Agenda item

Cllr Kate Gregory, Cabinet Member for Public Health & Inequalities, Cllr Dan Levy, Cabinet Member for Finance, Property and Transformation, Ansaf Azhar, Director of Public Health, Kate Holburn, Deputy Director of Public Health, and Sam Read, Public Health Programme Manager, have been invited to present a report on Business Management Monitoring Report - Public Health.

The Committee is asked to consider the report and raise any questions, and to AGREE any recommendations it wishes to make to Cabinet arising therefrom.

NB This item is to follow.

Cllr Kate Gregory, Cabinet Member for Public Health & Inequalities, Cllr Dan Levy, Cabinet Member for Finance, Property and Transformation, Ansaf Azhar, Director of Public Health, Kathy Wilcox, Head of Corporate Finance, Kate Holburn, Deputy Director of Public Health, Sam Read, Public Health Programme Manager, and Carys Alty, Head of Migration Policy and Partnership, were invited to present a report on the Business Management Monitoring Report focusing on Public Health.

The Director of Public Health clarified that his remit included statutory public health, communities and asylum and migration. The report covered the ring-fenced public health grant budget and related functions including asylum, domestic abuse, and additional grants for drug, alcohol and smoking cessation. Performance across these areas was outlined, with amber-rated issues identified for discussion.

The Head of Corporate Finance reported that, as of October, there was no forecast variation for public health against a gross budget of just under £43 million, which included the £37 million ring-fenced public health grant and other grants such as domestic abuse and drug and alcohol treatment. An underspend of £0.9 million for 2024/25 had been transferred to the public health reserve, now totalling £4.6 million, with a forecast drawdown of £2.7 million for 2025/26. The scale of public health funding within the council’s overall budget was emphasised.

The Deputy Director of Public Health introduced the children and young person’s substance misuse service, describing it as a small team with dedicated workers in family centres. The service provided psychosocial interventions for prevention, early intervention, and treatment, supporting both young people using substances and those affected by others’ use. Interventions ranged from brief advice and drug diversion schemes to structured treatment, with clinical support rarely required. National reporting focused only on structured treatment, which represented just part of the service’s work.

Victims of domestic abuse assessed for refuge accommodation were required to agree to the move, with decisions influenced by factors such as proximity to an ex-partner, children’s schooling, or financial circumstances. Data on those declining a space existed and could be provided, with reasons often linked to personal and practical considerations.

The County Council had established a domestic abuse partnership with district councils, including a dedicated safe accommodation working group involving housing officers and service providers. This group met regularly to address challenges in securing suitable housing for families leaving refuge. Difficulties persisted, particularly for larger families and in finding appropriate move-on accommodation, sometimes resulting in families remaining in refuge longer than ideal and affecting the availability of spaces for new arrivals.

The 12-month health visiting check, a statutory requirement, had a local target of 87%, with Oxfordshire achieving around 84%. Performance had improved since the pandemic and was comparable to statistical neighbours. Including parents who declined or did not attend would raise the figure to 96%. Efforts continued to understand and address non-attendance, especially in deprived areas.

Smoking prevalence in Oxfordshire had fallen significantly to about 7.5%, down from 11%. The reduction was particularly notable among routine and manual workers, though rates remained high among people with mental health conditions. The ambition to become smoke-free by 2025 had been disrupted by the COVID-19 pandemic, but national legislation and targeted local strategies had supported the decline. Persistent high rates in some groups remained a focus for further work.

The council focused on three of the eight Marmot principles: best start in life, employment, and healthy standard of living. Work with the Institute of Health Equity had highlighted the need to address gaps, such as attainment for children on free school meals. While it was too early to specify financial implications, investment in tackling inequalities had already been made, with an aim to maintain momentum and partnership funding despite financial pressures.

The NHS health check programme operated on a five-year recall cycle, aiming to offer checks to 20% of the eligible population each year, with an 18% annual target. This approach ensured that all eligible adults would be offered a check over five years, with the target reflecting the recall system rather than an inability to reach certain groups.

The public health grant was ring-fenced and mainly spent on five mandated services, leaving little discretionary funding. The council’s role included delivering statutory functions and influencing the broader health system. Additional NHS and partner resources were mobilised for prevention and tackling inequalities, such as through Marmot Place and joint forums. Regular collaboration with NHS partners aimed to align budgets and strategies for maximum population impact.

Vaping played a positive role in helping routine manual workers quit smoking, but there was concern about young people starting to vape without prior smoking history. These were considered separate issues: vaping was beneficial for smoking cessation but problematic as an entry product for non-smokers, especially youth. National efforts were underway to regulate advertising and packaging, and local trading standards were also addressing the issue.

The next phase of work on Marmot Place principles involved engaging other council directorates and the wider health and care system. A cultural shift was required, but enthusiasm for Marmot principles was growing. The council was reviewing the social value aspect of contracts, with public health working alongside procurement teams to ensure a focus on health inequalities, including using contract social value to address local or service-related inequalities.

The national 10-year drug strategy had recently evolved its indicators, introducing a new “treatment progress” measure about 18 months prior. There was not yet a full year of data for 2023–24, hence the reported figure of zero for the proportion of opioid users in treatment making substantial progress. Data was expected to be released soon. Local drug and alcohol services performed very well nationally on successful completion rates.

Addressing health inequalities was a long-term goal, but the immediate focus was on engaging people with the concept, building a social movement, and ensuring staff were trained to consider health inequalities in their work. The Marmot principles provided an evidence-based lens for reviewing data and identifying local inequalities. By the end of the two-year programme, system-wide recommendations would be produced, with shared responsibility for delivery across all partners.

Preparations for a government move towards a sponsorship-focused approach for asylum seekers and refugees had included engagement with community sponsorship, but accommodation challenges in Oxfordshire had prevented some cases from proceeding. The Homes for Ukraine scheme was host-based with a specific financial system, but lessons would be considered for future plans. The council’s “council of sanctuary” status meant proactive support for migrants, using services like libraries, and the approach would continue to evolve as national policy changed.

The Committee AGREED to recommendations under the following headings:

• The committee recommended taking forward lessons learned from the Homes for Ukraine scheme to inform future approaches to asylum and immigration policy.

• They suggested a follow-up on the inequality agenda, requesting consolidated data and a progress update in about a year, recognising the work as ongoing.

• It was proposed to establish a clear timeline for agreeing common approaches and follow-up actions on Marmot principles across the system.

• The committee recommended adding targets related to vaping use, especially among people who had not previously smoked, to complement existing smoking reduction targets.

The Committee AGREED to the following action:

• The Deputy Director of Public Health to send over data concerning treatment progress 2024/25 drug data when available