Decision details

Ruksana Sardar-Akram (Best Start in Life), Aidan Kirkpatrick (Healthy Hearts) and Fiona Inston (Happier Minds), Public Health, Lancashire County Council provided an update on the work to address the three key Health and Wellbeing Board priorities and updated on the associated milestones and performance.

 

Best Start in Life

 

Ruksana Sardar-Akram, Public Health and Mel Foster, Education Improvement, Lancashire County Council provided an update on work that has been happening since the initial report that was presented to the Board on 10 May 2022.

 

The priorities for Best Start in Life are:

 

i)  Infant Mortality

ii)  School Readiness

iii)  Adolescent Mental Health

 

Further detailed information can be found in the report.

 

The Board noted the Performance Review (Appendix 'A') for Best Start in Life and were informed that some areas had shown improvement since the last report and other outcomes are still poor.  There is a reduction in Infant Mortality which is the lowest it has been for 15 years, and Lancashire is currently in comparison to the national average.  Local variations are also detailed in the performance review and whilst some districts are well above the national average, others are still poor, and work continues to improve these district outcomes.

 

Mel Foster, Education Improvement, Lancashire County Council gave a brief update on the 2-year-old offer, even though the offer is for 2, 3 and 4 year olds, 2-year-olds are Lancashire's most vulnerable children.  Therefore over the past 12 months, there has been targeted work on this age group, which has resulted in a positive news story seeing a 14% increase in uptake from Spring 2021 to Spring 2022 (data only published annually in Spring).  Lancashire is above the England average and in line with the North West average for the first time.  Lancashire's growth was also higher even though it is in line with the North West, the growth was actually higher which is really positive.  There are still a number of priority areas that need continued focus on including Pendle which has the lowest district take up and has been for some time, however, there was success still in that area as there was a further 21% take up from the previous year from 60% to 81%.  The other areas that remain a priority are Preston, Hyndburn, Rossendale and Burnley.  There is a multi-agency approach to targeting these areas and work is being carried out closely with internal colleagues in Children and Family Wellbeing Service and Children's Social Care to ensure those vulnerable groups and those known to Children's Social Care are accessing those places.  Again an increase has been seen in children look after, children in need and children on child protection plans accessing places, however there is still more work to do in those areas.  Close work is also being undertaken with health colleagues and other wider partners on the school setting infrastructure which again is a multi-agency approach to improving outcomes.  The detailed analysis of the School Readiness (Early Years Placement Uptake) was attached to the agenda at Appendix 'B'.

 

The Board were asked to note the key milestones that were alluded to in the data as attached at Appendix 'A' – Best Start in Life.

 

In terms of next steps, it is about looking at some of the inequalities, performance data and looking at what the targets might be.

 

Following the presentation, the following comments/issues were raised:

 

·  The Board noted that there was now a Strategic Best Start in Life Group, which is a multi-agency group that brings key partners together so ensure that everybody is working towards the same outcomes and they the data is understood in terms of where the gaps are to pinpoint where the inequalities are and to prioritise them.

·  In terms of the data for School Readiness in Lancashire, on average 69.2% of children are ready for school when they start, however at Ward level, in some Wards only one in two children are ready for school, therefore there is still a long way to go in ensuring that every child in Lancashire is ready for school by the time they take up their placement.

·  The Health and Wellbeing Board can support the ambitions as set out in the data in terms of School Readiness and as the Early Years Services that are commissioned by Lancashire County Council and the Speech and Language Service, NHS are due for review, it is those opportunities that the Best Start in Life Board are pursuing.

·  It was noted that in the East, close partnership working with the Department for Work and Pensions is enabling targeted work with Universal Credit families that have got young children and ensuring that services that work with those families are aware of what the 2, 3 and 4 year old offer is. 

·  Close work is also happening with the voluntary sector and the same kind of approach as the one with the Department for Work and Pensions is also being rolled out with those agencies and the Voluntary Sector and getting those professionals trained, so that they can have engaging conversations with those families.

·  It is about breaking down some of the barriers with families that might not be accessing the offer, such as they see childcare as something that working families need.

·  There needs to be clearer pathways to the right support and accessing the right services.

·  Further opportunities to link in more with the NHS particularly around speech and language services and other NHS services to understand what the inequalities are from a health perspective and working together with public health to look at that intelligence and prioritise what is going to be key to moving forwards.

·  School readiness is often affected by parents' drug and alcohol issues and this target should also be included in Best Start in Life.

·  A key aspect is how services work with families as well as children and young people.

·  Another priority was adolescent mental health – James Fleet and Jacqui Old CBE agreed to discuss this outside of the meeting.

·  There is an opportunity for the Health and Wellbeing Board to commit to having one system that is easy for a family to be able to navigate across public sectors.

 

Healthy Hearts

 

Aidan Kirkpatrick and Alison Moore, Public Health Lancashire County Council and Jeannie Hayhurst, NHS provided an update on work that has been happening since the initial report that was presented to the Board on 8 March 2022.

 

The Board were reminded of the Healthy Hearts programme which has been developed to encompass the following seven thematic workstreams:

 

i)  Tobacco

ii)  Alcohol

iii)  Physical Activity

iv)  Supporting Healthy Weight

v)  Food Diet and Nutrition

vi)  Health in All Policies Approach

vii)  Cardiovascular Risk Modification

 

Further detailed information can be found in the report.

 

In terms of the some of the key activities over the past nine months it has been essential to ensure that there is a very solid foundation upon which to build on with regards to the healthy hearts approach.  The existing service offer has been scoped out as well as the evidence being robustly reviewed, and a gap analysis has been carried out to ensure that the program is designed to deliver in line with what the evidence base says.

 

In terms of the performance review, further detailed information, key milestones and ambitions for each of the seven delivery platforms can be found in Appendix 'A' – Healthy Hearts.

 

The Board noted that in the past week Lancashire has been awarded £50 million as part of the Levelling Up Fund specifically to support investment within East Lancashire to ensure that there is a complimentary offer not only around public transport, but also about developing cycling and walking opportunities.

 

Jeannie Hayhurst, Cardiovascular Prevention, NHS give a brief outline on the metrics in the Healthy Hearts Performance Review (Appendix 'A'), Cardiovascular Disease Risk Modification, which reflect the ambitions of the NHS long term plan that was released in 2019 and set out some 10 year ambitions in the attempt to try and reduce the number of heart attacks and strokes.  The main focus of the measurements within this section are to try and increase detection of the three main risk factors for heart attack and stroke and also improve the management of those three main risk factors.  They focus on atrial fibrillation; high blood pressure and high cholesterol and the measures look at how well the Service is doing in terms of identifying atrial fibrillation, treating people who have got a Defibrillation with anticoagulants in order to prevent them having a stroke.  As outlined in the Performance Data it shows that Service is doing well in the first area, atrial fibrillation and the ambition is to achieve a target of 85% of patients identified with this condition by 2029, with the figure currently at 84% across the area.  In terms of treating these patients with anticoagulants, the target is 90% and currently the figure is at 88.7%, again which is good news in that area.

 

The second area is high blood pressure, where there is still a lot more work to do with the target of identifying people with high blood pressure being set at 80% by 2029 and it is currently at 68% on average across Lancashire.  There are two measures that are recorded and reported on locally with regards to this condition which are, i) how well patients are treated over 80 and ii) how well patients are treated under 80. Data shows that treatment for those over 80 is better than those under 80, so there is quite a long way to go in terms of improvements.

 

The third area that is reported on is cholesterol and the first metric that is measured is how well cholesterol is recorded in people who are aged between 40 and 74, which obviously reflects the uptake of the NHS health checks across the patch and the second metric is recording how many people who are identified at high risk of having a heart attack or stroke, how well they are being treated in terms of giving them a statin and again there is a long way to go as targets are way behind currently being 21% with a target of 75% by 2029.

 

The final metric is the ambition to find more people with familial hypercholesterolemia which is a genetic condition and puts people at very, very high risk of heart attack at a young age.  The national ambition is to recognise up to 25% of people with the condition by 2024.  Progress data is currently not available on this; however it is something that is being worked on.

 

Following the presentation, the following comments/issues were raised:

 

·  An area of concern for the Health and Wellbeing Board is with regards to the health checks and current data outlines only 21% of Lancashire's population have undertaken one, which is exceptionally low, however, it is expected that by the end of this financial year the number will be back to 50% of pre COVID levels.  The big challenge however is the variation in coverage across Lancashire as some areas are already achieving 75% however other areas are performing very poorly and that is where crucial engagement with NHS colleagues to ensure that all practices are able to offer that service and if for any reason individual practices are struggling to deliver that service, maybe there is an argument for other models of delivery.

·  Lancashire County Council have recently commissioned Choose Health who are delivering the health checks in the community, workplaces and places of worship and started delivering on that in Spring 2022 where there has been a steady increase in the number of checks that are being delivered.

·  Significant progress has been made in terms of getting general practices back on track and there is much better communication now with Lancashire's 135 GPs.

·  There has been a review of different models for the payment because at the moment it is completely payment by results.  Work is ongoing on a Federated model over in West Lancashire working on a Primary Care Network model from Rossendale.

·  Data needs to be joined up across the providers to highlight the inequalities in the different districts.

·  Need to be more active in getting the public to take more ownership of their health and to come forward for health checks.

·  Elected Members could encourage Local Authorities to have health checks in the work place on an annual basis.

·  E-cigarettes and the use of these inside premises is still an issue and the under-age use of these is increasing.  The Board noted that there is a workshop shortly at a system level to look at this issue.

 

Happier Minds

 

Fiona Inston Public Health Lancashire County Council provided an update on work that has been happening since the initial report that was presented to the Board on 19 July 2022.

 

The Board were reminded of the Happier Minds programme which is a partnership and system leadership approach to addressing five key strands of work:

 

i)  Emotional Health and Self-Care

ii)  Loneliness and Social Isolation

iii)  Dementia

iv)  Alcohol and Drug Use

v)  Self-Harm and Suicide

 

Further detailed information can be found in the report.

 

The Board noted some of the key milestones in the Performance Review (Appendix 'A') which focussed mainly on Self-Harm and Suicide and Alcohol and Drug Use.  Research indicates that one in four young women and one in four young male, self-harmed.  This data is hard to measure because the data will say that in 2021 over 2000 people have attended A&E in Lancashire, however, it does not indicate what the hidden element of self-harm it is.  Feedback is received through Child and Adolescent Mental Health Services as well as schools and some work that is undertaken will be around parents understanding some of the signs and indications of self-harm and how they can support their child and be signposted to services.  Links to self-harm can also be associated with suicide and again this is the leading cause of death in men under 50 and women under 35 and it is also linked to deprivation with men living in the most deprived areas are 10 times more likely to take their lives, and suffer from mental health, which is a theme that keeps coming through in data.  Variations across the county based on the most recent figures show that the highest variation in suicide is 25 in Preston and the lowest is four in Ribble Valley.

 

A new National Strategy on Suicide to precede the 2016 version is awaited when the ambition was for suicides to reduce by 10% was produced for suicides by 10%. In 2021, nationally over 5000 died due to suicide.  Generally over the last few years there was an ongoing increase regardless of the pandemic in suicide.

With regards to the Happier Minds programme the key is about what the actions Services can commit to together to start addressing and supporting Lancashire's communities across NHS and down into grassroots in communities.

 

With regards to alcohol and drug-use, currently 15% of people in Lancashire are dependent on drug and alcohol treatment services as alluded to previously and there is an ambition that those accessing treatment will increase over the next two years and that there will be additional funding too into detailed programmes.  The other key aspect is around drug related deaths particularly in areas of deprivation.  In 2020, there were eight recorded related deaths that happened in Burnley and two districts Rossendale and Ribble Valley recorded no deaths due to drugs.  Nationally there has been a target to reduce 1000 preventable deaths due to related harm and in terms of the National Strategy what this means locally and going forwards is that there has been an appointment made within the Public Health team who is going to focus on drug related deaths (ie how it started and what lessons can be learned and how the learning can be taken forwards and influence change).  There is also a focus around establishing a drug related panel and to hold a drug related death conference in 2024 of which members of the Health and Wellbeing Board will be invited to.

 

Following the presentation, the following comments/issues were raised:

 

·  Happier minds is the most challenging priority for the Board and there is still a lot of work to be done on it, however, further investment will help residents in Lancashire to address financial security, relationships and that 50% of those who have a dependent alcohol problem are actually known to the authority, the others are known through child protection, child abuse, crime and mental health.

·  The Board will need to continue to oversee progress in this area.

·  The challenge is around how to continue some of that good work that has been done and also recognising the positive aspects of what has been happening within the communities and to keep the momentum going.

 

In general it was agreed that a review of the Board's three main priorities be brought back to the Board in 12 months' time and in the meantime a conversation would take place outside of the meeting with regards to the challenges and barriers each area was facing.

 

Resolved:  That the Health and Wellbeing Board considered the performance update and endorsed the areas identified as opportunities for collaboration and advocacy of the Board.