Agenda item

Ms Kelly O’Neill, the Council’s Interim Director of Public Health, advised that the public health function had moved to local authorities in 2013 as councils were deemed to be best placed to contribute to public health and wellbeing, with access to things like green spaces.  To ensure that the team was as effective as possible, it was important that it was made up of people from a wide range of backgrounds rather than all from the health service.  Ms O’Neill was currently building her team and recruiting people who understood public need, moving away from pure academics.

Communities needed to be engaged to glean their insight and simple information was needed that informed decision making.  This model had been introduced and public health was now working with the wider Council in a broader way, trying to develop more effective ways of working with the local authority, NHS and public. 

Ms O’Neill’s role was to optimise any decisions to think about:

1.    Health improvement

2.    Healthcare public health

3.    Health protection

Although public health had previously been seen as a department that scrutinised data, it now held more of an enabling role in the wider determinants of health.  With funding of around £18.5m in 2022/2023, the team had worked with the public to improve lifestyles and target inequalities. 

Ms Shikha Sharma, Public Health Consultant at the Council, had given Councillors a presentation at Member Development Day on 23 January 2023 and had mentioned about the inclusion of public health in all Council policies.  Ms O’Neill advised that the Council tackled inequalities all the time so consideration was being given to ensuring that every decision made by the Council had a positive impact on health.  Consideration needed to be given to promoting a better way of living by thinking about things like locations, etc (e.g., were things being placed within walking distance to reduce car use).  To this end, thought was being given to the inclusion of a section in all reports to identify the health impacts of any recommendations.  Members were supportive of this idea. 

Ms O’Neill stated that, for too long, public health had been a noun and that action was now being taken to make it everyone’s responsibility.  It was important that everyone had an understanding of the relative benefits and disadvantages when writing reports. 

The public health grant was allocated by the Office of Health Improvement and Disparities (part of the Department of Health and Social Care) and payment was based on size and need.  The funding settlement for 2023/2024 was expected to be announced around February / March 2023 and would have to be used to provide a number of prescribed functions, e.g., 0-19 Healthy Child Service, as well as discretionary services. 

Each year, local authorities had to submit a return on how the public health grant had been spent, with a signed assurance that it had been spent appropriately.  Ms O’Neil noted that there would be capacity and flexibility to work with Council services to make investments to provide improved public health outcomes on local issues.  This work would need to set deliverables and outcomes to provide the best possible return on investment. 

Members were advised that the report set out the eight integrated public health grant funded contracts and one aligned contract funded by the Council and NHS commissioners.  In July 2022, Cabinet agreed to extend those contracts that were due to end by 18 months.  This extension had allowed officers to undertake a comprehensive review of the public health contracts to establish whether or not the contract had been delivering what was needed.  Consideration was being given to maximising returns as well as looking at where additional resources could be placed and whether current funding levels would deliver the outcomes needed. 

Ms O’Neill advised that thought was being given to how Council services could be better aligned with public health priorities to get the best outcomes, e.g., aligning the work of the Anti Social Behaviour and Community Safety teams and drug and alcohol services.  It was thought that a one-stop-shop approach would result in better outcomes from engagement with services. 

Concern was expressed that the amount of money spent on some of the public health contracts seemed rather low considering the importance of the issue, e.g., less than £6k on the childhood obesity programme and £25k on the lifestyle weight management service for adults.  Ms O’Neill noted that this funding was lower than that of neighbouring boroughs but also recognised that mechanisms for reducing childhood obesity could be included in the 0-19 healthy child service which had a budget of just under £5m.  Consideration needed to be given to a whole system approach to obesity, using assets in the community to do things differently to get more from the contracts without having to spend more money. 

Members recognised the need to try to do things differently to deliver more with less but questioned how it would be determined whether or not these new approaches were working.  Although there was a two year lag on the national annually published data, local data was available for services.  Ms O’Neill advised that the Council would not always get the exact information that it wanted but was able to gather data in relation to local measures for specific pieces of work. 

After the tendering process had been determined, consideration would be given to how residents wanted to access services.  Ms O’Neill advised that the needs and perceptions of the public would need to be established and engagement with local communities would need to be undertaken.  This had been more difficult with regard to the substance misuse service and the outcomes had been lower than anticipated. 

Action would be taken to establish whether or not services were achieving their desired outcomes.  Existing data would need to be used so it would be 18-24 months into the contract before it could be determined whether or not it was achieving the desired outcomes. 

RESOLVED:  That the update on Public Health integrated service contracts be noted.