What do you think of plans to improve our city’s wellbeing and health?

Posted on 17/04/2013 at 07:59

The council and its partners recognise that tackling inequalities in wellbeing and health and improving wellbeing and health for all involves both:

  • improving the conditions in which people are born, grow up, live their lives and grow old, and,
  • strengthening the impact of services we provide and commission.

Newcastle City Council’s Vision for Public Health and Thematic Briefings

In April 2013, Newcastle City Council took over lead responsibility for public health in Newcastle.  The council sees this as a once-in-a-generation opportunity to change lives across Newcastle for the better, and this is reflected in the paper 'A vision for Public Health in Newcastle'.

As part of the new responsibilities, the Council has taken over the role for commissioning a range of ‘public health’ services from the former Newcastle Primary Care NHS Trust.  These services are grouped into eight themes as follows:

All of these topic areas require a range of policy actions as well as service provision.  In order to focus in on the new commissioning responsibilities, the council has created the Thematic Briefings (above) which outline the policy context; current understanding of needs; existing service provision and intentions to change or re-configure what is commissioned.

The Council is now consulting on the Vision for Public Health and the eight Thematic Briefings.  Please leave your thoughts on the topic wall.  

The consultation runs until 17 July 2013.

Communities and neighbourhoods

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Terrible economic damage is being done to Newcastle through negative images sent to potential investors and economic talent visiting from outside of the region as a result of the booze culture. It is not just their own health that is being harmed, but others through the contribution to economic deprivation resulting from negative branding. Any contribution to the economy from licensing revenues or visiting stag parties or the like is far outweighed by the broader health, wellbeing and economic impact.

I flew from Newcastle airport at 8am yesterday morning and was staggered that there were far more people drinking beer than coffee. This is a terrible indictment.

There needs to be a strategy to migrate Newcastle from a city of booze to a city perceived as being of nighttime culture.

1. remove licensing permits for anywhere before 11am, including the airport.
2. make licensing permits conditional on minimal unit pricing at particular premises
3. reward with lower levels of licensing fees those establishments which promote less alcohol fuelled drinking patterns
4. make licensing permits conditional on door staff breathalysing individuals after a certain hour and refusing entry to individuals above a certain level of alcohol

Posted by hugh55 on 17th Jul 2013 at 9:52PM

Response to the Newcastle 2016 Public Health Thematic Briefing: Drugs and Alcohol – Commissioning for recovery

As a team engaged in the study of alcohol use and health, we welcome this substantial initiative to prevent, and support recovery from, substance misuse. It is encouraging to see the prioritisation of multi-agency working to address broader issues associated with, or arising from, alcohol problems and to create pathways to support for those suffering problems but not engaged with specialist services. This is particularly important in helping those with co-morbid physical or mental health conditions, which can undermine attempts to treat alcohol problems on their own. The document also recognises the continuum of needs in proposing to commission various forms of support that research shows to be valued by particular sectors but difficult to access, such as peer support groups not specific to substance use, a recovery community and ongoing support in the wake of detox or rehabilitation.

From the perspective of public health in relation to alcohol, there are some risks to having a combined strategy to address both alcohol and drug misuse. Such an approach starts from a focus on addiction rather than prevention, and so is oriented towards recovery from dependent substance use. In England 26 to 39 per cent of men and 17 to 27 per cent of women drink alcohol at levels that are hazardous or harmful to health [1] and 8.7 per cent of men and 3.3 per cent of women are dependent on alcohol [2]. There is therefore a broader impact on public health from alcohol than just that arising from dependence, as witnessed for instance in the current record rates of liver disease. A focus on commissioning for recovery from dependence may also encourage this large community of heavy drinkers to think the issue is about people with severe problems in mental health services rather than about them, and that services are therefore not appropriate to themselves and their needs. Heavy drinkers are also likely to be reluctant to access services for those using illicit substances. However it is also clear that there are strong links between problematic drug users and problematic alcohol users, and within the specialist sector the substances may need to be looked at together.

At many points it is emphasised that commissioned services must be demonstrably evidence-based and effective. We strongly support a commitment to building and translating the evidence base, supporting service providers in keeping pace with best practice and ensuring that knowledge is disseminated and acted upon across a very wide workforce. There is substantial evidence for the effectiveness of preventive methods such as screening and brief interventions in reducing harm from alcohol consumption among the general population. Prevention and early intervention to tackle drinking before it becomes dependent are acknowledged in this document as important, but are not consistently included and emphasised. For instance, the Summary of needs analysis does not cover the needs of heavy drinkers not accessing specialist services. The importance of brief intervention capacity across the workforce is discussed under section 5.10, but as an adjunct to pharmacological support. Section 5.15 states that problems with alcohol and drug use in pregnancy are particularly complex and therefore require specialist support. This is certainly the case if an individual’s alcohol problems are severe, but the more widespread impacts on pregnancy from relatively low levels of alcohol consumption can be practically and effectively addressed with interventions delivered by non-specialist practitioners. Commissioning to address harmful drinking before it escalates to dependence will reap substantial public health benefits in the longer term.

We note that the document distinguishes between the needs of those younger than 18 and those older. This is an important distinction when planning commissioning as the evidence base for screening and brief intervention with young people in the UK is still developing. However patterns of need change across the life course and it will also be important to respond to emerging trends at different stages of adulthood, recognising that not all services suit all users with similar levels of need. For instance, although there is a clear intention in the document to tackle problem drinking in licensed premises, this will not address the burgeoning trend towards heavy drinking at home among parents and working professionals. In particular, rates of problematic or unhealthy drinking are increasing among adults in later life, when changing health states mean that risks from alcohol are greater and at lower levels of consumption than in earlier life. Newcastle has an ageing population, and as a city aspires to be at the forefront of age awareness. An emphasis on flexibility and diversity in service provision will facilitate support for this sector, who may for instance benefit most from out-of-hours provision. Commissioning a bespoke alcohol service or services for older people would address a clear gap in current provision, and it would be good to see this sector‘s needs recognised in the diagram of services on page 18.

Finally, the overall focus in this document on services to identify and support individuals is positive. However, tackling the identified problem of Newcastle’s ‘party city’ culture is important in protecting public health; although valuable initiatives such as tackling alcohol pricing and harmful advertising are mentioned, these might be most effectively deployed if woven into a more coherent community-level strategy.

1. Health and Social Care Information Centre (2013) Statistics on Alcohol: England, 2013.
2. NHS Information Centre for Health & Social Care (2009) Adult psychiatric morbidity in England, 2007: Results of a household survey.

Dr Graeme B Wilson
on behalf of the alcohol research team at Institute of Health and Society, Newcastle University

17th July 2013

Posted by Graeme Wilson on 17th Jul 2013 at 5:57PM

My comments are with regard to the Council's draft Public Health Strategy - although it was not possible to see the Children and Young People strand document as the link just takes you to the overall vision.

I like the idea of the four big themes that the Council is working to, and I think I get the concept of Progressive Universalism as an overriding ethos. However I am amazed to see that mental health as a public health issue receives such scant mention, either as a specific need, or as part of an overarching theme.

Time and time again the documents refer to the usual suspects, tobacco, alcohol, obesity, ageing, long term conditions, and infections and hazards. Even oral hygiene gets its own strand. And yet MH - which by the government's own figures represents the single biggest disease burden for the country as a whole - seems to be mentioned only in passing, and does not merit its own thematic strand. The national MH policy and its implementation framework aren't even referred to, despite the fact that they emphasise the importance of a whole population approach.

This overall position seems to suggest that mental health and emotional wellbeing is not high on the Council's list of priorities for public health and runs contrary to the advice set out in the LGA/DH Guidance for mental health wellbeing and communities (resource sheet 11), which clearly recommends that a public health approach to mental health should form a key part of any overarching strategy, and that this should include recognition of the links between physical and mental ill health.

In terms of more detailed comments, and in no particular order:

1. Will the emphasis on health checks be reviewed given the recently published research evidence questioning the effectiveness of health checks?

2. There is mention of £50k Wellbeing fund, which has in the past been used for initiatives that have included mental health. My understanding is that this could be lumped in with the Newcastle Fund. I am concerned about this as it will no longer be ringfenced for specific PH and MH initiatives

3. To prove my overall point, section 6 on page 8 of your vision document sets out a summary of your understanding of need. There are no bullet points or headline figures about MH whatsoever and this seems to sum up a kind of blindness that runs through the whole strategy

That a PH strategy should contain such omissions at the best of times is surprising. To appear to ignore MH at a time of economic hardship seems almost wilfully irresponsible. I urge the Council to consider again the place of MH in its PH strategy and vision, and to seriously reconsider how much of the £20m budget is allocated to MH PH interventions.

Many thanks for the opportunity to contribute, Steve Nash, Chair of VOLSAG, s.nash.volsag@mentalhealthconcern.org

Posted by Steve Nash (VOLSAG+) on 16th Jul 2013 at 12:38PM

I am extremely disappointed to see little to no overt mention of mental health in the strategy, which would be a very regressive step, given that mental health Public health has previously had some presence and profile in the City.
MH problems currently affect at any one time point one in four people in the UK. The incidence of MH problems in the UK is twice what is the average across mainland Europe. Currently MH problems, and depression in particular, are the single highest cause of disability across Europe. Given the levels of poverty within Newcastle, one would expect MH problems to have a higher prevalence here than national averages.

There are concepts within the draft PHS that are to be applauded. The idea that public health is a shared public good to which all citizens should actively contribute is an appropriate and bold message; as is a ruthless and unyielding focus on socioeconomic and health inequality. However, the draft PHS is lamentable in regard of an almost complete disregard of MH in Newcastle.

The draft PHS makes scant and often only passing reference to MH. MH is sometimes mentioned only as an afterthought: teenage mothers being at increased risk of MH problems is such an example. Where MH is mentioned, it is as a component of Wellbeing - which it undoubtedly is - but its significance to the city's public health is not so much highlighted as buried within this rather woolly concept. Currently no cogent and coherent population-wide strategic approach to promoting MH in individuals, communities and in the workplace exists in the PHS.

Posted by AlisdairC on 3rd Jul 2013 at 2:53PM

I am extremely disappointed to hear of plans to close the Specialist Weight Management Programme level 3. I initially attended an 8 week programme designed to help obese people reduce their weight and increase their mobility. We all know the basics eat less, be more active-simple!!!
In the real world its not that easy, we overeat for various reasons.
The programme educates giving advice on food nutrition, exercise, portion control etc along with encouraging the participation of the exercises at the end of each class.
At the end of the programme you are not abandoned, you graduate to the Progression group where the staff continue to support, motivate, help and advise. The emphasis in the Progression group is on exercise, catering for all levels of fitness, more challenging for the more active. I have lost 4 stone and massively increased my fitness level since starting the programme, joining a gym, I play golf and I now walk instead of automatically taking the car.
I continue to need the motivation and support of the group attending the Progression group on a weekly basis. The level 3 Programme is aimed at people with a huge amount of weight to lose, many of them considering various weight reducing surgeries and procedures. I cant believe it has been decided to scrap the programme when there is such an obesity problem and there will be no alternative provided.

Posted by Dorisday2915 on 19th Jun 2013 at 10:09PM
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