a)    Health Inequalities

The Chair invited Mr Tim Sacks, Chief Operating Officer, East Leicestershire and Rutland Clinical Commissioning Group (ELRCCG) to give a brief overview on the Sustainability and Transformation Plan (STP) in relation to the impact on deprived people in Rutland and how they accessed services.

Mr Sacks confirmed that the STP was about planning and managing health services.  In Rutland the focus would be on enabling more services to become available and expanding local services, increasing the number of repeat/outpatient appointments available locally in order to reduce the amount of time people had to travel to access services.  “Home First” would be aimed at looking after people at a local level.  There would be a consultation on the proposals in order to understand the views of local people.

During discussion the following points were noted:

1. Losing beds was difficult, but the solution put forward for the financial difficulties being faced made a lot of sense;
2. There was no funding to assist with public transport, but Health, Social Care and the Third Sector would work together to look for ways of assisting with transportation;
3. Engagement with the media would be carefully managed and communication with key influencers and the public would ensure that a clear and positive message was communicated;
4. Mr Sacks agreed to provide further information regarding how a risk assessment might be carried out to ensure that a person’s home was an appropriate place to carry out care and what the solution might be should a person’s home be found to be unsuitable;
5. Members of the community should look out for their neighbours and make sure they are alright and properties are maintained to an acceptable standard.  The Rutland Neighbourhood Watch had just launched an app which provided access to other services;
6. Ms Kibblewhite would provide further information regarding the powers that the council had with regard to enforcing housing associations and private landlords to maintain properties to acceptable standards;
7. There would be a Joint Leicestershire, Leicester and Rutland Health Scrutiny Panel focusing on the STP on 14 December 2016, Mr Conde would be attending with another member of the Rutland (Adults and Health) Scrutiny Panel;
8. Hospitals could provide a variety of services and it was important to get the message across  regarding the services that will be available and how they can be accessed;

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Miss Waller declared an interest at this part of the meeting as she privately rented two properties.

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Mr Sacks left the meeting and did not return.

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Trish Crowson, Senior Public Health Manager, introduced the Poverty Report on Health Inequalities, the purpose of which was to give an overview of how poverty can impact on the occurrence of obesity and issues around dental health.

During discussion the following points were noted:

1. It is important to understand the limitations with data at a population level in Rutland not least because of small sample numbers meaning that data can vary significantly from year to year;
2. There was some correlation in areas with higher levels of excess weight with higher rates of tooth decay;
3. Rutland has higher levels of diabetes than the national average, but this could be that Rutland GPs are particularly good at early diagnosis;
4. Being sedentary has a high impact on heart disease and diabetes;
5. In low income families 1/7 of household income could be spent on tobacco;
6. Members were keen to see how improvements could be made regarding communicating and promoting local sports clubs and activities to encourage members of the community to take part.  Use of the Council Tax leaflet in order to promote sports and activities could be beneficial as it was circulated to every house in Rutland, but we must ensure any information is accessible; 
7. Transport and costs of activities was identified as being restrictive.  Exploration of whether any funding could be made available to support those who could not afford to join a club or buy sporting equipment and also any support from the third sector;
8. Active Rutland website has a lot of information regarding sporting activities;
9. It was recognised that sports activities did not appeal to all people and so attempting to get people to build physical activity into their daily lives would have a positive impact.  Walking, for instance, instead of always using the car, also alternative forms of activity such as dancing or skateboarding could be promoted;
10. Local initiatives and schemes are not always supported  appropriately, which makes it more difficult for those working hard to promote activities in rural locations;
11. The Better Care Fund (BCF) may provide the opportunity to divert funds from treatment to prevention, if people can be supported to take part in activities there would be a positive effect on health and less need for treatment;
12. Educating young people at school of the benefit of being active was seen as important;
13. There are multiple reasons why people do not engage in activity, but given the opportunity and with support from voluntary and community sector, some may be encouraged to break out of the cycle;
14. Information on healthy eating and recipes could be handed out at food banks.  It was also suggested that food banks may be a good place to hand out advice on brushing teeth/dental health and the possibility of sponsorship for free toothbrushes and toothpaste could be looked into;
15. Active lifestyles benefit the old as well as the young, there is an aging population in Rutland and keeping active helped with postural stability and falls prevention;
16. GPs supported the use of exercise referral programmes, but cost could still be restrictive;
17. There are activities being funded and supported in the community, but the key was communicating what was happening and how people could be involved;
18. There was not a suitable, attractive offer for swimming in Rutland, particularly for teenagers who want to swim in a fun and modern environment;
19. There was a need to ensure that academies were offering suitable sporting facilities and promoting children to take part in sports, also teaching children about food and nutrition was important;
20. The most recent dental health survey had showed an improvement, but rates of tooth decay in 5 year olds were still high compared to the national average.  This was thought to be caused by children grazing through the day and drinking sugary drinks through the night.  There was a proposal to start supervised teeth cleaning sessions in pre-schools and nurseries in order to make improvements in this area; and
21. Peterborough Regional College could be approached regarding providing basic cookery courses.

b)  Access to Services

Sarah Iveson, General Manager, Healthwatch Rutland, introduced the appendix to the poverty report on Access to Services, the purpose of which was to provide an overview of the health and other services in Rutland and the difficulties certain groups have in accessing them.

During discussion the following points were noted:

1. Although Rutland was considered overall to be reasonably affluent, rurality and isolation were a barrier to accessing services.  Also, it was more difficult to ask for help in a more affluent area where a person might feel they were in the minority;
2. There was an assumption that everyone could access information through the internet, but the elderly, frail and disabled might not have access to the internet and others might not be able to afford internet connection;
3. There was a need to look towards the voluntary sector, Community Agents and also improving community relations.  Parish Councils and Meetings may also help people with accessing services and encourage/coordinate volunteers;
4. People who have moved into the area may not have a network of support in family or friends that live locally and so will be isolated in that way;

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Mrs Crowson and Mr Howard left the meeting and did not return.

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5. Discussions were ongoing regarding improving the community transport offer including the potential to have some professional drivers.  There was also an ongoing transport review led by the Places Directorate and the STP was looking to make accessing services easier by bringing them closer to home.

AGREED:

1.    The panel considered the topics and related issues/questions covered in the report;

2.    The panel identified further information or work it wished to undertake and this is as detailed above; and

3.    The panel authorised the Chair to produce a written report of findings to feed back into the overall project.