
• A quote from the World Health Organisation (WHO) was shared with the commission, “Research is indispensable for resolving Public Health challenges”.
• Although it was important for research to be generalisable, it was known that both research populations and researchers did not currently reflect what they should.
• Research applications from ethnic minority researchers were less likely to be successful. People from ethnic minority groups were under-represented on funding committees.
• Applications from female researchers decline with higher career stages.
• Uk geographies with the highest burden of disease had the lowest number of individuals taking part in research.
• There had never been a UK based cohort study that specifically looked at the health of black women.
• In April 2023, Leicester City Council entered a research bid to become an National Institute for Health and Care Research (NIHR) Health Determinants Research Collaboration (HDRC).
• The ambition was to become a research active organisation and to collaborate with academic and voluntary and community sector partners to evidence base the high quality work that was happening in Leicester City.
• The bid received backing from the City Mayor, Director of Public Health, the two Leicester Universities and colleagues from the voluntary and community sector organisations.
• Unfortunately the HDRC bid was unsuccessful, however the ambition remained. The judging panel were complimentary about the bid and were keen to work with Leicester. Subsequently two bits of funding were awarded for a Local Authority Research Practitioner and Public Health Engagement Lead.
• De Montfort University is one of only two Universities that are a hub for Strategic Development Goals. De Montfort was given the Strategic Development Goal 11 which focuses on sustainable cities and communities.
• De Montfort University was in the process of developing a master’s in Public Health.
• The Universities working together to look through the lens of health inequalities and to contribute to tackling local research priorities that are overseen by the Local Authorities, in Leicester this includes:

o   Civic Universities Partnership - Health, Wellbeing and Sport theme.

o   University of Leicester – Centre for Ethnic Health Research, Leicester Diabetes Centre.

o   De Montfort – Stephen Lawrence Centre, Centre for Primary care Research

o   Health and Wellbeing in Society, Global Health.

o   Ambition to the national leaders in research related to community.

As part of discussions the Chair invited members to make comments and it was noted that:

·       The research was not just about residents of Leicester being subjects in research, but ensuring there was more diversity in research. The research needed to apply to a diverse community.

·       Talking to communities and having  ...  view the full minutes text for item 115.

The Director of Public Health submits an overview of the Long Term Conditions (LTC) programme currently being delivered through Public Health and its proposed future direction.

The Programme Manager in Public Health presented the report, and it was noted that:

·       The strategic justification for the Long-Term Conditions programme came from the Leicester Health, Care and Wellbeing Strategy 2022-2027, the Prevention and Health Inequalities Steering Group, Primary Care Networks City Priorities and the Core20Plus5 national framework.

·       The principles were to prevent as far as possible; reduce health inequalities; ensure well-meaning work hadn’t compounded health inequalities; that it was data driven and evidence based whilst also being innovative; and that it addressed gaps and prevented duplication.

·       Hypertension is persistent high blood pressure and was often referred to as the silent killer as it was symptomless.

o   The high levels of cardiovascular disease in Leicester had contributed to the higher than average under 75’s mortality rate. In order to improve the health outcomes, those who had not been diagnosed needed to be found.

o   Interventions had included the NHS Health Check, Community Pharmacy and Primary Care Network case finding. It had been proposed to engage with those being missed through a community pharmacy outreach model, a roving health unit, targeted NHS health checks, PCN case finding and optimisation and working with GP practises where there was high prevalence.

·       An increasing number of people had been living with multiple long-term conditions.

o   Engagement work was done with GP’s who had higher than average prevalence of cases of multiple long-term conditions to conduct focus groups and development sessions which considered the barriers and challenges faced. 

·       The Health and Wellbeing Board had scheduled a development day in April to consider long-term conditions.

·       Lots of other work had occurred across the city addressing long term conditions including cardiovascular disease, respiratory disease, cancer, obesity and mental health.

·       There was an ongoing partnership with the PCN’s.

·       Part of the prevention strategy was the ‘Make Every Contact Count’ initiative. This was a national approach to behaviour change which focused on the numerous contacts that occur with members of the public to help them make healthy behaviour changes. This initiative considered broader determinants of health as well, such as poor housing and debt alongside more obvious ones.

·       Next steps of the programme were to consider what had been learnt from the hypertension programme and allow this to influence the direction of future programmes, to consider where public health intervention had best been used, to continue the roll out of ‘Make Every Contact Count’ and to further identify areas of need.

In response to questions and comments from Members, it was noted that:

·       A prevention team was working on a whole systems approach to obesity and all the factors that influence this.

·       This was a big partnership for the whole systems approach and the NHS had been asked to sign up.

·       Many factors influenced healthy weight, including environment, access to healthy food and education. The structures and environment can make it more difficult to live a healthy life. This included the big companies, and work was needed in advertising and planning to address their influence.

·       To assess how  ...  view the full minutes text for item 116.

The Director of Public Health submits a report to update the Public Health and Health Integration Scrutiny Commission of the progress of the Health and Wellbeing Board and the progress made on the Health, Care and Wellbeing Strategy.

The Director of Public Health submitted a report to update the commission on the progress of the Health and Wellbeing Board and the progress made by the Health, Care and Wellbeing Strategy. It was noted that:

·       The Health and Wellbeing Board is a statutory board of the Council, that was established under the Health and Social Care Act 2012.

·       The forum is for public accountability, all recordings and minutes from the meetings can be accessed via the Councils website.

·       It is a partnership forum, rather than an executive decision-making body, with Members from various organisations that sit on the board. Including Elected Members, NHS partners, ICB representatives, Public Health, the Police and Fire services, members of the Local Authority, the Voluntary Sector and the wider community.

·       A key function of the board was to oversee the Health, Care and Wellbeing Strategy, which dictated a range of work that is completed within Public Health and Social Care departments.

·       A key function of the strategy was to outline the approach in reducing health inequalities.

·       The strategy outlined key themes in areas that could be focused on at the time of drafting the strategy and it identified a delivery plan on how the issues could be addressed and be structured into priorities.

·       Within the strategy that has been published to the Councils website, 5 themes had been listed, which were:

o   Healthy Places

o   Healthy Minds

o   Healthy Start

o   Healthy Lives

o   Healthy Ageing

·       Within those 5 priorities there were 19 more tangible goals that had been outlined.

·       In the previous Health and Wellbeing Annual Report, the focus was on 6 key strategic priorities. One for each of the themes and under healthy minds the focus was on 2 areas. They are called due priorities, and they are the actions that were being focused on.

·       In the Healthy Places theme, the focus was on improving access to primary and community health care services. A more tangible outcome of this had been the work on enhanced access services in primary care, which included the Stork Programme for supporting families with newborn babies.

·       The focus on Healthy Lives was focused on increasing early detection of heart and lung disease and cancer in adults. This included work to promote cancer screening and producing videos around cancer screening for people with learning disabilities.

·       Healthy Minds focused on improving access to primary and neighbourhood level mental health services for adults. Work around mental health cafes for adults was still ongoing along with increasing access support for children and young people within schools and more disciplinary approaches.

·       Healthy Ageing was to support residents to age comfortably and confidently.

·       The Pathway 1 discharge to assess and work around effective discharge.

·       The Health and Wellbeing Boards Annual Report is a requirement that was set out in the terms of reference. The report outlines the progress that has been achieved, the strategy and the delivery plan monitoring.

·       The annual report included updates on case studies, the Better Care Fund and proposals  ...  view the full minutes text for item 117.

The Director of Public Health submits a report to provide an update on the Health and Wellbeing Survey 2024.

The Principal Public Health Intelligence Analyst presented the report, which showed the results of the most recent Health and Wellbeing Survey. It was noted that:

·       The survey was carried out in 2024. The last one was in 2018. It ran from April to October.

·       The full report of the survey was included in the agenda pack.

·       The data had been used and was intended to be explored further.

·       The survey interviewed those aged 16+. Children specific ones were previously completed.

·       The primary purpose of the survey was to inform strategic and specific needs assessments.

·       The surveys had previously been used across the council and its partners, including the VCS.

·       The survey provided levels of intelligence not everyone had access to.

·       2100 interviews were completed, which reflected about 100 per ward. This was a weighted sample to reflect population data in the census to ensure it was representative.

·       Sensitive questions were self-completed to encourage reliability.

·       The team reflected the diversity found in the city allowing for various languages.

·       A huge range of topics was covered, including new areas such as gambling, covid implications, mental health and wellbeing, food insecurity and some around vaping.

·       The top 5 positives identified by residents were:

o   4 in 5 residents rated their general health as good or very good.

o   There was a decline of 4% in those who smoked cigarettes compared to 2018.

o   3 in 4 residents had used waterways, parks and green spaces at least monthly.

o   Most residents felt they had support they could rely on in difficult times.

o   4 in 5 residents said they tended to bounce back quickly after difficult times.

·       The top 5 challenges identified were:

o   Nearly a quarter of residents had faced difficulties paying their food and energy bills, this was double the figure of 2018.

o   Challenges were faced by residents accessing medical services, particularly NHS dentists or GP appointments.

o   1 in 14 residents with children at home say they smoked in the home.

o   1 in 7 residents had an alcohol consumption that was classified as ‘increasing risk’ or higher.

o   1 in 20 households had reported damp or mould in their home.

·       Within Leicester, there had been an increase in the amount of shisha smoked.

·       Older age bands were more likely to consider themselves to be struggling to access a GP.

·       Half of the population abstained from drinking alcohol.

·       The figures around resilience showed disparities between age and gender in the results. Older groups were less likely to feel resilient, as well as those with multiple conditions.

·       11% of residents had felt socially isolated at least often, this may not appear a large figure but when considered as the number of individuals, the percentage was deceiving.

·       Culture related questions allowed local communities to be understood. Football and Rugby clubs had been in touch to use this type of data.

·       The key issue found around homes was tenure breakdown. When owner occupied, the focus was on the cost of heating and the  ...  view the full minutes text for item 118.

Members of the Commission will be asked to consider the work programme and make suggestions for additional items as it considers necessary.

The Chair noted that the topics noted in the items would be added to the work programme.

There being no further business, the meeting closed at 20.17.