Agenda item

A)        To receive verbal updates (5 minutes) on each of the five priorities:-

 

i)          Improve outcomes for children and young people.

 

ii)         Reduce premature mortality.

 

iii)        Support independence.

 

iv)        Improve mental health and resilience.

 

v)         Focus on the wider determinants of health through effective deployment of resources, partnership and community working. 

 

B)        Update on recovery plans for the four areas of concern discussed at the last Board meeting.

 

i)          Improve outcomes for children and young people Readiness for school age 5 – Appendix B1

 

ii)         Diabetes: The percentage of patients with diabetes in whom the last IFCC-HbA1c is 59 mmol/mol in the preceding 15 months – (Presentation)

 

iii)        Adults in contact with secondary mental health services living independently – Appendix B2

 

iv)        Cervical Screening Coverage – NHS England to be followed up separately - Appendix B3

 

C)        Presentation from the Housing Department on how they are working towards the Joint Health and Wellbeing Strategy Ann Branson, Director of Housing.

 

The Board received verbal updates on each of the following five priorities:-

 

i)       Improve outcomes for children and young people.

The priority had four elements:-

a)      Reduce infant mortality

         

·         The risk of mortality increased with deprivation.  Rates were reducing through a number of actions.  There was no single strategy but this element was reflected in a number of policies, plans and strategies which included:-

o   Reducing maternal obesity in pregnancy.

o   Improving rates of breast feeding and support and peer support.

o   Reduce smoking in pregnancy.

o   Achieve the UNICEF baby friendly standard in the city.

 

·         It was important to include infant mortality as part of an overall 0-3 year old strategy to achieve a more co-ordinated approach in larger framework.

b)                  Reduce Teenage Pregnancy

 

·         A number of initiatives and actions were taking place involving contraception and sexual health programmes, education programmes and raising the attainment within the city.

 

·      The rate of teenage pregnancies had halved since 1988 and it was important to maintain the decrease in the rates achieved.

 

c)      Improve readiness for school at age 5 – this was the subject of a written report later on the agenda.

d)      Promote healthy weight and lifestyles in children and young people.

 

·    There were a significant number of children who were overweight or obese at reception and year 6.

 

·    There were a number of actions ongoing to address this but it needed a continued focus to improve the situation.  There needed to be better integration in a wider 0-5 year old strategy.      

 

 

 

ii)      Reduce premature mortality.

 

·         Progress had been made in all areas of:-

o   Reducing Smoking.

o   Increasing Physical Activity and Healthy Weight.

o   Reducing harmful alcohol consumption.

o   Improving the clinical management of cardiovascular disease, respiratory disease and cancer.

 

·         There was progress on smoking cessation rates but the increase of e-cigarette usage was impacting upon how smoking cessation programmes worked.

 

·         There were campaigns on reducing smoking in cars and homes and reducing smoking at the time of delivery for pregnant women.

 

·         There were a range of activities promoting exercise and healthy lifestyles and a healthy needs assessment would shape the priorities for the future.

 

·         There had been a substantial reduction in the number of alcohol related hospital admissions but the rate in Leicester was still above the national average.

 

·         The recent alcohol summit chaired by Councillor Palmer had explored a number of issues and identified that actions happened through a number of organisations and agencies and there was a need to strengthen co-ordination arrangements deliver new messages and the ways of presenting them.

 

·         The new diabetes pathways, the lifestyle referral hubs and the NHS health checks were also having an impact.

 

iii)     Support independence.

 

·      This covered older people, cares and people with dementia and long term conditions.

 

·      Much of this work was on-going through the Better Care Fund.

 

·      There had been 2,562 care plans prepared by 30 November 2014 for the 2% of those at high risk of admission to hospital.

 

·      70 people were successfully using the ‘telehealth’ technology to manage their diabetes and COPD.

 

·      A successful Big Lottery bid would enable the voluntary sector to deliver more preventative options for older people in the next financial year.

 

·      More dementia carers’ assessment had been carried out and more identification of carers had been made through the dementia co-ordinators.  More work was ongoing.

 

·      There would be more demand upon carers following the introduction of new legislation in April 2015.  Work was in progress to raise awareness for carers to have independent assessments.  An open day for carers would provide guidance and help for carers. 

iv)   Improve mental health and resilience.

 

·         Work continued through the mental health streams of the Better Care Together Programme, particularly through the sub group looking at emotional resilience and generally improving mental health.

 

·         There was a wide membership of this work stream which included representatives of the voluntary sector.  The Chair of the Mental Health and Emotional Resilience Group had been invited to attend the next mental health summit to improve links and achieve a wider range of inputs from outside the NHS.

 

·         The Primary Care Strategy within the CCG continued to be developed and a key element of that was looking at local neighbourhoods and their health needs and bringing together local communities and stakeholders and agencies to address those needs.  One of the key themes will be around mental health.    

 

v)      Focus on the wider determinants of health through effective deployment of resources, partnership and community working.  

 

·         The current focus had been on continuing to strengthen the position of health and wellbeing within the wider work of the council business.  The presentation at the last Board meeting and the one later in the meeting were examples of this and demonstrated how the council’s activities contributed to health and wellbeing.

 

·         Consultation was currently being undertaken on the Local Plan Issues and Options Paper to shape the future growth and development of the City.  The Public Health team were preparing a detailed submission in response to the consultation to ensure that there was a spatial development plan for the city that acknowledged and understood the health and wellbeing challenges and how the planning process could improve the health and wellbeing of citizens and equally how it could impact negatively on health and wellbeing of communities.

 

·         Public consultation would begin in the new year on an Air Quality Action Plan for the city and it this too needed to acknowledge the wider health and wellbeing implications of good air quality rather than being focused on a purely technical aspects of transport planning, which they have historically tended to be.

 

·         The Council was currently working on a model and methodology to accurately quantify and calculate what the council spent on services to improve health and wellbeing to recognise the wider contribution made by all departments to improve health and wellbeing.   Activities in Children’s services, parks and spaces and leisure, for example, all made positive contributions to health and wellbeing.  Once developed it would be used inform decisions and policy making for the future.  This type of modelling was not known to exist elsewhere, but once developed; it should give a robust and accurate sense of what the council’s overall financial contribution was to health and wellbeing.

 

B)        The Board received updates on recovery plans for each of the four areas of concern discussed at the last Board meeting.  These were:-

 

 

i)          Improve outcomes for children and young people Readiness for school age 5.  In addition to the information circulated with the agenda it was noted that:-

 

·         Whilst it was encouraging that the figure had risen to 41% in 2014, Leicester was still the poorest performer.  Although the Council’s performance had improved, other councils had achieved greater levels of improvement in comparison to Leicester.

 

·         There was good quality of early years’ provision, which had been recognised in recent Ofsted inspections.  There was dedicated funding for early training and development of early years settings and there was a good take up of places, which were maintained at reasonable rates to encourage access to them.  

 

·         Communications and literacy were the weakest scores on the indicators but these were also the poorest areas nationally.  The Early Years Assessments would be conducted in English in the future and this would be a particular challenge for Leicester, as this would require additional support for those families and children where English was not spoken as the first language.

 

·         Improvements had been made in increasing the attendance of 3 and 4 year olds in education provision.  The provision of 2 year old take up for early years’ placements had doubled to 60% in the last quarter. The Healthy Tots programme was being developed within public health to be delivered through Children’s Centres and the Quality Improvement Team.   This would focus on physical activity and development, as well as social and emotional development for young children.

 

·         Work would be targeted at raising the achievement and readiness for school and this would focus on making sure that the strategies reached across all groups and that the commissioning became more integrated.

 

Councillor Dempster commented that the re-organisation of children’s centres would maintain the universal provision of services and also provide more targeted services as well and staff were working with schools to target the hard to reach groups more effectively.

 

The Chair referred to the recent published data in relation to the increase of children who were overweight and obese, and whilst this was of concern, he was equally concerned about the noticeable increase in the number of children who were underweight which could be an indicator of the food poverty in the City.  Councillor Dempster stated that Children’s services were responding to this by looking at how to ensure children who normally attended breakfast clubs in schools did not suffer from food deprivation through the school holidays, particularly the long summer break.

 

 

ii)         Diabetes: The percentage of patients with diabetes in whom the last IFCC-HbA1c is 59 mmol/mol in the preceding 15 months.  In addition to the information circulated with the agenda it was noted that:-

 

·         Some practices experienced more than twice the national average for patients diagnosed with diabetes.  If diabetes was not controlled it could lead to serious health consequences for patients.

 

·         The high prevalence rates in Leicester were not reflected in the overall commissioning budget from the CCG so the service was managing high levels of patient care with and average level budget allocation.

 

·         Approximately 20 practices have been trained to deliver a high level primary care diabetes service which enabled 95% of patients to receive their treatment from the practice rather than visit a hospital.  A training programme had now been commissioned for all practices to raise the standard of primary care treatment of diabetes.

 

·         The diabetes service model had been reformed so that there were more resources in the community to enable patients who required specialist services to receive them nearer to home.

 

·         A pilot project has received funding to allow patients to be remotely monitored, particularly where patients have poor compliance. 

 

·         Work was also continuing to get hospital staff expertise to work in the community and the CCG were working closely with UHL Trust and the Leicester Diabetes Centre to achieve this.

 

·         The number of cases in Leicester was now nearly 30,000 which was an increase of 800 on the previous year.  Structured education was being increased to allow patients to look after themselves and this was offered to 156% more patients last year than previously.

 

·         The number of patients who had good control of their condition, shown by having an HbA1c of 7.5% or less, was 66% in Leicester.  Whilst this was better than other areas nationally, the rate had remained the same as in previous years.  The reason for this was that there had been increased levels of diagnosis through the screening process and they were usually poorly controlled and it could take approximately two years for a patient’s condition to be stabilised.   There was also a significant variation in practice performance - some achieved 80% - 85% performance but there was a small number who achieved 50% - 55%.  Work was continuing to help these practices improve ion order to boost the overall performance for all practices.

 

·         There was much effort being put into this area and resources were being identified from other budget areas to reflect the high demand for this service.  

  

Members welcomed the work that was being undertaken in GP practices and in schools to discourage sweets etc. There was a major change needed in lifestyles to achieve better performance.  More publicity was required to raise awareness and reduce sugar consumption, particularly at times of festivals. 

 

The Chair commented that there were a number of initiatives taking place beyond the health community and referred to a local food establishment that had introduced sugar free celebratory sweets, which was to be commended.    However, much more could be achieved if there was a strong national approach to reducing high levels of salt and sugar in manufactured and processed foods.  As Type 2 diabetes was preventable reduced sugar in foods could play a major part, it would also require a wide range of initiatives in education, raising awareness of the issues and promoting healthy exercise to support the overall response. 

 

iii)        Adults in contact with secondary mental health services living independently.  In addition to the information circulated with the agenda it was noted that:-

 

·         The data related solely to adults on the Care Programme Approach who were receiving secondary mental health services and were living independently with or without support.

 

·         Steps were being taken through the Better Care Together Programme to improve the data collection and data sharing across agencies.

 

·         Data was required to be updated on an annual basis even thought their residency had not changed and this was part of the issue.

 

·         Data was collected by the LPT Health Trust and adult social care may not always be aware of adults in contact with secondary mental health services who were living independently.

 

·         Information was now being requested on people supported in residential care and not in the community and that may have a significant on those for whom the information is captured.

 

·         It was intended that better information would be available by the end of January. 

 

 

iv)        Cervical Screening Coverage – NHS England to be followed up separately.  In addition to the information circulated with the agenda it was noted that:-

 

·         More work was needed and the initiatives outlined in the report needed to continue to be developed and delivered through GP practices, schools and through joint commissioning of screening and promoting increased update through sexual health and family planning services. 

 

The Chair requested that if this issue was not already covered in Personal Health & Sexual Education in schools then it should be included in future. 

 

RESOLVED:

 

                        That the update reports be received and noted.