Agenda item

Considered – a presentation by Louise Wallace, Director of Public Health, Jenny Loggie Strategic Lead for Population Health and Inequalities, and Dora Machaira, Health Improvement Manager. The presentation centred on guidance for what could be done to keep well over winter, including practical solutions such as increased ventilation and staying away from people when unwell. Vaccination programmes were also discussed, and the importance of MMR vaccines was highlighted due to an increase of cases nationally. Reference was made to the value of working with multiple services to ensure those who did not regularly access NHS facilities received information, through the Stronger Communities team, fire and rescue services, as well as adult social services etc.

Following the presentation, questions from members concerned:

-       Local data on trips and falls, seasonality and injuries sustained.

-       Measures taken to prevent falls and what more preventative work could be done by the council e.g. increased gritting?

-       The figures on MMR vaccine uptake in Scarborough and Whitby

-       Recommended levels of ventilation and preventative work around winter infections.

-       Dental provision for residents who had struggled to access services since a closure on Eastfield Road – steps to alleviate this?

In reply, members were advised that:

-       The data requested on trips and falls would be provided. Please see data below and supporting information which was provided following the committee:

Context and latest data for Scarborough (number of people):

Source PHOF 21/22 data.

Falls prevention is a complex area with over 400 risk factors, for example, polypharmacy, cognitive impairment, vision impairment, continence, foot-pain, environmental hazards, postural stability etc.

-       One in three people aged over 65 has at least one fall each year (many go unreported)

-       Half of those aged over 80 have at least one fall each year

-       One in five people who have had a hip fracture will enter long-term care during the year following the injury

-       Falls are the commonest cause of death from injury for those aged over 65

-       Significant cost: estimated at £4.4 billion in the UK each year, of which £1.1 billion is social care costs

Currently 27.5% of the Scarborough population are over the age of 65 but this is expected to increase to 36% which means the number of falls will increase. Some areas of Scarborough are already higher than this e.g. Filey and Hunmanby (36.6%).

However, there are effective evidence based interventions that can help to reduce the risk of falls and fracture. World Falls Guidelines have been produced setting out what local areas can do to prevent falls.

-       The Director of Public Health would share a report from a recent conference on falls prevention - measures included promoting use of slippers, medication reviews, increasing strength-based exercise, and identifying trip hazards in the home.  Gritting pavements was a Highways matter. Please see response below which highlights recommendations following the falls summit:

Local response

A falls summit was held recently to look at how organisations can work together to prevent and respond to falls and the following recommendations were made:

Develop a strategic approach to falls

-       Establish a working group to take forward a renewed focus on falls prevention and responding to falls. Explore the need to establish locality groups as well as countywide

-       Keep stakeholders updated on developments and explore opportunities to bring partners together in future

Pathways and services

-       Develop a clear pathway from prevention to responding to falls to ensure there is equity in provision across North Yorkshire. Needs to include risk stratification – identifying people as low, intermediate or high risk

-       Review assessment tools in line with the world falls guidelines (WFG) with a view to have a single consistent falls assessment

-       All health and care professionals should ask about falls history – opportunistic case finding

Training and awareness raising

-       To explore opportunities to raise awareness of falls prevention amongst the public and professionals

-       To identify opportunities to develop a comprehensive training programme for professionals

Physical activity

-       Promote the importance of having a broad leisure offer to increase physical activity amongst people at low/medium/high risk of falls – feed into leisure review

-       Include physical activity options in the falls pathway (for people at low, medium and high risk of falling)

Care settings, housing and wider environment

-       Develop a comprehensive training programme for care settings (linked to practice such as safety huddles)

-       Identify opportunities to gather better data on the causes of falls to inform action around links to the wider environment e.g. pavements.

Urgent falls response

-       Crisis response services to work with YAS and community pendant alarm providers on clear pathways in each area for falls pick-ups

-       To have in place a mapped pathway for each area that is also available digitally

Work has already begun on addressing some of these issues and an action plan is being drafted and a county wide working group established. Some areas have expressed an interest in setting up locality sub groups.

-       Locality level data on MMR data is not routinely reported (immunisation data is reported at North Yorkshire level), however Public Health have been working with GP practices and other partners to address areas with low uptake. In Scarborough town there is a lower uptake of vaccines. However, uptake for the MMR vaccine was trending downwards locally, regionally and nationally which was an issue which required collective action.

-       Regarding ventilation levels, air quality was stressed as important, and any ventilation was better than none; it was recognised that during the winter months this was a challenge due to cold temperatures. Public Health had been raising awareness of this in schools and now care homes in North Yorkshire, with other methods of prevention including vaccinations, and hand hygiene.

-       Jenny Loggie, Strategic Lead for Population Health and Inequalities would feed back the problems encountered by Eastfield residents in accessing dentistry and provide a response to the committee. The response is outlined below:

For dentistry in Scarborough, to confirm that following the closure of the Eastfield dentist, a procurement exercise was undertaken for a new dentist in Scarborough.  This was awarded to Smile on Falsgrave Road.  Following a period of set-up and mobilisation, the Smile dentist opened approximately in July 2023 and patients from Eastfield were informed that they could register there.

Since then, a visit took place with the team at Smile in Sept 2023 to understand the new contract and how they were getting on with the delivery.  Discussions were had around challenges, which are affecting all dental practices, with regards to securing permanent dentists who are willing to work in the NHS.  Many dentists make the change to work in private services.  Smile is very committed to offering NHS dental services and as such, struggles to retain dentists who want to move to private work.  In addition, Scarborough (along with other coastal locations) does struggle to recruit healthcare professionals whether these are dentists or GPs, etc. so Smile is affected by this national trend.  Smile do have a presence nationally and have good recruitment methods, where they aim to fully recruit to the practice and even have a flat available for new recruits.  Workforce recruitment and retention are a challenge across the ICB, and we do have a transformation plan in place, but it will take time to train, recruit and retain dentists in our area.  The ICB is developing plans to establish Centres for Dental Development which aim to train and retain the workforce within the ICB.

For Scarborough specifically, we are aware of pressures in the town and are working with existing providers to offer additional investment (non-recurrently) to increase the number of urgent access sessions available.

As with all dental providers, we do follow the nationally agreed methods for contract management and will recover any funding owed if practices are under-performing.  Where this does occur, the funding is reinvested non-recurrently to boost provision where it is needed.  Scarborough does feature in our reviews in terms of an area of need and where further investment is required so we do aim to reinvest in the town when possible.  As an ICB, we continue to prioritise our identified areas of need.  Nationally, dental provision is facing significant challenges with regards to access and workforce.

Resolved – That the presentation be noted.