P 74

Ymchwiliad i’r Adolygiad Blaenoriaethau ar gyfer y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon

Inquiry into the Priorities for the Health, Social Care and Sport Committee

Ymateb gan: Iechyd Cyhoeddus Cymru

Response from: Public Health Wales

National Assembly for Wales – Health, Social     Care and Sport Committee Consultation 2016

1. Public Health Wales believes that the Health, Social Care and Sport Committee has a significant opportunity to place a spotlight on pressing challenges and evidence based solutions regarding improving health and well-being in Wales. In addition to areas already identified for long term focus by the committee, such as sport and public health, gambling addiction, loneliness and isolation among older people, Primary Care, our submission highlights other areas the Committee could consider as part of their work.

2. Public health challenges and priorities

        Wales faces significant challenges to improving health and well-        being including:

· Tackling inequity in health – we know that there is a substantial and unacceptable gap in health and well-being between people living the most and least deprived areas of Wales

· Improving early years experiences – life before birth and during early childhood shapes health and experiences of inequalities in later life and therefore needs to be a topic of focus

· Improving mental well-being – poor mental well-being impacts on physical health and social inequalities and is a fundamental component of good health

· Shifting to a partnership model of prevention – our current system cannot continue to meet increasing demand and is not financially sustainable. Partnerships with individuals, communities and between public services and different sectors should help to deliver a better focus on prevention

· Improving healthcare outcomes - further improvements could be made through focusing on quality of care, patient safety, innovation, sharing and implementing good practice.

3. Public Health Wales’ strategic priorities have been identified as  means by which we can contribute to addressing these issues and include adopting a multi agency systems approach; working across sectors to improve the future health and well-being of children; supporting primary and community care services to improve the public’s health; supporting the NHS to improve outcomes for people using services; and continuously improving the quality, safety and effectiveness of the services we deliver.

4. The Well-being of Future Generations (Wales) Act provides a legislative framework and driver for adopting a more radical and transformational approach to the way we work. More specifically, the Committee has an opportunity to use the Act as a lens through which it undertakes it scrutiny function, thereby facilitating the embedding of the Act.

5. Investing in sustainable health and well-being

       Public Health Wales has published a report “Making a Difference: Investing in Sustainable Health and Well-being for the People of Wales”, which draws together expert opinion and research evidence on effective and sustainable solutions that are worth investing in to optimise health in Wales. The report highlights how removing the causes of poor health and inequalities saves lives, money and improves mental, physical and social well-being. Prevention has both short and long term benefits for not just the health system, but also for communities, society and the economy.  

6. The report identifies three priority areas, which are enabled by legislation and approaches such as the Well-being of Future Generations Act, Prudent Healthcare principles and a systems working approach of building partnerships and synergies across sectors and stakeholders. The priority areas are:

a. Building resilience across the life-course and setting

          Specific areas for action include:

·   Ensuring a good start in life for all

·   Promoting mental well-being and preventing mental ill health

·   Preventing violence and abuse

b. Addressing harmful behaviours and protecting health

          Specific areas for action include:

·  Reducing smoking prevalence

·  Reducing prevalence of alcohol misuse

· Promoting physical activity

· Promoting healthy diet and preventing obesity

· Protection from disease and early identification

c. Addressing wider economic, social and environmental determinants of health

          Specific areas for action include:

·  Reducing economic and social inequalities and mitigating austerity

·  Ensuring safe and health promoting natural and built environment

7. There are already examples of partnership working to address the priorities identified. The United in Improving Health initiative, which includes representatives from the NHS, Local Authorities, Welsh Government, the Police, Third Sector, academia and local services, has identified the first 1000 days of life as a priority for action, with the aim of improving outcomes and reducing inequalities through realigning existing local and national resources.

8. Public Health Wales is using the findings from the report to further shape its strategic priorities for 2016-17. The report has been shared with partner organisations, with the aim of supporting the implementation of the Wellbeing of Future Generations Act.

9. The Committee may wish to consider the report when identifying areas for focus of its work.

10. Adverse Childhood Experiences

To date, Public Health Wales has published two reports which examine      the prevalence of adverse childhood experiences and their impact on health and well-being across the life course. Adverse childhood experiences include abuse and neglect of children, as well as growing up in households where children are routinely exposed to issues such as domestic violence or individuals with alcohol use problems.

11. The first report links these experiences with health harming behaviours in the Welsh adult population and the second examines the impact on mental well-being. A third report, examining the use of health, social care services and premature mortality will be published later in 2016. Children with greater exposure to adverse childhood experiences are more likely to develop health harming and antisocial behaviours e.g. being a high risk drinker, smoking tobacco, committing violence or being incarcerated, as well as reporting worse mental well-being. 

12. The reports provide compelling evidence about the need to prevent adverse childhood experiences, to not only benefit those children, but also future generations in Wales. Preventing such experiences is also likely to reduce pressures and costs on the NHS and improve outcomes for the health, social, criminal justice and educational systems. 

13. Recognising the importance tackling Adverse Childhood Experiences, Public Health Wales is translating the findings into practice. For example, the ‘Early Intervention and Prevention: breaking the generational cycle of crime’ project aims to increase early intervention, prompt and positive action by ensuring that the police and partners have the right knowledge, skills and support in place so that they are able to identify and respond appropriately and effectively to early indicators of harm and vulnerability through the lens of Adverse Childhood Experiences. 

14. Public Health Wales recommends the Committee consider how these findings could be used to inform its work programme.

15. Broader determinants of health and well-being

Tackling the wider determinants of health is pivotal to achieving the types of improvement in health and well-being – and the reduction in health inequalities – that are required in Wales. However, while National Assembly Committees facilitate discussion and action around a broad range of public health issues, we are concerned that the specific focus of each may not encompass a review of overarching problems facing the Welsh population. Such issues include housing-related matters (covering home safety, carbon monoxide, falls prevention, poor housing conditions), climate change mitigation and adaptation, outdoor air quality and other built and physical environment concerns such as sustainable design and planning for healthy communities and road traffic crashes and casualties.

16. Such public health priorities pose significant challenges as they   require multi-faceted solutions that can only be achieved through multi-agency and multi-disciplinary collaborative action. There is a concern that these matters do not fall under one Committee, but rather straddle them all, with the associated risk that they may not receive the required attention. We would advocate that National Assembly Committees consider these overarching priorities

17. Other areas of focus

Specific areas we would recommend the Committee focus on, over the   forthcoming term include: 

· Immunisation and vaccine preventable diseases. For example, expanding the children’s influenza programme is expected to impact on reducing morbidity and mortality at all ages and associated NHS winter pressures due to influenza because children are ‘super-spreaders’; Improving uptake of immunisation among school children, particularly aimed at preventing meningococcal disease and eliminating measles; Implementation of human papillomavirus (HPV) vaccination for men who have sex with men through sexual health clinics in Wales; Introduction of universal hepatitis B vaccination to the infant schedule (subject to UK procurement of a cost effective vaccine).

· The use of real-time genomic diagnostics in the community. This is likely to have a significant impact in providing fast and accurate diagnostics for infectious disease e.g. for disease surveillance or responding to disease outbreaks.

· Ensuring that Welsh Language and culture is a consideration in the services we provide to the public.

18. About Public Health Wales

     PHW is an independent NHS body that has four statutory functions.   These are to:

· provide and manage a range of public health, health protection, healthcare improvement, health advisory, child protection and microbiological laboratory services and services relating to the surveillance, prevention and control of communicable diseases;

· develop and maintain arrangements for making information about matters related to the protection and improvement of health in Wales available to the public; to undertake and commission research into such matters and to contribute to the provision and development of training in such matters;

· undertake the systematic collection, analysis and dissemination of information about the health of the people of Wales in particular -including cancer incidence, mortality and survival; and prevalence of congenital anomalies; and

· provide, manage, monitor, evaluate and conduct research into screening of health conditions and screening of health related matters.