Agenda item

7.1

A presentation, subsequently published on the Council’s website was delivered by Chris Gibbons (Public Health Principal, Sheffield City Council) and Jackie Mills (Chief Finance Officer for Sheffield, NHS South Yorkshire).  This covered what the Integrated Care Board (ICB) spends money on in Sheffield, outlined the high-level outcomes, the Local Authority Spend, and Return on Investment (ROI) and gave examples of where moving funding might deliver different outcomes.

7.2

The Chair noted the four questions asked in the report which were as follows:

1. How do we create consistent methodologies for evaluating value for money, both for existing spend and future investment?
2. What outcome measures (for example, Wellbeing measures) do we not currently measure that we should? How can this be operationalised?
3. Who or what should be responsible for reviewing progress towards improving outcomes? How would this work?
4. How should this be reflected in the Health and Wellbeing Board Strategy?

He requested that a fifth question be added:

5. The Health and Wellbeing Board Strategy has been signed up to in partnership with the ICB committing to the left shift of funding (i.e. prioritising early preventative interventions rather than later medical interventions) so why is this not being carried out?

7.3

Board Members raised the following points:

• Public health interventions have around 4 times the return in health terms as downstream health care.
• Healthy life expectancy and a reduction of the inequality gap with regards to this, was the outcome that should be measured.
• The Health and Wellbeing Board is responsible for reviewing progress and asking “are all the right planes in the air” to deliver on the Strategy over the long term.
• It was important to avoid the need for patients to be hospitalised if they could be treated in another way or if the issue could be prevented from arising in the first place, and to explain why timely discharge from hospital is so important, i.e. because it is better for people’s health.
• There was a need to address the combination of factors affecting people’s health rather than tackle each factor individually.
• Energy should be focussed on people rather than on their conditions.
• The reduction in Local Authority budgets had had a serious impact on health.
• There was an opportunity to spend money differently to how the Board was instructed to spend it by the government and to use the data to drive this approach.  This might require bravery on the part of partners together to do something different.
• A united approach would need to be taken to these changes by all involved and all decisions should be evaluated to establish how they square with the left shift approach.
• There was a moral choice to be made between looking after the few and looking after the many.
• Respiratory data was important in showing how people were interacting with healthcare.
• A piece of work was proposed which would set out what the Board’s top priorities were for improving health.
• The importance of prioritising prevention rather than late intervention had been agreed by members of the Board and even though these were ethical decisions they would potentially be controversial to the public.
• Could the Board consider approaches like a Citizen’s Assembly to build consent for a different approach?
• Depression, obesity and high blood pressure were the 3 main issues arising from the data and if these were concentrated on, a great difference could be made.
• This approach needed to be balanced in order to reassure patients that they would still be treated for other matters.
• Prevention should be explicitly stated in the Board Strategy.
• There was a need to be “people centric” to give people agency and capacity for better health.
• The Board had chosen to focus on Health and Wellbeing rather than on Social Care integration.
• The Board’s role is connecting with other areas that address the wider determinants of health.  The NHS is just one part of the Board- this is about broader public service reform.

7.4

RESOLVED: that the Health and Wellbeing Board notes the paper and the progress of the work.