Agenda item

Dr Fiona Wright, Consultant in Public Health at LBBD, presented the report, the aim of which was to give assurance to the Board that it had discharged its duties in relation to the JSNA.  It also aimed to summarise the approach taken and key findings in the current context and to share the key findings and next steps.  The presentation highlighted three key approaches to reducing health inequalities and the key plans and strategies for the borough.  The Board’s attention was also drawn to the context of the JSNA in regards to key plans and strategies for the LBBD, notably the Joint Health and Wellbeing Strategy.  The JSNA provided a ‘snapshot in time’ of the Borough’s health and wellbeing needs and inequalities.  There was continued concern on a number of key health issues, details of which were set out in the report and presentation.  Fiona particularly drew attention to life expectancy and healthy life expectancy rates in the Borough, as these indicated that healthy life expectancy was the lowest in London, with healthy life expectancy in women being particularly low.  The Borough also has a comparatively young population and would need to prepare for the projected increase of more than 70,000 residents by 2031

Fiona also drew the Boards attention to a number of key points including:

·  Over a quarter of 4 to 5 year olds are overweight and a third have tooth decay.

·  The second highest rate of teenage conception in London

·  The second highest proportion of young adults not in education or training (NEETS)

·  The highest rate of pregnant smokers and lower than average percentage of mothers that breast feed.

·  Heart disease most common cause of premature death.

·  Cancer being the most common cause of death.  Lung cancer was the most common cancer, with 9 out of 10 lung cancer deaths being related to smoking.  Improving cancer screening coverage was clearly important.

·  Issues that affect older generation such as depression and falls: that had resulted in nearly 400 emergency admissions to hospital.

·  Domestic violence and homelessness on their negative effects on physical and mental health and health inequalities.

In response to a question from Cllr Carpenter, Cabinet Member for Educational Attainment and School Improvement, Matthew Cole advised that there had been improvements in many areas but we were not improving as fast as other London boroughs.  The Sustainability and Transformation Plan (STP) would be prioritising some issues to enable targeted resources by partners; this would in effect create a smaller number of key priority areas. 

The Chair reminded Partners that the JSNA needs to be more clearly shown in the strategies they develop and to be more explicit in why they are concentrating on specific issues.

Cllr Turner, Cabinet Member for Corporate Performance and Delivery, pointed out that there are differences in demographics between areas and that it would be helpful to break down the information at sub borough level.  Cllr Turner also raised the effect that constantly changing demographics would have on the trends and how change could give a false perspective of performance.  The Chair pointed that localities would be key.  Matthew Cole advised that work was underway already for the data to be split at locality level and in effect they would have mini JSNAs for those areas.

In response to a question from a member of the public about training for GP surgeries to promote screening, it was noted that whilst the CCG do not commission training they would promote screening and that the programmes are well resourced and some GPs performance need to improve their performance.  Dr Mohi commented that whilst there are incentives performance is down to individual doctors and performance needs to be raised to achieve consistency across the Borough.

Healthwatch said that a recommendation had been made by them in regards to toothbrushes being taken into nurseries to encourage tooth brushing, but the £15,000 funding had not continued.  It was noted that Matthew Cole was working on a strategy on oral health, including prevention and this would come to the Board in due course.  Ceri Jacobs, Director Commissioning Operations NCEL, NHS England, advised that she would raise the issue of dentistry prevention with her colleagues at NHS England.

Discussion was held on the end of life or hospice care.  Dr Mohi advised that most end of life care is undertaken by a referral by the hospital consultant.  It was noted that St Francis Hospice was currently looking to expand its home support provision as many people would prefer to die at home and more needs to be done to allow that choice.  Fiona advised that further details on end of life care were within the JSNA report.

The Chair raised her concern on the confusion that seemed to have appeared recently in regards to commissioning responsibility and performance and professional standards.  This was noted by NHS England.

The Board agreed the recommendation of the report to:

(i)  Consider the implications of the findings of the JSNA in the development of strategies of partnership organisations and commented accordingly;

(ii)  Support the commissioning of services by Partner organisations that align with the JSNA findings and the Joint Health and Wellbeing Strategy (JHWS);

(iii)  Assess the impact of the JSNA on the Delivery Plan of the JHWS by March 2017; and

(iv)  In-line with statutory requirements, require the Public Health Department to lead an update and refresh of the JSNA in 2017 to inform commissioning in 2017/18.