Agenda and minutes

Apologies were received from Mrs L Game, Mrs K Grehan, Mrs P Cole and Mr T Hills. 

Mrs K Constantine and Ms J Hawkins were in attendance virtually. 

There were no declarations of interest.

RESOLVED that the minutes of the meeting held on 7 July 2024 were a correct record and that they be signed by the Chair.

1. Mr Watkins, Cabinet Member for Adult Social Care and Public Health, gave a verbal update on the following: 
   1. Health Protection- The covid and flu booster vaccine roll out for autumn and winter 2024 was set to commence from 1^st September 2024. Mr Watkins set out eligibility. Further details were to be shared with all Members. 

2. Dr Ellen Schwartz, Deputy Director of Public Health, gave a verbal update on the following: 
   1. Publication of the Lord Darzi Report- The independent investigation into the NHS in England was published on 12^th September 2024. The report referenced the power of prevention in reducing the pressure on the NHS and social care. Dr Schwartz announced the development of a Kent Marmot Coastal Region, using the eight principles of Sir Michael Marmot, to address the social determinants of health and reduce health inequalities. This had been shaped around the coastal areas of  ...  view the full minutes text for item 334.

1. Victoria Tovey (Assistant Director for Integrated Commissioning) introduced the report which detailed performance against Key Performance Indicators within Public Health commissioned services. Four areas were performing above target whilst two were below the target. 

2. Ms Tovey noted the fall in performance against PH14 “number of mothers receiving an antenatal contact by the health visiting service”. Members asked for further information:  
   1. The provider (KCHFT) had identified a data reporting error subsequent to their move to a new IT system. That error had inflated their previous performance, upon which the 24/25 targets had been set. The error had been resolved, but that led to a decline in performance against targets (i.e. less women had received face-to-face contact from their health visitor than originally recorded).  

3.    In response to questions around the lower number of people attending an NHS Health Check than being invited for one, it was said: 

a.    The Health Checks program was stopped during the Covid-19 pandemic and once it re-started progress varied across primary care providers. The 2024/25 target was increased to reflect the over-achievement of the 2023/24 target.  

b.    To increase attendance, various pilots were underway, including a campaign looking at the wording used in communications to different groups of people.

c.     An audit had been undertaken into the individuals that did not respond to invitations to understand the barriers. The outcomes were being used to inform future communications. Following a question around the number of people setting a quit date for smoking, Ms Tovey explained that the service was evidence based (NICE guidelines) but there were a number of other initiatives helping to improve effectiveness. There was an aspiration to use linked data (using NHS numbers to anonymously monitor whether an individual’s outcomes have improved since using a service).

4.    RESOLVED that the performance of Public Health  ...  view the full minutes text for item 335.

1.    Mark Chambers, Head of Intelligence, provided an overview of the report: 

a.    A selection of 10 indicators from the Integrated Care Strategy were included in the report. These were presented in greater detail than they would be to the Integrated Care Strategy Board, with trends and benchmarks for each set out along with a breakdown by district.

b.    Whilst there were targets for each indicator, this was not a performance report.  

c.    The report showed the stark variation of outcomes between areas of Kent. Thanet, Swale and Gravesham for example were typically in the lower end of the spectrum, and this was reflective of the characteristics of the population.  

d.    The report highlighted three areas of particular concern for Kent overall: a rise in severe obesity in children aged 10 to 11 years old; longer waits for diagnostic tests in East Kent and Swale; a stubborn gap in hospital admissions for ambulatory care sensitive conditions between most and least deprived populations. 

e.    Mr Chambers assured members that his team continued to monitor the indicators and data, working with colleagues across the Integrated Care System. 

2. In response to the comments and questions, it was said: 

a.    Acknowledging only 63% of Year 6 children were a healthy weight, a Member asked for data about the children falling between a healthy weight and severely obese, as well as how that transferred into adulthood. Mr Chambers noted a worsening trend in Kent, and halting that decline was important. Secondary school children did not routinely get their weight measured, so it was not currently possible to monitor if obesity continued into adulthood. Childhood weight was measured against UK reference curves from 1990. Mr Chambers offered to report back on the weight range falling between healthy and obese.?

3.    The Committee spoke about future reporting on the indicators. It was agreed that an annual report on the same 10 indicators would be brought before the Committee, with any additional indicators of concern highlighted in the narrative. 

4.    RESOLVED that the findings from the report be noted. 

1.    Dr Ellen Schwartz, Deputy Director of Public Health, provided a brief overview of the report that highlighted Public Health’s communication activity during the 2024/25 year. 

2.    A Member requested that measures of campaign effectiveness be included in future reports.  

3.    A Member asked how adaptive campaign communications were to social media habits. Dr Schwartz undertook to provide a response outside of the meeting. 

4.    A Member reflected on society’s changing attitude to activities such as drinking alcohol, where behaviour seemed to have changed without the input of a particular campaign. They questioned whether lessons could be learnt and applied to other areas.  

5.    The use of campaigns during particular events and seasons was noted, and a Member asked about the scope of working with other public bodies for joint areas of concern.  

6.    RESOLVED that the progress of Public Health communications and campaigns in 2024 and the need to continue to deliver throughout 2024/2025 be noted. 

1.    Sarah Crouch, Consultant in Public Health, provided an overview of the agenda report. She highlighted two key areas, whilst recognising that work was needed to build confidence and trust with the relevant communities: 

a.    A community of practice had been established – a group of 25 stakeholders who were able to engage with communities and take forward the findings of the 2023 Health Needs Assessment.  

b.    The role of a Gypsy, Roma and Traveller Co-ordinator was being recruited to. 

2.    In response to the comments and questions, it was said: 

a.    The Health Needs Assessment had been populated with national research along with locally held data, supported by groups that were closely aligned with the GRT communities. Ms Crouch recognised that more work was needed before engaging with the communities directly.  

b.    Access to primary care was a real issue, and a Member felt it important that the rights of individuals in the GRT community be reaffirmed. They also questioned whether there was suitable training in place for NHS workers. Ms Crouch confirmed that communications had been sent to GPs setting out the rights of individuals to register with a GP. Practices within close proximity of a known GRT site had received information about sending invitations to health screenings along with a survey about how well equipped they were to engage with GRT communities. Responses would inform the type of training required. 

c.     The team had reached out to Districts to identify suitable contacts to support the work around health needs. 

3.    RESOLVED that the Committee notes the ongoing efforts and progress made to date to address the observed health inequalities of Gypsy, Roma and Traveller communities identified in the Health Needs Assessment.

1.    Sarah Crouch, Consultant in Public Health, provided an overview of the prevention agenda, which was looking at patterns of need alongside preventative work on offer. The ambition was to change the trajectory of care and keep people well for longer. 

2.    A Prevention Delivery Group had been established to oversee the programme of work, and a Public Health and Social Care Innovation and Prevention Manager had been recruited which was jointly funded by adult social care and public health. 

3.    One of the first areas to be explored was preventing falls. The team were looking to use integrated data to identify people at risk of a fall who could benefit from an intervention. The team would then tailor a package of support based on the individual’s needs and what methods were proven to be effective. Ultimately, a prevention blueprint would be created - a way of testing the impact of preventative action on improving the health of the population and reducing the need for adult social care. 

4.    In response to the comments and questions, it was said: 

a.    A Member asked about the use of home modifications. Ms Crouch shared with members that her team had been looking into modifications such as grip rails and removing trip hazards – these were reactive to an individual’s needs. Dr Schwartz added that the Kent and Medway Housing Strategy was undergoing a refresh and that involved planning for the future and building homes for life. She would feedback to the relevant group.  

b.    Quantifying the savings made from upfront investment was difficult but vital because of the scale of savings needed in adult social care. Data sharing between organisations was historically difficult. Norfolk County Council presented a successful preventative pilot to the National Care Conference 2023 and Kent were working with those colleagues to learn lessons. Mr Watkins said Kent was in a good position when it came to data, and that could be used to target individuals at risk of a fall. District level data was not held, but the team planned to apply deprivation data to filter certain groups. There were also plans to establish a peer network with other councils. 

c.     A Member asked about proposed cuts to community services, recognising the vital support they provide in the community. Mr Watkins noted there were no relevant savings in the 2024/25 budget but there were in future years. He assured members that any proposals would be subject to public consultation before being made. He highlighted the importance of community groups being able to evidence their effectiveness. Dr Schwartz noted the variation of community services across Kent, and the importance of making decisions based on evidence.  

5.    RESOLVED that the Committee note the content of the report and the work underway with the Prevention Programme.

1.    Rutuja Kulkarni-Johnston, Consultant in Public Health, gave a presentation on the contents of the report. She explained KCC and the Kent and Medway Integrated Care Board (ICB) had jointly developed the Kent Weight Management Strategic Action Plan, which sought to tackle obesity across the county. There were seven strategic actions. Weight management services were provided across four tiers, with tiers 1 and 2 commissioned by KCC.   

2.    A Member asked how many individuals would be treated under the action plan. In 2022-23, 3,000 people were referred into the service (tiers 1 and 2). This had increased to 5,000 in 2023-24. Ms Kulkarni-Johnston welcomed the uptake in individuals accessing support services.  

3.    In terms of judging the success of the programme, a Member asked for detail on overall need as well as the capacity of the service. Ms Kulkarni-Johnston would take the request away but noted that data would only include those accessing commissioned services, not those that were taking steps to manage their own weight. Dr Schwartz added there were numerous services that addressed weight management. The Member therefore suggested looking at system savings might be a way the Committee could monitor success going forward.   

4.    RESOLVED that the Committee consider and provide comment on the Weight Management Strategic Action Plan. 

1.    Chloe Nelson, Public Health Commissioner, provided an overview of the agenda report:  

a.    The Programme aimed to ensure all services in receipt of Public Health Grant were efficient and effective in delivering outcomes for Kent residents.  

b.    The Programme was in its local engagement phase, which involved testing the preferred service model through internal engagement, current providers, wider market providers and individuals.  

c.     A public consultation was planned for proposed changes to the Emotional Wellbeing and Mental Health Service (for children and young people aged 5 to 19 with mild to moderate mental health needs) – currently known as the Kent Children and Young People’s Counselling Service. A Key Decision would follow as part of the children’s portfolio of work. 

d.    Evidence gathered showed an increasing demand for public health services, along with complexity of need.  

2.    A Member asked what steps had been taken to engage with young people. Ms Tovey assured Members that a significant amount of work had gone into seeking the views of children and young people, including engagement events, and working with staff such as youth workers to promote the consultation. There had also been networks through youth clubs and schools and the team had built on work conducted by the ICB.  

3.    The report set out the timescales of future consultations and Key Decisions.  

4.    Services included in the Programme were those funded/part-funded by the Public Health Grant. There were no plans in place to cut service budgets, although efficiency savings were being considered. The funding allocation for 2024/25 was not yet known. Additional funding was sometimes received for specific areas (such as substance misuse and smoking) but there were often conditions attached.  

5.    RESOLVED that the Committee note and comment on the report.

RESOLVED that the work programme was noted.