Agenda item

This report responds to the motion on Access to NHS Services which was passed at the Council meeting on 15 December 2016. It also updates the Committee on subsequent discussions with the Vale of York Clinical Commissioning Group. 

Members considered a report which responded to the Council motion on Access to NHS Services, which was passed at the Council meeting on 15 December 2016, when the Executive was asked to commission the Director of Public health to assess the impact of this policy, including health inequalities, and report back to the Health & Adult Social Care Policy & Scrutiny Committee. The report also updated the Committee on subsequent discussions with the Vale of York Clinical Commissioning Group (CCG). 

The two speakers who had registered under public participation were invited to speak on this item and to address Member questions:

Dr Shaun O’Connell, Joint Medical Director of Vale of York CCG, who was also co-author of the report being considered, spoke on the obesity epidemic, and the financial impact this was having on already severely overstretched budgets. He clarified that any delay to operations would be temporary but explained that improvements to an unhealthy lifestyle would significantly improve the chances of success for each procedure and speed up recovery times. He also stated that the greatest impact on an unhealthy lifestyle was intervention from a GP.

Paula Evans, GP at York Medical Group, stated that her patients were predominantly from Westfield ward, one of the most deprived areas of the City. Levels of childhood obesity and smoking were higher and patients were far more likely to access health care at a young age. Whilst York was considered a relatively healthy population this was not reflected in areas like Westfield and there were high instances of diabetes, high blood pressure and use of painkillers for weight related aches and pains.

During discussion between Members, the Director of Public Health and the two speakers, the following points were raised:

·        There was a need to be more preventative and less reactive.

·        A Public Health and Wellbeing Service had been set up with funds from the decommissioning of GP ‘wellbeing’ services. However, there were currently 8 Wellbeing Officers covering the whole City which meant they were extremely overstretched.

·        In terms of delays to procedures, GP’s would make a record of lifestyle advice given to patients and the time from that initial intervention would count if they were subsequently referred for surgery.

·        The new Integrated Assessment  Tool which was being used in Council decision making did include public health. However, a discrete Health Impact Assessment during the decision making process was an aspiration.

·        Whilst there were other things which posed a threat to public health e.g. alcohol, smoking and obesity were considered two of the most significant problems in terms of preventable impact.

·        There were clear exemptions to the policy and these were recorded to ensure that nobody was unfairly disadvantaged.

·        At the time of implementation around 50 ‘delay’ letters were being sent out per week. This was now down to around 30 per week.

·        Whilst the NHS were looking closely at CCG’s who were rationing services, they understood the rationale behind the VoY policy and considered it to be robust.

Resolved: Members recommend to Executive that;

                                     I.        the Executive Member for Adult Social Care and Health review her decision on the level of support for smokers and in particular the provision of free Nicotine Replacement Therapy for smokers and funding for Varenicline (Champix) stop smoking medication.

                                   II.        the Council set itself an ambition to increase prevention spending and integrate preventive action into all decision making to tackle inequalities utilising a “Health in all Policies” approach.

                                  III.        the Council, through the Health and Adult Social Care Policy and Scrutiny Committee, and the Health and Wellbeing Board, hold the leaders across the health and care system to account for looking beyond the interests of their own organisations and driving forward improvement in health and wellbeing outcomes for the citizens of York, leading a cultural change to a health and care system in which different organisations work together to narrow the gap in inequalities across the City.

                                 IV.        the Council, together with its partner organisations, be required to establish innovative ways of tackling inequalities within existing resources, working in partnership with communities using a coproduction approach.

Reason:     To respond to the Council Motion on Access to NHS Services.