Agenda item

A report was presented by Sakthi Karunanithi, Director of Public Health, on the key public health outcomes indicators for Lancashire, benchmarked against England and the North West Region, along with a breakdown by district level where data was available. It was noted that the indicators highlighted worse outcomes in Lancashire compared to the national average.

Service level key performance indicators that the county council's public health team were responsible for were provided. The report also outlined the steps being taken to recover from the Covid pandemic and restore and reform our public health services.

It was reported that individual Public Health services would be highlighted in future reports to the Cabinet Committee.

The globally agreed meaning of health was complete physical, mental, social and spiritual wellbeing. Only approximately 20% of health was determined by access to good quality clinical and care services with the rest determined by behaviours, education, income, jobs, family support, community safety, housing, transport, environment, access to green space and how we are able to live a healthy lifestyle.

The steps taken to improve our health and wellbeing would, in turn, improve our planets health and the county council had a huge opportunity to make a difference to the wellbeing of the residents of Lancashire.

In relation to key outcomes – how long someone was expected to live and how well they live - there were a number of determinants for this. In Lancashire, although there is a wider variation within the county, it was reported that as an average we had more access to woodland than the national average, in addition to less overcrowding, less unemployment and less homelessness. In Lancashire, we supported people with learning disabilities very well and we had a good youth justice system and pupil absence service reflecting better outcomes that determined overall health.

Both male and female healthy life expectancy in Lancashire had been decreasing since 2009-2011 and figures were significantly worse than the England average, although the decreases were not statistically significant. It was expected that males would spend 17.9 years in poor health and females 20.3 years in poor health which were long periods of time to live with disabilities or health conditions. There was therefore lots of opportunity in Lancashire to add years to life, in addition to life to years.

In order to influence positive health and wellbeing for the residents of Lancashire, the county council needed to:

·  provide services to people on an individual level;

·  improve community level wellbeing by promoting community groups/assets including natural assets;

·  embed wellbeing into all the policies the county council establishes.

The Public Health Team had core expectations in terms of delivering statutory services. The team worked with experts within the county council to improve wellbeing, in addition to partners. There was an opportunity to add £10bn to the economy if health issues could be mitigated. It was noted that the essential mandatory services expected to be delivered included health visiting, school nursing services, health checks, contraception and sexual health services and alcohol and substance misuse services. The pandemic had impacted all these services differently. For example, support to mothers and babies and people dependant on alcohol or drugs had either been maintained or had improved through either virtual or face to face support. The Committee noted that the county council's alcohol and drugs misuse service was regarded as one of the best in the country.

For sexual health and stopping smoking services, the percentage of people supported in order to deliver a successful outcome had continued to improve, although the numbers of people going through public health services had declined over the past year.

The aim of the NHS health checks were to diagnose high blood pressure, chronic kidney disease, diabetes and early signs of dementia in apparently healthy individuals, and any issues detected would be referred onto the NHS. As the main providers of this service were general practices and surgeries had not been open, figures for health checks had declined significantly to around 200 in the past year which was a concern. Due to other pressures in the NHS, prevention services were not seen as a priority at the moment. However, whilst adhering to infection control standards, anyone with urgent care needs or suspicions of cancer had either been fast-tracked or had received online consultations. The county council was currently exploring options, continuing to work closely with GPs and looking at carrying out health checks in the community e.g. in libraries, leisure centres and workplaces.

Due to Covid having a big impact on the Public Health Team, the public health transformation programme had had to be paused. However, this was now in the process of being re-established with a refreshed 10 year mission to support Lancashire as a thriving place enabling residents to lead safer, fairer and healthier lives. There were 3 main strands for the programme - 'Respond', 'Recover' and 'Reform', the details of which were outlined in the report. The Public Health Team were also starting to recover services lost during the pandemic and continued to prioritise young babies and children and maintain performance for health visiting and school nursing services. The Team had prioritised health checks and healthy weight and obesity as the next services to look into improving, whilst trying to identify different ways of improving wellbeing. In addition, work with partners, District Councils and the NHS was underway looking at community wellbeing through various initiatives.

As it was some time since an overview of public health had been provided to Committee, the Committee's support had been requested to improve public health services and, more importantly, to embed improving the public health agenda as part of the Corporate Strategy and how this is monitored going forward.

CC Buckley queried why mental health was not included under the mandatory public health services listed in the report given that the Covid pandemic had put a great strain on people's mental health and the fact that mental health remained the main reason for sickness absence. CC Buckley raised concern about the mental health of young people leaving school and universities and how this would be addressed. It was reported that, although the services listed were those which had been identified nationally as part of the statutory delivery of services, the county council recognised that mental health was of paramount importance and offered a range of mental health and wellbeing services including supporting young people's mental health and wellbeing, suicide prevention and an alcohol and substance misuse service. Members were reassured that the county council invested a huge amount of resources into supporting people's mental health, including having a specific wellbeing at work programme.

Looking at economy and health and how these services could connect, it was reported that wellbeing at work had a lot of impact on this. The Public Health Team were looking to meet with Cabinet Members and Service Leads to discuss this issue.

CC Green pointed out that there were various links to public health issues across different service areas and portfolios that needed to be made or strengthened and that there was a lot of work to do collectively. He agreed that health checks needed to be taken out into communities, as those who were reluctant to visit GPs surgeries were more likely to engage with a community based service. CC Green stated the importance of 'achieving the best start in life' and 'community wellbeing' being among the immediate priorities.

CC Ali paid tribute to the tremendous work done by the Public Heath Team, particularly during the Covid pandemic. CC Ali stated that, with children now returning to school, the Healthy Child Programme needed to be a priority and that, going forward, it was crucial for mental health services to also be given priority. In relation to the issue around face to face GP appointments, CC Ali appreciated that there were some GP practices who were keen to get back to normal but that many other practices very rarely offered face to face appointments. This was a major problem, especially for elderly people who may not be able to use or have access to technology for virtual appointments. We needed to move forward with the prevention agenda and to reduce the number of hospital admissions. CC Ali considered that a strong, clear message needed to be sent to GP surgeries asking that patients be seen face to face, wherever possible.

CC Gooch emphasised the importance of community health and hoped that a substantial percentage of money the Government was raising from the National Insurance levy would be passed onto local authorities to take forward the prevention agenda and avoid people having to access NHS acute services.  CC Towneley stated that the public health of Lancashire residents was fundamental and that she was particularly interested in encouraging and supporting young people to become more active which could, in some cases, avoid the need for them to access NHS services.

CC Vincent agreed that the lack of face to face GP appointments needed to be addressed, particularly in relation to elderly residents who may not be able to access technology for virtual appointments.

CC Williamson emphasised that although the county council could embed these public health issues, we needed partners to do the same.

The Committee's concerns in relation to the lack of face to face appointments at GP surgeries would be referred onto the NHS and their response provided to the Cabinet Committee.

Resolved: The Cabinet Committee agreed to:

(i)  Support the steps being taken to improve the performance of public health services.

(ii)  Include public health outcomes in monitoring the impact of the corporate strategy and wider council's service delivery on improving health and wellbeing and reducing health inequalities across Lancashire.