A report from Dr Jyoti Atri, Director of Public Health setting out the approach being proposed to tackle health inequalities.
Councillor Mason welcomed Dr Jyoti Atri and Val Thomas from Public Health, and Annabel Tighe to the meeting.
Dr Atri shared a presentation giving some of the key health outcome data and gave a brief introduction to the Health and Wellbeing Strategy and the statutory Director of Public Health Annual Report.
Some key points from the demographic data:
· The population of Fenland is aging.
· Fenland Life Expectancy for both males and females is shorter in Fenland compared to Cambridgeshire and England.
· Fenland has one of the highest rates of early death (under 75) from cardiovascular disease in the East of England, much of which is preventable and linked to deprivation and behaviour.
· Since 2013, rates of premature mortality, not just caused by cardiovascular disease, have been increasing. Rates are significantly higher in Fenland than England and this is not declining.
· Childhood obesity is worse in children in Fenland than Cambridgeshire with about 20.5% of year 6 children being obese (up to 36% if looking at overweight and obese) and 15% of Fenland children are living in absolute low-income families.
· 2018 against 2021 data shows a decrease in children’s wellbeing and mental health
· Fenland has one of the highest rates of death by suicide in the East of England.
Dr Atri explained that both Peterborough and Cambridgeshire Health and Wellbeing boards have merged to form a single entity that meets as a committee in common with the Integrated Care Partnership, with representation from the Combined Authority and Office of the Police and Crime Commissioner. The mission statement is ‘All together for healthier futures’ with three overarching ambitions:
1. Have better outcomes for our children
2. Reduce inequalities in deaths under 75 years
3. Increase the number of years that people live in good health.
Dr Atri further outlined a series of priorities that have been agreed to fulfil these ambitions and the approach to health inequalities.
Members made comments, asked questions and received responses as follows:
1. Councillor Mason said he thinks the report and presentations identifies the problems; it is a matter of getting to the solutions.
2. Councillor Booth thanked Dr Atri for the presentation. He said what Dr Atri is basically saying is that different tools are used to target different issues. In terms of using a universal approach to make improvements, it is his view that it is more at government level where that needs to be led. He would like a better understanding of what is being done to improve Fenland health outcomes. In the past there has been a list of action plans, and he remembers hearing a few years ago that smoking cessation was going in the right direction, but last year’s report indicated that smoking was increasing in the working population so he would like to know what is happening there. The previous action plans involved holding workshops to target large employers to encourage smoking cessation in the workplace. So, it is more of an understanding of what is happening in Fenland to tackle the issues; it is his view that the current report is quite nebulous in what we are trying to achieve so would like to know more about what is happening for our district.
3. Dr Atri said that unfortunately the last two years have been distracted by Covid. Public Health is only now starting to recover activity and reinvigorate the Health and Wellbeing Strategy post Covid. Obesity is now the priority in Fenland as it affects many more people than smoking does, although that is still important, but obesity is the bigger risk factor.
4. Val Thomas added that smoking cessation is still on the agenda and work is continuing. GPs services are still commissioned for smoking cessation, but this has been hampered by the pressure on GP practices currently. Lifestyle services has picked up on this and looking at the data from last year we are starting to see a slight improvement, but we do rely on GP support, and they are compromised by multiple demands. There have been a few discreet projects in Fenland to tackle smoking in pregnancy, with targeted approaches in Wisbech involving health visitors and other professionals working with pregnant women and their families in the community. The Tobacco Control Alliance is being supported by the whole integrated care system, and the NHS has a focus on prevention of smoking currently, with a tobacco control plan. We are also looking at young people, although the landscape has changed due to the uptake of vaping, and we are concerned with some of the vaping practices and the way they have been targeted at young people. In addition, we are still looking at illegal tobacco sales, working with Trading Standards and traders. Our lifestyle services do go into workplaces, but we do not always find them receptive to stop smoking services, although they do like NHS health checks, but the offer is there and publicised.
5. Councillor Mason said there are two sides to health, physical and mental and Fenland District Council has a responsibility to assist with physical health and he thinks the Council is doing that. For example, upgrading the Manor Leisure Centre in Whittlesey. However, he has concerns about residents’ ability to access healthcare across Fenland, particularly GPs and minor injury units due to capacity resourcing problems etc. and he asked Dr Atri what is being done to tackle these accessibility issues.
6. Dr Atri responded that this is not her responsibility but that of the Integrated Care Boards (ICB). However, they have been called to County Scrutiny and questioned over this and she believes a number of measures have already been put in around supporting people’s access at the right point. For example, 111 has been strengthened and people are directed to call that number first if they need minor injuries. In terms of access to primary care in the form of GP appointments, they are reporting that they are offering as many appointments now as they did pre-pandemic. Dr Atri suggested that it may be worth the Panel inviting the ICB to a meeting to ask them directly. Councillor Mason said although he accepted that this is not Dr Atri’s remit it needs flagging up that it is not acceptable that people are having to queue for several hours to have a flu vaccination.
7. Councillor Mason said in respect of mental health, he understands there is a service provider, Centre 33, providing a drop-in centre. Dr Atri responded that this service is commissioned by the Clinical Commissioning Group (CCG), and Public Health pays a small contribution, to improve mental health provision for young people. There is a keen interest in this area as children and young people are waiting too long to be seen. There is a strategy around early access and prevention as this leads to better mental health outcomes; discussions are ongoing to improve this issue, but part of the problem is that there is not enough money in the system. Needs have increased but the budget has not. Public Health are looking at interventions to support people on the waiting lists. Councillor Mason said that there has been talk of inequalities in health and deprivation in Fenland, but he had noted that Centre 33 is open for 23 hours a week in Cambridge, but only 4 hours in Fenland and that needs to be addressed.
8. Councillor Miscandlon asked what is being done to target groups who either drink, smoke or eat unhealthily to help them control their lifestyle. He stated that the district has many immigrants who bring their problems with them. Dr Atri advised that nobody is called a problem group or individual; people have different needs across the population. Needs assessments are routinely carried out so if there is a higher prevalence of smoking in Eastern Europeans, services are promoted in those languages. Val Thomas added that they have health trainers with appropriate language skills realising a variety of needs to try to shape the service accordingly.
9. Councillor Purser stated that he had mixed views on the statistics shared in the presentation. He has never smoked but has health problems so good health and a good lifestyle are not always linked. Councillor Purser commented that March has a free park run and wondered what Dr Atri’s thoughts were on that sort of scenario. Dr Atri agreed that there are many cheaper, free, or cost-effective interventions for exercise. Obesity has become the priority over and above smoking because of the number of people affected; it has become normalised, and people do not recognise it. It is a fact that 60% of our population are obese or overweight. Although Public Health is tackling both, in terms of strategy then obesity is the focus. Early intervention in schools will help, for example introducing a daily mile walk, reducing sugar in school meals, and looking at tuck shop/vending machine provision.
10. Councillor Miscandlon asked what is being done by the medical services to alleviate the problem of increased air pollution in our towns. Dr Atri advised that this is an issue for national Government to cap pollutants. However, Public Health advocates active travel, promoting improved public transport and encouraging good routes for walking and cycling and this is something that they are working on with the Combined Authority.
11. Councillor Miscandlon stated that as he lives in a rural area, unfortunately public transport is not an option and there is no infrastructure for electric cars. Travel in rural areas will not change.
12. Councillor Mason commented that there is a lull in the recruitment of GPs and asked what is being done nationally to address this. Dr Atri responded that this is a matter for the ICB and not something she has any control over.
13. Councillor Booth said that although Dr Atri made the comment about not having control or involvement, he got the impression from the report that they are working much more closely together now, but this is not the impression he is getting from her answers. He asked if there is still more work to do to overcome these structural and bureaucratic barriers. Dr Atri responded that they are working together on health and wellbeing, but not the entirety of the health service remit. There has been agreement to work more on preventative and public health measures. As Director of Public Health, Dr Atri does have an interest in primary care and GP recruitment, recognising that easy access is important. However, she does not have direct control over this, and she would suggest the Panel approach the ICB.
14. Councillor Connor said that Dr Atri had commented that she has no say in the minor injury units, but he has been trying to get in touch with the CCG. They are doing some work in Wisbech, but no mention has been made for the upgrade of Doddington. Fenland will be building several thousand more homes and so we need to make gains with those services. People now need to travel further afield just to get their Covid vaccinations and it is a job for some people to get to other hospitals. Given the deprivation levels in Fenland, he had thought this would be something that Dr Atri could assist with. Dr Atri responded that Public Health are trying across the country to ensure that when developments are planned, then health provision is linked in at an early stage.
15. Councillor Purser said that he wanted Dr Atri to report back that he has personally received superb medical treatment and he cannot thank medical staff enough.
Councillor Mason thanked Dr Atri, Val Thomas and Annabel Tighe for their attendance and contribution to the meeting.
(Dr Atri, Val Thomas, and Annabel Tighe left the meeting).