Agenda item

10:30

The report (HWO7) contains an update on the Health & Wellbeing Board’s response to the report of the Health Inequalities Commission. The paper includes extracts from a paper presented to the Oxfordshire Health & Wellbeing Board on 9 November 2017 detailing progress against the report’s sixty recommendations. Dr Joe McManners, Chair of the Oxfordshire Clinical Commissioning Group (OCCG) will attend the meeting to present the report..

The Committee had before them a report which had been presented to the 9 November 2017 meeting of the Oxfordshire Health & Wellbeing Board (HWB) detailing progress made against the Health Inequality Commission (HIC) report’s sixty recommendations (JHO6). The County’s Strategic Director of People & Director of Public Health, Dr Jonathan McWilliam, together with Jackie Wilderspin (Public Health Consultant) and Ally Green, OCCG (representing Dr Joe McManners, Clinical Chair, OCCG) attended the meeting to respond to questions.

Dr McWilliam commented on the importance of keeping the topic alive amidst many other competing priorities. The Commission report had produced recommendations which were very specifically targeted at particular organisations and some which were outside of the normal statutory organisations. Furthermore, a key task of the HWB, in its capacity as an advisory partnership, had been to undertake an overview and co-ordinating role to the work of the Commission.

Jackie Wilderspin introduced the paper and responded to questions from members. The Committee welcomed the report recommendations and views, comments and questions from members were as follows:

·         The usefulness of this work in breaking the silos apparent between organisations was very good. However, this type of work did not fit with planning timeframes and the measurement of performance. For example, BME women needed additional obstetric intervention in childbirth – was this taken into account with the proposals to close the obstetric services at the Horton General Hospital? Dr McWilliam responded that there was no need to wait for implementation of the proposals, organisations were welcome to act on them themselves;

·         With regard to the need to carefully monitor food banks, in light of the Council’s removal of funding to support homeless shelters, a member asked if the need for food banks was increasing and wasn’t there a need to understand their use, rather than just mapping and monitoring? Jackie Wilderspin responded that work was still ongoing in relation to their use and a report back on food bank activity had been requested;

·         The decision to form an Innovation Fund was good but this might not meet the greatest need in some geographic areas. How robust was the strategy to conduct this? Dr McWilliam commented in response to this on the need to adopt three main approaches simultaneously. The greatest was the goal of adopting long term strategies for which funding was required both to spark and keep county-wide interest and to drive the Health Inequalities programme through. The short-term work was necessary to keep the programme rolling and action going via specialist interest and strategic drive. Health Inequalities were driven by population need, not where there were initiatives;

·         The Joint Strategic Needs Assessment (JSNA) and all other policies were in danger of allocation to those who shouted the loudest? Jackie Wilderspin stated that the Commission had formed its report on representations from communities at meetings and objective data from the independent Director of Public Health’s independent report and the JSNA. Dr McWilliam encouraged a request from the Committee to see the assessment criteria to see which projects qualified for funding. As an additional piece of scrutiny, and as a good companion to the Commission’s report, he suggested that members read ‘Oxfordshire Uncovered’ by the Community Foundation which highlighted where inequalities lay across the county;

·         In light of the recommendations contained in the report highlighting the future work needed to monitor the impact on school readiness in terms of previous family link work done with nurseries prior to the closure of children’s centres, Dr McWilliam reminded the Committee that he had flagged up the need to take an overview of this trend in his independent report. He added that school readiness was monitored via Child Health. The Committee requested an update on criteria determined and agreed upon;

·         A member asked about ongoing work on gaps in the provision of mental health services for older people in relation to access to the service on the basis of age, not need. NHS England had stipulated that it should be on need. Jackie Wilderspin responded that a review of mental health services was currently in progress and work was also ongoing on getting a mental health need assessment to support the review. The Health Inequalities Commission would be tapping into this review;

·         In response to an enquiry about whether social prescribing was likely to arrive in north Oxfordshire, Jackie Wilderspin stated that explorations were ongoing into this issue as service use data was very poor. Patient records with regard to ethnicity were incomplete, the belief being that a proportion of patients chose not to have it recorded, thus making analysis impossible. However, whatever data was available could be used to encourage all organisations to make use of it equitably. She added that there were no detailed plans regarding social prescribing at present. A Team was currently working on it. The Committee requested the timetable for rolling out details, when available, for social prescribing;

·         A member asked if there was more that could be done by the HWB to encourage take-up on services to assist with poverty, ie the living wage and affordable housing. In addition, was there anything Public Health could do to increase the provision of affordable housing within the county. Dr McWilliam stated that it was a joint effort by both the county and district councils, both being public health organisations. It was the key business of the Health Improvement Board, a partnership group reporting to the HWB who engaged with all the wider determinants of Health affecting all key organisations;

·         In response to a question about whether the recommendations of the Commission were reflected in the STP plans for major development in Health to respond to need, Dr McWilliam stated that this Committee in its role as scrutineer, had an important role to play in prompting each organisation to think about health inequalities, adding that it would be very helpful if HOSC was to keep it on its future Agendas in order to keep the subject alive. Ally Green agreed to request Dr McManners, Chair of the Commission, to give a response to the Committee’s questions and these to be circulated to all members of the Committee;

·         A member asked about issues relating to housing need for older people in social housing. Jackie Wilderspin responded that this had not been addressed as yet, but once it had she would circulate a response to the Committee;

·         A member expressed concern in relation to the abundance of references to the support of older people digitally and about the complex nature of the forms, such as that for the Attendance Allowance applications. Dr McWilliam agreed with this observation.

On the conclusion of the question and answer session, the Committee thanked Dr McWilliam and Jackie Wilderspin for their attendance and AGREED that the Health Inequalities Commission recommendations be re-visited every 6 months for the foreseeable future.