Minutes for Overview & Scrutiny Committee for Adult Services meeting, Feb 11 2009, 9.45AM official page

Apologies for absence were received from Mr P Hardy, Mr D Rowlands and Mr D Watson.

To declare any personal or prejudicial interests

There were no declarations of interest.

To agree the minutes of the meeting held on 14 January 2009

The Minutes of the meeting held on 14 January 2009 were agreed and signed as a correct record.

Contributor:

Jane O’Grady, Director of Public Health

Purpose:

To inform members about the Healthy Communities Strategy and the impact this will have on Buckinghamshire residents.

Context:

The Healthy Communities Strategy seeks to provide an overarching framework for achieving a vision of Buckinghamshire as one of the healthiest places to live in the United Kingdom, by improving health for all Buckinghamshire residents and narrowing the gap in inequalities in health. The Healthy Communities Strategy has been developed under the direction of the Healthy Communities Thematic Partnership (HCP) of the Bucks Strategic Partnership (BSP).

At a previous meeting of the Committee, a member requested more information about the Healthy Communities Strategy (HCS). Jane O’Grady is attending to inform members about progress with this initiative, and will explain how the various work streams that drive the strategy are working in practice.

Papers:

• Healthy Communities Strategy
• Link to Countywide Mapping of Healthy Communities Work:

http://www.buckscc.gov.uk/assets/content/bcc/docs/community/Appendix_2_to_HC_Strategy_2009.doc

Mike Colston, Chairman of the Healthy Communities Partnership and Jane O’Grady, Director for Public Health, were both welcomed to the meeting.

The Chairman of the Healthy Communities Partnership told Members the following:

• The Healthy Communities Partnership dealt with the Health Prevention Agenda.
• In the past 18 months the work of the Partnership had started in earnest. The governance had been agreed and the Healthy Communities Strategy had been developed.
• The Strategy was now in its final draft form. A Consultation on the Strategy had finished and the draft Strategy had been taken to the Bucks Strategic Partnership Board and to the Local Strategic Partnerships.
• Feedback from the Consultation and from these Boards had been incorporated into the Strategy, and the delivery/actions plans for the Strategy were now being developed.
• All workstreams in the Strategy would be achieved within the existing resources, unless additional external funding became available.
• Work had also begun on how public awareness of healthy communities could be increased. The main conduits for information would be the three tiers of elected Councillors.

Jane O’Grady, Director of Public Health, then gave a PowerPoint presentation, and made the following points:

• The Healthy Communities Partnership was one of the thematic partnerships of the Bucks Strategic Partnership, and was chaired by the Cabinet Member for Adult Social Care.
• The Partnership was responsible for various LAA indicators, and these had been incorporated in the Healthy Communities Strategy.
• The Partnership reported to the Bucks Strategic Partnership Board.
• Health was a vital resource for life, for individuals, for the community and for business.
• The major influences on health were outside the remit of the NHS, and included the age someone finished full-time education, whether they were in employment or not, and the locality in which they lived (e.g. if they lived in fear of crime).
• A Joint Strategic Needs Assessment (JSNA) had been carried out in 2008 to map the health and wellbeing of the Buckinghamshire population. The results of the JSNA were currently on the Council website for Consultation.
• A number of priorities had come out of the JSNA. One of these was the growing burden of long-term conditions such as diabetes, heart disease and stroke on the community. These accounted for 70% of the money spent by the NHS and Adult Social Care.
• There was a need to start addressing preventable conditions so that more resources could be put into non-preventable conditions (such as expensive treatments for Parkinson’s disease).
• The PCT categorised each electoral ward in Buckinghamshire into one of five quintiles depending on the level of deprivation. Approximately 100 000 residents lived in wards which fell into the lowest quintile. Death rates were higher in this quintile, as were admissions to hospital (including for heart attacks and mental health issues). Life expectancy was lower in the lower quintiles.
• The top two causes of death in both the lowest quintile and the highest quintile were circulatory diseases and cancer. However the lower quintiles had higher rates of these diseases. A countywide focus was needed on these two causes of death.
• Studies in Italy and the USA had shown that a high level of social cohesion produced low levels of heart disease.
• The emergency admissions rate for diabetes also differed between wards. The average rate for the County was steady. However if the data was broken down further, it was apparent that admissions in the lower quintile had fallen, whereas admissions in the higher quartile had risen. This was an example of how further analysis of data gave a greater understanding of where resources should be targeted.
• Buckinghamshire had a higher rate of breast cancer than the national rate. The reasons for this were not clear. High rates of breast cancer were linked with higher social class. A high alcohol intake also increased the risk of developing breast cancer.

The Healthy Communities Strategy

The Strategy did not duplicate existing work (e.g. work on drugs and alcohol). There were three Strategic Aims:

• All Buckinghamshire residents to live healthier, happier and longer lives – happiness was one of the biggest determinants of a person’s health. This aim included addressing childhood poverty by working with the Children’s Trust, improving workplace health (beginning with the organisations in the Partnership), improving health of older people (through the Age Well project) and promoting physical activity (e.g. external funding had been obtained for a walking project in Wycombe).
• Reduce health inequalities between different geographical areas and groups of people within Buckinghamshire – this aim included increasing income in the most disadvantaged areas, e.g. through increased take-up of benefits and debt management. A co-ordinated approach to these by all organisations was being worked on.
• Create an environment that supports the health and wellbeing of the population – this aim included reducing the carbon emissions for all public sector organisations.

Jane O’Grady told Members about three of the projects in the Strategy. These were:

• Preventing heart disease, stroke and diabetes – GP practices in three deprived areas were calling in patients aged 50-60 to be assessed for their risk of these diseases. Lifestyle advice would also be given and referrals made if necessary.
• ‘At Risk’ People – for people at risk of developing disease, a range of programmes had been developed, including negotiations to provide 12 weeks free access to Weight Watchers, a Cardio-wellness programme running alongside the ‘Bucks Stop Smoking’ programme, and the ‘Re-activate Bucks’ Programme to encourage more physical activity.
• Older People – The first meeting of the new Age Well group had taken place in January 2009. The group would be carrying out mapping work to identify priorities.

Members then asked questions and made comments. These are summarised below.

Issues with diet and exercise may be due to lack of knowledge. How is this being addressed?

The Strategy maps work which is already going on in these areas, but will not duplicate existing work.

The Council Plan promotes community and personal responsibility. There is no instant answer to these issues, but we are moving in the right direction. Unfortunately the leisure centres are no longer subsidised and have been externalised. The costs of the leisure centres may exclude use by some heard-to-reach groups.

I am a diabetic and I have never had any problems as long as I follow the health advice given to me, and the care has been excellent.

The NHS information on diabetes has not previously been translated into other languages. This needs to be done, and the courses which are run on diabetes also need to be run in several different languages.

I also have diabetes but I have found the information given to me can be confusing.

If there are any inconsistencies in the information which is provided, this should be reported to the PALS officer.

Are you happy that one representative for the Voluntary and Community Sector (VCS) on the Partnership is enough to represent all the diverse VCS bodies?

The VCS representative acts as a communications channel back to VCS organisations, to provide feedback and information and to act as a signpost. However the current representative is more focused towards work with adults, and we have now been asked to provide a VCS youth representative too.

Do the deprivation quintiles use average figures for each ward?

Yes they do.

Buckinghamshire has some wealthy areas which have pockets of deprivation. Is it harder to convey information on healthy communities there due to a perception that these areas do not need it?

As resources are limited we are targeting areas with the largest areas of deprivation, and focusing on priority areas.

It may be difficult to convince affluent residents of, for instance, the fact that they may be drinking too heavily for their health. There is a need to develop communication methods which do not appear to be too prescriptive.

The credit crunch will lead to higher levels of social deprivation and this could lead to a higher rate of dependency on alcohol and drugs. The Consultation which was carried out on the draft Strategy was conducted before the full effects of the credit crunch were felt. Some of the feedback may therefore be flawed. The Strategy will need to react quickly to the new financial circumstances.

We are all concerned by the current economic situation and how it may affect people’s health. However this gives the impetus for more to be done and strengthens the purpose of the Strategy. There is no current evidence to show that a person’s interest in healthy living will diminish if they are struggling financially. People may even choose to walk more to save money.

The Strategy will identify residents whose health is affected by their living conditions.

There is a Healthy Living Centre in Aylesbury which has done a lot to improve health. There need to be more of these.

The Healthy Living Centre was originally funded by a lottery bid. It has been very effective and the Community there sets its own priorities. The Healthy Living Centre is a multi-agency project and all partners need to be engaged for more to be developed. We have raised it as a possibility but it needs to be pushed at a local level.

The Joint Strategic Needs Assessment was a good opportunity to see where there were gaps in the County, and enables partners to have informed discussions.

Alcohol in moderation is said to be good for you. For instance, why is stout no longer provided in hospitals for patients with low iron levels?

The NHS has taken a decision to prohibit alcohol on hospital premises to discourage drunken behaviour and the problems associated with that.

A small amount of red wine may be beneficial in preventing heart disease. However for women, any intake of alcohol increases their risk of breast cancer. So it is about finding a balance for each individual.

How will you measure the success of the Strategy? Is there one indicator which would show success?

The performance monitoring will be robust and NHS, Local Area Agreement and Performance Assessment Framework indicators will all be used as targets.

How will you engage with people who are not interested in improving their health?

If a resident goes to their GP for a check-up then they will be given relevant information. There are different ways of influencing people, including PR campaigns and also gently ‘nudging’ people in the right direction. There is a need to convey the message in a way which people find acceptable, and many different attitudes need to be overcome.

Affluent residents who lose their jobs in the recession will become vulnerable. Will they be less able to cope with this than people who have been deprived previously?

There is no way to tell what will happen, but this is something which we will be watching.

Should the approach to health be mainly strategic or focused at a ‘grassroots’ level?

It should be a ‘grassroots’ approach, but expectations need to be managed regarding what statutory organisations can provide.

Local Area Forums could be a means of encouraging ‘grassroots’ work.

There needs to be a balance between promoting personal responsibility and a paternalistic approach.

What can we do as Members to spread information about the Strategy and Healthy Living?

Individually, if any Members are School Governors then they could ask questions there about what is being done to promote the Strategy’s main aims. Also, if the work on welfare benefits could be hastened, this would be very helpful.

Collectively, when the Committee reviewed policies and documents, Members could consider the impact on the health and wellbeing of the population, and consider whether a health benefit could be derived.

Members also made the following comments:

• Country Park authorities could be used to distribute information to residents, as a very large number of residents used the Parks.
• Libraries and town halls could also be used as locations for information.
• Future generations (i.e. children in schools) needed to be educated about healthy living.
• Gardening provided very good exercise and also produced healthy food. Younger generations needed to be encouraged to have an interest in gardening.
• Members said that they would be happy to distribute information on Healthy Communities at Local Area Forum meetings. ACTION: JOG/CS/ALL MEMBERS
• The Strategy and its content should be promoted to ensure its prominence despite the current climate.

A Member proposed that the Committee sent a letter containing the following statement to the Cabinet Member for Adult Social Care:

‘The Committee resolves to support the Healthy Communities Strategy and requests that a robust monitoring regime is in place to ensure that the Strategy is flexible enough to adapt to change. The Committee also resolves to promote healthy living through local working, for example through the Local Area Forums.’

Members agreed the proposal, and that this should be submitted to Cabinet on 23 February 2009, when the Healthy Communities Strategy was to be discussed. It was also agreed that the letter should refer to the Healthy Living Centre and how Members saw this as an example of good practice which should be encouraged.

It was agreed that Claire Street, Policy Officer, would draft a letter which would be e-mailed to Members for their comments. The agreed letter would then be sent to the Cabinet Member for Adult Social Care and submitted to Cabinet. ACTION: CS [see attached]

Contributor:

Mike Colston, Cabinet Member for Adult Social Care and Lead Member for Healthier Communities

Purpose:

Mike Colston will talk to members about his role as the Lead Member for Healthy Communities, and the Council’s role in improving health.

Context:

Mike Colston is both Lead Member for Healthy Communities and Chairman of the Healthy Communities Partnership. Mike will explain his role in leading on the Council’s Health and Well-Being agenda, and will inform members about the wide range of services and initiatives that promote the health of the local population in Buckinghamshire.

Papers:

• The Council’s Role in Improving Health

• What is a Healthy Community?

The Chairman of the Healthy Communities Partnership said that this item had been covered under Item 4 (The Healthy Communities Strategy), but was happy to answer any further questions from Members.

Purpose:

To inform members about forthcoming key decisions on the Forward Plan in the area of Adults’ Services and for members to put forward suggestions for the future Work Programme

Papers:

Forward Plan

Members considered the Forward Plan of Cabinet and Cabinet Member Decisions, and made the following points:

• The Committee should review recommendations which had been made in previous Reviews.
• Updates to the Corporate Plan should also be looked at by the Committee.
• The Decision regarding the disposal of the Old Library premises at High Wycombe should be monitored.

Purpose:       The Chairman will update Committee members on developments since the last meeting.

Mrs W Mallen, Chairman of the working group for the Review into Delayed Transfers of Care, said that delayed transfers of care occurred when patients were medically fit to leave hospital but became delayed. Reasons for delay could include waiting for a bed in a residential care home or waiting for assessments to be carried out.

The Working Group had met with a number of officers from health, social care and the Oxford and Buckinghamshire Mental Health Trust. The purpose of the meetings had been to find out what was being done to reduce delayed transfers and where any gaps might be.

The Working Group had heard of examples, particularly at Stoke Mandeville, where staff from all agencies were working well together to put in place better processes to improve delayed transfers. However this good practice was not seen in all areas of the county, and there continued to be capacity issues concerning residential care homes and care packages.

A visit to Wiltshire County Council was planned for 23 February 2009, as Wiltshire had made improvements to its performance for delayed transfers, and carried out a scrutiny review into this area of work last year.

There was a very tight timescale for the review because of the forthcoming elections, and a draft report would be produced in March to be submitted to Cabinet in April.

A Member asked if there had been any feedback about patients who returned home from hospital after suffering a stroke. Mrs Mallen said that the Review was not looking at individual cases but at the general processes.

Claire Street, Policy Officer, said that in the final report there would be some case studies of patients who had been delayed, and their experiences.

A Member asked about the data being used for the Review, and asked if it could reflect what was happening in individual hospitals. Claire Street said that she would investigate if more detailed information was available. ACTION: CS

A Member asked when the full Committee would see the draft Report. Claire Street said that the draft final Report would be submitted to Members of both Overview and Scrutiny Committees (Adult Services and Health) as it was a joint Review.

However the draft Report might not be ready for the March meetings and might have to be sent to Members by e-mail for comment. It was suggested that Members from one of the Overview and Scrutiny Committees involved attend the meeting of the other Committee so that the Report could be looked at by both committees at the same time. ACTION: CS

Wednesday 11 March 2009, 9.45am. Mezzanine Room 1, County Hall, Aylesbury

11 March 2009 at 9:45am in Mezzanine Room 1, County Hall, Aylesbury.