Agenda item

The Board considered a report of the Co-Chairs of the Board concerning the Health and Wellbeing Strategy: Outcome 2 – ‘Health and Wellbeing is Improving’. The report set out what had happened in relation to the 8 key actions over the past year and areas in which the Health and Wellbeing Board could make a difference.

The report was presented by Tim Furness, Director of Business Strategy and Partnerships, NHS Sheffield CCG.

Members of the Board discussed the two main themes of the ‘Health and Wellbeing is Improving’ outcome area, which were:

·         emotional wellbeing; and

·         living longer.

In discussing particular actions under each theme, the Board considered what progress had been made in the past year; the main issues and opportunities for the action and what the Board/ Members of the Board could do over the next year in relation to that action. A summary of the discussion is as follows:-

Emotional wellbeing

Action 2.1: Promote a city-wide approach to emotional wellbeing and mental health, focusing on promotion of wellbeing and resilience and early support, and embed this into strategies, policies and commissioning plans.

With regard to the challenge to protect investment in emotional wellbeing, prevention and early intervention, the circumstances of reducing funding meant that this may become more acute. However, the commissioning plans for mental and physical health aimed to increase investment and community activity and spend more on prevention.

The City did not have a strategy relating to suicide and a more focussed approach was required in that regard. This could be considered as part of the Strategy for Mental Health. There was also a link to transition from childrens to adults’ services. The need for work to prevent suicides and promote awareness thereof and the transition from children’s to adults’ services were recognised in the report as submitted.

Action 2.2: Commission a needs-led response to support children and young people’s emotional development to enable them to develop personal resilience and manage transition from childhood to adulthood.

There were no additions or further comments.

Action 2.3: Support the implementation of the new city Parenting Strategy which focuses on positive parenting and developing resilient families and communities so that all children have a stable and enriching environment in which they will thrive.

The relationship with parents and carers was vital and parents should be viewed as partners in parenting initiatives. Work was being done in early years to help develop positive parenting, which was being monitored.

It was not clear whether the ambition of the Strategy was to deal with immediate issues relating to parenting or whether it was intended to deal with breaking the cycle of where parenting breaks down.

There was a strategic programme for early prevention and intervention at the point of crisis to enable families to stay together and prevent children and young people from being brought into care. The Best Start work also included peer support and mentoring to help people before they reached a point of crisis. The strategy was intended to cover both early intervention and universal parenting concerns.

There were actions that individual schools, such Arbourthorne and Tinsley Primary schools were taking in targeting particular activities for the needs of children and families in their communities. This was best practice which could be shared. Arbourthrone Primary had used LAP (Local Area Partnership) funding and private sector funding to transform the former caretaker’s house into a lifeskills centre, where young people could learn to look after themselves with activities such as cooking.

Under the ‘issues and opportunities’ heading on page 8 of the report, the first bullet point should be amended by the inclusion of the word “initiatives” after the words “The delivery of Parenting”.

Living Longer

Action 2.4: Support the ‘Move More’ initiative to encourage people to be more physically active as part of their daily lives.

Whilst the Move More strategy was intended to encourage people to be more physically active, some people were not able to afford to participate in some physical activities as they were priced-out by the cost, for example, of gym membership.

The Move More strategy included physical activity which might not take place in a gym, such as gardening and dancing. However, the cost of gym memberships did need to be addressed. The chair of the food and physical activity Board, Dr Ollie Hart, had met with schools to try to use them to encourage young people into sport.

The addition of an action under section 3, page 10, as follows:-

To invite Graham Moore and Ollie Hart of the Food and Physical Activity Board to the next Health and Wellbeing Board strategy development meeting.

The Green Commission had heard evidence concerning the approach in Bristol to active travel and Calderdale also had an active travel planning mechanism to encourage walking and cycling. People might increase their physical activity by walking between tram or bus stops. It was also thought that people overestimated how long it took to walk to a destination.

The Board was not necessarily in a position to hold the city to account with regards physical activity, although it should consider how it was able to influence people to engage with the work relating to increasing physical activity. This included making sure that partner organisations were promoting increased physical activity.

The Learning Disabilities Partnership Board was also considering how physical activity might be promoted, including improving access to sports and health services and facilities.

Action 2.5: Implement an integrated approach to reducing levels of tobacco use through integrating work on: smoke-free environments; helping people to stop smoking; using mass media by reducing the promotion of tobacco; regulating tobacco products; reducing the affordability of tobacco; and substance misuse services.

A programme of tobacco control had been launched in April 2014. The introduction of smoke free spaces to protect children under 5 years from exposure to harmful tobacco smoke had been successful. A question was whether people who used electronic cigarettes viewed themselves as non-smokers. There had been a slight increase in the number of women smoking during pregnancy and this also needed to be addressed through the stop smoking relapse prevention service for pregnant women.

Tobacco was a major cause of early death and it was also a large cost to health and social care. It was noted that Greater Manchester Pensions Authority had taken a decision to dis-invest in tobacco. One of the actions for the Board was to ask the South Yorkshire Pensions Authority to review its investment in tobacco. The Board should state in writing that it would wish for the Pensions Authority to seriously consider dis-investment in tobacco and request the Pensions Authority to respond.

In relation to the idea of a similar request to the pensions authority but relating to alcohol, there was a logic in tobacco being put first as it was the biggest single issue.  

Action 2.6: Commission appropriate interventions to reduce harm and promote pathways to structured treatment services for those abusing alcohol or misusing illicit or illegal substances, including reducing the ‘hidden harm’ to children living in households where adults abuse alcohol or drugs.

Consideration would be given to the timetable and logistics in the preparation of a new alcohol strategy and approach to the commissioning of alcohol treatment and prevention services. Alcohol related admissions to hospital had increased in 2012-13. There was concern that the licensing rules were quite restrictive. Other local authorities used planning consents as a means of controlling the availability of cheap alcohol. The extent to which it may be possible to restrict the hours of the sale of alcohol would depend upon a strong case and would be subject to policy. These were issues which could be taken into account in the development of the new alcohol strategy. The involvement of the CCG in addition to the drug and alcohol co-ordination team (DACT) was endorsed and it was recognised that alcohol abuse had a cost to health services in terms of the treatment of in-patients.

Action 2.7: Commission a joint plan and integrated pathway across the city including schools and the commercial sector to act preventatively and with lower-tier interventions to tackle obesity, providing accessible information.

It was likely that the CCG would be tasked with commissioning tier 3 community obesity services, in the next year or two. This was, at present, a complicated pathway and it was likely the CCG would be given responsibility depending upon the financial resources that were available. There was concern that the Government approach was to use surgical procedures in relation to obesity and that the funding and targets to combat obesity would follow this approach and there would not be sufficient funding available to the CCG, which would be driven by the Government target. There was evidence to suggest that surgery was effective as a ‘rescue’ treatment for obesity and whilst it was expensive, it was cost effective. That did not mean that prevention shouldn’t be undertaken. If the CCG had control of the entire obesity pathway, an integrated approach to obesity would then be possible. Family nutrition should be recognised in addition to improvements to school food. The Let’s Change for Life programme included work in schools to improve nutrition. 

The addition to the list of public health initiatives of a reference to community initiatives concerning food under section 3, page 16 was suggested.

It was noted that there had been a report regarding the number of people in receipt of prescription medication, including statins. It was said that in certain cases, the equivalent benefit would be achieved from not taking the medication, but taking other action, for example doing more physical activity. The prescription of antacids was raised as a concern as they masked the problem of people eating the wrong types of food and drink. However, it was acknowledged that the medication did make people feel better.

Self-care was a minimal intervention approach, which encouraged people to look after themselves and could be relevant in helping people control their weight and general health.

An example was given of Devon CCG, which had decided to deny people operations until their BMI measured below 37. This was driven by cost and budget considerations and rationed access to elective operations and was also evidence of policy makers choosing which interventions they wished to use first.

There was a high incidence of women being prescribed anti-depressants and a question was asked as to whether there was a link to other conditions such as cardio vascular disease. In answer to which it was considered that in cases of severe depression, there was also a greater risk to physical health.

Action 2.8: Continue to prioritise and focus attention on cancer and cardiovascular disease, the main causes of premature mortality in Sheffield.

There were no additional comments.

Outcome Indicators

The percentage of patients aged over 18 years with a new diagnosis of depression had increased from 6.93 in 2012-13 to 7.43 in 2013-14. This may be due to better diagnosis and treatment of patients with depression or there may in fact be a higher number of cases. Sheffield had a higher rate of depression than the national average, but the increase was in tandem with the national trend.

The Tackling Poverty Strategy consultation had shown that key workers and debt advisers had seen an increase in depression and mental ill health connected to poverty. Women were described as ‘shock absorbers’ in that they protected their families and the impact of poverty and debt may be a higher incidence of mental ill health. Research into child poverty had been undertaken by the Joseph Rowntree Trust indicating the importance of removing people from poverty and providing stable homes.

There was a need to understand for adults, in the same way as had been done for children and young people, the problems and solutions regarding access to services.

There was better diagnosis relating to mental ill-health and activity to reduce the stigma around poor mental health. Other programmes such as the Move More initiative, which aimed to make people more active might also mean they had more opportunities to meet other people. Consideration also had to be given to prevention of mental ill health.

The Joint Strategic Needs Assessment provided evidence of where there was need and consideration was given to how services were provided to meet that need and identify which interventions would work and in relation to which area of need in the most cost effective way.

The weight management contract was to be put out to tender and a question was how this linked with other aspects of a healthy lifestyle, such as food and an individual’s journey mapped out in order to build a clear pathway.

The Board needed to make sure there was a market before it made investment. Learning should take place from, for example, the retail sector in order to overcome problems such as the inverse care law, where availability of care was often inverse to needs of the population. Such learning might be applied to the work on stopping smoking.

Thought had been given to the most cost effective methods of prevention and national and international research had been taken into account and interventions based accordingly. However, some approaches were found not to be delivering. Thought was being given to how people accessed services and how intervention might be made most effective. Interventions needed to be targeted to particular communities where they were most needed.

The same people may be in each indicator area and there may be many interventions into one household, which would require a holistic approach to dealing with the causes of health conditions, such as alcohol consumption and smoking, in that household. The estimated prevalence of smoking for 2011 (19.5%) was thought to be unrealistic as it was out of line with the estimates for 2010 and 2012 (which were 23.8% and 23.2% respectively). The indicator for the proportion of 10 to 11 year olds overweight or obese was more or less static over 3 years. The indicators for alcohol related admissions to hospital and breastfeeding of babies at 6 to 8 weeks were worsening. Nonetheless, Sheffield was comparatively good in terms of the rate of breastfeeding. Activity to increase breastfeeding was targeted at particular communities.

Issues relating to poverty and inequality were reoccurring concerns throughout the outcome, which also had connections with the City’s Health Inequalities Action Plan.

Resolved: that the Health and Wellbeing Board:

1.    Actively supports the recommendations made under each action in the report as submitted, subject to the following additions having discussed report in some depth:

Action 2.3:

Under the ‘issues and opportunities’ heading on page 8 of the report, the first bullet point should be amended by the inclusion of the word “initiatives” after the words “The delivery of Parenting”.

·         The delivery of Parenting initiatives in Sheffield is well established.  There is now an opportunity to develop targeted programmes and projects that respond to local need.  We also have an opportunity to consider the marketing and promotion of parenting programmes to ensure the service is accessible to families from all backgrounds. 

Action 2.4:

The addition of an action under section 3, page 10, as follows:-

·         To invite Graham Moore and Ollie Hart of the Food and Physical Activity Board to the next Health and Wellbeing Board strategy development meeting.

Action 2.7:

The addition to the list of public health initiatives of a reference to community initiatives concerning food under section 3, page 16.

·         Support public health initiatives that indirectly contribute to the agenda, for example, 20mph areas, playing out schemes, including regular road closures to allow for active play, improvements to school food, ensuring that public sector catering provides healthy and sustainable food; and community initiatives concerning food etc.

2.    Supports the ongoing programme of needs assessment.

3.    Requests another update on this outcome in December 2015.