The Director of Public Health and Public Protection was in attendance at the meeting, to provide the Overview and Scrutiny Board with a briefing in relation to the areas of concern identified within the Balanced Score Card, in respect Public Health and Public Protection.
The Director of Public Health and Public Protection referred to the indicator on the Balanced Scorecards in relation to satisfaction of business with local authority regulation services; the figure was currently 89.2% but this was subject to monthly fluctuations.
The workforce was currently under review but a new model of working was due to be put in place and it was anticipated that this would improve satisfaction. An update would be provided following the implementation of the new model of working. It was an important measure of the overall health and was a good indicator of inequality in length of life across all age groups.
In Middlesbrough, life expectancy at birth was 76.2 years for males and 79.8 for females. This was lower than the national average of 79.5 for males and 83.2 for females. Up until 2010/11 there had been a year on year improvement in the figures. There had been a plateau in the figure in 2011 and since then, the life expectancy figures had reduced. A report published on 18 July 2017 by Sir Michael Marmot highlighted this as an area of significant concern. A full analysis of the statistical data would be included in the Annual report.
In respect of the measure for early deaths from all causes (standardised mortality <75), of the 1400 deaths recorded, 500 of the people were below the age of 75 which was higher than the national average. This pattern was similar to other areas in the north east. Redcar, Stockton and Middlesbrough had the same trend.
Nationally, life expectancy was slowing down although in the South of the country, this was not the case. The causes of early deaths included cancer, heart disease, strokes, respiratory diseases (such as bronchitis) and circulatory disorders.
There were several vulnerable groups that had a lower length and quality of life. These included:
People with serious mental illness - evidence showed that they died 15 to 25 years earlier than the rest of the population;
Learning disabilities - these people died, on average, 14 years earlier than the rest of the population. The causes of these deaths were often preventable long term conditions such as diabetes, obesity, heart failure, chronic kidney disease or stoke or cancers;
Minority ethnic groups - generally had poorer health and increased premature deaths.
In terms of drug related deaths and suicides, the incidence was usually much higher in young men than women. There had been 13 drug related deaths and 28 suicides. In terms of suicides, Middlesbrough was the highest in the country. A member queried whether the level of suicides was attributable to deprivation. The Board was advised that the pattern mirrored the pattern of deprivation and poverty.
In relation to drug related deaths, a member queried with regard to how Middlesbrough compared to the rest of the country. The Director of Public Health and Public Protection advised that if it was considered in relation to published data, Middlesbrough would fall within the top 10%.
A member queried how the data was recorded. Members were advised that rather than wait for the result of an inquest, as soon as it was suspected that the death was due to suicide, it would be included in the figures. The World Health Organisation had stated in 2004, that suicides were not inevitable, they were preventable. The Board was advised that two new posts had been established within public health; one to lead on work to prevent drug related deaths and one to lead on work to prevent suicide deaths.
The Board was advised that there was a requirement to work on emotional well-being and mental health from an early age. The Council needed to work with the voluntary and community sector on this issue.
The Director advised that he had heard of 2 anecdotal case studies of two people with learning disabilities that had committed suicide as a result of cuts to benefits. When conducting an inquest, the coroner could however take a different view as to the cause of death. A member commented that the fact that people with Learning Disabilities had committed suicide due to benefit cuts was a very serious public health issue.
It was commented that Universal Credit had to be applied for on-line but people with learning disabilities could have difficulties in accessing benefits. More pressure needed to be placed on the Government with regard to access to benefits. It was recommended that the Director of Public Health and Public Protection prepare a report on the impact of the Welfare Reforms on public health for submission to the Executive. It was recommended that the Chair of Overview and Scrutiny Board submit the completed report to Executive.
A member stated that there was an issue with alcohol abuse in the area and this caused health problems. The Director advised that use of alcohol over a long period of time could lead to heart problems, circulatory problems or cancer. The authority was trying to raise awareness of issues with alcohol and encourage sensible drinking. The work that had been carried out by the licensing authority in promoting a responsible alcohol trade in Middlesbrough, placing licensing conditions on licences, reviewing licences when necessary and through the Best Bar None programme had been very positive.
The Director of Public Health and Public Protection advised that in terms of cancer screening, the uptake of the service was below the national average but progress was being made in increasing the uptake. Members could encourage the uptake of screening within their own Wards.
In terms of high blood pressure, 20-25000 adults who had experienced high blood pressure were not going through the health system and it was important to encourage people to enter the health system via a planned route rather than an emergency route.
The Board was advised that the Live Well Centre was providing a good service and it was important to ensure that the community were making use of the initiatives in place such as the cancer screening service. A member commented that if people did take up the opportunities available, it could place more pressure on doctor's surgeries. The Board was advised that services had to be ready to deal with any increase in work and work was currently ongoing with the NHS to ensure that the services were available. It was positive that people were attending the Centre but the real test was what happened next after that appointment.
The Board was advised that in the past, a practitioner had been paid to go into offices so staff could make use of various services. The Director of Public Health and Public Protection advised that the University, the hospital and Middlesbrough college had signed up to hold awareness sessions and small and medium enterprises were also being encouraged to sign up to hold such sessions. The Town Hall was currently hosting flu vaccination sessions for members of staff. The Director of Public Health and Public Protection advised that lots of different opportunities were available including immunisations and screening programmes.
A member queried whether the Director could report back on how the Council were performing in relation to supporting staff and what opportunities were taken up by staff and how the authority could promote the initiatives available.
The Board was advised that in terms of child deaths, after the age of one, there were few deaths in children. For Middlesbrough, there were seventeen deaths in children aged 1 - 17 in six years (2010 to 2015), fewer than three per year, on average. The child mortality rate was lower than England. The Chair of the Teesside Child Death Overview Panel reviewed all child deaths and made recommendations to agencies with the aim of preventing future deaths but sometimes there was no preventable cause. The infant mortality rate was in line with the national average.
The Public Health Team had looked at the number of people killed as a result of a road traffic accident. The team were looking to see if there were any patterns and to ascertain if there was anything more that the Council could be doing to prevent the accidents from occurring. The Annual Report was due to be presented to the Health and Wellbeing Board on 6 December 2017.
The data in respect of excess winter deaths showed that Middlesbrough had an additional 88 deaths in the winter months of 2014/15 when compared with the preceding and following months, Not being able to heat a home to adequate levels, could contribute to excess winter mortality. It was estimated that there were 9000 households in Middlesbrough in fuel poverty, spending a high proportion of their income on energy. This equated to more than one in seven households. The rates of fuel poverty in Middlesbrough were higher than both the North East and England rates. Mark Fishpool from Environment City had advised that over 400 homes in Middlesbrough did not have a central heating system.
It was suggested that the Director of Public Health and Public Protection be invited back to a future meeting of the Board. The Director advised that the previous year's Annual Report was positive, but this years had been difficult to write.
A member commented that in terms of poverty and the use of foodbanks, a whole generation of children were not eating healthily. The Director advised that a Healthy Child Programme was being operated in schools but there was more work to do particularly in relation to the provision of free school meals in the school holidays. The Board was advised that Public Health were currently working with the supermarkets to utilise food waste. It was commented that some supermarkets had a box of free fruit which children were able to access. The Council were also working with the Director of Education and Gregs regarding healthy breakfasts.
It was suggested that the private sector be approached with regard to assisting in the provision of free meals during the six week holidays. It was also suggested that the Council look at whether the six week holiday period was still fit for purpose.
ORDERED as follows:
1. That the Director of Public Health and Public Protection prepare a report on the impact of the Welfare Reforms on public health for submission to the Executive. It was recommended that the Chair of Overview and Scrutiny Board submit the completed report to Executive.
2. That the Director of Public Health and Public Protection report back on how the Council were performing in relation to supporting staff and what opportunities were taken up by staff and how the authority could promote the initiatives available.