Meeting documents
Health Scrutiny Sub-Committee (DCC)
Monday 4 October 2004
Meeting: Health Scrutiny Sub-Committee (County Hall, Durham - Committee Room 2 - 04/10/2004 10:00:00 AM)
Item: A5 ISSUES FOR INFORMATION: - (a) Commission for Patients and Public involvement in Health - Proposed Abolition (b) The Chief Medical Officer's Annual Report (c) Department of Health - National Standards, Local Action
| Health Scrutiny Sub-Committee 4 October 2004 Commission for Patient and Public Involvement in Health - Proposed Abolition |  |
| Report of Head of Overview and Scrutiny |
Purpose of the Report
1 To explain the recent announcement by the Department of Health about changes to the way that patient and public involvement forums are to be supported in the future.
Background
2 The Department of Health has been carrying out a review of ‘Arms Length bodies’ involved with the Health Service. This is generally part of the review of administration. One proposal is that the recently introduced Commission for Patient and Public Involvement in Health will be abolished in the future and new arrangements will be introduced to support forums.
3 It is understood that legislation will need to be introduced to achieve these changes and, for the time being, the Commission will continue to support forums and promote its agenda at national and regional level.
4 Sally Young from the North East Office of the Commission has kept us informed about progress and has provided assurances that, until any new arrangements are in place, they will be working hard to ensure that business as usual is maintained.
5 In the debate about this issue in Parliament, the Health Minister indicated that “I emphasise that our decision to abolish the Commission was not borne out of concerns about its performance. The Commission’s performance…… is highly commendable”.
6 We will need to await more clarity about the arrangements which are to be put in place to replace the Commission.
Recommendations
7 You are asked to note this information.
| Contact: Ian Mackenzie Tel: 0191 383 3506 |
| Health Scrutiny Sub-Committee 4th October 2004 Chief Medical Officer’s Annual Report | |
| Report of Head of Overview and Scrutiny |
Purpose of Report
1. To provide information about the latest annual report of the Chief Medical Officer. Some of the information in the report is based on a briefing from the Democratic Health Network.
Background
2. The Chief Medical Officer (CMO) advises the Health Minister and government departments on health matters. He identifies health issues which need national action and leads on the implementation of change. In this report the CMO reflects on changes in the government’s approach to public health.
3. In 1998 the focus was on treating illness, which led to an emphasis on “filling” and maintaining hospital beds. The balance is now shifting to improving health so that people do not need to access NHS services. There is ‘an unprecedented interest’ in public health across all government departments. The Wanless report established the importance of prevention for the economic sustainability of the NHS. The recent consultation Choosing Health sought the views of the public on a range of public health matters, including the extent to which they agreed with regulation on matters such as smoking. A public health White Paper is to be issued later this year.
4. The report introduces five new topics, highlighted as the focus for attention for the coming year. It also describes progress on topics from previous years and identifies some regional variations.
New topics for attention
Smoking causes premature ageing
5. The report indicates that smoking prematurely ages the skin. It creates a ‘smoker’s face’ that can look up to twenty years older than the person’s age, with wrinkles and dull colouring. Young people, particularly young women, are taking up smoking at an age when they are easily influenced by the tobacco industry and the fashion industry in which models are associated with smoking. 26% of fifteen- year-old girls and 21% of boys smoke. The report recommends targeted campaigns to put the message across to young women that smoking will cause premature ageing. It proposes generic packaging and pictorial health warnings for tobacco products, and urges the fashion industry to use its influence with young people to promote non-smoking.
Going smoke-free
6. There are two major arguments against smoke-free enclosed public places: the negative financial impact on the leisure industry and people’s right to smoke. The CMO has commissioned independent research which indicates that both profits and employment increase in areas that have gone smoke-free. It is particularly important that work-places become smoke-free since research indicates that fewer young people would take up smoking. The second argument - the right to smoke - is outweighed by the wider public interest. Going smoke-free has high levels of public support. The report recommends that the Government legislate for smoke-free workplaces and enclosed public places. NHS premises should be smoke-free by the end of 200 4.
Early detection and diagnosis of HIV
7. The incidence of HIV has been lower in England than many comparable countries partly due to public education campaigns. However, recent trends are worrying - a 55% increase in new diagnosis from 2000 to 2002. Furthermore 33% of people with HIV are unaware of this and large numbers of people have HIV for up to six years before finding out. This causes problems for treatment and the spread of the disease. The report recommends a number of measures including targeting prevention for at-risk groups and improving diagnosis through genitourinary medicine clinics.
The importance of academic medicine
8. England is second only to the USA in terms of research and teaching - a remarkable achievement given its size and resources. Despite increased investment there are worrying trends. Posts in academic medicine fell by 14% between 2000 and 2003 despite an increase of 28% in numbers of medical students. Half the ‘best’ medical research staff are employed in only five universities. The report recommends a number of measures to support academic medicine through improved training, career structure and national initiatives.
Better blood transfusion
9. Blood transfusion is much safer in this country than in many others but is not risk free. ‘Wrong blood incidents’ have increased by 21% (although some of this may be due to improved reporting). Although improvements have been made there is still inappropriate or unnecessary use of blood. The report proposes a number of measures to improve the safety and management of blood stocks.
Reviews of previous topics
10. A number of the topics proposed in previous years resulted in continued public concern. These include:
- Epilepsy - a wide range of actions has been initiated to improve services for the 400,000 affected.
- High blood pressure - targets have been set by the Department of Health and the Food Standards Agency to reduce salt in foods
- Liver cirrhosis - measures to address binge drinking by young people are under consideration. Much of the action needed to combat this issue requires a major change in behaviour and culture.
- Health inequalities (North South divide) - Tackling Health Inequalities: a programme for action was produced in 2003
- Obesity, the health ‘time-bomb’, is being addressed through a number of measures
- Reducing deaths from tobacco through smoke-free public places and workplaces has been the subject of extensive media and political debate.
Regional topics
11. The report identifies one topic in each of the nine regions of England that illustrates a national public health issue. In respect of the north east, this is the range of dental health among five-year-olds. There is more than a three-fold variation in the number of decayed, missing and filled teeth between Hartlepool (average 0.86 per child) and South West Durham (average 2.82 per child). The report indicates that the main causes of this variation are fluoridation and deprivation and that extending the provision of fluoridated water remains a priority in tackling inequality.
Comments from the Democratic Health Network
12. Many of the themes of this public health annual report and its predecessors will be familiar from public health advertising campaigns - a number of the images in the document are taken from TV adverts about smoking related illness. Increasingly, these public health issues have been taken up by the media, which has regularly covered, for example, the 5 A DAY campaign, concern about obesity, and debates about regulation of smoking in public places. In many of the priorities identified in the report there is a clear role for local authorities in addressing the public health agenda. Local authorities have been involved in developments such as pilots in exercise and food in schools. The public health White Paper will be an important document for councils as well as the NHS.
Recommendation
13. You are recommended to note this information.
Contact
The report can be viewed at the following website.
http://www.publications.doh.gov.uk/cmo/annualreport2003/index.htm
The Wanless Report - Securing our Public Health: taking a long term view (2002) and Tackling Health Inequalities: a programme for action (2003)
http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/HealthInequalities/fs/en
| Contact: Ian Mackenzie Tel: 0191 383 3506 |
| Health Scrutiny Sub-Committee 4 October 2004 Department of Health - National Standards, Local Action. | |
| Report of Head of Overview and Scrutiny |
Purpose of Report
1. To explain:-
the planned framework for National Health Service organisations and Social Services Authorities for the next three financial years and in particular, the standards which all organisations should achieve in delivering National Health Service care.
Background
2. The Department of Health has produced an Improvement Plan which sets out a vision for future health care and improved health. They have also produced a document setting out national standards and the local action to be taken to improve the health of the population.
3. The National Standards are set out in a number of priorities as follows.
Priority 1: Improve the health of the population.
National targets:-
By 2010:-
- to increase the life expectancy of men to 78.6 years and women to 82.5 years.
- to substantially reduce mortality rates:
- from heart disease by at least 40% in people under 75.
- from cancer by at least 20% in people under 75.
- from suicide and undetermined injury by at least 20%,
- to reduce health and inequalities by 10% as measured by infant mortality and life expectancy at birth.
- to tackle the underlying determinants of ill health and health and inequalities by:-
- reducing adults’ smoking rates (from 26% in 2002 to 21% or less with a reduction of prevalence among routine and manual groups (from 31% in 2002) to 26% or less.
- halting the year-on-year rise in obesity among children under 11.
- reducing the under-18 conception rate by 50%.
Priority 2: Supporting people with long-term conditions
By 2008:-
- to improve health outcomes for people with long-term conditions by offering a personalised care plan for vulnerable people most at risk and to reduce emergency bed days by 5% through improved care and primary care and community setting for people with long-term conditions.
Priority 3: Access to services
By 2008:-
- to ensure that no-one waits more than 18 weeks from GP referral to hospital treatment .
- to increase the participation of problem drug users and drug treatment programmes by 100% and increase year-on-year the proportion of users successfully sustaining or completing treatment programmes.
Priority 4: Patient/user experience
- By 2008:-
- to secure and sustain national improvements in NHS patient experience ensuring that individuals are fully involved in decisions about their health care, including choice of provider, as measured by independently validated surveys.
- To improve the quality of life and independence of vulnerable older people by supporting them to live in their own homes where possible by:
- increasing the proportion of older people being supported to live in their own home by 1% annually in 2007 and 2008 and;
- by 2008, to increase the proportion of those supported intensively to live at home to 34% of the total of those being supported at home or in residential care;
- achieve year-on-year reductions in MRSA levels expanding to cover other health care-associated infections as data from mandatory surveillance becomes available;
- by 2005, to improve life outcomes of adults and children with mental health problems by ensuring that all patients who need them have access to crisis services and, by 2006, a comprehensive child and adolescent mental health service;
- by the end of 2005, to ensure that every hospital appointment will be booked for the convenience of the patient, making it easier for patients and their G.Ps to choose the hospital and consultant that best meets their needs. By December 2005, patients will be able to choose from at least 4-5 different health care providers for planned hospital care, paid for by the NHS;
By December 2005
- ensure a maximum waiting time of one month from diagnosis to treatment for all cancers;
- achieve a maximum waiting time of two months from urgent referral to treatment for all cancers;
- By 2006:-
- 800,000 smokers from all groups successfully quitting at the four-week stage;
- updated practice-based registers introduced so that patients receive appropriate advice and treatment, including advice on diet, physical activity and smoking;
- a minimum of 80% of people with diabetes to be offered screening for early detection of diabetic retinopathy and 100% by 2007;
- By December 2005 to achieve:-
- a maximum wait of three months for an out-patient appointment;
- a maximum wait of six months for in-patients ;
- a 10% increase per year in the proportion of people suffering from a heart attack who receive thrombolysis within 60 minutes of calling for professional help;
- By 2006, to reduce delayed transfers of care to a minimal level.
Recommendation
You are recommended to note this information and to use it in the scrutiny role.
| Contact: Ian Mackenzie Tel: 0191 383 3506 |
Attachments
DOH - National Standards, Local Action - 4 Oct.doc;
Chief Medical Officers' Report - 4 October 2004.doc;
Commission for Patient and Public Involvement - 4 October.doc