Agenda item

A report was included in the agenda pack at page 25. Jeanelle de Gruchy, the Director of Public Health introduced the report to the Board. There was also a presentation which was included in the agenda pack at page 33. The report and presentation provided an update to the Board on progress of the Healthy Environment Strand of the Haringey Prevention Pilot. Following the presentation the Board discussed the findings.

The Board was advised that a business case outlining the proposals for the devolution pilot was presented to the London Health and Care Devolution Programme Board at the end of July. Haringey would continue to work with London partners and national government over the coming months to refine those proposals. A final business case was due to be submitted to the London Prevention Board by December 2016.

The Director of Public Health circulated three handouts which provided a conceptual approach to prevention, using a pyramid diagram to outline the primary, secondary and tertiary prevention approaches. The approaches to prevention were broken down into three types of intervention; population level, community development and personal services. The three diagrams represented the separate approaches for children and young people and for adults, as well as a version with ‘I’ statements i.e. how residents would experience the outcome of interventions.

The Chair enquired whether the empty boxes represented the absence of population level interventions at the secondary prevention stage or whether it suggested that there was an intervention that did not currently take place, but which might be developed in the future. The Director of Public Health advised that population level interventions also impacted as secondary and tertiary interventions. The Director of Public Health advised that this would be better illustrated in future versions of the diagram. The Board was given an example of someone recovering from a heart attack that utilised parks or council leisure services which were available to the whole population. 

The Chair of Healthwatch Haringey suggested that one possibility in this area would be measures that were aimed at the whole population which increased understanding of certain conditions particularly within certain groups of the population. The Director of Public Health acknowledged that there was a cross cutting aspect of prevention around information advice and guidance and also stated that this was where the ‘I’ statements contained in the overview diagram were relevant.

The Lay Member Haringey CCG commented that the fuel poverty and work intervention captured on the adults diagram appeared to be marooned between secondary and tertiary areas of prevention but could be considered to be more of a counterbalance to the whole of the population level activities. The Director of Public Health responded that the fuel poverty work tended to be targeted more toward older people. The Lay Member Haringey CCG elaborated that her concern was that by looking at specific interventions at the secondary and tertiary levels there was a risk of missing some of the wider determinants at a primary prevention level. The Lay Member Haringey CCG also commented that there were some issues around mental health that may not have been captured and that domestic violence was missing from the adults strand. The Director of Public Health acknowledged that the diagram was not comprehensive and agreed that the domestic violence strand could be added into the adults model. The Director of Public Health agreed that the broader point around work and employment could be captured under the existing intervention on place shaping through regeneration and planning; and done in way that reflected the overlap across primary, secondary and tertiary levels of intervention. (Action: Jeanelle De Gruchy).

The Director of Public Health went through the presentation with the Board. The devolution ‘asks’ were summarised as:

• Powers to address areas of problem gambling through greater local control of Fixed Odd Betting Terminals and devolved funding for local solutions to tackle problem gambling.
• Establish health as a 5^th licensing objective to enable local authorities to take all health impacts into account when considering licensing applications.
• Tobacco control powers: Extending smokefree areas to smokefree outdoor restaurants, cafes and pubs; and introducing positive licensing of tobacco products. 

The Board was reminded that Priority 2 of the Health and Wellbeing Strategy was to increase healthy life expectancy. The two ambitions that sat underneath this priority were: Ambition 3 - Haringey as a healthy place to live; and Ambition 4 – every resident enjoys long lasting good health. The Board considered that the Healthy Environment strand of the Prevention Pilot had clear links to Priority 2; particularly the performance measure for Ambition 4 around achieving a 25% reduction in early death from stroke by 2016-2018. The Board were invited to have a discussion, focusing particularly on the tobacco and smoke free outdoor restaurants, cafes and pubs ‘ask’.

The Lay Member, Haringey CCG asked whether, in light of changing attitudes to smoking more generally, there was any information on how attitudes had changed to people smoking outside. The Director of Public Health responded that she didn’t possess any specific information, but that she was aware of similar schemes which would have gathered significant feedback such as, Brighton’s smoke free beaches scheme. The Director of Public Health agreed that some work needed to be undertaken to gather all of that information together. The Lay Member, Haringey CCG commented that it would be a shame to have moved public opinion so far on smoking generally only to lose it with smoking outside, particularly as people may be equally concerned with air pollution caused by motor vehicles, for instance.

The Chair suggested that it would also be interesting to understand perception levels across different parts of the borough, as there could be parts of the borough or particular communities where smoking was much more prevalent and there would be an increased likelihood of push back to this type of intervention. The Chair also suggested that attitudes to smokefree restaurants may be different to say smokefree beaches or outdoor spaces more generally, as it was a defined space.

The Chair, Haringey CCG commented that the issue of perception was an interesting one and that Highgate and Muswell Hill had high levels of alcohol related illness, but that this was less obvious than in other less affluent areas of the borough. The Chair of Haringey CCG also suggested that the provision of alcohol for sale had become easier to access in recent years not harder, and that this was in stark contrast to tobacco. 

The Director of Public Health advised that the business case was being further developed and that dialogue was ongoing with various government departments, therefore this piece of work was evolving quickly. The Director of Public Health suggested that she would keep Board members involved via email and welcomed any further feedback on the devolution feedback.

The Chair enquired whether there was any way of looking at licensing decisions that had been taken in the last two or three years for instance, to ascertain whether the presence of a fifth licensing objective around the health impact would have had a significant influence on determining those applications. The Director of Public Health responded that there was a piece of work underway looking into this, and that as part of this process Public Health had been challenged to look at what powers the local authority already had and whether these were being fully exercised.

The Chief Executive of the Bridge Renewal Trust sought clarification on the legal position of these powers and whether the Council had the power to carry out the proposed regulatory changes. Officers responded that this was part of the negotiation process with the DCLG and other government departments, and that any additional powers would need to be conveyed as part of the proposed Bill.

RESOLVED:

I). That the Board note the development of the Haringey devolution prevention pilot.