Issue - decisions

The Public Health Consultant(AL) outlined the following areas from within report in relation to ‘Be Well B&NES – A whole systems approach to health improvement’. 

·  Be Well B&NES is a new Whole Systems Approach to health improvement in Bath and North East Somerset. It has been developed, and will be owned and delivered, by a collaborative network of partners including healthcare providers, educational settings, leisure providers, Council departments, and community organisations.

·  Two well attended network events have been held and enabled a wide variety of partners to come together to think about how we can do health improvement better across B&NES.

·  Be Well B&NES aims to take action on the biggest preventable risk factors for ill health, health inequity and premature death including obesity, tobacco, physical inactivity and the harmful use of alcohol and drugs. These risk factors are closely linked with emotional wellbeing and contribute to a wide range of health conditions including cancer and heart disease.

·  Studies have shown that Whole System Approaches work; when we tackle health issues across and at deeper levels of the system, we see better results.

·  Two network groups are proposed to bring together system stakeholders with relevant interest and expertise. One network group will focus on a geographical community and one on a children and young people’s setting. These networks will co-develop and deliver action plans enabling prioritised actions across different levels of the system. A third operational delivery group will be created to ensure a universal health improvement approach is delivered, and to take forward targeted actions, for example improving the reach of training.

·  This is an iterative way of working; regular review will enable the network groups to develop and change in response to the system. It is likely that over the ten-year span of Be Well B&NES, we will shift focus and work across several different areas and settings, learning from successes and challenges.

·  The approach we have used in Bath and North East Somerset is based on the Whole Systems Guide for Obesity commissioned by Public Health England. We have been supported in the process of developing the framework by academics at the University of Bath.

Councillor Paul Crossley asked how the success of the programme will be identified, how would they monitor any long-term benefits and have any targets been set.

The Public Health Consultant(AL) replied that this a slightly different way of working although targets for individual based interventions would be set. She added that the project will seek to look at the reasons behind the actions that have been taken.

She said that there could be common factors such as access to facilities, transport needs or support as to why these issues are occurring. She added that they have heard from Community Partners in the preliminary stages of the programme and they will now seek to hear the views from the communities themselves.

She said that action plans will be developed as work progresses.

Councillor Crossley asked if any work was to be carried out that would look at whether there is an infrastructure deficit in the area. He gave an example of how the swimming facilities have been withdrawn from the Culverhay Leisure Centre and asked if there were any plans to replace them.

The Public Health Consultant(AL) replied that their ambition is to work with many partners to understand the needs of the particular community. She stated that no community had yet been specifically approached to commence this work. She said that she was not able to give any guarantees at this stage, but that they are aware of assets within the local area.

Councillor Crossley referred to the issue of obesity and asked if the programme would address making the best choices in terms of food that is purchased and cooked. He explained that a local chip shop is known to give larger portions to children / families that they know are on a particularly low income.

The Public Health Consultant(AL) replied that if a community were to identify that this was an area of concern then a discussion would take place with regard to what actions, if any, should be taken.

Councillor Dave Harding said that he would like to know more about how the particular geographical communities will be decided.

The Public Health Consultant(AL) replied that a data assessment has been carried out to attempt to assess where the greatest health improvement need is. She said that a discussion has taken place within the Be Well B&NES Steering Group with regard to how best to approach the identified community.

Councillor Harding asked if the Steering Group reports could be shared with the Panel.

The Public Health Consultant(AL) replied that the framework of the project has been reported to the Integrated Care Alliance and the Health & Wellbeing Board, but that Steering Group information has not been part of any public records to date.

Councillor Joanna Wright asked if any anthropological research had been used within the programme and whether any other areas of the country have used this approach successfully.

She also raised the issue of trust and how important it would be to build the right networks for the programme to succeed.

The Public Health Consultant(AL) replied that trust was indeed an important issue and the reason why community representatives and groups were identified as the best place to provide information and help build those networks.

She added that the approach used has been commissioned by Public Health England and developed by Leeds Beckett University in 2015. She added that she was aware of a number of other local authorities that were using it and that Swindon also use a Whole Systems Approach towards Obesity.

Kevin Burnett asked if this programme was linked to finding factors that impact a child’s attainment at school and does it identify these factors in terms of the role of the school and the role of the wider network.

The Public Health Consultant(AL) replied that are two ongoing inter-linking pieces of work being carried out, this Health Improvement Framework and work around Educational Attainment and that the parties involved need to be aware of both.

The Public Health Consultant(AM) added that there was a crossover of people involved and that in terms of attainment there has been a previous commitment to update the Panel on this project. She said that they need to assess where best to input the provision as they recognise the importance of improving the lives of children and young people.

Kevin Burnett referred to section 3.8 of the report and asked if the ‘children and young people’s setting’ was likely to be a school.

The Public Health Consultant(AL) replied that they have not assumed that it will directly be schools, but recognise that it needs to be a tangible setting to work within.

Councillor Onkar Saini asked what are the key health metrics that will be tracked in terms of Active Travel and health improvements.

The Public Health Consultant(AL) replied that Active Travel was given as an example as it shows the multiple of different departments and people that need to come together. She added though that no specific target has been set.

Councillor Saini asked how the programme can adjusted if further needs are recognised during the pilot period.

The Public Health Consultant(AL) replied that they are not viewing this as a pilot, it is a framework that they want to see and develop over a ten year period. She added that Public Health were not leading the programme, it is very much a systems partnership. She said that some priorities have been identified and envisaged that a number of action plans would be created and monitored.

She said that the hope over the ten year period is to see an improvement in the big metrics, such as smoking, physical inactivity and rates of obesity.

Councillor Saini asked what data sources were being used and how recent was this data.

The Public Health Consultant(AL) replied that many sources have been used, including national statistics that have been broken down to a local level and available in the local Strategic Evidence Base. She added that information on subjects such as rates of overweight and obesity in adult populations and food insecurity are amongst those gathered.

She added that where possible they will try not to introduce new measures to monitor against as this can have an impact on resourcing. She said that they will also ensure that qualitative data is gathered.

Councillor Liz Hardman asked how secure the funding for the programme was, given that it is set to be over a ten year period. She also welcomed the work within her locality, such as Somer Valley Rediscovered.

The Public Health Consultant(AM) addressed the Panel and outlined some key areas in relation to Social Prescribing.

·  In recognising that people’s health and wellbeing are determined mostly by a range of social, economic and environmental factors, social prescribing seeks to address people’s needs in a holistic way.

·  There are a number examples of social prescribing good practice underway in B&NES. The Community Wellbeing Hub delivers social prescribing by creating the infrastructure for residents to be referred to a wide range of community partners that offer support to connect with local services and activities.

·  A multi-partner Social Prescribing Task and Finish Group has been established to oversee and inform the work, joint-chaired chaired by 3SG and B&NES Council, and with support from Bath Mind.

·  To develop a strategic approach to social prescribing, a two-year Social Prescribing Project Manager post (employed by 3SG) has been funded to lead and coordinate system-wide work. In year one (2024/25) the post-holder will co-ordinate the development of the social prescribing framework. Current activities to support this include; working with partners to agree shared language and a definition of social prescribing that all partners can work to.

·  A business case for the Active Way is currently under development, which will be used to try and secure longer-term funding for elements of the Active Way that demonstrate both effectiveness and cost effectiveness. Without further funding, the service will come to an end in Autumn 2025.

·  The Active Way is in year two of its three-year pilot and is currently delivering a wide range of walking and cycling related interventions within the Somer Valley, in priority areas such as Twerton, and in partnership with settings such as Pennard Court.

·  The University of West of England (UWE) is verifying results as part of their evaluation of the Active Way programme, and suggest that there were statistically significant increases in cycling and walking more than three times a week after the end of the 6 week game compared to at the beginning.

The Public Health Consultant(AM) addressed the Panel and outlined some key areas in relation to Sexual and Reproductive Health (SRH).

·  From 1st April 2013, Local Authorities have been mandated to commission comprehensive open access sexual health services, including free testing and treatment for sexually transmitted infections (STIs), notification of sexual partners of infected persons, and free provision of contraception.

·  B&NES generally has good SRH outcomes, for example new STI diagnoses are lower than the England and SW averages, the teenage conception rate remains low and shows a significant reduction from 2009 to 2021, and total prescribed long-acting-reversable contraception (LARC) rates remain high.

·  However, although HIV diagnoses are much lower than the England and SW averages, late diagnoses of HIV are increasing and double the England average.

• Our mainstream service/clinical hub Riverside Clinic is contracted with Royal United Hospitals NHS Foundation Trust until March 2029 with agreed funding until March 2026.

• Services currently delivered or subcontracted by HCRG are part of the community transformation programme, including Clinic in a Box, GP LARC and pharmacy sexual and reproductive health services, and will either be recommissioned or re-contracted from August 2024 with an aim for contract commencement in April 2025.

The Chair asked if work is carried out with our local universities and colleges as well as our schools.

The Public Health Consultant(AM) replied that they do and have a good relationship in place with them and meet on a regular basis. She added that they will attend Fresher’s Week events and have held webinars to provide information to students.

Kevin Burnett referred to framework and commented that in his opinion it was specific in some areas, but generic in others. He asked if this was based on the levels of Public Health funding or how was it agreed.

The Public Health Consultant(AL) replied that these are the health improvement aims that the system has come together and agreed upon. She explained that in the first workshop with partners they carried out a mapping exercise that included around 50 people looking at the causes and factors towards health improvement in B&NES and a number of common themes were identified.

She added that at the second workshop discussion then turned to how could this all be brought together. She said that it was not related to funding within Public Health.

Councillor Crossley stated that the Panel should champion this ongoing work, but would like officers to consider whether they were able to put any aims, goals or targets in place.

The Public Health Consultant(AM) replied that they will consider that and could return to a future meeting of the Panel to give them an update on progress.

The Chair thanked the officers for their work and for attending the Panel

The Panel RESOLVED to:

i)  Note the work underway for each of the three programmes of work.

ii)  Note the risks to long-term sustainability of some of the interventions available for our residents.

iii)  Support the ambitions of each programme of work by considering opportunities to champion each programme and their alignment with wider Council work.