Agenda item

To consider a joint report from the Consultant in Public Health, Executive Programme Manager, LCC Projects, Programmes and Procurement Unit, and Head of Safeguarding and Community Safety Partnership Development, LCC Safer Leeds, which provides an overview of approaches taken to address challenges relating to three determinants of health and wellbeing:

a)  supporting the inactive to become active,

b)  air quality, and

c)  domestic violence and abuse.

The report acknowledges the clear links with the priorities of the Leeds Health and Wellbeing Strategy 2016-21, and provides the Board with the opportunity to understand and discuss persistent challenges relating to these wider determinants, provide a view on what else can be done, explore and ensure links with our city’s other strategic plans (such as the Leeds Health and Care Plan, Inclusive Growth Strategy) and agree individual and collective action that can contribute to improved outcomes for people in Leeds.

(Report attached)

The Board considered a joint report providing an overview of the approaches taken to address challenges relating to three Breakthrough Projects with very clear links to the priorities of the Leeds Health and Wellbeing Strategy and the wider determinants of health and wellbeing: supporting the inactive to become active, air quality, and domestic violence and abuse.

The report provided the Board with an opportunity to discuss and explore the challenges related to the issues; to provide a view on what else could be done to ensure links with Leeds’s other strategic plans and to consider individual or collective action that can contribute to improved outcomes for people in Leeds.

1. Supporting the Inactive to become Active – In presenting the report, Anna Frearson (Consultant in Public Health) and Mark Allman (Head of Sport & Active Lifestyles) encouraged discussion on:

-  How to reduce sedentary behaviour in staff as well as residents. As representatives of large employers/organisations how to encourage physical activity and/or exercise which was acknowledged as being beneficial to work and home wellbeing.

-  Meeting the challenge of what else can be done to embed support for physical activity in terms of the workplace, built environment and infrastructure

The Board acknowledged the relationship between activity, mobility, health, mental health and work and made the following comments:

·  Leeds Teaching Hospitals NHS Trust staff had responded well to health and wellbeing training, challenges, etc. and the use of sustainable travel transport schemes. Extension of the Leeds Cycleway to link St James’s and the Leeds General Infirmary was identified as an additional measure to further encourage activity.

·  A campaign of information and signposting on the location of cycle paths, walkways and bridleways was identified as a measure to increase their use; alongside information on cycle safety.

·  Recognition of the need to link to Mindful Employer measures.

·  Acknowledged that Leeds West NHS CCG was committed to factoring in physical activity in its approach to commissioning pathways of care, particularly for musculoskeletal disorders; and the commitment to build this into health coaching and Making Every Contact Count policies.

·  Recognition of concerns for the health of some health & care sector staff, particularly community health staff, who were physically inactive due to the nature of their work which required them to drive between appointments and impacted on their diet as well as their ability to be active.

·  The need to consider any cultural or behavioural issues which may prevent people from taking up physical activity and to consider how individual communities provide their own activities. It was noted that the Third Sector had a key role to play in being able to provide information on what is provided throughout Leeds own communities.

·  The role of education – through schools, health visitors and parents to encourage physical activity.

·  Whether ‘physical activity’ could be promoted through; and encourage wider involvement in; the Leeds Health & Care Plan, noting that any campaign would need to be sustainable with a long term commitment

The Board noted the intention for further discussions between the Chief Officer, Health Partnerships and the Head of Sport & Active Lifestyle on a collective approach to this Breakthrough Project.

RESOLVED -

1)  To note the discussions on the contribution that physical activity and moving more can make to the city’s priorities;

2)  To note the comments and pledges made during discussions outlined above in terms of how to contribute to increasing physical activity including:

·  As commissioners – how to integrate physical activity into health and care pathways and services.

·  As employers – how to upskill staff to better support people to become active and commit to creating workplaces that support staff to become more active / less sedentary (including active travel to work).

·  As collective leaders – how to develop a whole systems approach to physical activity in Leeds in relation to improving collaboration and the sharing of resources between partners.

3)  To note the comments made during discussions which provide views on the role of the HWB in terms of new governance structures that will be put in place for Sport Leeds and the new Sport and Active Lifestyle Strategy; to better reflect the positioning of Physical Activity in the City and focus on decreasing inactivity levels

4)  To note the intention for discussions to be held between the Chief Officer, Health Partnerships and the Head of Service for Sport & Active Lifestyle on a collective approach to this Breakthrough Project which will further the consideration of the matters outlined in points 1 to 3 above.

2. Air Quality – Andrew Hickford (Project Manager, Resources & Housing) and Dr Ian Cameron (Director of Public Health) presented this section of the report, and sought to encourage discussion focussing on the role of health organisations in transport, the use of use of air pollution information to inform the public and providing advice and guidance on the link between air pollution and health to health professionals.

The following issues were highlighted:

·  The Department for the Environment, Food and Rural Affairs had recommended the use of Clean Air Zones (CAZ) in Leeds to tackle pollution, with 4 key roads requiring action. A further report would be presented to the Board for consultation once CAZ areas are determined.

·  Important to note that most of Leeds maintained good air quality

·  Air pollution in Leeds contributed to 680 deaths annually and was a factor in the number of recorded cases of respiratory; lung and Chronic Vascular Diseases

·  The public’s attitude towards air pollution showed that in general, more people were concerned about the impact of air pollution on asthma, than its impact on cancer.

·  The link between fuel poverty and health. It was noted that Leeds had 70,000 Victorian era homes, which were expensive and difficult to insulate and upgrade to modern effective, heating systems

·  Affordable warmth was very important for good health. Community nurses often came into contact with patients in cold homes and the offer of close working and support between health organisations was welcomed to tackle fuel poverty and provide information to residents and staff on the opportunities available to them to improve air pollution and reduce fuel poverty.

·  Both Leeds Community Healthcare NHS Trust and Leeds and York Partnership NHS Foundation Trust representatives expressed an interest in closer working with Leeds Teaching Hospitals NHS Trust to see the work being done there in terms of the vehicle fleet and reducing individual air pollution.

·  Important to reiterate that cycling in high polluted areas was still better than being in a car

·  In response to a query about how to encourage wider use of electric cars, a number of measures were identified; including parking permits for electric vehicle owners/users which grants free on-street parking and use of LCC car parks; and grant funding was available for electric charging point installation. Further information on this would be sent directly to Board members and partners to encourage consideration of electric vehicle use. Acknowledgement that despite the work already done in Leeds, the need to increase uptake  in public transport and active travel whilst reducing the number of private vehicles entering the city centre still remained

RESOLVED -

1)  To provide advice and guidance on how best to link through to the city’s health professionals to promote key messages on air quality.

2)  To encourage the city’s health organisations to lead by example in terms of their own fleet and travel planning.

3)  To consider how best to utilise air pollution data to support vulnerable groups

4)  To participate in the air quality consultation process and to commit to provide input in to the Leeds Transport Conversation

5)  To support an integrated independent living and affordable warmth service to ensure that vulnerable people receive physical improvements to their homes that will allow them to be warm and well at home.

6)  To champion affordable warmth across the health and social care sectors, to ensure that trusted frontline carers continue to refer clients for support.

7)  To consider new joint investment in energy efficiency improvements for particularly vulnerable residents where there is a health business case (i.e. to improve hospital discharge processes).

3. Domestic Violence and Abuse – Michelle de Souza presented this element of the report, seeking consideration of the impact of domestic violence and abuse on health and wellbeing; mental health and cost to services. She reported that Leeds was regarded as being at the forefront of DV work, with good links operating between adult social care, midwifery services and Accident & Emergency departments. However key challenges for the future were development of the workforce; consideration of how to deal with perpetrators of domestic violence and the scale of the issue – with approximately 19,500 domestic violence related calls to West Yorkshire Police recorded last year. Other key issues to note included;

-  Serious Case Reviews often revealed social isolation as a recurring theme in cases

-  When dealing with case reporting; using family members to translate could prevent a victim from reporting the full details

-  Not all victims report to the police in the first instance, as some may feel safer in other settings.

It was noted that LCC Department of Children and Families sought to employ a multi-agency partnership to support affected families, with a scheme in place to support the children of the family. The Board further discussed:

·  Whether the definition of domestic violence included Female Genital Mutilation. It was noted that this had been considered as part of the DV Breakthrough Project but was not a key focus of the Leeds Health and Wellbeing Strategy. As a safeguarding issue, several sectors within the health & care sector received awareness training with health professionals being duty bound to report cases. However it was acknowledged that victims may not know how to access support. The Board further noted the offer from the representative of NHS England to provide a co-ordination role in order to prevent a fragmented support system.

·  Understanding of what ‘safe’ means is different and based on cultural experiences. Part of domestic violence support work must be about clearly explaining rights, expectations, etc. across the Leeds community

·  Reference was made to the Making Every Contact Count initiative, noting that this was being rolled out across the city.

·  Raising awareness was identified as key to tackling the issue

In terms of identifying measures that the health & care sector could undertake to capture and identify cases the following comments were noted:

-  To consider the long term impact of what children or others have witnessed in a DV environment

-  To seek to encourage more primary care, GP practices and health & care settings to introduce a routine domestic violence enquiry as a general rule.

RESOLVED -

1)  To note the contents of the report and the comments made during discussions seeking to identify collective action to address persistent challenges:

2)  To continue to identify opportunities to increase capacity at the Front Door Safeguarding Hub.

3)  To seek to identify new opportunities to upskill staff and services to identify and respond to Domestic Violence and in particular issues of coercion and control

4)  To remove barriers and improve access to appropriate services for people with complex needs who are experiencing domestic violence

5)  To continue to consider ways to increase services and interventions available to perpetrators of domestic violence

6)  To continue to consider opportunities to tackle issues of social isolation as a barrier to addressing issues of domestic violence and abuse.