Agenda item

The Director of Public Health Annual Report for 2022 is entitled “Hearts and Minds – Preventing Heart Disease and Stroke in Buckinghamshire”.  The report focuses on the importance of the prevention of cardiovascular disease for Buckinghamshire’s population.  The aim is to support a strategic approach for the Council and partners to address the cardiovascular health and risk factors for our population.

The report states that differences in cardiovascular between different groups are a significant driver of health inequalities across Buckinghamshire.  As well as hearing from the Director of Public Health, Members will also hear from a number of key health partners on their programmes aimed at reducing the risks of cardiovascular disease and how they are tackling health inequalities.

Presenters:

Dr Jane O’Grady, Director of Public Health

Dr Toby Gillman, Aylesbury GP

Mr Andrew McLaren, Chief Medical Officer, Buckinghamshire Healthcare NHS Trust

Ms Rose Hombo, Deputy Director of Quality, Oxford Health NHS Foundation Trust

Ms Philippa Baker, Place Director, Buckinghamshire

Papers:

Cover report

Director of Public Health Annual Report (full version)

Director of Public Health Annual Report (short version)

The Chairman welcomed the following presenters to the meeting - Dr Jane O’Grady, Director of Public Health; Dr Toby Gillman, Aylesbury GP; Mr Andrew McLaren, Chief Medical Officer, Buckinghamshire Healthcare NHS Trust; Ms Rose Hombo, Deputy Director of Quality, Oxford Health NHS Foundation Trust and Ms Philippa Baker, Place Director, Buckinghamshire.

During their presentation, the following key points were made:

·       The death rates from cardiovascular disease had decreased over the last 20 years, but have started to increase again, especially in men and in the most deprived areas. Evidence had emerged that having Covid, even without pre-existing cardiovascular disease, increased the risk of having cardiovascular events. The indirect impacts of the COVID pandemic could also increase cardiovascular disease and events.  This could be due to a more unhealthy diet, less physical activity, an increase in smoking and missed opportunities to manage blood pressure during the pandemic. It was estimated that around 47,000 people in Buckinghamshire were unaware that they had high blood pressure, and 10,000 unaware of diabetes.

·       Although smoking rates were decreasing, there was an increase in unhealthy weight and diabetes. A systematic approach across all partners was needed to address environmental, social, behavioural and clinical risk factors.

·       It was noted that the cost of living crisis would worsen people's cardiovascular risk factors. People living in the 10 % most deprived areas needed to spend 75% of their disposable income on food to follow recommended guidelines on healthy eating. A system-wide response was needed to address this. This included improving data collection around ethnic coding in the NHS, and monitoring the most at-risk communities, such as African groups for high blood pressure and stroke, and South Asian groups for high blood pressure, diabetes and heart disease.

·       Dr Gillman commented that space was a challenge in some practices, such as Whitehill, Poplar Grove and many of the practices in High Wycombe.

·       Practices were working with Live Well Stay Well on a smoking prevention and cessation programme.

·       High rates of obesity were another multifactorial problem requiring different approaches such as engagement through Weight Watchers, Slimming World and Weigh Forward Bucks.  Some PCNs had recruited Health Coaches and Aylesbury Central PCN were using different approaches, such as a low carbohydrate diet, which had yielded positive results in some cases.

·       People were also supported by social prescriber link workers.

·       The Hospital Trust had started a health check service for staff, including blood pressure monitoring, cholesterol checking and mental health services. Furthermore, the Trust had engaged with the Heart of Bucks Community Foundation and provided funding for cancer awareness programmes, targeted in the most deprived areas.

·       The challenges around primary care data were highlighted. Over the last two years, the trust had moved towards an electronic patient record.  Improvements in data collection was a key priority across the system.

·       Buckinghamshire’s drug and alcohol draft strategy would be published in early 2023 and would be refreshed in light of the new Harm to Hope Strategy.

During the discussion, Members raised the following questions.

·       A Member asked whether more health checks could be carried out within the community and more exercise classes held at community centres to help people in losing weight. It was noted that community activities were being reviewed by the community boards. Furthermore, the ‘Health on the High Street’ model utilised facilities to offer health checks. A pilot was also being run in High Wycombe to ask people which services should be offered to better support them in managing their health.

·       The pandemic had created a backlog in health checks. However, the team were tackling this, particularly in deprived areas, for example by providing mosques and libraries with training, support and materials to carry out blood pressure checks.  It was stated that an NHS health check was offered to everyone eligible over 40. For those who had not received this offer, an outreach service was in place.

·       A Member asked whether children and adults with disabilities should also be targeted as part of tackling health inequalities. It was noted that most of this work was currently done through schools and specialist care services.

·       In response to a Member question around waiting times, it was noted that there had been an increase.  Elective surgeries were particularly impacted, with 7,000 people waiting. Outpatient appointments had also seen an increase in waiting times. However, the National Elective Recovery programme had been driving an improvement in waiting times, with an expectation to eliminate 18 month waits before March 2023. 22 % of appointments were now being dealt with over telephone and video call. The data for wait times were published on the NHS website and updated on a monthly basis.

·       A Member asked how the multi-level approach to tackling cardiovascular challenges would be managed. It was noted that all partners would jointly work on this issue, including the local authority. The approach was embedded in the health and wellbeing strategy, and a working group with NHS partners had also been set up. It was also being discussed in the levelling up workstream and in the BOB ICP strategy. Different community and charity groups were also involved to facilitate further health checks. However, the issue of reaching people not actively seeking out healthcare is further complicated by the lack of capacity and staff in the practices, making it difficult for those already seeking health checks.

The Chairman thanked all the presenters for their attendance and participation.