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City of York Council |
Committee Minutes |
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Meeting |
Health, Housing and Adult Social Care Scrutiny Committee |
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Date |
13 December 2023 |
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Present |
Councillors D Myers (Chair), Vassie (Vice-Chair), Baxter, Rose, Runciman, Wann, Wilson, Steels-Walshaw, K Taylor (Substitute) and Healey (Substitute) |
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Apologies |
Councillors Kelly and Smalley |
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In Attendance |
Councillor Coles, Executive Member for Health, Wellbeing, and Adult Social Care |
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Officers Present |
Peter Roderick, Director of Public Health Philippa Press, Public Health Specialist Practitioner Advanced Jodie Farquharson, Head of Public Health (Healthy Child Service) Michael Melvin, Corporate Director of Adult Social Care and Integration |
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External Attendees |
Debbie Leadbetter, NHS Humber and North Yorkshire Integrated Care Board Primary Care Programme Lead (Dental and Optometry) Jason Atkinson, Chair of the Humber and North Yorkshire Local Dental Network Mark Green, General Dental Practitioner |
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18. Declarations of Interest (17:33)
Members were asked to declare at this point in the meeting any disclosable pecuniary interests or other registerable interests they might have in respect of the business on the agenda, if they had not already done so in advance on the Register of Interests. None were declared.
19. Minutes (17:33)
Members considered the minutes of the meetings of the committee held on 18 October and 13 November 2023.
In respect of the minutes of the meeting held on 13 November 2023, members suggested amendments to incorporate questions raised by Committee under item 15 (Update Report on Homelessness / Resettlement Services 2023) in relation to access to council services for rough sleepers and the impact of council procurement processes, and to the wording of the resolutions under item 17 (Work Plan).
With reference to the resolutions under item 15, the Chair noted that he had written to the Chair of the Audit and Governance Committee to request a review of the process around the Salvation Army contract, and that the Executive Member for Housing, Planning and Safer Communities had invited the Chair and Vice-Chair to meet early in the new year to discuss the rough sleeping policy conference.
Resolved:
i. That the minutes of the meeting held on 18 October 2023 be approved as a correct record and signed by the Chair.
ii. That the minutes of the meeting held on 13 November 2023 be amended to incorporate the additional points raised by the Committee and that the amended minutes be brought back to the next meeting for approval.
20. Public Participation (17:39)
It was reported that there had been no registrations to speak at the meeting under the Council’s Public Participation Scheme.
21. Oral Health (17:40)
The Committee considered a report which provided an update on work being undertaken on oral health in the city, including work in schools and oral health promotion programmes. The Committee were joined for this item by Debbie Leadbetter, Primary Care Programme Lead (Dental and Optometry) for the NHS Humber and North Yorkshire Integrated Care Board (ICB), Jason Atkinson, Chair of the Humber and North Yorkshire Local Dental Network, and Mark Green, General Dental Practitioner.
Officers introduced the report, noting the council’s statutory oral health promotion responsibilities and outlining the work being done by the Oral Health Promotion Service in schools, workforce development, and collaborative work with the ICB and local and regional partners. They noted that dental access in York was below the regional average for adults at 39.7%, and above the regional average for children at 61.3%. Urgent care rates were higher in more deprived wards of the city with rates of routine care higher in less deprived wards. The proportion of the population on waiting lists for dental procedures was above the regional average, and while York had an above average number of dentists per head of population this included a mix of NHS and private provision.
Debbie Leadbetter outlined the Humber and North Yorkshire ICB Commissioning Overview (Annex C to the report), providing a summary of progress since the ICB had assumed responsibility for commissioning dental services from NHS England in April 2023. She noted the ongoing challenges to dental access, including a lack of flexibility in the existing NHS dental contract, and highlighted the importance of flexible commissioning in improving access to urgent care and for vulnerable groups. Jason Atkinson and Mark Green emphasised the impact of these developments from their experience as dental practitioners.
The committee discussed children’s oral health, including supervised toothbrushing schemes. These had been run by the Oral Health Promotion Service over the last year in six settings and feedback from schools and parents had been positive. Officers confirmed that a suitable provider had not been secured to undertake the National Dental Epidemiology Survey for five-year-olds locally, but a working group was looking at how this might be addressed on a regional basis for 2026. It was confirmed that there was good uptake across the city for Health Visitor reviews at 9-12 months, with accompanying oral health promotion. The ICB was also looking to commission child-only contracts to address gaps in access for children.
Members enquired about dental access for vulnerable groups. It was confirmed that until the ICB assumed commissioning responsibilities, dental services for care home residents had not been commissioned since 2006. Efforts were being made to encourage dentists to specialise in gerontological care, and the Oral Health Promotion Service was developing an offer aimed at older people, as well as expanding existing pathways for looked-after children. Technology was being used to improve translation services for patients who needed them.
The committee discussed the opportunities presented by the integrated care system reforms to transform healthcare in smaller communities around York. The visitors declared a willingness to participate in the creation of new primary care centres that might incorporate dental services, pharmacies, and GP surgeries on single sites as a way of better managing resources and ensuring residents had access to health services without having to rely on cars or limited public transport.
Officers and visitors responded to questions from the committee on urgent care provision and dental health inequalities. It was confirmed that there was not currently a dedicated emergency provider in York, but that flexible commissioning was being used by the ICB to bolster emergency care and to commission services located in areas of high need and higher deprivation. It was noted that better data was needed for a fuller picture of the extent of urgent need, as well as for tracking provision for shifting populations including students in the city.
The Executive Member for Health, Wellbeing and Adult Social Care was in attendance and welcomed the progress that had been reported. She raised concerns around the impact of inequalities on emergency pathways with patients being sent out of York for support, the oral health of secondary school children, and access to dental provision for pregnant women.
[Cllr Healey left the meeting at 18:20, and Cllr Runciman left the meeting at 18:59. Cllr Coles was in attendance 18:08 – 19:12].
Resolved:
i. To note the report.
ii. To welcome the work of the ICB and partners to increase access to dental services.
Reason: To support work to prevent dental decay and improve the oral health of our population.
[The meeting adjourned for a comfort break from 19:12 – 19:18].
22. Breastfeeding and Infant Feeding (19:18)
The Committee considered a report which provided an update on the work being undertaken as part of York’s Breastfeeding and Infant Feeding Delivery Plan. Officers presented an overview, noting that the multi-agency Infant Feeding Partnership was aiming to increase rates of breastfeeding. This could play an important role in reducing health inequalities for the most deprived wards in the city, although infant feeding was a topic which needed sensitive handling and it was important to facilitate personal choice.
Members enquired about the provision of formula milk to those in food crisis. It was noted that while formula was part of many families’ infant feeding journey, a very profitable industry existed around it. Food insecurity was a concern, and local public health teams were bound by conventions around the advertising of formula. It was confirmed that emergency provision was one element of a citywide community approach being developed to ensure foodbanks, Citizen’s Advice, Local Area Coordinators, community hubs and GP practices were able to direct those in crisis to 24-hour emergency support andother relevant services.
The committee discussed how a citywide breastfeeding-friendly culture could be promoted. Officers confirmed an ambition to use available funding to encourage businesses to better support employees and customers who were breastfeeding, and that similar initiatives had been successful in other cities in the region. Work was being done with local partners including the Treasure Chest Group, and national support helplines were also being promoted.
Members also enquired about workforce training. It was confirmed that this was being prioritised to better target the more deprived wards identified in the report where the drop-off in breastfeeding was stark. Midwives and Health Visitors completed UNICEF Baby Friendly Initiative (BFI) training, and work was being done to achieve BFI accreditation across the service.
Resolved:
i. To note the work being undertaken in both areas.
ii. That officers provide the Committee with further detail on the ward-level data contained in the report.
iii. That the Committee receive a short report at a future meeting to provide examples of best practice in promoting a citywide breastfeeding-friendly culture.
Reason: To support our ambition of protecting, promoting and supporting breastfeeding and safe infant feeding practices.
[Cllr Myers left the meeting at 19:43, and Cllr Vassie took the Chair for the remainder of the meeting].
23. Smoking in Pregnancy (19:43)
The Committee considered a report which provided an overview of the work being undertaken to reduce smoking during pregnancy in York. It was noted that in line with national averages there had been a downward trend in the rate of smoking at the time of delivery to 8.1% in York in 2022-23, although there were significant inequalities in ward-level rates.
Members enquired about the smoking cessation support provided by the Council’s Public Health team. It was noted that in line with the nationally accredited Russell Standard, the service focused on achieving cessation through a 28-day quit rather than on smoking reduction. This was a free Council service which worked closely with local maternity services with incentives offered to those on the pregnancy pathway. 72% of those who engaged with the service and set a quit date went on to a successful quit attempt. Officers confirmed that this was an opt-out pathway, with full implementation across local hospital trusts expected by the next financial year.
The committee discussed public health messaging around smoking in pregnancy. It was noted that hope was an important part of this messaging, and those who had quit and relapsed were no less likely to quit successfully on a subsequent attempt. Although no local data was available for postnatal cessation after three months, it was confirmed that this messaging would be reiterated through the Healthy Child Service once women were discharged from midwifery whether they had successfully quit at three months or not.
Members also discussed vaping and e-cigarettes, which were part of the nicotine replacement therapy offered to pregnant smokers and their significant others on the pathway. It was noted that nuance was required in public health messaging around vaping, which was not as harmful as smoking and needed to remain part of the quit toolbox for smokers. However, the marketing of vaping to young people was unacceptable and these messaging channels needed to be kept as separate as possible.
[Cllr Coles rejoined the meeting at 20:15].
Resolved:
i. To note the report;
ii. To endorse the recommendation to support our local Hospital Trusts and health partners in embedding smoking cessation in their pathways.
Reason: To encourage health colleagues to implement the pathways committed to in the NHS Long Term Plan.
24. Work Plan (20:24)
Members considered the Committee’s 2023/24 Work Plan, including proposals for items on Building Repairs and the Adult Social Care Commissioning Strategy to come to the next scheduled meeting of the committee in January. Members noted a desire to receive a report on the recent Tees, Esk and Wear Valleys CQC Inspection as soon as possible.
Resolved:
i. That the Committee request that a report on the Tees, Esk and Wear Valleys CQC Inspection be brought to the next scheduled meeting.
ii. That the Committee receive a report on the Adult Social Care Commissioning Strategy at its next scheduled meeting.
iii. That the proposed item on Building Repairs remain on the Work Plan for the March meeting of the committee.
Reason: To keep the Committee’s work plan updated.
Cllr D Myers, Chair
[The meeting started at 5.32 pm and finished at 8.30 pm].