Agenda item

Report Attached. NHS Leads for the Prevention Workstream will attend and provide the Joint Committee with an update on the above.

Dr Guy Pilkington, Chair of the regional STP Prevention Board, explained that a Board had been established to progress this area of work to demonstrate a system wide commitment to prevention work in the north east.

 

Dr Pilkington advised that his role was that of SRO and he was supported by Directors of Public Health from across the patch and Terry Collins, Chief Executive Durham County Council who was acting as sponsor for the work and Alan Foster STP Lead so that assurance can be provided to the STP Board in relation to this area. Prevention is viewed as central to the success of the STP process.

 

Dr Pilkington noted that Prevention work was critical. Although there are financial constraints in the north east there are still good services being delivered. However, in spite of these factors there are still very poor health outcomes in the north east and there is a significant health and wellbeing gap that needs to be closed.

 

Dr Pilkington stated that the North East Combined Authority and local NHS organisations had established a Commission for Health and Social Integration in 2016 as part of a devolution bid and this had reported its findings in “ Health and Wealth: Closing the Gap in the North East”  which had provided a good steer. This work had complemented the NHS Five Year Forward View which set out the need for the NHS to support a step change increase in prevention. The Marmot Report in 2010 also supported the need for building on existing prevention activity.

 

As NHS budgets are fully stretched it is important to shift the focus towards prevention otherwise services will always struggle to meet demand. There has also been an increasing recognition that to progress prevention work there cannot be a reliance on local authorities alone. It is also important to shift activity and investment to support the prevention agenda in order to close the health and wellbeing gap.

 

As part of upscaling prevention work there is a regional ambition to address the harm caused by tobacco and the target is to reduce smoking to 5% by 2025.

 

Dr Pilkington advised that there is a need for system leadership to drive forward the prevention agenda and this would be the role of the Board. Dr Pilkington set out the proposed work programme for the Board.

 

Work focuses on action to embed prevention at all levels and in particular for the STP primary and secondary prevention.

 

In relation to primary prevention, this would deal with what is being done to improve the health of the population before they become ill and focus on tackling key areas such as smoking, alcohol, providing children with the best start in life and preventing / reducing obesity. Dr Pilkington stressed the importance of people being active to keep well and the fact that there is significant evidence to support intervention in this area.

 

In relation to secondary prevention, this would look at reducing premature mortality in areas such as Cardio Vascular Disease (CVD) Cancer, Chronic Obstructive Pulmonary Disease (COPD) and Diabetes.

 

The Joint Committee was advised that this winter there had been a number of pressures on the system and outbreaks of norovirus had exacerbated those pressures. In addition, a flu epidemic had affected the primary care workforce highlighting a need for extra take up of the flu immunisation amongst that workforce. An important focus for the Board’s work will therefore be getting better rates of workforce and population immunisation. Workplace health is an important area of focus within the prevention agenda. However, shifting spend to prevention is still a challenge when particular crises take up the available budgets. The Board will therefore be looking at how partners can make the shift and think differently and imaginatively about potential options.

 

Dr Pilkington advised that going forwards a community asset based approach would be key as part of social prescribing. Public Health England would be leading a conference on this area in the next couple of months. The methodology behind this is to make every health contact count. This means that the workforce would act as health champions and consideration will need to be given to how they are skilled and trained to provide brief advice. The aim will be to have the most skilled regional workforce who can deliver health messages at every opportunity.

 

The Joint Committee was advised that the Prevention Board would also be working closely with the mental health workstream in relation to people at risk and suicide prevention. The ambition is to have zero suicides. It is also planned to work with local maternity services to progress work to become smoke free.

 

Alice Wiseman, Director of Public Health for Gateshead, advised the Joint Committee that the initial focus for the region has been on preventing tobacco harm through implementation of a smoke free NHS. This area was addressed as a priority as it is one of those areas which will make the greatest difference to health and wellbeing of our populations. This Prevention Board has prioritised and endorsed this work to support a regional vision of having only 5% smoking prevalence by 2025 which is an ambitious target. The aim is to ensure that tobacco dependency is treated the same as other dependencies.

 

A dedicated Task Force has been established, chaired by Dr Eugene Milne and Tony Branson, which has representation from both NHS and local authorities with a view to ensuring that all Trusts fully implement NICE guidance PH48.

 

Amongst other things, this will mean that every person the Trusts come into contact with will be asked their smoking status and a conversation will be had on their admission to hospital and nicotine replacement therapy will be provided whilst an individual is in hospital. Subsequently work will continue with individuals in the community and support offered.

 

This approach has been endorsed at the STP oversight group and consideration is now being given to proposals for implementation.

 

Dr Pilkington stated that resources will be allocated to support acute trusts to become smoke free. In relation to secondary prevention work this will mean that opportunities will be provided to consider individuals’ tobacco use prior to any planned procedures.

 

Dr Pilkington stated that one of the most significant challenges was around the amount of work involved in a single element in a process. Dr Pilkington stated that there is a need to examine whether it is feasible to shortcut some of the processes and have a governance arrangement which will drive forward a combined agenda.

 

Dr Pilkington highlighted an example of shared commitment where there was a need to expand the broad agenda. Peter Kelly will therefore be convening a meeting in the next couple of months. There will be a need to confirm the focus for funding and assure the system as a whole that appropriate outcomes will be delivered.

 

Dr Pilkington stated that the Prevention Board will continue to review its membership and its terms of reference to ensure that these are appropriate. Alice noted that as the Board was an important vehicle for delivering and implementing the recommendations of the Health and Social Care Commission, which also link to economic development, it was important to make sure that the Board was linking into the right forums to deliver on that agenda. A report had been taken to the North East Combined Authority (NECA) Overview and Scrutiny Committee where it had been agreed that there was a need to focus on those priorities.

 

Councillor Mendelson noted that there are an increasing number of workplaces, where employees may be on temporary contracts and there is no union involvement, where it may be difficult to drive forward the health prevention agenda. There are also a number of individuals who are on the edge of workplaces and Councillor Mendelson was concerned at how these individuals can be supported. Councillor Mendelson noted that the Joint Committee had received information about the prevention strategy and the mechanism for taking this forward but queried what the Joint Committee could expect to see in terms of a delivery plan as there appeared to be lots of disparate initiatives.

 

Dr Pilkington advised that given the geography of the STP a lot of activity would take place in local areas. In terms of local authority footprints there was no ambition to shoehorn localities together to form one area. The aim is to look at how individual local delivery plans can be made more effective. However, finances will need to be dealt with at a regional level.

 

One area of activity would focus on flu immunisation and the aim that every organisation with a cohort of the population should be in the top quartile of flu immunisation rates nationally. In addition, the aim was to have all children in primary education in the north east in the top quartile for immunisation. Having agreed this ambition processes will then need to be put in place to ensure that each local area is able to report back on its success in achieving this ambition and that there is peer to peer challenge if areas fall behind.

 

Dr Pilkington acknowledged that workplace terms and conditions have an impact on physical and mental health and indicated that the Prevention Board would be happy to engage with others to think about how such issues might be addressed.

 

Alice advised that health and workforce were key considerations for Councils and a number of recommendations had been developed and this included access to psychological therapies. The Better Health at Work Award has also been developed as a region and continues to be supported although it is recognised that one of the challenges relates to progressing the agenda with smaller employers. Alice stated that this needs to link into the Strategic Economic Plan as there is a real economic argument for employers to engage.

 

The Chair of NewcastleGateshead Healthwatch highlighted the importance of developing community asset based approaches and stated that if such approaches are to be developed then it is important to start conversations with communities early. The Chair of NewcastleGateshead Healthwatch also noted that due to budget issues there are now fewer staff to initiate such conversations and queried how it was planned to develop such work in light of such challenges.

 

Dr Pilkington stated that it was planned that work would focus on social prescribing and supporting practitioners to take a broader view of individuals’ ability to stay healthy and think holistically about individuals and the fact that homes and relationships play a key part. Dr Pilkington stated that it would be important to develop a regional language around this work and collectively bid for NHS funding to put in place a more co-ordinated and easier to understand system. In times of reduced funding community assets are important and need to be supported. There is a really vibrant voluntary and community sector in the region and it will be important to tap into this. It was noted that Public Health England would be holding a conference on Community Asset Based approaches in March.

 

The Joint Committee noted that the Empowering Communities Model cuts across the work of all the STP workstreams and was a potential area for further consideration.

 

The Chair of the Joint Committee supported Dr Pilkington’s view that a regional language needed to be developed.

 

Councillor Hetherington noted that South Tyneside OSC had carried out a Commission on Smoking last year and one of the key findings was that there are a number of reasons why people start smoking and there is not one solution. Therefore any health contacts with individuals will need to explore those reasons as, until those reasons are identified it will not matter what health benefits are articulated around not smoking and individuals will continue to smoke. It is essential that the root causes of smoking are identified and tackled and that it is recognised that smoking is an addiction and needs to be treated the same as other addictions. Councillor Hetherington noted that there are still some acute trusts which make smoking acceptable by providing places in hospital for individuals to smoke. There is a need to change attitudes.

 

Dr Pilkington agreed with Councillor Hetherington and stated that there is evidence which suggests that if 40% of smokers were offered brief advice and supported to stop smoking every year then it will be possible for the region to achieve the 5% target.

 

Dr Pilkington stated that it is not the case that the population lacks awareness that smoking is bad for individuals’ health. It is important that when contacts are made with those who smoke they understand that there is no blame attached and they do not feel that they are being punished for smoking. Dr Pilkington stated that e-cigarettes are an enabler for individuals who have tried a number of other avenues.

 

Dr Pilkington noted that Balance had held a conference about why young people start to drink alcohol and what the industry do to encourage people to drink alcohol. Dr Pilkington considered that this approach was needed in relation to smoking.

 

Councillor Huntley stated that the closing the gap ambition was fantastic but queried how robust the Board was to enable it to drive forward this ambition and how it would empower its workforce. Councillor Huntley stated that OSCs in Sunderland and South Tyneside had often received information that workforce were not involved until the later stages.

 

Dr Pilkington stated that the workforce will be receiving significant engagement from the Prevention Board. The Board would be rolling out training to enable the workforce to support individuals to stop smoking and look at how they can think differently about alcohol as well as being open to individuals in distress so that they can work towards a target of no suicides. Dr Pilkington stated that whilst the Prevention Board has senior management representation it does not have all the levers it needs and this is why it is taking matters to its most senior leadership.

 

Councillor Schofield thanked Dr Pilkington for the presentation and outlining the ambitions of the Prevention Board. However, Councillor Schofield noted that Newcastle’s Overview and Scrutiny Committee had received a presentation on CAMHS and how the model would help to reduce demand on specialist services and it had been hard to see how this could be achieved with the resources available. Councillor Schofield considered that this was the case with many DOH initiatives and this inhibited the rate of change. Councillor Schofield queried where Public Health sat in all of this and whether collaboration would take place through existing mechanisms or new structures and what the legal liabilities would be and whether they would be shared if they were progressed via Partnerships.

 

Dr Pilkington advised that some of the points raised would be addressed in the update on Accountable Care Organisations. Dr Pilkington stated that it would be important to look at what Partnerships can achieve together that organisations can’t currently do alone and how this is managed. Dr Pilkington stated that voluntary and community assets will also need to be used to the full.

 

The Joint Committee was informed that Public Health are involved in leading on this work jointly with the NHS around population health. The role will focus more on providing advice to the system as there is a recognition that there is only so much that can be done in terms of service delivery.

 

It was noted that 60% of NHS budgets have been focused on the acute sector and there is a need to shift some of that resource into secondary and tertiary prevention.

 

Councillor Davinson highlighted that work had been taking place in Durham to reduce smoking rates and whilst these had reduced there were still 38% of people in his area who still smoked so there was still a lot of work to be done. Councillor Davinson also highlighted the importance of exercise as a key element of prevention work as it supported both physical and mental health and if individuals joined clubs then it could also support social inclusion. However, Councillor Davinson considered that prevention initiatives would not have any impact unless they addressed the root causes of why people smoke etc and individuals had a positive view of their lives and what they might achieve.

 

Dr Pilkington stated that he supported Councillor Davinson’s view and considered that exercise is key to helping prevent diabetes and the mental health component of exercise was very important. Dr Pilkington highlighted that councillors can be considered to be community assets as they can be key to bringing people in communities together and creating connections between them and relevant organisations.