Good afternoon everyone thanks for coming today today’s meeting of um 12 March the Active Health and active lifestyle scrutiny board um just for everyone’s information today’s meeting is being webcast Live on YouTube um and it’s obviously a public meeting for those watching online you can find all
Our papers on the council’s website we just put into a search engine leads adults health and active lifestyle scrutiny board it’s always the first uh first result when I when I search for it and we’ve got a slightly different meeting today so normally we have a
Number of items um and we sort of keep them quite separate but today we’re going to put them all together so there’s a lot of people around the table um and we’re going to go through each item as an appendix but everyone will stay and we’ll have a conversation
Because there’s a a lot of um integration across the papers so I think we’re going to try it this way today and see it works um and consider how we do other papers in the future um but but clearly when when items uh affect many different departments I think it’s quite
Helpful to talk about it all together so with that I’m going to go into introductions so I’m Andrew Scopes I’m Council Bon HCK and I am the chair of this committee and I’m going to go around to my left thank you thank you chair Luke Farley labor Council of Burman and Richmond
Hill Muhammad ibal labor councilor for hunet and ride John be uh a member of the Board of Health watch leads and a carped member of this board councelor M France mayor from mortown and meanwood good afternoon councelor Taylor from chap Alon good afternoon councelor James Gibson proat and wi
Award good afternoon everyone councelor Kevin Richie from Bramley and stanning Le Ward good afternoon everybody I’m counselor Salma Aran the executive member for adult social care public health and active Lifestyles good afternoon everyone Victoria Eaton director of Public Health at Le Council hi I’m Jame Wallen I’m chief
Officer for active leads and operations in City development good afternoon I’m Stephen Baker I’m the head acted leads good afternoon I’m Helen Lewis director of path integration for the um integrated care board in leads good afternoon I’m Ram Krish I’m clinical portfolio from leads Community Healthcare hello I’m David Wardman I am
A clinical lead for long-term conditions for the West Jor ICB I’m Dr Marcus Julia I’m a GP and I sit on the long-term conditions Health population board good afternoon Jim bwick chief executive of the Le GP Confederation good afternoon Heather Thompson I’m head of Public Health for health Improvement and Healthy
Living good afternoon Anna Ross head of Public Health Children and Families hi I’m Katherine inold consultant and public health and chief officer for Children and Families hello everyone I’m I’m Anna fersen I’m a consultant in public health for Healthy Living lead Council hi I’m councilor and K you representing mly
South good afternoon Council Paulson from gine Roden Ward good afternoon everybody I’m councelor Caroline Anderson I represent adelin Warf Deale Ward good afternoon M Angela brogon the principal scy adviser super thank you everyone and thanks for coming today I’m going to hand over to Angela for the first few
Items thank you chair um under item one there are no appeals against the refusal of inspection of documents under item two there are no items for exclusion in relation to item three there are no late items and under item four um please may I ask if board members have any
Declarations of interest and I shall take the silences n thank you under item five we have received apologies from Council hartbrook and we also have apologies from Caroline barrier as the Director of adults and health thank you thank you very much okay we’re going to
Move on to the minutes can I first uh ask if the members happy there an accurate record yeah I can see everyone no one indicating that they’re not so I’d accept those and then into matters of rising Angela do you have any matters of rising uh nothing specific at this stage
Chair obviously I appreciate this is the last um planned formal meeting so the information the requests that been asked for earlier um I’ll ensure that they get circulated once I’ve received them thank you very much matters arising from any members I can’t see anyone indicating so
I’ll move on to item seven which is supporting healthy weight and active Lifestyles so as I said I do you want to come in can I just say about um the last meeting we did I thought the um drugs and the suicide was very very well um
Put together and very informative and I just got to say a massive thank you to your people it was very good thank you thank you and and I I I agree with that and I think it’s worth noting that um I felt like members dealt with the
Topic in a sensitive and appropriate and professional way so I thought that was very very positive yes thank you okay so on to item seven so this is um supporting healthy weight and active Lifestyles and as I said earlier we’re going to have it as one big discussion
But we’ve got effectively we’ve got four appendix appendices so there’s four different slightly different topics obviously it’s crosscutting and so um as we go through if you want to comment ask questions after the each sort of short um presentation we’ll go into that and then we’ll have any further comments at
The end as well so with that I’m going to hand over to councelor Arif to start and and Anna ferson for paper one thank you thank you thank you chair and coun K thank you for your very kind comments in relation to the previous scrutiny meeting I totally agree it was a really
Good buied conversation um so the report covers a number of parts of my portfolio starting with public health work on and healthy weight uh we know that excess weight can lead to serious health consequences such as cardiovascular disease type 2 diabetes and some cancers these conditions can cause disability
And premature death obes obesity can reduce life expectancy by an average of 3 to 10 years and we also know that mental well-being can also be affected with both adults and children more likely to experience poorer mental health the proportion of adults and children children who are overweight or
Living with obesity remain high in leads um and nationally the reason behind these high levels of access rate are complex however two of the main factors are an increasingly unhealthy environment and the extensive marketing and availability of cheap nutrient poor food which is hind fat sugar and salt
All the more action is needed at a national level there are many interventions at a local level to create an environment that leads to a healthier weight this report outlines our four strategies and plans which support healthy weight in the city these are the healthy weight declaration leads food
Strategy adult healthier weight plan and the child health weight plan the intention is to work towards a single healthy weight plan covering adults and children check I look forward to the views of scrutiny and our future approaching um around healthy weight and I’m sure it’ll be a really interesting
Discussion and really great to see lots of different partners in the room as well thank you so I’m just not going to be very long but I just want to make a few key points and I know councelor Scopes you wanted me just to talk about BMI and
Just explain that as a as an indicator so I’ll just do that first so body mass index is calculated by measuring a person’s height and weight uh that’s weight in kilogram divided by the square of their height in meters um it’s not a perfect measure um because it doesn’t
Directly assess body fat um for so for example muscle and bone density are make are much heavier than fat um so if you’re a muscular person unlike me um you may have a high BMI but for most people it’s a pretty good measure um so I just wanted to I suppose
Just really emphasize the scale of this issue so we’re talking about 2third of adults in leads who are overweight or living with obesity that is a lot of people uh there’s a strong link between obesity and deprivation and then Katherine was just going to tell you the children’s
Statistics um yes for um children uh we usually look at data around children living with um obesity but when we look at overweight and obesity combined um it’s um around 21% of um children in reception uh live with overweight and obesity and 37 um U percent uh at year six um and um
These are very very similar to National Data although in leads as you know our population of children um a third of children living the 10% most deprived and children living deprived Le um the rates are double that I hope it comes through in the report um but to address the issue of
Healthy weight we need a systemwide approach with an emphasis on changing the environment and particularly the environmental and Commercial factors that affect food intake focusing on o overly focusing on individual lifestyle interventions is of limited Effectiveness has a low return on investment and will not benefit many people particularly not people who live
In more deprived areas there’s a strong association between highle levels of deprivation and more unhealthy food thank you super thanks very much just so members aware at the moment we’re looking at Pages 16 to 37 um so if you want to ask a question on this appendix
Please indicate just to start with um I know we just talked about uh children’s levels so on page 19 there’s a chart I know we made some really positive progress with the Henry program in in leads but I mind I think think that was before Co I’d just be interesting to
Know how architect has been sort of the last few years thank you yes so um in the covid years we were really alarmed um um Ted obesity Rose by 4 percentage points is absolutely unprecedented we are um pleased and relieved um that for uh reception age children they have um dropped down to
Pre pre-lock down um levels um for um children in year six they asked slightly um higher um uh but in leads they are very similar to the national average uh which um obviously we would like them to be lower but given that a third of our children live in the 10% most deprived
Areas we feel that that um is a success although there’s so much more um we need to do and we’re very well aware of that thank you and um you also mentioned about um the availability of certain food types and I guess my take is there’s limited power the council has to
To change that and um affect um what is available and we were talking actually in the pre meeting around the availability of fast food products um and the ease of those and I just wondered if you had any comments about what could be done to change that availability and where would that um
Power sit I’m going to bring in s and then I’ll come back to you an Council AR sorry thank you chair I think it’s a really important question and I think it’s just worth noting just going back to your previous questions as well and Katherine’s answer in relation to
Lockdown uh we did see high levels of um children in deprived areas and and the reason for that was because a lot of them didn’t have access to Green spaces particularly if they don’t have any back Gardens um so it was really difficult and I think it’s good to see that way it
We’re heading the right direction now to come back to your second Point um in relation to the limited pow the council has so as somebody who represents near Inner City W like gibon and hair Hills particularly in hair Hills we’ve got high streets um that has have there’s a
Lots of lots of takeaways um and and the problem we’ve got there is is the lack of control as a council to stop the influence of high saturation of of of takeaways now what works really well in in an area like hair Hills and we have
Seen is the CIA for uh off licenses where we’ve been able to successfully through the help of Public Health and various different colleagues um stop the saturation of off licenses it’ be absolutely fantastic if we were able to as a council to have powers to do something similar um because um if
You’ve got access to um really cheap food and particularly in the cost of living crisis for some parents healthy option it’s cheaper for them to to to go to a takeaway um but it is really concerning for me as an elected member to see the level of or the number sh
Number of um takeaways in in the area so I think it’d be fantastic if we as a council had the powers to to to do and stop the influence and I know this is a conversation we’ve had with colleagues and officers and Anna’s really passionate about this as well so that’s
What I’d like to see chair thank you so we do have some Powers um we have a supplementary planning document around hot food takeaways which we’re about to review um which um has a number of aspects to it but including things like proximity of takeaways uh to to schools
Um but we definitely need to look at that cumulative impact effect through that uh policy with planners um I think the other aspect we like to look at is the amount of advertising in deprived areas um and there’s been a number of articles in the media recently about this um association between increased
Advertising of unhealthy food and other harmful products um in more lik to be in deprived deprived areas so they’re just two of the things that we’re really really Keen to look at thank you I think we’ll be interested to see how that moves along going forwards um it’s interesting because
Because there was a report wasn’t there week last week or week before about ad block and how by Adblock and how there’s more bright adverts in the inner city areas like the area myself and counc represent different parts of of the inner city but still the inner city
Thank you okay I’m gonna bring in Dr B next uh thank you chair um can I thank all those who’ve produced not just this appendix but also the other three appendices as well I think they were all very helpful um one quick question then one perhaps longer one um on page
25 it talks about um sponsoring and advertising um are there any major organizations and I’m thinking perhaps the sporting organizations it could be others um such as uh you know football you lead um football club um be Cricket Yorkshire uh cricket team so are there any major um organizations that advertise
What we might term as less desirable um high salt high fat high sugar foods um and secondly I was talking to one of my colleagues before the beginning of this meeting uh and uh she was talking about how her children learned to cook uh and and they
Learned in the family and you they used to help Mom when they were very small they first of all watched then they helped and they learned to cook and and I’m sure that’s the best way of children learning how to cook so my question is firstly for children um many of the moms
And dads probably as well um cannot cook themselves so how did their children learn and it seems to me that the only way that they can really learn is through schools actually teaching them um going back into the Middle Ages when I was at school uh it was only the girls that
Learn to cook um that would be totally inappropriate nowadays boys and girls Al the question is to what extent is cookery part of what schools do provide to um assist in healthy eating at home and in the future when those children are parents themselves let’s break the
Cycle of families which don’t cook um and don’t know how to cook and secondly as far as adults are concerned one of the ways in which adults who don’t know how to cook uh is through third sector organizations but we know that third sector organizations are being hit with
Uh reductions in their GR mons so what effect will that have uh on those people who might have gone to um cookery class let’s call them who won’t be able to in the future um and they won’t learn how to cook and and indeed I’m aware that a
Number of those households don’t even have the wherewithal to cook they don’t have sets of pots and pans and and so on so what effect is the cuts to the third sector can to have influencing adults who might have learned to cook so that the families uh can be properly FedEd
With Healthy nutrition and the children will in their turn learn how to cook I’ll pick up the first question which was mainly around advertising and Sport um I think you are probably more likely to find a gambling advert on a sports shirt um in terms of the the grounds and um the
Adverts that might be in the grounds and the food that’s served at grounds for example we’ve uh doing some work with the lead rhinos to exactly look at the stadium and the environment of the stadium um so that that’s something that um Emma who’s I think in the audience is
Working very closely with the lead rhinos on uh and we’d like to obviously do that with all all the clubs locally Catherine do you want to ask answer the children yes um you raised very good good questions and I think the um problem is so it’s so large um I
Think it would be um disingenuous to think um that every single child in Le has taught um cookery skills but there are a few things um that are happening um so Henry which we talk about um you know um frequently and which is targeted at families where children are at risk
Of um living with obesity parents are um taught about the eat well plate and they and they share ideas about cooking there are um there we our locality team has um projects where they will um go go out in the community and have bags of ingredients with uh recipe cards around
How to um cook and prepare meals uh we commission the family um Healthy Living service um that works with children and one of those projects uh delivers cooking skills another project um dance action Zone leads um delivers um cooking skills to parents while they’re waiting
For children um the way that we do this more um systematically is with the um health and well-being Service uh that that covers healthy schools um and there’s um information um about cooking there are um family food leaflets and healthy pack launches there are standards um that we advise um School
Meals to um to ad here to um and that is the way that we are trying to um mainstream and reach your children but there is more that more that could be done thank you very much okay are you satisfied Dr be yeah just if I could ask
I mean you mentioned Henry for instance as one of the um third sector organizations which does actually provide that that training for for families or parents um to what extent are they going to have reduced level of provision because of uh cats to their grants um to be honest uh
Nothing imminent uh which is good news so the model um Henry is a national charity uh we pay not very much money at all um to have um a license and it’s run on a Cascade training model um and so uh colleagues are trained and then that information is fed down into our
Children’s centers which currently uh we have Universal coverage across the whole city which we’re so proud of um and it links into the system so we have um obviously we have um Health visitors which offer a universal service with five mandated checks um those um staff um see individual families in the home
It’s not quite um working with anat at the moment but all of the other all of the other checks um Children at Risk of um living with um overweight obesity are identified and supported there are Pathways and we’re also very proud that those pathways are um shared um by um
The n 19 Public Health Integrated nursing staff and the children center staff that we call them Healthy Start Pathways and so so the me um support can be accessed um through that and we we are unaware of any family that wants that that hasn’t um got it we don’t have
A waiting list for that so that’s something that is working really well currently super thank you very much okay councelor rich thank you chair and thank you uh for the introductions uh my question um well first of all I think I’m remembering rightly pre um covid we were
Celebrating leads booking the trend in reducing childhood obesity um so if that’s the case what we were we doing then compared with now and what’s changed in that time other than I’m aware of of Co and can we just go back to what we were doing
Then um the secondly it’s on the Henry courses um they’re also been funded through um Health Partners as well out through local care Partnerships certainly the lead West one funded one but I’m actually interested in the the data on the uptake of those it’s all well and good putting on the courses but
If people aren’t attending them so I’d be interested to know if that’s monitored and what percentage uptake is taken I realiz you won’t have that information right now but perhaps it can be brought back because I do know one of the LCP ones wasn’t very well attended
And that’s no you know not to the detriment of those that put on they did the advertising and what have you but it just wasn’t well attended um my next point I’m on page 29 talking about infrastructure and I’m really passionate about um leveling up in our city on our
Parks so at the moment Capital funding for Parks is through usually through development planning gain so in areas where you don’t have a lot of development you don’t get that investment in pars and it’s it’s usually the more deprived in a sit in a city areas that don’t have any room for
Building so it’s mainly a plea to um the council officers and and the exact members to join my ask uh for a push that it goes up on the uh still I think we have a one two three list and I do realize we’re having to fund um the lack
Of building schools for future and a lot of the money has gone into that but I really think the focus should be um Beyond section 106 and development and a Citywide ambition to bring up all our parks to top quality because I think that’s when you’ll get uh children going
To the parks and and being healthy and their wellbe will improve greatly and then just a final comment um reading the paper this first section it it’s clear to me that the government policy is really weak it kind of says that uh without directly I suppose um and my conclusion is that the
Lobbying that the Westminster lot uh subject has been more powerful than doing the right thing and um perhaps you’ll agree with me that if it would dealt with the same way as smoking because the the health effects seem to be similar we might we might get some change with that thank you chair
Thank you for your questions you’re quite right and Le did Buck the trend and it was something that we were really proud of around childhood obesity uh you’ve asked what what has changed nothing has changed in terms of support we still have children’s centers we still have Henry we still have um a
Focus all of the healthy schools work what has changed is increasing poverty uh stress um austerity um coun AR mentioned the uh differential impact of uh the lockdown experience on children living in Flats with no access to park so my view would be um it that is um
What has changed um and and as I mentioned at the beginning we are um we are on par with um the England average but we have got more poverty in city so we still are um we still are doing things right but there is so much more
More that we can do um the you mentioned the um local care partnership course and Le West what course was that it was it Henry course or yeah it was a Henry course yeah okay all right then yeah um I have to be um truthful I don’t know and and I
Remember when we brought the um director of Public Health annual report here that was your question wasn’t it around Henry how do we know is the families that really need that that are going to that do you remember I remember that was a question and it’s a good question and so
Off the back of that and our kind of curiosity that as a piece of work we’re doing we’re looking at we’re looking at the Henry courses and we’re seeing which families are are attending it is targeted our more deprived communities and is targeted using the um National child measurement program data which is
Excellent data um that we get but we aren’t sure about uptake um and we uh we want to look at that so something we can report back on um the um Capital funding for Parks Public Health AR in charge of parks we’d like to be um somebody else
Might want to answer that question but um this is something that um Council of Vena was interested in as part of the thriving strategy work if you remember because of that impact um of um Co lockdown the differential impact and when we looked at the data actually uh
The the data the kind of I think it’s ons data show um that um actually more deprived areas have got more access to Parks but when you look at data around access to Green Space it is the more afferent areas that have got access and that’s something that’s a priority isn’t
It in the thriving strategy you’ve got colleagues from parts and Countryside uh looking at that and there’s work on the play place efficiency strategy I don’t know if if somebody else would like to comment on that and then your final uh comment was that your final comment
Sorry the national policies then oh yeah okay do you want to answer that Anna yeah good point your naal thank you for mentioning the national approach and particularly smoking because that’s a great example of um where policy has changed things like advertising uh the Norms around
Smoking um and the it’s also help the effectiveness of the stop smoking service it’s still the number one cause of preval ill health and death we do need to remember that um but we do need a similar approach around around food absolutely thank you just on on the
Place efficiency that is something that the council is the first uh Council in in England to be pursuing that and it’s clearly something that needs to keep moving forwards but it’s definitely something we need to push because every CH need deserves uh sufficient play space I agree Victoria do you want to come
In thank you chair just just briefly um it was just to come back um again because it feels really important on councilor Rich’s question about what was it that made us um book the trend what was our learning from that and then how are we applying that now and into the
Future um as Katherine said um what what were the two main um themes that came through around why leads did book the trend around um reductions in childhood obesity but particularly for um children living in deprived areas there was two main things and one of them was that it
Wasn’t there wasn’t one program or one service that was kind of the magic bullet on this but in leads we had that whole portfolio of interventions that Katherine’s mentioned around Henry children’s centers healthy schools not to 19 service Etc all the working neighborhoods the Community Food projects Etc
And that combination of all of those things um what was something that was felt to be really strong in leads that was less strong in other areas so it was the breadth of the programs that we were committing to the the second um um headline from the learning was that we
Um actually committed to those on a on a long-term basis so they weren’t shortterm non-recurrent bits of money they were invested into kind of over a decade in all in order to to give us the the outcomes they they did so we’ve not changed that formula um what has changed
In the is the proportion of children and the numbers of children who are living in deprived lead so our our our our um our rates of children living with obesity and overweight should be much higher than they are as Katherine said that we we absolutely want to drive them
Down further but we’re still in a positive position um dep um reflecting our demography from where we we all we other areas are with the with the same demography um so so it’s those two key points really um are things that we very keen to keep hold of going forwards thank
You thank you very much for that uh Victoria despite being a um sort of a bleak Outlook at the moment for uh young people in deprived areas okay I’m going to bring in councelor fary next thank you chair um I think this is really important work that’s taking
Place across City because you know we we’re facing a real crisis um with um with obesity the then leading on to real health concerns diabetes um prior to this meeting I was actually talking to councilor Scopes um about the impact of of diabetes and how
It’s going to impact on on the NHS and uh and wider wider care services um so I’ve I’ve really got three three comments leading into questions uh um from my own experience so I suppose firstly Cano in my ward of BM and Richmond Hill where working with an
Organization called uh Community shop um and what they’re doing is they’ve introduced um cooking lessons um at our youth clubs um so it takes place once a week over a period of several weeks and it’s really about looking at the education for young people how they can get
Involved in in cooking think about like healthy lifestyle s this is also then replicated via healthy holidays which I know um uh cross green growing together runs uh via hiy Park Source again really great local organizations that are operating and thinking about how we can improve the education around food and around
Actually making your own food um at that level I suppose it leads on from what what Dr Bill was saying with regards to kind of looking at Cana school education so this this then leads me to ask what what more work can be done um across the city working with third sector Partners
To encourage Healthy Lifestyles um and then perhaps even looking at tying that in with with social prescribing um I know for example like you know go for a walk around the park is is part of yeah not to minimize it but that’s part of the repertoire but
Is there is there social prescribing for um go yeah going to the gym uh or additional sort of like Gym training I know for yeah I mean I’m in the gym 5:00 in the morning um and you see a lot of users who are not necessarily well skilled in in using equipment but
Perhaps that’s something that that we can look at um as a city providing access too so I’ve got two other points but I’m going to leave my comments there for now because I appreciate that’s quite a big chunk of uh chunk of uh question so I guess um to there’s there
GP element in terms of describing I don’t know Jim if you want to comment on that first and then I’ll bring in um uh Katherine and ano again if that’s okay yeah thank you um so Primary Care networks and practices do have Social prescribers and Health and well-being
Coaches that do offer advice around uh weight management uh whether they’ve got access to um actual services like uh gyms Etc will vary from from place to place what we do find though is that where there is a lack of services or resources in one part of the system
It’ll impact on general practice and have a consequence with them also so it ends up being a um a bit of a circle that we can’t break so while social prescribers or health and well-being coaches are focusing more on supporting people with weight management problems they can’t support them on other issues
That are maybe C to the to the work of a Primary Care Network or practice for example so it’s a it’s a it’s a tension it’s a difficulty and it’s down to the resources available often within within a particular practice thank you our next one is tier
Um tier three weight management so I think we’ll come back to this point about the system which is really valid point and it’s one of the biggest challenges with uh funding reductions um the Katherine and an do you want to comment on that to actually I think Steve is going to
Come in about the gyms access was that that was the next main point wasn’t it I think yeah thank you um in terms of the gym access in terms of social describing there are a number of different um health programs that we kind of support from an active lead kind of perspective
Um and we have been working on a pilot kind of scheme in terms of an exercise referral kind of program um that we have been working with Primary Care Net works and likes um to kind of get that um self-referral route um but also social prescribing and making sure that in
Terms of physical activity that is a big part of it and where that is access to the gyms or where that is actually supporting the community and go into a community fitness program or other the likes then we do have a program that is currently in a pilot phase um on that
Front so the leads encouraging activity in people which is put into the report um when it comes to our are part of that report so there are schemes in there that we are supporting through that side of things and obviously you’re aware of the department for transport initiative
In terms of the social prescribing element there as well so um we do try and make sure that that’s very personalized to what the individual needs and what they want um so very much um there is a number of different schemes that we do there but
Again it all relies on funding to allow us to keep those kind of pro programs running um which obviously are heavily subsidized from our side of things to keep them moving on that front thank you thank you can Farley so yeah I mean I suppose the the question is still there around
Partnership working with third sector around CIO um healthy choices when it comes to food but I I was just um I was just contemplating something that counc Arif said earlier with with regards to her own experience in in hair Hills um near where I live there’s there’s a
There’s a takeaway shop that sells burgers for 99 p uh you can buy three pizzas for for10 um and this is clearly you know clearly leading to bad choices when it comes to when it comes to diet um I suppose the question is and you know perhaps you’re not really in a
Position to to answer answer it directly but is is there work that that is looked at or you know can take place um around say licensing um and planning with regards to um to shops um promoting like unhealthy Lifestyles and then thinking more specifically about my ward of burms
And Richmond Hill um and reach across the board into Gibson and ha Hills um what what works specifically is taking place um to look at some of our in inner city communities where uh weight management and the um um some of the associated Health impacts um Can can be really quite quite
Difficult or people might be more prone to example for you for example diabetes um which is quite heavily prevalent within South Asian communities um so what what really has been done to look at kind of these particular areas thank you um the first point about um the burgers
And the pizza B away she talked about um would link to my initial comment about the supplementary planning document so that that’s something we uh we’re currently or about to review uh and would hope to strengthen um in terms of uh there’s also I suppose advertising sites in presumably in your
In your area that the council may have control over I mean we we’ve I mean we’ve got a number of kind of the bright advertising yeah you know advertising hold I mean my my argument will be and it has actually been with the ad block campaign they’re not actually promoting
Anything that I view was particularly harmful um you know generally speaking it’s you know it’s bank loans or cars or um actually there was a huge advert for the gym the real issue is when you go on to when you go to hail’s Lane um uh or
On York Road and what you find is there are numerous advertisements on shops and posters and whatnot for bad choices you know um you’ve got vape shops you’ve got um you’ve got grocery stores all of which are promoting bad choices when it comes to health and that’s that’s
Something we wouldd also look at through through planning um we’ve actually just got a new post which is um going to work across planning and public health to look at exactly that um type of issue um just coming back to the um choices offered by takeaways Etc um you
Know if we had more resource we would like to look at things like healthy catering award um work with colleagues in environmental health actually go out to um take away another food outlets and restaurants as well um but they are very stretched so there are options we could
Look at if we had more s thank you um do you want to move on to your do you have do you want to move on to you have a question oh you the third sector is that yeah third sector third sector Partners um I think I can’t remember how
Many list in the report but we do have some um food projects with third sector so I think there’s an example in westle sorry I think it’s a re car my colleagues would know more more than me but there are some specific examples but um Catherine do you yeah there the
Things that I mentioned before with the um localities Team the bags the bags of ingredients that um are taken out with recipe cards um and the um Family Healthy Living Services that the children’s team um commissions that has an element of cooking skills um there
Could be a lot more of there’s a lot more resource the the difficulty is that how we um deploy the resource because we don’t have very much so we try and we try and um uh pick things that would that would work with partners and uh cover greater numbers of people so for
Example the work we’re doing around healthy schools if we have more money it would be great to do but we haven’t got the resource I can we might want to just give you a a list outside the meeting of the of the projects that we uh we are commissioning currently
Thank you okay do do you want to go on to other two questions that’s it great okay I’m going to bring in uh councelor Taylor next thanks chair um thanks for the report it’s really good enjoyed it I’m going to just throw it out there for
Everyone to pick it up on your own Department um it is hard for you into it it’s really hard because reading the report we want the best for our young people and adult but we only can do so much and you are doing the best you can however air sticks and reception they
Are children their parent accountable for them their diets we’ve got GPS in the room we know it’s not just eating make you overweight through lack of sleep energy and all different factors can come across it you also talk about advertisement and the television if you notice they cut down the fast food
Advertisement they do it differently but then you go out in the Town Center you go into urban they’re all over advertisement you don’t need it un plug cards for the shops is just there so what are we doing working with parent for instance I know we talk about
Third sectors I cherish third sectors but there’s not enough fin to get to all third sectors they are doing a brilliant job but you just said it there isn’t the finance so central government need to step in one with planning the manufacturers supermarkets the pound shops you name it
That’s where it’s all started from because if those products not there the kids can’t get old of it can they we fight to move ice cream van from from schools over the years because they used to finish school and get into ice cream we do need planning we do need
Restrictions in Supermarket to move all those silly junk Foods pound shops and all these things and we need to educate parents to cook properly instead of going to fast food because a fishing chips is10 it’s cost a living 10 pounds could give them two healthy meals if they cooked it at home
Gyms are very expensive again it’s cost of living we need a bit more equipments in the park because if parent don’t accompany some a six and reception children they won’t able to get in the park so the real route is coming really from the adult to educate the young par
Kids do you know what I’m trying to say but I admire you all for the work doing we’re doing a brilliant job but is a challenge and we need to look for the root before we Fest thank you thank you cancel Taylor I’m not sure that a question but I think those all
Statements of fact so uh I think everyone’s nodding so we’ll I’ll accept that as a as a comment thank you I’m going to bring in um counc Anderson next thank you chair I’ve got a number of points I’ve noted down now the last time I looked in our Leisure centers
That are vending machines with chocolate and crisps and cafes selling what you might call unhealthy food um so we can’t be saying one thing and doing another we need to practice what we’re preaching now I’m not against that actually because I think people should be free to choose what they eat I don’t
Think the state should be telling anybody what they can eat and what they can spend their money on and but it should be seen as a treat and not an everyday thing you know there’s nothing wrong with McDonald’s there’s nothing wrong with a pizza there’s nothing wrong
With a takeaway if it’s once a month that’s a treat and something to look forward to it shouldn’t be an everyday thing and as coun Taylor rightly said if we’re in the middle of a cost of living crisis people haven’t got money so I don’t really know how they can afford
These things and it’s really sad that we have to train people how to cook because I mean I was lucky enough to my mom taught me a little bit of cooking she was a really good cook but I uh kind of picked it up as I went
Along but we did get cooking at school to a certain extent um down at kurate Market are actually doing a really good job with the um cery school down there and they’re also they’ve got recipes and they’re also actually taking people around the different stalls to show them
Where they can buy the ingredients so that’s like a two it’s a win-win because the Market’s getting something out of that the Traders are getting something out of that and obviously the customers are getting a lot out of that in terms of um low alcohol drinks or no alcohol
Drinks unfortunately a lot of things like um cider no alcohol cider is absolutely full of sugar and that’s the you know massive downside to to that cuz it’s not all fat that’s bad I mean sugar is quite a a bad thing people you know you do need some fat in your diet but
Sugar is the is a real um problem and just we had a session at our Outer Outer Northwest Community Committee on the 6th of March and subgroup for health and uh Andrew Walker came and spoke to us about social describing and that was really interesting I think the members got a
Lot out of that so thank you thanks K Anderson I think there um quite of comments there but I think it’s worth asking Steve about the point around uh the Leisure centers and the foods available thank you yes um it is something that we work very closely with public health um on in
Terms of making sure from a tender point of view when we do um review the kind of contracts put abandon machines that that all meets all the the guidelines um in terms of lower sugar options um healthier snacks so there are healthier options in there and the size of the
Bars and different things also meet those kind of requirements as part of all that so we do try to limit as much as possible um but it’s still on our kind of radar to kind of keep reviewing that um to try and remove them unfortunately some of the healthy
Options sometimes when they’re in the vending machines or giving people options to have a bit of a snack they don’t obviously sell by date and nothing else that is because caus us a bit of a challenge um but yeah in terms of the vending side of things we will continue
To kind of review that side of things um as well as making sure from a an income perspective that we’re not um kind of penalized by that as well on yes just under the healthy weight declaration we have done some work around all lead counil vending machines
And I can send some information around after the meeting but there’s a set of buying standards which restrict things like calorie content Etc of products and vending machines but I I won’t go through it now I’ll I’ll circulate after the meeting yes thank you and and I
Think there’s um there’s a whole public health issue about um sort of the um how much you’ve earned so I think a lot of us certainly I do I go for a run and then I think I’ve earned myself this much but actually it’s got much more
Reason I’ve actually burnt off in the run which is deeply uh deeply disappointing okay do you want to come back an y oh yeah I think you have to run a mile to burn about 100 calories which is that’s a lot of running can’t hear cancer ven explain in
A marathon you get 3,000 calories for that which I think’s maybe maybe a decent maybe half a takeaway but um there you go okay I’m going to move on to councelor France M next well I just want to say thank you for the report today um I completely
Agree with what um Council Taylor um had mentioned and councilor Anderson as well and um I’m just you know um Council Anderson mentioned the Kate Market um um outfit that was there but also it’s just going back to to healthy school and the fact is it’s all right teaching
And and supporting the children um and making those lifestyle choices but we’ve also got a culture shift where we’ve got parents that are making unfortunately the wrong choices when it comes to purchasing and being able to cook um and and recycling meals for a few days and we don’t want to
Become an anist State we don’t want to teach parents how to parent however some of the um healthy schools um play scheme and that perhaps um should be opened up to parents and children um because it’s at the end of the day the wallets with the parents in um in um choosing those
Um ingredients and so on um but yeah no but thank you for the work that you’re doing I know it’s extremely hard and it’s extremely extremely difficult in in in trying to manage something where there is a culture of all these Tik Tok videos and other is it Snapchat um where
They by they and have this sour sweet and this that and the other and it’s it’s virtually impossible to do what you’re doing so thank you very much thank you for those comments canel France me um yeah Snapchat there you go okay I’m going to move on to the next appendix I’m goingon
To move on to Helen for the next uh session I think you’ve got some slides that right hopefully thank you so much I’m actually going Ram’s going to present um and I’m just going to kindly share the slides just a piece of context this is followup from conversations that
We’ve had with you previously around the specialist Weight Management Services known as tier three um sure counselors will recall so given that you had a lot to read from other colleagues we thought we’d give you some light relief and something to look at um so ram ram and
David are going to take you through a set slides and then we’ll be happy to answer questions thank you if you want to move to the next slide please um so from last time we had a conversation about this I appreciate that we talking tears so I thought it would just be worthwhile
Setting a bit of context around what we mean by Tears so there are four uh tiers to weight uh management provision tier one being the universal Prevention Services which we’ve talked a lot about today around access to healthy food sign posting to healthy information Etc tier two is then around intervention
Specifically around um dietry lifestyle uh exercise uh Pro programs and advice um and then the NHS really then starts to come in at uh tier three um where we commission um at tier three specialist multi-disciplinary Weight Management Services and then even more complex than that we’ve got tier four which is
Surgical options so your gastric band type operations so in that tier system the idea is that the more complexity somebody is living with the higher up the tiar that they go so particularly where um patients are living with uh morbid obesity with uh other health problems and and things that’s where that
Multidisciplinary kind of support really comes in so in that tier there is psychological support dietician support physio support medical support there’s support around uh drug treatments uh and things like that usually um an 18mth 12 to 18 month program and some of those patients um may go on
To have bariatric surgery and or maybe identified as being more suitable for biopc surgery um so obviously in that tier model um as the complexity goes up we you know struggle to see uh huge amounts of patients and the cost of of that goes up so as you know um we previously um
Spoke to scrutiny around a deis de ision to foruse tier three So today we’re just going to go through um what we’ve done in terms of recovery and and where we are with that so I will pass on to my colleague Ram everyone um in terms of just to give
You a bit of a context about the tier three criteria which is um commissioned by ICB in NHS if somebody needs to be 18 plus should be lead GP registered under BMI of over 40 and if they have co-morbidities between 35 and 40 also is considered actually um the I think the
Handouts is a little bit wrong in terms of the BMI but we have amended it on the slides actually and they should have demonstrated it previously we had this as one of the criteria that they should have had engaged very well in tier one tier two prior to coming to tier three
However unfortunately tier 2 was decommissioned sometime in 202 2 which had a significant impact on the tier three offer which we provided through Lee Community Healthcare and if you go on to the next slide actually um that provides the timeline and the demand we have had actually um I think it started
Off somewhere in March 21 actually and then it continued to do and between September 22 October when the tier 2 offer was stopped that’s when I think the service couldn’t cope with the increased demand um initially the service was commissioned to provide only 250 take 2250 patients a year but we
Started receiving around 125 100 to 150 patients a month and because of which the service that was provided for the people within the case load became very diluted and we need to it wasn’t as intensive as we would offer that’s why we went through scrutiny board and a
Very unfortunate decision was made to pause the service actually to so that the ca the pay so that the staff could concentrate on the current case load if we move on to the next slide that provides a bit of context in the last eight months uh the services
Worked very hard to reduce the case load by around 19.7% that’s what it says on the slide but in since doing this report it’s come down further that we have um uh reduced the case load by 23.7% actually we have done an eqa to mitigate all the risk and servic is
Concentrating on clearing of the backlog and also working through the new uh weo pathway which is a medication offer the nice ta came about last year and therefore elad commun Healthcare is working with ICB in terms of commissioning the wo way which is medication offer has to be provided through the tier three
Multi-disciplinary team so that’s something that’s what we’re working on and the service also is working through redesign to reopen the service um and we are it’s very difficult to give a time period when the service could be reopened um but we are looking to see probably by the end of this financial we
Might be able to 24 25 we might be able to make tell when we could reopen uh and if you go on to the next slide that gives a little bit of timelines actually what we’re going to work between March and June it’s through implementing we have identified your opportunities to improve efficiency
And capacity the nice ta 875 which is a weo pathway is being embedded in is going to be offered soon it’s going through the Peg and other executive Partners actually for final sign off in the next week or so between July and de we tracking the progress and probably by
JN 25 we might be able to tell when the service could reopen and just to give a bit of a context um which is not in the paper um I think the chair asked to provide what’s the criteria for tier 4 um um if you go on to the next
Slide that gives a summary of in if somebody who hasn’t lost any weight BMI of over 40 or if they have comorbidities above 50 non-smoker alcohol managed hba1c less than 60 and they’ve engaged with tier three around 75% at least actually and they go through the bariatric surgery actually
And they shouldn’t have had any surgery in the past all those criteria at a multidisciplinary team offered by the hospital in leits and we have a joint um assessment from tier three and tier four colleagues actually so that the right people are chosen actually for the surgery and they followed up for two
Years actually at least and um as um as we discussed during the Tier 1 2 3 4 actually each of the tiers is is approach in such a way that this lesson people who needs goes to the top of the tier 4 rather than a square or rectangle we go to the next
Slide actually that gives a bit of a data in terms of for a quarter around 36% ently move on to surgery which is carries its own complexity and 64% are seen by tier three either and discharged either because they’ve reduced weight to an agreeable limit or they are able to
Sustain and they don’t need surgery um that’s just to provide stamp shot we don’t have any National Data Benchmark the leads deer three offer but we working through it thank you anything you want great thank you very much for that R very helpful just um a question start
Us off and open it up to members again around um so on the tier four categories one of them is uh engaged with tier three at least 75% I just want to know the impact of the current pores of tier three on people who need uh tier four
Surgery thank you it’s probably worth um talking about capacity in tier four so capacity in tier four it’s a surgical paway so patients need to um access surgeons theater space um historically also Critical Care space but I think less so now in the new surgery so we’re
Capacity constrained in all parts of our pathway so I don’t know the numbers of people waiting for surgery already in the system but there will be some so um the other thing that’s really important and I think um was really helpfully um recommended through scrutiny colleagues
Was to make sure we had a fast track pathway so we do have high-risk patients and a way to track people all the way through we’ve always had a direct access in 4 for people who are clinically high risk and that remains that pathway so all of these are Arts not sciences
And there’s always a a continuous conversation um so if there was somebody who was identified as requiring immediate surgery for whatever reason there is there is a way through that isn’t yeah um anybody who has got Ral complications or anybody is waiting for another surgery like hip surgeries
Or back surgeries they will be prioritized actually for um yeah Patric surgeries so they have a it’s a multidisiplinary assessment actually but it’s looked at Case by case actually from it’s based on the clinical priorities thank you very much I can’t see anyone else indicating so I think
It’d be quite helpful to go go and cancel sorry sorry I thought you were going to ask again um could you just explain what the surgery is is it gastric band reductions or is it kind be other interventions that’s the first question um they have quite a few
Surgeries depending on what is required I think there are five or six actually but I’m not able to answer but I can find out and tell you from the hospital colleagues but gast paratrigeminal that’s why I asked if it would just the one operation and do you
Find that people go abroad to have them and the co if the anything goes wrong with either through the private sector or abroad does that then impact on the service here the capacity here so we obviously don’t have data directly on people accessing private sector surgery
Or indeed um care abroad I don’t have the data on complications but we can certainly ask um colleagues to to see if they have any data on that we don’t um routinely have that data but I can I can ask um ask for the second question I
Think in terms of private sector access there was always a strong private sector market for um the bariatric surgery and I can’t imagine that that has changed I think it’s the after care that is also really important so all of these Pathways should have um multidisciplinary Aftercare behavior
Management after care around them and I think one of the concerns is surgery on its own is probably less effective so we were look we did have a long conversation with independent sector Partners about how making sure that they also provided the Aftercare and that people didn’t then bounce bounce back
Into NHS funded Aftercare just creating a different set of bottlenecks so I think when we talked to the chair I don’t think he understood quite how multifaceted these are long-term problems and the surgery on its own without the after care probably means that they are less effective and um less
Effective so we can definitely ask about data on complications um and whether there is any data that the local team um maintain um it’s not been escalated to me as a specific issue but I can I can check with the cical team happy to do that and come back to the scrutiny
Officer thank you so just to come back there because you mentioned after care which isn’t necessarily a complication does sometimes they does the have care sometimes fall on the NHS and does it is it affecting the service delivery do we know because I presume even if if someone has an operation
Privately some will it be registered with the GP that they’ve had this surgery at some point or not necessarily if it’s a good private provider and it works properly then I think the answer would be yes I’m going to I’m looking at my GP colleague yeah um I mean there’s there’s after care
Directly related to the procedure but then there’s after care in terms of a weight management service so I know for example SP nuffield here would have made sure that they have a proper psychological therapies offer and a proper dietetic offer and a proper after care offer things you need to monitor as
Part of their pathway can’t speak obviously for all the independent sector providers either in the UK or abroad um it’s just to add that’s why people go through all the tier one tier 2 tier three offers so that they are well prepared psychologically to go through the tier four and it’s
Sustainable after the surgery um that that’s why they have this strict criteria nice as recommended and when they have the T4 surgery from NHS I’m not sure about the private provider and what happened actually but they usually followed up for 2 years in terms of the support what’s offered from the
Hospital thanks for that when we had our chair’s brief we talked a lot about the lifestyle challenges to any any um of the teers actually so unless you unless is it like unless you change your your choices your weight isn’t going to change so you need to have the diet and
The activity both both combined I think I talked with Anna about this in chair’s brief as well the need to have it like the whole the whole package so surgery by itself won’t change anything unless there’s also the the lifestyle factors and I think it’s really important to
Remember that that it’s not Silver Bullet it’s a even with the we talked about the new um the new drug even with that it’s about changing Lifestyles as well as that in the short term together can make a longer term difference good okay I’m going to bring in Dr B
Next uh thank you chair um I understand the situation with regard to the four tiers but there are two mentions of the WEA V pathway in the slides that we’ve just shown and I’m not quite sure how that fits in with the tier process and it does say that if it’s supported by
The integrated care board at their meeting later this month or in March it might already been held for all I know I can’t remember I’m not on it any longer um I I wonder if you can explain to me what that actually means for the residents of leads who will be able to
Access this particular pathway yeah so I I’ll just give a little bit of introduction in terms of what the the drug therapy is so it’s been approved by nce and for using the NHS and there’s been a lot of media coverage about that and you know particularly in um not just the TR
Traditional media but also on social media you know the new skinny job game changing um the way that the drug works it’s an injectable therapy and it um basically acts like an appetite suppressant so while you’re on the drug it will reduce your appetite therefore you will eat less and lose weight now
All the clinical trials um the drug was used alongside the The Wider tier three support to lose weight so all the the lifestyle the eating L the exercise psychological support went along with it to produce the outcomes so there’s no evidence around if you just use the drug
On its own it will have the same impact but I think some of the perception out there of it’s It’s a magic drug I have this drug and I’m going to lose weight so that’s why it’s really really important that we embed it as part of a a comprehensive service because also
When you come off the pathway there’s there’s no long-term evidence if you just use the drug when you stop it and the appetite suppress goes away you just will G regain the way if you carry on the same behavior so that’s why it’s really important that we you know
Look at this pathway in the round and introduce it sustainably and also um I think just to give you a rough idea you know there’s there’s about 60,000 patients who would meet the nice criteria in leads um and the cost of delivering that whole package to those patients would be in
The region of 15 50 million if we was to do that so clearly it does have a really important place in therapy we’re working across West Yorkshire to come up with a implementation strategy that would mean that those at the highest need would be able to get access first um so that
That’s work in progress um and also so we don’t create inequalities um whereby as we know the inverse care law those who often need health care the least access it the most so yeah we we we’re working on that and progress is is being made yeah just just to confirm um so we
Have the um ICB committee that leads place tomorrow um we have despite the enormous Financial challenges of the ICB across West in the lead’s place made a small amount available to set up a team to support the first cohort of people to take the drug because it’s a nice ta
Which stands for treatment advice I think something really yeah technological techology teal advice technological advice there you go um there’s a um a requirement on um on bodies to to follow nice Tas and we have to explain how we’re following it but as as David said what we don’t want to do
Is take the whole cohort that’s not ethical and that would wipe out pretty much every all the other discretionary commission that we do across the whole pathway and clearly across the whole system so what we what colleagues have done has worked worked on a on a more
Refined set of criteria so we’ve put some money into our budget for next year um to set up a small team to start that multidisiplinary support so that we can start a cohort of people so that we’re in um accordance with the requirements
Of a of a TA um but in a in a way that we think is responsible and targeted for those who would benefit most and obviously significant proportions of our um patients in tier 3 are from imd1 and imd2 it is part of our inequalities work
Um so that’s what we’ve done um so the reason it’s going to committee is obviously it’s part of the wider budgetary arrangement so it’s about the only piece of growth that we’ve put in to next year’s plan um and we’ve also made a small amount of proposal to make
Some more of the um uh the tier three um non-recurrent funding recurrent recognizing the enormous pressure on those plants I think the behind people’s question was how soon can we open clearly it’s not satisfactory not to have an active tier three service nobody thinks that’s a good thing so we we’ve
Just tried to squeeze a bit more into the system it’s small numbers the numbers in tier three are small compared to the the size of the the prize but that we are where we are so that that’s what we what we’ve done that’s why it’s going to committee tomorrow it’s part of
The wider budget um it also needs because we’re not a statutary body anymore that the criteria and the way in which we’re implementing it have to be approved through the West yorshire committee um for the for the actual um prescribing so we we’re working closely with colleagues to suggest that we do it
In the way that we’ve suggested which is um a narrower cohort of people than than our recommended through nice but we think a more appropriate cohort of people thank you do you um when you’re deciding when you deciding how much money to invest into tier three and tier four um
Budgets do you consider the impact of obesity on across the NHS whether that’s um on heart services or uh diabetes experts or the stroke facility etc etc because obviously weight does have an impact on all all services and all comes with Associated costs thank you a short answer and a long answer I
Think um the answer is yes but in in a situation where we’re not close to meeting balance at all we’re looking at what else we can do um and so it’s a balance of the least harm as well as the the most benefit um and I think that is
A real tension I know that colleagues have struggled with this all of us and we’re struggling with this every day at this point um so we have a obligation to meet Financial balance in the year as well as the statutary obligation to try and do things that are sensible over the
Next five years and they don’t always match I think would be um where we are so yes we’re absolutely aware that those people are greater greater risk of harm as individuals and across the population um and just to be clear you can’t like the council is can do invest
To save because it’s allowed to borrow because it’s going to save money in the future the na the ICB can’t do that even if it believes it will save significant money over the next five years it could if it could also Achieve Financial balance in the
Year okay I’m not going to push anymore I think uh I think I understand your answer okay um I’m going to move on to um I can’t see anyone Syndicate going to move on to Jim and his paper which starts on page 47 um for some initial comments and then we’re going to
Questions I think be quite helpful if we just picked up the initial comment around um ways to fast track people through the tears and your experience as a GP or whether that’s possible or the GP confederations point about whether that’s possible and then any comments and then um we’ll move into questions so
Thank you very much Jim thank you I’ll do a a brief summary of the uh briefing then I’ll bring in uh do Julia to uh give uh some examples of what it’s like actually in practice uh on the ground so I think there’s a bit of a perfect storm in all this and
You’ll you’ll gaze through the briefing the the sense of what it’s like in in primary care for patients people and for colleagues that work in in the service so there’s the bit that’s been described around uh all the public health type issues um and the choices people make
And the social factors uh education uh cost of living Etc and what that means around um choice is around food or exercise there’s a second bit about tier two and tier three and I think the tier two bit is really critical because that’s the access that’s the preventative stuff that is so uh
Important and in the uh absence of those Services uh as well as tier three not withstanding the explanation that’s just been given um it leaves uh general practice with little Choice as to where the support for individuals uh uh can can receive any sort of care or or or
Services there is then the the third element which is the overall context of of general practice so it has multiple demands and multiple priorities put upon it um increased complexity often of older people with Frailty for example and their own Workforce uh challenges too continuative care is sometimes
Difficult so combining those three bits leaves with a um a perfect storm which is multifactoral in its nature as has been described there are some mitigations to the issues which which we tried to do so different types of Workforce and we’ve spoken already about um uh health coaches uh social prescribing some
Primary Care networks are uh considering employing dietitians so there’s more um of a clinical approach to some of the care and also motivational coaching within the health check environment but this has consequences and the consequences are are stated uh in the paper and when I spoke with many uh GPS
And the LMC and the clinical directors of the Primacare networks this this is one of their biggest problems because poor weight management not only leads to a longer term physical health problem but also mental health problems and that whilst there’s a fast track into tier 4 there’ll be lots of people who are
Waiting for tier three services who can’t lose weight for whatever reason and their health will deteriorate over that period of time and the whole thing uh snowballs and there’s an example in there but I’ll I’ll pause for now I’ll just ask Dr Julie if there’s any other
Comment uh yeah I mean I think the paper puts it well there’s obviously as as a GP on the front line it doesn’t stop patients coming in to ask for help with their weight and particularly in areas where funding or the the the finances are tight so we talk about inequalities
The areas like bofs are the areas that need the help um and we don’t have anything to offer them really we do have health coaches but they weren’t really employed to do this work this is additional work that they’ve been asked to do um you know only the other day I saw a
Lady whose BMI is 50 she would qualify for a tier three service but we can’t provide that and it’s the second time she’s been in because we can’t tell her when that service might come and who knows how many times she might come in if it’s going to be 2025 before that
Restarts and obviously the the biggest problem we’ll see in the short term would likely be with people with things like arthritis and and then they’ll be too heavy to have the operation they’ll have to stop work in fact the public health economic case calculator for tier 2 Services
Makes the case for the biggest savings are in wages and the biggest impact of that must be in areas like bov’s Fair Hills Richmond other areas of the city where people are very poor I’ve got nothing else to to add so great thank you thanks I think that’s really
Helpful both talking about the system challenges um and and also the mental health aspect so thanks for raising that because I don’t think we’ve brought that in yet the mental health aspect which is really important um and we’ve talked about system challenges before in this meeting around as as um budgets get
Tight each part of the system starts watching its own budget rather than uh the whole system can you just as a starting question I’ll open up to questions if members want to ask um the two GPS here um just a starting question what’s the what’s the um what’s the
Practical challenge around getting more sort of weight coach and non GP appointments for people across leads in your practices and I guess just to spell it out we’re we’re lay people here so in my head uh a weight coach is less expensive to pay than a GP and so from a
Pure low person perspective it appears that that would be a cheaper option so if you could just help me out with that thanks yeah Primary Care networks which for those that don’t know they are geographical groupings of maybe five to nine uh GP uh practices they have access to uh funding
For additional roles so the additional roles are uh different Workforce to support the GP as a clinician and there’s a list of roles uh they come anything from pharmacists to health coaches to physiotherapists to dietitians and in fact nurses are included in that uh list now so the
Primary Care Network has a choice to make and there will be lots of different types of Demands uh mental health is a is a huge one um on that particular Primary Care Network so they have to make workfor recruitment choices um some of which is done in a
Coordinated way in the city hand on heart I don’t think the uh all of the workforce challenges and coordination of different types of Workforce in in Primary Care is as coordinated as it could be um which leads to a differentials in different Primary Care networks as to what Workforce is
Available but you’re absolutely right um if health coaches are uh recruited and if they are trained in in motivational coaching to encourage people to lose weight then that would be much more economic to do uh and Primary Care networks do that sort of work but what it means where there’s uh pressures and
Demands in one part of the system around weight around weight management then it will have a consequence somewhere else because there are only so so much Workforce to go around in because the the funding is is only limited the other factor is the Primary Care Network direct enhanced scheme which is their
Their contract it was only agreed a couple of weeks ago uh for this by the year we we’re um about to enter so there’s lots of variables around which people uh U reluctant maybe to commit to employing someone full-time when that funding stream might not be
Guaranteed can I just make the point um we as GPS directly might have made a short intervention you know something that you could fit into a 10-minute consultation but we would never have taken on treated or helping someone to lose weight so that would have previously been referred onto the tier 2
Service but now that doesn’t exist it it gets referred to the health coaches all we’ve done is changed the funding from the Council to the NHS but there is no more funding in the NHS so there are no more health coaches I presume the people offering the service are paid in a very
Similar way to the tier 2 service was yeah thank you and just to be clear in terms of the funding for those um those extra stuff is that ICB uh directed it’s from NHS England through the ICB but essentially it’s an NHS England Thing transacted by the ICB is
Very little gift to do to do anything different with it okay thank you I’m going to bring in h councelor Richie yeah thanks uh for your report um thank you so just reading the summary and you you site the the loss of tier 2 impact in the
Service when I you look holistically at how we run our other countes run and the rhetoric that you get from Westminster again around boot need the need to boost the economy and they talk about increasing productivity improving health so that people are able to work and you’ve as
Well as in the report you mentioned those aspects in in your summary so they know what we need to do we’ve talked about invest to save there are strategies that we know if we Implement we’ll improve things we’ll save money we’ll do all those things to boost the economy so you’ve
Got to ask the question why it’s not rocket science why aren’t we doing it why aren’t we doing it the crucial thing for me is Local Government funding is the foundation that everything is built on if we get that right everything else will fall into place we got the public um
Health um devolved didn’t we and since then it’s I think it’s been cut since since it was introduced so I think we’re probably all on the same page so what what happens is it when they walk through that door the Pearly Gates of Westminster or what is it
Watford Gap when they go past there from the north that they don’t get what councilors are telling them that are dealing with these issues day and day out GPS are telling them health professionals are telling them and nobody seems to be listening and that’s what needs to change start by funding
Local government properly and then everything else will fall into place and the evidence is there for it it’s not a political statement it’s not rhetoric it’s a matter of fact thank you thank you Adam I’ll take that as a as a comment if that’s right councelor Rich thanks for that though okay I’m
Going bring in Dr B uh thank you chair and and some extent it goes back to what councelor Richie has just been saying um when I read the appendix one which was from the director of Public Health uh it talked a number of times about the importance of of diet and mentioned high
Fat high sugar and high salt and as a retired dentist it mentioned high sugar and I thought ah maybe there’s a role for dentists in this as a regional consultant in Dental Public Health each of the regional consultants had leads in particular aspects of uh dental health
And one of the areas that I had responsibility for was dentists and smoking and we produce guidance encouraging dentists to refer appropriate patients to the smoking cessation services and I thought maybe dentists who’ve got patients who may well be at deese but have got high Dental cares rates as well maybe there’s
A role for them to refer to an appropriate service for advice they wouldn’t take kindly to the dentist saying you’re fat you want to go and see someone but if we say you’ve got a lot of tooth decay then maybe they would understand the dental implications and when I came to appendix
3 I found the GPS have exactly the same problem they don’t know where to refer the patients to either because the services aren’t there and it seems to me chair that it’s it’s the age of problem when money is tight where do we put it do we put it into trying to heal
Trying to improve the life of those who’ve already got the disease or do we put it into other ways of preventing the disease from those who haven’t but might well be on uh the line to getting the disease and it seems to me that we’ve lost now
Um tier two and tier three and at the bottom of the um the appendix it’s critical that we now do all we can help to help patients who need to lose weight and welcome your support to reinstate the essential service we could do that and we could
Say we we welcome we would welcome it but it’s mentioned that general practice I think it was Jim originally and now presumably your colleague who’s on the long-term conditions population board and it seems to me that what we ought to be saying at least is that the long-terms condition uh population board
And I’m sure they’ve looked at this already but they look at it again and we encourage them from the scrutiny board and say we are concerned about this would the population board look at the way forward on this uh and how we can improve the situation thank you Dr Bill and I think
That’s a very good idea as um I was thinking Victor just indicated but um I was going to ask you anyway um just to give us some context around the tier 2 because obviously the counts it’s been inferred by uh our colleagues uh Marcus and Jim about the tier two but we
Haven’t addressed it head on so welcome to make the comment he’s going to make anyway but could you also comment around tier 2 services and the challenges um because it’s been talked about but we haven’t addressed it thank you thanks chair so just to add a few
Comments um anim may want to come in because she’s been most involved in this um I think um to to talk to the point of the um the resources around public health and prevention um cancel Rich’s Point um we we absolutely have seen reductions to the that budget since um
Public Health came to local authorities um 10 years ago 11 years ago now so on average that’s about a quarter of the resource that has gone um that’s a national issue but our lead’s position reflects that um on top of that leads is funded at the lowest level of any core
City um so we’ve already got a low starting point on which to lose that um on which to make that reduction um on the um on the tier two service um kind of context um the there was ABS in terms of the work being done by the population board and Anna kind of
Leading the public health contribution to that working with um NHS colleagues um we were very actively looking at um a better way of providing that kind of tier 2 type service um because you’ll see from the trajectory of the graph that was shown before that even when we
Had our two tier two service we were still seeing um referrals going up it wasn’t a Magic Bullet and actually the nice guidance around tier two is is quite modest in terms of the the contribution you would expect to see in terms of the outcomes for people who
Would actually have a successful kind of weight loss so we knew that we weren’t really reaching as um the outcomes we wanted to reach with our historic tier 2 service and the work was going on across the city um to come up with um a proposed model for doing that better um
And we’ve always said um as and when there’s opportunities to do that we would absolutely want to get around the table and look at that model again so it’s not about going back to the service we had necessarily but looking at how we can do that better um so I think that’s
Still a very live offer but obviously it’s very dependent on resource um and that’s some that’s still as we stand today that’s the the resources the fundamental uh challenge um you know it Ideal World we we wouldn’t have had to make any of these reductions but we we
Obviously live in a time where we’ve had to do some very difficult things and the only thing to end with is that I know that across the Yorkshire in Humber and West Yorkshire there are some areas with no tier 2 or tier three service at at all whatsoever so even though this is
Very challenging it’s it’s not the very worst of our kind of geographical neighbors so this is this is a very much a kind of a a national issue Anna I don’t know if you want to add anything to that thank you um Dr Bill do you feel like your comments been
Addressed well half of it has but uh the referral back to the population board I think is absolutely crucial I assume that public health is part of that board as well as uh uh the the NHS people uh who are involved and I do think that it’s it’s important to to talk that
Through again um whether it results in any new money or any more money being found is another matter but I think that we ought to be asking the public health representatives from the city council and those who are there from the NHS to look at it again and with the the
Impetus behind it saying the scrutiny board were very concerned about the current situation what can we do about it yeah I just wanted to come in as the as the chair of the board so yeah absolutely um we will do and I think that’s in our plans you know we’re in a
Bit of a recovery phase but our long-term plans is to look at that model again pick it up and and and see you know where we can make improvements I think what’s really important to mention is that you know obesity is a is a chronic relapsing condition and and you
Know obesity as a whole is just is is just going up and up so actually a benefit you know a positive outcome might be a flattening of the curve you know and I think that seems to be some of where the economic modeling kind of comes from it can be quite vague
Particularly in terms of that long-term what intervention actually has the biggest impact but overall the thoughts of even a small weight reduction over somebody’s lifetime you know build builds up and to have a significant impact so you know there’re the things where the sooner we do things with
People the earlier on you know if it’s only half a kilogram over an entire over 40 years that can have a significant impact rather than there’s no magic bullet that’s just going to cure obesity overnight but I think it’s collectively what’s what’s the sum of all the parts
That’s just going to help us keep that trajectory subdued and and bring the most health benefits to people so just for the board are we content to write a letter as per John Peel’s uh description I’m seeing nods n on sense no good okay so I think that I think we
Will we will right to you David I think there’s um just just in terms of like summing up a little bit I think it’s worth commenting that uh I think we’ve heard from the ICB Victorian public health and the GPS that funding is an issue on this matter
And it’s really frustrating from the board’s perspective because it feels like there’s a there’s a weight of evidence that suggests tackling obesity will save money in the long term because of other chronic co-morbidities and so I guess there’s a we’ve got to find a way
Of expressing this to um we need to find think about who we can write to about this because I do think there’s a it’s it’s a Act of corporate like um we’re missing something if we’re not working all together to find more funding to
Tackle this um and so I don’t know if we need to write to the minister appropriate Minister raising this as a concern but I think it feels like um it’s like everyone’s saying there’s a funding issue um and that’s not just a political organization which it lead
City council leads it’s also the ICB and GP Federation which are not political organizations um okay so we’re going to move on to our fourth paper now and hopefully this will um be a little bit more positive around uh around I I call I call this tier one I’m not sure it’s
Technically tier one um but like lifestyle choices and we’ve talked about how active lifestyle is important in the um the the fight against weight and so I’m going to start with counselor Arif and then we’ll move on from there thank you thank thank you chair so yeah the
Report provides an update on the physical activity ambition for leads which is being led by active leads and public health it includes details of the work programs achievements delivered against the priorities of active environments and active people which were selected as the initial Focus for the physical activity ambition uh which
We discussed and agreed by the which was agreed and discussed U by the physical activity ambition Steering group the health and well-being board and also the this scrutiny board back in 2022 as we discussed earlier in the discussion um there is clear evidence that being physical active is essential
For good physical uh and mental health and delivering the best city ambition which is lead is a place where everyone moves more every day whilst the latest physical activity data highlights that lead Compares well uh with other core cities and neighboring local authorities there is much more to be done on
Inactivity levels the levels of inactivity in the city remain highest in the most deprived areas uh which is where we are focusing our resources the report describes progress uh across the seven workstreams of the physical activity ambition one example that I want to highlight is the department for transport funded active travel social
Prescrib project in the burms hair Hills and Richmond Hill Primary Care Network area of the city the project aims to increase physical activity levels through prescribing walking and cycling in primary and secondary care links between infrastructure and development both new and existing existing will also try to encourage more active travel uh
Looking forward to a good discussion thank you chair Jane do you want to make any opening comments or Steve y thank you chair um yeah I won’t go over what um cancer just kind of described but yeah there has been lots of positives um that we’ve kind of done
In terms of some of the work effort that I just wanted to highlight but also just to say that this is the physical was the ambition so this is as part of the Citywide kind of initiatives in terms of the Partnerships we’ve got across third sector and GPS and everything else that
We’ve we’ve brought together um so that’s the whole kind of picture it’s not an actively is kind of General kind of update um which obviously is a lot of areas of work that we’re kind of progressing with um but some of the key achievements um like cancel Ro already highlight
Department for Trans Sport element but also children and young people side of things um in terms of young minds get active um which in terms of the campaign the report kind of highlights you know that was a fantastic piece of work that kind of delivered with um children in um kind of
Making their own videos around physical activity uh on and their effects on Mental Health which again um The Campaign has been really welled and um in terms of the reach of young people um has been really highlighted on that front similarly in terms of the Aging well and strength and balance campaign
It’s one of the best kind of campaigns in terms of the reach that we’ve kind of be able to have as part of all that um so again it just shows that the fiscal the element that is kind of making and is getting to the people that they kind
Of need it and then lastly like we kind of spoke around in terms of um earlier in terms of our leak program which is our lead encouraging activity in people pilot um again record numbers coming through um unfortunately waiting list has been created as part of all that
Kind of demand um in terms of physical activity and the need for it which is currently working in a couple of four-part primary care networks um currently working in that kind of clinical pathway um but specifically around diabetes um mental health and hypertension um El that we’re kind of
Getting referred into that at that this point in time and that is a self-referral program um as well so we don’t have to go through that clinical pathway um but the numbers that we’ve kind of reached so far and the impact we’ve had from the research that leads
Becket have done is showing that we are actually targeting the right people we are getting to the inactive people um and we’re making lasting improvements in terms of that physical but more importantly as well that mental health kind of benefits on that program um but unfortunately very very similar kind of
Elements um in terms of resources wise that is a pilot program and we need kind of to make sure we can sustain that program because it is um reaching the people that we require it um but yeah it’s stuff that we kind of are working through at this point in time but yeah
Thank you for taking the time to read the U report there is a lot more we can do and a lot more we need to do in terms of the inactivity side of things especially in the inequality side um but but that’s where we are trying to put
Our Focus attention at this stage thank you thank you very much I’m going to open up to questions but just a couple of comments if in case members want to think about it so on page 52 it’s positive to see the activity rate increasing I think there’s still a
Challenge to keep pushing it up back to pre-co levels and hopefully beond there I think that is a really important aspect just like to say gets at local stuff certainly my w has been really positive um some excellent officers have um been involved in that work um along
With volunteers which has been really really positive to see and people getting active in different ways we’ve had a a skate a skate uh Club um in our in my ward which has been really good and the other thing I think that’s just worth mention is they’ve done well
Getting outside funding so from all sorts of sports associations for our facilities here in needs um councelor Richie I’ll bring you in thank you chair yes I agree it’s an excellent report uh very positive uh great ambition and and great delivery thus far if I may who appear to be a
Critical friend I would like to see it augmented perhaps by a report specifically on people with a learning disability because it’s referenced on page 21 about the high levels of obesity in that group and I do think and I know there is work going on through disability partnership board and so on
But I’d like to see that referenced in the report and just maybe tweak out any barriers to access and so on how we could add that so that’ be my constructive uh comment towards next the next year’s uh report thank you yes you’re right to highlight in
Lear difficulties element um and is an area that we kind of prioritize in terms of that those priorities in terms of the to people side of things so we are doing a lot of work in that area and yeah we need to reflect that in report so um
We’ll do that for next time to make sure that that highlights that element as well um but again there’s huge amounts of work that is happening but we can always do more on that front thank you very much um so I think we’re we’re moving toward the end of
This section um but I’d like to give an opportunity for anyone who um of our guests and partners who want to make any any further comments about the conversation um any other observations they want to make based on what they’ve heard today just give people opportunity
I’ll start with Jane and then if you if you want to please indicate thank you councelor Scopes um I suppose the other element that the physical activity strategy it touches on and a couple of members around the table have mentioned around parks and green spaces which are
Are a critical part of physical activity health and well-being but they’re also used by millions of people in our cities every day whether that’s Sports pitches sports clubs coaches dog walkers tennis players and they’re a really important asset and Council Richie will recall fondly our time spent together building
Up six leveling up bids across the city that were unsuccessful um fortunately we’ve been able ble to secure some funding for the hbec scheme uh and we’re still working on other schemes in the background so the work’s not wasted but that was all directly about investment into green
Infrastructure and it’s it’s the one area that we could really prioritize investment into and get maximum benefit out of with little part partner intervention so there are probably about 200,000 people that use our Sports pitches every year and they’re a really important part of our infrastructure and those sports
Clubs probably fall under the radar of conversations like this and probably need a little bit more space to be able to articulate what they do so it’s just I just wanted to touch on that I thought it was important yeah thank you very much janen and with my school Governor hat one we’d
Call out the universal offer so the basic offer that everyone has available to them um and absolutely do value that and investment need needed which is exact why um sort of linking it back to the investment we’re getting from third third parties and I think that’s that’s really um
Important um I can’t see anyone else indicating um so i’ just like to take a moment to thank everyone for coming I I really appreciate you sitting through the whole thing um I found it really helpful and I’ve found your comments and insight useful um I feel like we’ve got
A suggested Way Forward at least a little bit of a way forward from a be uh to keep us uh um moving forward um so yeah thank you for your time thank you for your papers um and thank you for your inut okay I’m gonna I’m going to
Let you guys go go now I think most the the items now are are internal so you don’t you don’t need to sit through them obviously it’s a public meeting so you’re welcome to uh sit sit and enjoy the next uh next phase of our meeting if
You wish okay so I’m going to move on to item eight so uh this is the end of year scrutiny report um I’m not going to say anything about it because you’ve read it are there any comments to be made if there’s no comments uh we’ll take it as
Agreed okay Y super thank you okay I’m going to move on to item nine which is the work schedule now this is always a challenge because obviously we don’t know who’s going to be on the successor board that’s a that’s a Democratic process to be G gone
Through um and it’s useful to give some items particular for the first couple of meetings um but if you’ve read it and or have any comments and or have any work items that you’d like us to recommend to the successor board please tell me but just note that the successor board will
Have discretion at their first meeting after the elections to decide what’s actually on it thank you saari thank you chair um so just Just for information for for the rest of the committee I had had a quick discussion with the chair prior to uh prior to the meeting following a conversation that
I’d had with um a consultant nephologist uh working in leads Dr Sunil dger um and I bumped into him at the opening of one of our new surgeries in in hair Hills um and he is very interesting because he wants to talk about kidneys uh and good
Kidney Health um currently some of the key stats for um around chronic kidney disease uh it currently impacts on 10% of the um population and that’s between stages 1 to five but predicted dialysis growth is going to be around 400% within the next 10 years um and by 2040 it’s
Going to be the fifth leading cause of premature uh death um for general population a um so what I’m going to suggest is because I think there’s a public health role here um that we could look at this as part of our um part of our ongoing discussions around uh
Improving Public Health but also looking at how we can prevent um how we can help to prevent um kidney disease across uh across leads soorry thank you kis did you want to come in yes if I may it just so happens that Dr was my mom’s early Consultants actually my mom said a
Kidney transplant um I I think it’s something that we don’t perhaps talk about much and I think it’s really important that we do and from a public health perspective I think this is really important agenda um so i’ fully support that recommendation thank you thank you I I thought it’d be really um
I thought it really interesting item and I thought we need to think about whether we bring it in with sort of wider Health messaging because there’s a lot of Health messaging that does get out about um chronic diseases but this isn’t certainly one that I’m aware of and
Maybe that’s me or maybe I haven’t had my uh haven’t been educated probably a bit of both um and also I think there’s there’s a number of chronic diseases in the city which which we might want to look at so we’ll definitely make a note of that are there any other items anyone
Wants to put on now in case they’re not on the successor board no good okay so just um like to say thanks I’ve had a good time this year I feel like we’ve covered a lot of different items um I feel like we’ve had some good debates and uh
Challenged uh appropriately as we should um so thanks for your support um I won’t see you again until uh in this committee until after May unless there’s a call in which I I hope I hope there isn’t just there for for ease I guess but thank you
Very much for time and commitment to the board and um I hope you have a good uh next couple of months okay thank you there’s there’s there’s so there is a chance um that so thank you very much I’ll take that councelor could you beci