Agenda item

Cllr Oconnor (Cabinet Member for Public Health and Inequalities) and David Munday (Consultant in Public Health) have been invited to present a report on the Oxfordshire Health and Wellbeing Strategy Update.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

The following were invited to respond to the Committee’s questions in relation to the Health and Wellbeing Strategy Update; Cllr Liz Leffman (Leader of the Council and Chair of Health & Wellbeing Board), David Munday (Consultant in Public Health), Cllr O Connor (Cabinet Member for Public Health and Inequalities), Daniel Leveson (BOB ICB Place Director for Oxfordshire), and Veronica Barry (Executive Director, Healthwatch Oxfordshire).

The Committee outlined that this item was looking at the work undertaken by key actors and partners within the Oxfordshire system to update the strategy, and understood that the report received was not the official strategy document, but provided an outline of the work being put into updating the strategy.

The Committee urged to have site of a draft of the strategy document prior to its ratification at the health and wellbeing board in December this year; so as to allow for an opportunity to provide feedback on the draft.

The Leader explained that the strategy was a product of a joint production of many system partners; including the ICB, the County Council, the District Councils, and Healthwatch Oxfordshire.  In essence, this was a system strategy and not an OCC strategy. The strategy was not looking at the nature of clinical services, but focused on the building blocs of health, and how this played out at the place level. The strategy was about focusing on a few key priorities as opposed to everything and anything related to health. The strategy also aimed to provide equity across the board.

The lead OCC Public Health Consultant working on the strategy also explained the following points:

1.    A lot had changed since the publication of the last Health and Wellbeing Strategy.

2.    The occurrence of the Covid-19 pandemic had a significant impact on public health overall.

3.    The cost-of-living crisis had also emerged since the previous version of the strategy, with significant implications on health and wellbeing.

4.    The way the strategy was formulated was that it was an objective plan, built out of the Joint Strategic Needs Assessment (JSNA).

5.    The Strategy also drew in the voices and experiences of residents and how they felt about the priorities around Health and Wellbeing.

6.    The Integrated Care System’s strategy also informed the wider Health and Wellbeing Strategy for Oxfordshire.

It was also emphasised to the Committee that data had been drawn into the strategy, which indicated the following:

1.    There was an ageing population in Oxfordshire.

2.    There had been an increase in people living with long-term conditions.

3.    There were more challenges with children being able to learn age 5.

4.    There were unequal impacts relating to Healthy Weight

5.    Challenges around loneliness had also increased.

In regards to the public engagement exercises, the Committee was also informed that with Healthwatch Oxfordshire’s lead, 1100 residents were consulted with questions around what helped their health and wellbeing, what hindered their health and wellbeing, and what was important to them. It was also emphasised that the residents spoken to were those who may often be hard to reach or hear.

It was also highlighted to the Committee that the Strategy also aimed to work on promoting healthy weight and physical activity, as well as on improving mental health overall, as the focus of the strategy was more holistic in nature so as to allow for considerations of mental ill health as opposed to physical ill health only. The strategy was built around key principles including Prevention, tackling inequalities in Health, and Collaboration and Partnership. The strategy would also take a life course approach, as there are a number of factors within the life course that could either be supportive of or detrimental to health.

The Committee was assured that subsequent to the Strategy’s ratification by the Health and Wellbeing Board in December, a delivery plan would be established which would determine the nature of the strategy’s deliverability.

The Cabinet Member for Public Health and Inequalities added the following points:

1.    That the report emphasised the wider determinants and building blocks of health, and that residents should increasingly recognise the importance of these blocks.

2.    That there were challenges around inequalities, and that the strategy revolved around tackling such inequalities that could raise susceptibility to ill health.

3.    That interlocking between partners in the Oxfordshire system was pivotal to the strategy’s effectiveness and deliverability. Partners should perceive each other as cohesive elements of a system as opposed to operating as separate entities as much as possible.

The Committee queried the role of inclusivity in the strategy’s development, and the fact that what the report described as the building blocks of health may be undermined by individuals not having efficient access to healthcare services and support. For instance, individuals with epilepsy who struggled to receive swift access to healthcare may struggle to work on the wider building blocks of their health. The ICB Place Director explained that it was important to focus on things that the ICB and its partners can do together in partnership. The Place Director highlighted the following:

1.    The ICS strategy described the avenues of access to healthcare support and the ICB was committed to pursuing this.

2.    The Joint Forward Plan outlines how the NHS would, in the next five years, work on reducing waiting times.

3.    The work around the Primary Care Strategy would also help to improve access to primary care services for residents, which could help improve their overall health and wellbeing.

The Executive Director for HWO emphasised the importance of easy access to healthcare services, particularly for those with complex or long-term conditions who feel that they would be reassured if they have good access to healthcare which could act as a safety net.

The Committee referred to how the report stated that one of the building blocks of health was housing. The Committee queried the extent to which housing was being taken into account when updating the strategy, and whether there had been work with other partners or actors within the county (including District Councils) to help inform a stronger understanding of the role of housing, or to explore avenues of support for residents whose health and wellbeing were undermined by poor experiences in housing. It was explained to the Committee that housing was a pivotal aspect of health, which the strategy certainly understood. For instance, cold homes and homes with damp are bad for individuals’ health. There was work being undertaken in the context of a countywide “better housing better health” service, and more work is currently underway with District Councils to help improve housing and housing conditions for residents.

The Committee enquired as to how the nature and deliverability of the strategy would be communicated as explicitly and plainly as possible for the public to hear and understand. It was responded to the Committee that it was crucial for the strategy to be as clearly understandable as possible to the public. The strategy should not only include statistics and data but also personal and qualitative stories and input. A consultation exercise would also take place in a public consultation period whilst the strategy is being developed prior to its official ratification.

The Committee enquired about the input from disadvantaged groups, and asked whether input from such groups had been adequately incorporated into the strategy’s development. It was explained to the Committee that over 30 different groups had been contacted in an attempt to facilitate the focus groups that were highlighted in the report, and there would be more opportunities for input as part of the consultation period prior to the strategy’s official ratification.

The Committee moved on to enquire about the relationship between the Health and Wellbeing Strategy and the wider economic strategy of the County Council, particularly given the strong relationship between economic factors on the one hand, and overall health and wellbeing on the other. The Leader responded that financial considerations were crucial, and that if residents were struggling with employment or cost of living, this could impact their mental health and wellbeing. However, the Leader reiterated that the purpose of the health and wellbeing strategy was not to produce an enormous document to cover each and every aspect of life, but to focus on specific priorities/factors that could be measured, and how these measures compared with outcomes in other areas/places.

The Committee pertained to how the report outlined that the strategy would build on and affirm existing partnership-wide climate action commitments. The Committee queried how this contribution to climate action commitments could be achieved, and whether there was a process underway for determining any potential resources that may be required for this contribution. The ICB Place Director referred to how the ICS had a green plan, and how every NHS organisation must statutorily submit a green plan. The procurement and supply chain was the largest contribution of carbon in healthcare, and this chain urgently needed to be reviewed so as to reduce this.

The committee concluded the item, and AGREED to issuing the following recommendation:

“To ensure careful, effective, and coordinated efforts amongst system partners to develop an explicit criteria for monitoring the deliverability of the strategy; and to explore the prospect of enabling input/feedback from disadvantaged groups as part of this process.”