Agenda and minutes

Apologies for absence were received from Councillor C Hood, Chief Constable R Bacon, L Buckley, K Burrows, Dr J Carlton, S Jacques and M Kelleher.

There were the following substitutes: Assistant Chief Constable R Allen substituted for Chief Constable R Bacon; M Edwards substituted for M Kelleher; and S Burns for L Buckley.

There were no Declarations of Interest.

The minutes of the meeting held 20 March 2024 were agreed as a correct record and signed by the Chair. 

The Corporate Director of Adult and Health Services, Jane Robinson noted that the Care Quality Commission (CQC) would be at County Hall next week looking at the Council’s delivery of Adult Social Care and explained that, following high level feedback, she would report back to the Board. 

The Director of Public Health, Amanda Healy noted that further of discussion at the last meeting in relation to tobacco, feedback from the Police and Crime Commissioner, Joy Allen had been received in a letter to the Director of Public Health, FRESH and the Director of Public Health for Darlington.  She added there would be in depth work with young people in our schools on associated issues, including vapes.

The Chair noted that Item 9, Oral Health Promotion and Community Water Fluoridation would be brought forward as the next item.

Presentation of the Director of Public Health, Durham County Council.

The Board received a briefing note in relation to North East Water Fluoridation from NHS England (for copy see file of minutes).  The Director of Public Health noted she would give a presentation to the Board on Oral Health Promotion and Community Water Fluoridation.  She explained a member of the public was also in attendance to ask a question to which she would respond, the Chair having used his discretion to allow questions.

The Director of Public Health explained that in the past, prior to 2022, Local Authorities had had statutory responsibility and decision-making responsibilities for any new or varied water fluoridation schemes.  She noted the responsibility had transferred to the Secretary of State for Health and Social Care in central Government.  It was added that the Leaders of the seven Local Authorities in the North East had wrote to Government in terms of going ahead with water fluoridation.  The Director of Public Health noted that the Adults, Wellbeing and Health Overview and Scrutiny Committee had recently met and supported water fluoridation, with that response to be forwarded as part of ongoing Government consultation.

The Board noted that Local Authorities were responsible for the promotion of oral health, and in 2023 the Oral Health Promotion Strategy for County Durham was updated with water fluoridation being identified as an effective way of reducing inequalities in dental health.  The Director of Public Health noted that the aims of the strategy were to: improve oral health of everyone living in County Durham; reduce oral health inequalities; create supportive environments, working with communities and partners to promote oral health; and contribute to good oral health across the life course.

The Director of Public Health referred to the evidence base for community water fluoridation, noting that it was effective, safe, reduced inequalities, cost effective and sustainable.  She noted oral health was an integral part of overall good health and wellbeing and that the impact of severe tooth decay had wide implications for children and families: pain, hospital admissions, and missed days from school.  

She added that tooth decay was the most common oral disease affecting children and young people with lifelong impacts and although largely preventable, a significant proportion of our residents still experienced poor oral health.

The Director of Public Health explained that water fluoridation was associated with less dental caries and an increase in the number of individuals with no caries.  She added that there was also an increase in the number of individuals with dental caries in areas where water fluoridation schemes had been discontinued.  She noted that ensuring drinking water contained the recommended level of fluoride was an effective way to prevent tooth decay and water fluoridation at levels within the UK regulatory limit of less than 1.5mg/l was effective and safe, and without any convincing evidence of adverse health outcomes.  She explained that fluorosis was a possible dental side effect of water fluoridation and that in mild cases it appeared as white flecks on teeth, however, the risks of fluorosis  ...  view the full minutes text for item 5.

Report and Presentation of the Corporate Director of Adult and Health Services and the Director of Public Health, Durham County Council.

The Board received an update report on reducing alcohol harms within our local communities as part of one of the four Joint Local Health and Wellbeing Strategy priorities (for copy of report see file of minutes).  The report was accompanied by a presentation, given by Rachel Osbaldeston, Public Health Advanced Practitioner and Sue Taylor, Head of Alcohol Policy, Balance.

The Public Health Advanced Practitioner noted the key findings from Office for National Statistics (ONS), with the North East having the highest rate of alcohol-specific deaths of any English region in 2022, 21.8 deaths per 100,000, 32.8 percent greater than the last pre-pandemic rate in 2019 of 11.8 deaths per 100,000.  She noted that therefore it was important to look how we would tackle that increase and look at groups being disproportionally impacted, such as men, as well as how the alcohol industry was marketing their products, such as the rise of alcoholic drinks being aimed towards young women.  The Board noted that County Durham was not an outlier in terms of alcohol related mortality rates within the North East, however, it was noted that the county was more rural in nature when compared to other parts of the region.

The Public Health Advanced Practitioner explained that the new Combating Drugs and Alcohol Partnership (CDAP) was set up across County Durham and Darlington, chaired by the Police and Crime Commissioner, and had many partner organisations feeding information into this partnership.  She noted that one aspect was for each organisation to look at their internal culture and it was noted that phrases such as ‘it’s wine o’clock’ or ‘Friday night, drinks night’ reinforced alcohol consumption as a norm, and partner organisations needed to be ‘on the same page’.

The Public Health Advanced Practitioner explained as regards ‘making every contact count’ training and work with the Alcohol Care Teams within the NHS Trusts in County Durham and Darlington and Tees, Esk and Wear Valley. 

She added it was important to recognise that addiction was a condition, and not ‘a choice’ and to tackle that image, and other stereotypes such as ‘they can’t handle their drink’, those not capable being perceived ‘weak’.  She added that when people were admitted into hospital, this was often a good opportunity for intervention, with people often more receptive to the idea of change when they are feeling most effected by the issue.  It was noted that online drink coaches were working very well, with many people preferring that approach rather than face-to-face meetings, with some being reluctant to be seen attending services that also dealt with drug misuse.  The Public Health Advanced Practitioner added that with alcohol harm being such a large issue, it was placed front and centre, with progress having been made over the last 18 months.

The Public Health Advanced Practitioner noted that a recent World Health Organisation report had shown that young people were consuming less alcohol that previous generations, however, we still saw a lot of  ...  view the full minutes text for item 6.

Report and Presentation of the Corporate Director of Resources.

The Board received the annual report of the Corporate Director of Resources on Poverty Issues, with accompanying presentation, given by Victoria Murray, Head of Transactional and Customer Services (for copy of report see file of minutes).

The Head of Transactional and Customer Services noted that the report and presentation would refer to: the most recent welfare, economic and poverty indicators for County Durham; core expenditure which supports poverty related activities; progress in alleviating poverty; priority actions to be progressed during 2024-25.  She explained that the work of the Poverty Action Steering Group (PASG) was structured around four key objectives.

The Board noted Objective One related to the use of intelligence and data to target support to low-income household, and it was explained the objective was developed at the same time as the Inclusive Economic Strategy.  The Head of Transactional and Customer Services noted funding in terms of the Household Support Fund, Department of Education and the UK Shared Prosperity Fund (UKSPF) and the work of the public sector together with the voluntary sector in terms of the ongoing delivery of the Poverty Strategy Action Plan.  She explained that the other objectives were: Objective Two - reduce the financial pressures on people facing or in poverty; Objective Three - increase individual, household and community resilience to poverty; and Objective Four - reduce barriers to accessing services for those experiencing financial insecurity.  She noted that there had been many projects with issues including food poverty, welfare and benefits advice, training and employability; Durham Index of Need, Credit Union, the change from ‘Warm Spaces’ to ‘Welcome Spaces’.  An example given was that of ‘The Bread and Butter Thing’ food network, with 15 hubs offering support to around 1,200 families.

The Head of Transactional and Customer Services noted other local actions that were to help lift people out of poverty, as well recently received data sets that would help inform further actions.  She noted that the work of the Poverty Strategy and Action Plan would continue and would be monitored by the PASG.

Councillor R Bell noted the spend of the County Council was limited and likely to be more so in future and asked what data had been gathered in terms of being able to see what interventions and projects had been successful, noting the work of the Area Action Partnerships (AAPs).  The Head of Transactional and Customer Services noted there was not a direct comparison between each project, however, each has a business case and evaluation carried out. 

She noted the work in terms of such evaluations, noting the change from ‘warm spaces’ to ‘welcome spaces’ following evaluation.  She added there were a lot of opportunities for social inclusion and reassured the Board that there was robust analysis of projects, however, noted the point made that Council resources, as well as those received from Government were reducing. 

Councillor R Bell noted that such performance data would be important in the future when the Council was making decisions on which projects had  ...  view the full minutes text for item 7.

Report of the Corporate Director of Adult and Health Services and the Director of Public Health, Durham County Council.

The Board received a report of the Corporate Director of Adult and Health Services and Director of Public Health in relation to the Health Protection Assurance Annual Report, presented by Joy Evans, Public Health Strategic Manager and Joanne Darke, Consultant in Health Protection, UK Health Security Agency (for copy of report see file of minutes).

The Public Health Strategic Manager noted the report was presented differently this year, with a covering report and separate annual report, to help with accessibility and delineate partnership roles.  She added that the protection of health was one of five mandated responsibilities under the Health and Social Care Act 2012, with the Director of Public Health responsible for public health functions. 

She added that there was significant reliance on upon partnership working and the Health Protection and Delivery Partnership met bi-monthly to seek assurance and share data and communications.

The Consultant in Health Protection noted that organisations involved included: the UK Health Security Agency in terms of surveillance data, infectious disease containment; the Local Authority, with Public Health having strategic oversight, coordination and consumer protection; the Integrated Care Board (ICB), in terms of resource and diagnostics; and NHS England in terms of immunisation programmes.

The Public Health Strategic Manager noted chapter four within the report set out the governance arrangements and how key groups met to facilitate monitoring and maintain close working relationships.  The Consultant in Health Protection noted that it was good that in County Durham a number of Outbreak Control Nurses had been retained, with outbreaks most likely now within either school or care homes settings.

The Public Health Strategic Manager explained that subsequent chapters set out the key pillars, including screening programmes where a ‘life course’ approach was being taken, important post-COVID.  She noted as regards issues in terms of newborn infant screening, with ongoing work looking at data.  She added that diabetic eye screening was looking at increasing the speed in which they were completed, with the current trajectory being positive.  She explained that NHS England had a commissioning role, working with GPs and Community Pharmacies to deliver.  She reminded the Board that County Durham had a strong record in terms of vaccinations, however, those receiving their second dose of the MMR vaccine had reduced, and there were national trends, such as the increase in measles cases, to be aware of.  The Public Health Strategic Manager noted that in terms of adolescent vaccinations, there had been some fluctuations, and there was a new provider in respect of flu vaccinations.  She noted regular meetings with the provider and NHS England, again with recent improvements and an upward trajectory in this regard.  She noted that flu vaccination uptake in the over 65s was very good, and co-location of services for early years, 2–3-year-olds, were showing big benefits, with Horden Nursery given as an example, with 38 families having come forward as a result.  She noted the work the Local Authority carried out in terms of flu campaigns, increasing uptake in older adults from  ...  view the full minutes text for item 8.

Joint Report of the Corporate Director of Resources, the Corporate Director of Adult and Health Services and the Director of Public Health, Durham County Council.

The Board received a report of the Corporate Director of Adult and Health Services and Director of Public Health in relation to Durham County Council becoming signatories to the MIND Mental Health at Work Commitment (for copy of report see file of minutes).

The Director of Public Health noted that health and wellbeing and mental health were priorities, with data supporting that priority.  It was explained that the Corporate Director of Adult and Health Services chaired the Council’s Better Health at Work Group and colleagues from Public Health and Human Resources worked together to bring mental health to the fore.  It was added that the Council had been a signatory to the ‘Time to Change’ employer pledge, however, the charity had closed in March 2021.  It was noted that signatory organisations were allowed to continue to use the pledge, and MIND has committed to carry on the pledge work through their Mental Health at Work Commitment. 

It was noted that to date, 30 organisations signed up so far and Board Members were asked to help share information in this regard especially in relation to the start of national Mental Health Week, 13 – 19 May 2024. 

The Director of Public Health noted the recommendations within the report, noting the Council becoming a signatory to the commitment and the call to action for the Health and Wellbeing Board organisations to promote the commitment within their respective organisations as an approach to developing and improving staff mental health and wellbeing.

Resolved:

That the report and call to action be noted.

Resolved:

That under Section 100(A)(4) of the Local Government Act 1972, the public be excluded from the meeting for the following items of business on the grounds that they involved the likely disclosure of exempt information as defined in Paragraphs 1 and 2 of Part 1 of Schedule 12A of the Act.

J Pearce left the meeting at 11.28am

Report of the Director of Public Health, Durham County Council.

The Board considered a report of the Director of Public Health which presented a summary of Pharmacy Applications received from NHS England in accordance with the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (for copy see file of minutes).

Resolved:

That the report be noted.