Agenda item

Report of Dr Andrew Howe, Director of Public Health

The Director of Public Health introduced the report, informing Members that it was the second anniversary of the establishment of the Joint Public Health Service with Barnet.

The Committee noted that the ring fencing of the public health grant had been extended for a further year beyond the initial two years and was anticipated to be extended for a further year.  Whilst the aspiration was to move to a needs based allocation, Harrow currently had the second lowest allocation with £36 per head which was based on historical funding.

An officer responded to the following questions from Members:

·                     What extent, if any, was the public health service consulted regarding major regeneration schemes and, if so, what was the benefit?

Public Health was consulted in relation to these schemes.  It was critical that a Health Impact Assessment was produced at an early stage.

·                     What percentage of families and children were failing to get adequate food and vegetables and were in poverty having to rely on food banks?

The selling of fruit and vegetables by parents in schools had been a success and had become self sustaining.  The officer undertook to investigate whether any work had carried out locally to measure the use of food banks.

·                     As Harrow had a traditionally low smoking rate, why was the local proposed indicator for the Health Premium Incentive Scheme the smoking prevalence in adults aged 18 and over?  Would the low base make the achievement of significant improvement difficult?

The officers considered that, on the information available, the target was achievable.  The increase in the use of Shisha and e-cigarettes had been factors in the adoption of the indicator as was the lack of opportunity to give up smoking for those in prison or with mental health issues.  As e-cigarette use was not routinely measured, London data was used.  The service liaised with Trading Standards as appropriate.

·                     What was the effect of the different funding formulas for Harrow and Barnet on the joint service?

Whilst the ring fencing remained separate, service efficiencies had taken place.  Examples were sharing expertise such as on the procurement of drugs and alcohol service or, as appropriate, one officer working across both boroughs.  Best practice was shared and the Inter-authority Agreement was regularly monitored.  The boroughs worked together, such as with regard to Health and Wellbeing Boards and strategies.

·                     The report stated that, although the overall growth rate of the public health grant in 2014-15 was 5.5%, the growth in allocation for Harrow was 3.1%.  Did this mean that Harrow was falling back in the formula?

Yes, fair shares were not being implemented and lobbying was taking place as a result.

·                     How did Barnet being significantly bigger affect the joint funding arrangements?

The post of Director of Public Health was funded 50/50 between Harrow and Barnet Councils, some posts were funded 60/40 depending on the staff and budget and some posts were 100% Barnet.

·                     How was the performance indicator 1.07, re proportion of all people in prison aged 18 or over who have a mental illness or a significant mental illness, defined?

The general term was a severe and enduring mental illness, not necessarily requiring sectioning.

·                     What was the percentage target for getting people of working age who had bipolar or schizophrenia back to work?  What schemes were available for those with less significant mental health disorders, how many people had been assisted and how long had they been off work.

The longer people were out of work the harder it was to return.  There were programmes to help people within the first few weeks of being out of employment with conditions such as anxiety.  About 30% had been helped back to work.  Mental health was a priority in the Health and Wellbeing Strategy which was being refreshed and would be submitted to a future meeting of the Committee.

·                     Were psychological therapies more difficult to source and sustain in the NHS?

It was one of the key targets of the NHS with the Clinical Commissioning Group (CCG) having a target for improving access to therapies.  The West London Alliance (WLA), based in Ealing, had obtained £1.4million to fund mental health and employment initiatives.

·                     The performance indicators do not provide a sense of what would happen if an initiative was either not undertaken or increased.  For example, did the distribution of leaflets have a measured impact on a performance indicator?  If the public health budget was no longer ringfenced, how could the continuation of the performance indicators be justified?

The challenge for public health was long term prevention and as such was under threat during a period of austerity.  An example of an initiative where the benefit to Harrow Council was difficult to calculate was the stop smoking services but it benefited the NHS.  Likewise the drugs and alcohol services benefited the criminal justice system.

·                     How can the effect of Harrow Council’s funding on no smoking initiatives on Harrow be calculated when some people stop smoking voluntarily and there are government campaigns?

There is evidence that public health intervention surpasses other public sectors, for example, the one to one smoking initiative reduces smoking by 5%.

·                     How are healthy outcomes calculated when Harrow residents have dementia, and experience fuel poverty, and poor housing?

One measurement for long term outcomes, for example, is life expectancy.  However there are pockets of inequality within the Borough.  However there were good rates for heart disease, low rate of cancer deaths and good outcomes for diabetes.

·                     What is the correlation between unemployment and health?

There was a need to refer those with mental health to psychological therapies.  The team was working with the welfare benefits taskforce.

·                     Being out of work was a significant issue for young people so were there schemes for young adults?

The officer was unaware of specific schemes so would consult with colleagues.  It was the responsibility of the General Practice Commissioning Group.

The Chair thanked the Director of Public Health for this attendance.

RESOLVED:  That the report be noted.