Presentation by Terri Roche, Director of Public Health
Minutes:
Terri Roche, Director of Public Health, gave the following presentation:-
Health Challenges in Rotherham
- Life expectancy lower than England average
- 9 year gap in life expectancy across the Borough for men and 7 year gap for women
England average men 79.4 years
Rotherham men 78.1 years
England average women 83.1 years
Rotherham women 8.14 years
- Rotherham people live longer with ill health and/or disability than England average
- Rotherham men live 21 years and women 22 years in poor health
- Health Life Expectancy is:
England average men 63.3 years
Rotherham men 57.1 years
England average women 63.9 years
Rotherham women 59 years
Health Challenges
- High levels of unhealthy behaviours (obesity, smoking, alcohol use)
- Too many children not having a good start to life: high rates of smoking in pregnancy, low breastfeeding rates, 11,000 children in poverty
- 1 in 4 will have a mental health problem. Half first experience mental health problem before the age of 14
What is Public Health?
- “The science and art of promoting and protecting health and wellbeing, preventing ill health and prolonging life through the organised efforts of society”
Faculty of Public Health
- Individual lifestyle factors – social and community networks – general socio-economic, cultural and environmental conditions
Core Functions of Public Health (examples of activity within each function)
- Health Protection (Health Protection Committee, Suicide Prevention)
- Health Improvement (Tobacco Control programme recommissioned, Active for Health funding)
- Healthcare Public Health (Better Care Fund, Potential Years of Life Lost plan)
The Director of Public Health
- Accountable to the Local Authority Chief Executive
- Must have a place on the Health and Wellbeing Board
- Duty to write an annual report on the health of the population – Local Authority has duty to publish the report
Role of Local Authority in Public Health
- Statutory Public Health programmes
Protect the health of the local population
Ensuring NHS commissioners receive the Public Health advise they need
Appropriate access to Sexual Health Services
National Child measurement Programme
0-5 Child Health Services (Health Visiting)
NHS Health Check
What other services does Public Health Commission:-
- Non-statutory Programmes
Sexual health advice, prevention and promotion
Adult and child weight management
Adult and child physical activity
Substance misuse (drug and alcohol) – Adult and Youth Services
Tobacco control including Stop Smoking Services
Children 5-19 health programme
Non-statutory 0-5 children’s health services
Public mental health
Nutrition, dental public health, information and intelligence, wider determinants, health at work and more
How is our impact measured?
- Public Health Outcomes Framework
- Overarching indicators – life expectancy/healthy life expectancy
- Four domains
Wider determinants
Health improvement
Health protection
Healthcare and premature mortality
Public Health Staff Review
- Required within 8 weeks of Director of Public Health appointment (Improvement Plan)
- Simplified structure focussed on:-
Core Public Health functions
Supporting integration of Adult Health and Social Care
Increasing capacity for Children and Young People’s agenda
Increasing support for Health and Wellbeing Strategy delivery
Discussion ensued with the following issues raised/clarified:-
· Public Health funded a national survey (the dental epidemiology survey) which was taken by dentists who went into a selective number of schools and looked at children’s teeth, counted the cavities and the extent to which the children had cavities. It was a small survey but the results were extrapolated up to suggest what the health of children’s teeth was like. That was in the process of being re-commissioned across South Yorkshire
· An Oral Health Service was currently commissioned which worked with the Early Years Provision where tooth brushing clubs were encouraged and educational programmes for the children and their families. Attempts were also being made to encourage dentists to offer fluoride paint but often it was reliant on the parent being motivated enough to take their child to the dentist
· The annual report would be submitted to the Select Commission in March
· The number of NHS dentists in the Borough
· The annual report would be submitted to the Select Commission by March
· School Nurses were a very important part, as were Health Visitors, in getting messages out to families. It had to be part of the whole system’s approach and did not necessarily require extra appointments to give consistent messages to families across the whole health community. The evidence suggested that behaviour change was influenced by consistent simple messages.
· One of the key ways to measure effectiveness in the next 3-5 years would be delivery against the Health and Wellbeing Strategy. The Health and Wellbeing Board, as a partnership, had signed up to the key priorities in the Strategy. Also close effective working with Elected Members who knew their electorate in order to tailor the messages to be relevant to the communities. A more difficult issue was with regard to targeting provision to those at greater need to reduce health inequalities, rather than all services having a universal offer to all people.
Alison Iliff, Public Health Principal, gave the following powerpoint presentation:-
Public Health Grant
- Grant from Central Government
- Ringfenced until the end of 2017/18
- Requirement to report to Government annually on how the grant has been spent
Value of the Ringfenced Grant
- 2015/15 - £14.175M
- 2015/16 - £15,270M (includes £1M in-year reduction plus half year transfer of 0-5 Child Health Services)
- Grant: £54 per head of population
- Under target allocation
Spending on Health and Social Care in Rotherham
- 97% - RMBC and RCCG spending on Health and Social Care Services
- 3% - Public Health Grant
Directorate Spend: Percentage of total RMBC Budget
- 32.10% Children and Young People Services
- 13.40% Economic Development Services
- 29.40% Neighbourhood and Adult Services
- 2.20% Public Health
- 17.30% Resources
- 5.50% Central Services
Public Health Grant Distribution 2015/16
- 9% Public Health salaries
- 73% Contracted Public Health services
- 15% Reallocated services
- 2% Overheads
Public Health Grant – Breakdown of spend on Commissioned Services
- 26% 0-19 Health Services
- 7% Weight Management
- 7% Tobacco Control
- 2.00% Health Checks
- 31% Drugs and Alcohol
- 22% Sexual Health
- Health Protection 1.30%
- Oral Health Promotion 0.70%
- Physical Activity 0.60%
- Community dietetics 0.50%
- Ministry of Food 0.50%
- Mental Health Promotion 0.20%
Public Health Grant – Breakdown of Reallocated Spend
- Children and Young Peoples Services 47%
- Drugs and Alcohol 16%
- Physical Activity 9%
- Other RMBC staff salaries 8%
- Sexual Health 7.40%
- Mental Health – Domestic Violence 6%
- Health Protection 3%
- Noise and Complaints 2%
- Homelessness 1%
- Home Surveys 0.80%
What does the future look like?
- Current cuts – minimising impact to Public Health activity and commissioned services
- Non-statutory programmes likely to be focus for future cuts
- Staff redundancies possible
- Requirement to target services to most vulnerable (removal of universal offer for some?)
- Propose working group of Members to oversee strategic decision about spend of Public Health Grant
Discussion ensued on this part of the presentation with the following issues raised/clarified:-
· Rotherham was receiving less per head than Barnsley, which was below its target per population, and less than Doncaster which was above its target head of population. At the moment it was still largely based on the historical spend made by the Primary Care Trusts on Public Health prior to its transition to local authorities but there were national plans to move towards an allocation formula. However, the allocation formula was very complex and included things such as the standardised mortality ratio for the under 75s, % of the population eating 5 fruit or vegetables a day, % drinking more than recommended levels, % of current adult smokers, diagnosis rate of STI plus market forces factor which took into account the costs of local health care delivery
· There were huge variations across the country the same as it varied in South Yorkshire. There was a spreadsheet for 2014/15 which showed the allocations (to be forwarded to the Select Commission)
· Public Health England had created the Spend and Outcomes (SPOT) tool which looked at certain long term conditions/behaviours where they did look at spend and outcomes but not across the whole picture of Public Health. You would probably find that the health outcomes were clearly linked with deprivation (report to be forwarded to the Select Commission)
· Recognition that this was the Public Health grant not the entire Health grant for the Borough. The graphs within the presentation attempted to demonstrate that the Public Health grant was a tiny slice of the whole Health and Social Care economy in the Borough and the £54 was only a tiny proportion compared to what Health Care actually cost and reflect the need for Public Health to influence the wider NHS & social care spend
· A specific nursing post was funded by Public Health that sat within the Safeguarding Team that supported CSE
· The Equality Impact Assessments were carried out by the Public Health team in conjunction with the providers
· The Service would do its best for 2016/17 to find the additional savings, once known, which were over and above ASR savings. The services would have to be modelled on what there was and what was provided currently to ascertain if things were provided in the right way. Members and partners should be involved because it may be that (a) stop doing things (b) do less or (c) look at ways of delivering services in an entirely different way that provided efficiencies that had not been considered before and it may be that some services would have to be delivered by particular groups
· The Drug Intervention Programme was made available to most areas of the country, but not all, approximately 12 years ago. It had been in 2 parts (1) to place teams of people within police custody cells in order to support the police who were going to test on arrest and check if positive for Class A drugs and (2) an enhanced offer for treatment as at that time the national waiting time for treatment was 3 weeks; the proposal was that would reduce to 5 working days for anyone charged with an acquisitive crime offence. Historically that grant was split into 2. The part that paid for the workers in the cells was transferred to the Police and Crime Commissioner budget who was currently conducting a review of all budgets. The Custody Suite in Rotherham would close at the end of March, 2016, and Rotherham prisoners would be taken to Sheffield. It was not known whether Rotherham staff would transfer to deal with Rotherham prisoners or a new service be commissioned
Resolved:- (1) That the new structure within Public Health to support delivery of the three pillars of Public Health, the Authority’s statutory Public Health functions and the Council priorities of the child-centred Borough and health and social care integration be noted.
(2) That the emerging pressures being placed on the Public Health Grant as a result of the announcement in the Comprehensive Spending Review be noted.
(3) That the proposed Public Health commissioning programme for 2016/17 and 2017/18 be noted.
(4) That in principle agreement be given to a Members Working Group being established after the May 2016 local elections to agree the future strategic spend against the Public Health Grant.