Agenda item

(Note: At this point in the proceedings, the Lord Mayor (Councillor Anne Murphy) left the meeting and the Deputy Lord Mayor (Councillor Magid Magid) took the chair for the remainder of the proceedings.)

7.1

The Council received a presentation by the Director of Public Health, Mr Greg Fell, concerning the health of the local population, which set out the three key strategic messages from the Joint Strategic Needs Assessment (JSNA) and why these were priorities for the City’s health and wellbeing.

7.2

In his presentation, Greg Fell outlined how and why adverse childhood experiences, mental health (across the life course) and multi-morbidity were important in terms of their impact on healthy life expectancy, life expectancy, health inequalities and the use of health and social care services in Sheffield.

7.3

He described a number of priority actions identified in the report which were concerned with how best to respond to these issues and achieve required improvements. These actions took into account the available evidence, what was already happening in Sheffield, and the opportunities for maximising health and wellbeing outcomes accordingly.

7.4

Mr Fell outlined three key recommendations, made in the Annual Report, as follows:-

1.    The Council and the Clinical Commissioning Group (CCG) should request Public Health England to co-ordinate further research into identifying and describing the long term return on investment and effectiveness of models for preventing Adverse Childhood Experiences (ACEs).

2.    The Council and the CCG should review the Sheffield mental health strategy and evaluate the city’s approach to mental health and wellbeing against the current evidence base for high impact/high value interventions, including developing the economic case for investment in good mental health.

3.    The Council and the CCG should commission more in-depth epidemiological analysis of changes in multi morbidity and ways to enhance Sheffield’s approach to healthy ageing, including care of people who have multiple illnesses.

7.5

Members of the Council asked questions and commented upon issues raised by the Director of Public Health’s Annual Report and presentation and these, together with the responses to them, are summarised below:

This report focussed on shifting the approach to health care, looking at prevention as well as treatment. Mr Fell acknowledged the key challenge was moving from a health and care system focused on an episode-based, reactive model, to a preventive and community focused model with a greater focus on utilising assets in the community (e.g. pharmacies) to enable people to self-manage and reduce acute illnesses.

Despite having a significant impact on health, no specific mention of air quality had been made in the report as it was being addressed in the new Clean Air Strategy, which had been taken to Cabinet for approval in December 2017.

A question was asked about the health implications of an application recently discussed by the Planning and Highways Committee. The Director of Public Health responded that he and the Chief Planning Officer had agreed to screen future planning applications for potential health impacts and advise where further stipulations were needed.

With regard to national public awareness campaigns, the evidence of success was mixed. With specific reference to smoking, campaigns 30 years ago had been very successful with lasting impacts on people’s habits. This was now being extended into encouraging smokers to replace cigarettes with e-cigarettes as current evidence indicated that these were significantly less harmful than traditional cigarettes.

In response to further questions regarding vaping, the Director advised that there was no conclusive evidence that vaping encouraged children to smoke. He also stated that although less harmful than cigarettes, he would still not recommend vaping indoors owing to the distress reported by some people.

In response to a comment about promoting the health of employees in the private sector, Mr Fell reported that it had been easier for larger companies to implement changes or policies but smaller businesses struggled owing to their smaller workforce. This was an issue recognised locally and nationally, with the Chamber of Commerce and other bodies recognising this.

With regard to the financial benefits to a healthy population and the economic benefits of a healthy workforce, the links between a healthy population and economic prosperity were increasingly being recognised. Mr Fell stated that there was a need to move away from short term savings and solutions based on a one-year financial cycle, and instead to look further into the future for a long term return on investment.

A question was asked as to whether more could be done by individuals, and the Director confirmed that the personal actions of the whole population of the City, rather than the provision of additional health services, would have far greater impact than changes to health services. Members discussed personal responsibility and the value of sport and exercise and noted that the advice to ‘move more’, regardless of starting point or ability, was recommended.

Responding to a comment regarding health inequalities and deprivation by Ward, the Director confirmed he was very concerned about the different outcomes. With regards to austerity, he confirmed the evidence was increasingly clear that austerity had a negative impact on health and wellbeing and was one of the factors in the slowing in the slowing of improvement in life expectancy, although it might not be the sole cause.

Responding to a comment about other illnesses, the Director advised that asthma was linked to damp in housing, poor air quality, and smoking. Support for people with diabetes could be improved; a Diabetes Prevention Programme was in place for individuals, which was effective but required willpower to stick to. A structural policy would have a much bigger impact, as demonstrated by the results seen by Sheffield International Venues who had implemented a sugar tax for over a year with positive results.

Responding to a number of points, Mr Fell advised that it was necessary to develop a clear model of how to help those affected by Adverse Childhood Experiences and to prevent them, which was why the report recommended further research and development in this area.

A question was asked as to the average waiting times for therapeutic services (mentioned at page 15 of the report) and how they had changed over the past 2 years, to which the Director of Public Health undertook to confirm the figures and contact the Member outside of the meeting. He also undertook to speak to interested Councillors about specific policies the Council could implement.

A comment was made about Members’ experiences as local Councillors regarding the difficulty in accessing mental health services. Mr Fell acknowledged that Councillors would see the most complex cases and agreed that although services in Sheffield were good, they could be improved.

With regard to ‘gatekeeping’ observed in relation to mental health treatment, the Director stated that enabling primary care services to refer patients with social, emotional or practical needs to local, non-clinical services, could help tackle the stigma of mental health problems and these issues of ‘gatekeeping’.

7.6

RESOLVED: That this Council notes the information contained in the Director of Public Health’s report, expresses support for the three recommendations outlined in the report for improving the health of the local population, and thanks him for his presentation.