Agenda item

The Council received a presentation concerning the Director of Public Health Annual Report 2013 entitled New Opportunities, given by the Director of Public Health, Dr Jeremy Wight.

Dr Wight outlined the changes and opportunities arising from the transfer of public health leadership to the City Council. The presentation showed that, whilst life expectancy for women and men in Sheffield was gradually increasing, it was also less than the England average. Dr Wight described disability-free life expectancy and the inequality in disability-free life expectancy across the City. 

The various recommendations of the Annual Report were included in the summary report previously circulated to Members of the Council.

Members of the Council asked a range of questions and responses were provided by Dr Wight, as summarised below:

Affordable warmth was an issue which particularly affected children and older people. For children it might impact on their attainment and development. The ability to heat a home was important to health. Cold and damp houses were harmful and contributed to respiratory disease in children and coronary vascular disease, among other things. People’s mental health and the contribution of a cold home and heating bills to stress was also recognised. Energy charges were increasing and ways needed to be found to help people to live in warm homes by such means as insulation. The Council’s housing stock was of generally good quality having been subject to improvements brought about by the Decent Homes Programme. However the quality of private sector rented housing was a real issue and it was hoped that property owners would invest more in the quality of insulation in their properties.

Air quality contributed to respiratory problems and deaths and the East of Sheffield was particularly affected by poorer air quality. Poor air quality was a significant cause of early deaths and might be due to poor air produced by energy production, transportation or industry. Public health could work with other services of the Council to improve air quality in such areas as transport policy and economic development. In respect of planning applications, such as the proposals for an IKEA store, there was a need to know the likely impact on peoples’ health and to make sure that decisions which were made were ones which improved people’s health.

In terms of meeting future challenges in the context of the present funding climate, a ring-fenced grant of £29.6 million had transferred from the NHS to the City Council and the amount of that grant would increase slightly in 2014/15. It was important that this resource was used to best effect and in the context of people living longer and a greater number of people with disabilities. The Right First Time initiative in Sheffield showed greater integration of health and social care. Public Health could identify cost effective prevention measures, for example funding for people who are hypertensive. The root causes of ill health were such factors as housing and employment.

In relation to health checks, the figures for uptake were not good but they were increasing. Prior to the introduction of the health checks programme, there had been a number of successful initiatives which did much of what was subsequently incorporated into the health checks; although these were not badged as health checks. GPs were working hard to make sure that people were invited for a health check and a member of the public health team was working with them on that particular issue. However, it was often the case that people who least needed a health check took up the offer. GPs were incentivised to get people from deprived area postcodes to take up a health check.

In connection to the relationship between the Council and GPs more generally, there had been anxiety that public health practitioners would lose their link with the NHS following their integration into the local authority. The Health and Social Care Act mandated public health teams to provide an offer to GPs through the Clinical Commissioning Group.

Social isolation was suggested by some data to be as detrimental to health as was smoking. Community resilience needed to be built to help people to help each other and to prevent isolation from occurring to begin with.

For young people not in education employment or training, the Children and Young People’s Directorate was undertaking work to address the issue and there were known health implications for people both in the present and the future.

The Council should lobby on the setting of minimum pricing of tobacco and alcohol. Public Health England had made its views clear to the Government regarding the failure to introduce legislation regarding smoking.

Minimum unit pricing of alcohol would be likely to have a major effect on purchasing and consumption and liver disease was the only cause of death which was rising and was related to alcohol consumption and obesity. It would be possible to extrapolate the relevant data for Sheffield

The introduction of the Living Wage would have significant health benefits, for example in reducing fuel poverty. Diet was an important public health issue, with some families unable to adequately feed themselves. Introducing a Living Wage was therefore an important intervention in public health terms.

Of the recommendations in the Director of Public Health Annual Report, the staffing of public health teams was especially important in making a substantial impact on improving outcomes in Sheffield. Some initiatives were being held back by not having staff in place to take them forward. It was important therefore to fill vacant public health posts.

Water fluoridation would improve the dental health of children and young people, particularly in the poorer areas of the City. However, it was not necessarily easy to bring about change to introduce fluoridation, partly because of the infrastructure for the distribution of water to Sheffield. Whilst it was within the gift of the Council to request that water is fluoridised, this would need to be done on the basis of collaboration between the various authorities in the region.

In response to an invitation to submit a written contribution to a Scrutiny exercise concerning Child and Adolescent Mental Health Services (CAMHS), Dr Wight replied that he would be pleased to provide a written submission. There was, he said, increasing evidence that the poor mental health of very young children (i.e. below school age) was a disadvantage, which inhibited their future development and opportunities. Sheffield’s bid to the Big Lottery’s Fulfilling Lives Better Start fund had the potential to attract significant funding to the City for children aged 0-3 years.

When a child of school age was truanting, they were not receiving an education, which was most important in determining their life trajectory and the potential effect on their health was similar as for young people not in education, employment or training.

Removing the health barriers for employment for people with mental health conditions was a challenging area to progress and the former Local Area Agreement did include targets relating to getting people with mental health conditions into employment. It was difficult to find suitable employment and to support people in retaining their job. Good employment was a positive aspect in improving people’s mental health. The Council was in the process of formulating proposals in this regard, although there would not be a quick solution.

There was debate as to the value of electronic cigarettes which delivered nicotine. It was either considered to be a good way to wean people off cigarettes; or it was something which normalises smoking, which was not, from a health perspective, desirable. The results were inconclusive and some people say they have use electronic cigarettes to help them to give up smoking. On the other hand, electronic cigarettes might encourage children to take up smoking. There had also been recent debate in the European Parliament about regulating the sale of such e-cigarettes.

Poverty was bad for health and long standing public health issues relevant in the Victorian period, including air quality and diet remained. Access to clean water was an exception, since this is now universal. Health inequalities were brought about by socio-economic inequalities; and initiatives such as the Healthy Communities Programme aimed to minimise poor health resulting from inequalities. Measures to help mitigate the effects of inequality would be taken forward through, for example, locality working.

There were 450 deaths in the UK annually due to late diagnosis of breast cancer and improving this situation required the public health team to work with GPs.

The Southey and Owlerton Area Regeneration programme had done some fantastic work in respect of smoking cessation. Smoking cessation services were important in the City’s approach to tobacco and were also one of the most cost effective means of reducing smoking. Provision of such services was subject to a tender process and particular communities would be targeted in this process. The supply of cheap and illicit tobacco was a problem, with half of the available tobacco being illegal. There was a relationship between the price of tobacco and the level of consumption. It was planned to divert some funding to support Trading Standards and Environmental Services to support enforcement and prosecutions. A difficulty was that Magistrates did not issue fines in relation to illegal tobacco that provided a large enough deterrent.  

Methods did need to be found to help older people to be more active. The Health Survey for England indicated that activity levels decreased in older people aged over 60-65 years. Activity such as gardening was beneficial to people. The Move More initiative promoted physical activity for older people.

There was data relating to inequalities in the City which can be provided to Members.

A distributed model of public health had been implemented in Sheffield and it was important to have public health professionals working throughout the organisation and the location of those working in public health would be communicated to Members.

There were risks in participating in sports including rugby, horse riding and climbing and the responsibility for mitigating the risk of injury partly lay with the relevant governing body for those sports. It was also necessary to tell people about the benefits of participating in sport and physical activity.

On behalf of the Council, the Lord Mayor (Councillor Vickie Priestley) thanked Dr Wight for his presentation to Council and for his responses to Members’ questions.