►
Description
AGENDA
1. Declarations of Interest 00:04:56
2. Minutes 00:05:05
3. Public Participation 00:09:44
4. Arrangements for Policy and Scrutiny in York 00:09:55
5. Presentation from the Director of Public Health 00:25:59
6. Work Plan 2019/20 01:13:15
For full agenda, attendance details and supporting documents visit:
https://democracy.york.gov.uk/ieListDocuments.aspx?CId=968&MId=11635
A
Good
evening,
ladies
chespin
sites
bye,
she
sought
make
a
startling
welcome
to
the
City
of
York
council,
health
and
adult
social
care
policy
and
school
committee
just
a
few
bits
of
housekeeping
we're
not
expecting
the
alarm
to
sound
tonight.
So,
if
it
does,
we
need
to
leave
by
the
nearest
stairwell,
which
is
just
through
here,
and
the
assembly
point
is
by
the
hotel
on
the
right.
A
A
A
Okay,
the
minutes
of
the
previous
three
meetings
are
here
reason
being
the
January
and
February.
Is
it
here
because
I
didn't
feel
like
I
could
sign
them
off?
I've
made
comments
previously
about
they've
been
able
to
ensure
that
we're
able
to
attribute
actions
to
either
officers
or
organizations
that
are
attend
and,
and
indeed
councillors
and
I,
didn't
feel
it
necessarily
reflected
in
the
way.
It's
not
the
style
that
the
the
officers
have
taken.
A
It's
the
style,
the
counselors
as
us
as
a
star
when
it
take
us
to
write
them,
and
it's
something
I'm
not
entirely
happy
with
I've
made
that
clear,
previously
I
do
think
the
March
minutes
do
give
slightly
better
indications
of.
Are
they
it's
some
of
the
parts
of
it?
It's
give
an
indication
of
the
officer
title
as
as
suggested
one
thing
or
said
another
and
I
think
that
that
that
I
do
prefer
that
style.
One
thing
that's
Chris
suggested
to
me
that
might
be
a
way
around.
A
It
is
to
have
the
officers
names
for
each
agenda,
item
and
I
think
that
that
will
be
essentially
a
way
around
it,
rather
than
repeat
names.
You
know
on
and
off
you'll
be
able
to
actually
see
clearly
who
attended
and
from
that
way,
I
think
it
would
improve.
You
know
possible,
possibility
of
future
scrutiny
and,
as
I
say
it's
not
just
picking
it
officers.
A
It's
it's
important
from
a
point
of
view
might,
in
my
view,
when
we
would
have
got
outside
outside
organizations
attending
as
well
so
I
just
want
to
to
to
put
that
on
record
I.
Think
it's
useful
actually
that
you've
got
the
much
young
me
on
March
minutes
anyway,
because
particular
for
the
new
members
you'll
be
able
to
have
a
bit
of
a
flavor
for
what
we've
been
discussing
so
I
think
it's
actually
useful
from
that
point.
A
B
A
I
mean
I,
don't
want
to
make
a
big
deal
of
it
raised
it
several
times
now
and
it's
something
I'll
I'll
put
in
writing
too
much
Democratic
services,
specifically
bearing
in
mind
we've
got
a
piece
about
how
scooty
works
in
here.
Yes,
I'll
do
a
follow-up
to
them.
For
that
and
we'll
call
it
a
day
in
that
respect,.
C
If
I
could
just
make
a
point,
Jeff
yeah,
the
question
of
minutes
has
been
discussed
by
group
leaders
twice
during
the
last
administration
and
there's
a
further
reports
going
to
group
leaders
within
the
next
fortnight
and
they'll
confirm
whether
the
ones
continue
with
the
course
approach
the
thought,
because
they
need
to
standardize
minutes
across
all
committees,
not
just
scrutiny,
committees
blow
across
planning
and
audio
governance
and
boy.
So
that's
been
discussed
again
by
green
meters
imminent
way.
Okay,.
A
A
Right,
thank
you.
One
thing,
I
will
just
say:
the
acoustics
can
sometimes
be
really
difficult
in
this
in
this
room
and
one
or
two
other
rooms,
particularly
for
people
that
sitting
at
the
back
of
the
back
of
the
room.
So
it's
important
that
if
we
can
all
speak
up
into
the
microphones
when,
when
you
are
speaking
and
for
those
are
new
to
it,
when
you
want
you,
when
you
wanted
to
speak,
you
press
the
button
that
says
my
egos
might
be
a
bit
obvious.
But
sir
okay.
A
We
don't
have
anyone
registers
to
speak
in
public
participation
today,
so
we
can
move
straight
through
the
the
first
agenda
or
the
main
of
the
first
agenda
item,
which
are
the
arrangements
for
policy
and
scrutiny
pages
25
to
42
in
the
agenda
when
it
so
useful.
I
think
agenda
item
this.
For
for
us,
bearing
in
mind
we
are
almost
new,
a
new
committee
and
really
if
this
is
something
that's
gonna
be
replicated,
it
has
been
replicated
again
with
other
committees
as
well.
C
Right
this
is
something
that
we
do
at
the
beginning
of
each
cycle,
just
to
give
just
to
give
members,
particularly
new
members,
and
all
the
scrutiny
function
since
the
last
round
of
meetings
that
there's
been
some
significant
changes.
The
most
significant
related
to
this
committee
is
that
the
housing
element
this
used
to
be
the
health
housing
in
adult
social
care
policy
of
scrutiny.
Committee
is
now
just
Health
and
Social.
Care
which'll
relieve
a
lot
of
the
pressure
and
relieve
a
lot
of
the
work
Lord.
It
got
to
the
stage
where
it
was
just.
C
It
would
becoming
impossible
to
do
to
do
proper
scrutiny,
and
so
the
old
committees
be
split
into
two.
So
you're
just
talking
about
how
issues
parts
of
the
reason
for
that
change
and
also
to
make
all
scrutiny,
committees
monthly,
was
to
enable
more
in-depth
scrutiny
of
key
issues
and
because
you've
had
the
housing
element
removed.
Then,
hopefully,
that
you
know
that's
going
to
develop
during
the
course
of
this
administration.
There
are
other
significant
decisions
taken
by
the
executive
following
a
scrutiny
review
into
the
scrutiny
function.
C
One
of
them
is
that
Directorate
Directorate
policies
are
shared
with
the
vice
chair,
the
chair
and
the
vice
chair
on
a
regular
basis
on
this
line.
Errol
the
development
of
a
work
plan
which
reflects
the
director
of
priorities
and
also
all
scrutiny
members
will
receive
factual
briefings
in
areas
of
chores
and
interests.
If
anybody
wants
to
review
anything,
the
others
would
receive
factual
briefings
from
them
from
senior
and
senior
officers.
So
that
again,
that's
that's
a
step
in
the
right
direction.
The
actual
report
is
just
a
basic
summary
of
how
scrutiny
house
with
equations.
C
The
main
things
to
stress
is
that
the
scrutiny
is
not
a
place
of
conflict.
It
should
be
a
place
of
of
cooperation.
I
mean
that's
that
that's
why
we
want
the
basic
aim
of
scrutiny
is,
that
is
to
ensure
the
council
provides
better
public
services,
and
many
of
the
many
of
the
activities
of
scrutiny
are
enshrined
in
in
legislation.
C
C
C
Responsibilities,
so
that's
a
nice
going
to
the
committee's
then
and
it
got
into
the
ends
of
scrutiny
and
it
just
as
I
just
said:
scrutiny
should
not
become
confrontational,
divisive.
It's
not
it's
not!
It's!
Not.
The
role
of
this
committee
to
apportion
blame
and
scrutiny
works
principles
of
good
scrutiny,
making
effective
recommendations.
That's
important
that
the
recommendations
are
smart.
C
Then
there's
pre.
We
have
pre-decision
scrutiny
now,
which
replaces
we
used
to
have
a
pre
decision
calling
which
wasn't
particularly
effective,
because
you
could
only
call
in
things
from
from
the
actual
work
program
and
that
gear
28
days
for
an
issue
to
be
called
in
which
didn't
give
enough
time
for
proper
street
proper
consideration
of
issues
and
then
and
then
to
make
recommendations
before
the
report
went
to
the
executive
always
actually
remember
with
pre
decision
scrutiny.
C
The
intention
is
for
reports
to
scrutiny
a
lot
earlier,
perhaps
two
or
three
months
before
a
final
report
is
published,
so
you
can
have
a
genuine
input
into
into
policies
as
they
develop.
So
that's
a
bit
quite
important
and
then
it
just
goes
onto
solicitor.
All
the
roles
have
first
group,
the
officers
group,
your
chairs
and
the
scrutiny
team.
So
if
there's
any
questions,
I'll
try
to
answer
them.
D
Am
thank
you
Steve
I'll,
just
ask
the
same
question
after
the
last
one,
which
is
just
to
clarify
and
confirm
which
executive
roles
and
portfolios
we
are
helping
to
provide
policy
and
scrutiny
for
and
also
the
second
question
is
just
about.
What's
been
looked
at
in
the
past,
and
whether
we
could
have
a
brief
summary
of
what
what
reviews
have
been
done
over
the
previous
administration
so
that
we're
not
wreaking
overall
goals
and
also
that
with
I
think
something
new.
Thank
you.
C
Before
the
before
the
change
in
the
committee
structure,
all
scrutiny
committees
were
linked
to
directorates.
The
previous
Directorate
was,
as
I
explained,
it
was
health
housing,
an
adult
social
care
had
that
has
the
Directorate
of
evil
and
the
previous
scrutiny
committee
Lords
issues
related
to
their
directorates
that,
since
changed
and
the
housing
elements
been
taken
away,
there's
a
separate,
Housing
Committee
now
as
well.
This
committee
is
looking
at
health
and
Adam
social
care.
C
As
far
as
as
far
as
previously
reviews
are
concerned,
it's
been
said
that
this
committee
hasn't
been
particularly
productive
and
that
probably
reflects
the
world
Lord
of
the
committee
in
the
last
12
months.
David
did
a
review
into
substance.
Misuse,
yes,
which
which
led
to
a
change
in
in
funding
iron.
E
So
yeah,
the
last
review
that
the
committee
did
was
the
substance
misuse
review,
which
resulted
in
three
recommendations.
One
was
related
to
public
health
budget
within
the
substance
misuse
to
be
looked
at
again,
second,
to
ensure
that
risk
assessments
are
taken
whenever
services
are
being
reviewed
for
budget
reduction
and
thirdly,
for
more
networking
to
occur.
C
Prior
to
that
that
we
had
an
in-depth
review
in
to
interview
them
Hospital,
and
that
was
done
with
the
with
the
assistance
of
opted
experts
who
was.
It
was
very
good
that
was
a
substantial
piece
of
work.
We
worked
closely
with
NHS
England
and
they
launched,
or
that
they
revealed
their
lessons
learned
report,
which
was
a
big
big
piece
of
work
that
they
released,
that
buyer
scrutiny.
C
C
Work
than
actual
scrutiny,
although
on
the
pre
decision
or
pre
scrutiny,
I
think
that
this
committee
has
done
as
well
as
most
because
the
Director
of
Public
Health,
for
example,
has
been
very
proactive
in
providing
reports
of
this
committee
early
with
hundred
from
the
hospital
about
issues
like
a
home,
the
home
first
strategy,
which
this
committee
had
input
into,
and
similarly
with
the
with
the
CCG,
we
were
asked
for
our
views
on
things
like
patient
transport,
for
example,
at
an
early
stage
to
help
inform
the
reports
before
the
policy
was
decided.
I.
A
Think,
just
to
add
to
that
I
think
that,
since
we
share
a
building
with
organizations
like
the
csha,
things
haven't
given
improved
in
terms
of
communication
between
the
organization's-
and
that's
that's
once.
One
thing
that
I
do
see
is
a
big
improvement
from
when
I
first
started.
The
council,
when
we
were
in
this
in
the
same
building,
so
I,
think
that
the
links
and
this
being
the
same
buildings
actually
helped
that
a
lot
as
Steve
says
that
the
the
most
important
piece
we
did.
A
F
Thank
You
chair-
and
you
said
that
it's
quite
unusual
and
this
committee,
because
it's
got
a
statutory
obligations
and
we've
got
another
document
which
gives
a
summary
of
the
statutory
responsibilities.
But
I
was
just
wondering
where
we
can
find
more
details
of
exactly
what
are
the
statutory
obligations
are
I'm.
A
C
A
Okay,
yeah
the
piece
on
page
28,
which
is
specific
to
our
to
our
committee.
Let's
list
some
areas
and
I
did
want
to
make
a
brief
comments
on
it
on
the
services
for
care
carers
having
been
listed
separately
because
of
I
do
feel
as
if
that
should
it
shouldn't
be
separate
and
it's
a
thread
that
should
run
through
all
the
other
areas.
G
C
Much
so,
and
in
fact,
all
the
scrutiny
chairs
and
vice
chairs
have
been
invited
by
the
chair
of
CSM
C
to
a
meeting
on
the
1st
of
July
to
talk
to
try
to
get
uniform
approach
to
scrutiny,
and
one
of
the
things
that
they
will
be
discussing
is
how
you
receive
finance
and
performance
reports
at
the
moment.
Is
that
doesn't
seem
to
be
a.
C
There,
similar
approach
by
different
committees,
C
SMC,
for
example-
have
all
the
key
performance
indicators
on
one
she's
a
pair,
but
some
committees
it
can
go
into
four
or
five.
It
depends
on
what
you
want.
All
the
information
that
you
get
in
performance
and
performance.
Knowledge
report
has
first
been
through
the
executive
and
then
it's
filtered
down
to
the
various
committees,
and
it's
it's
Tony
know
where
that's
specific
to
us
to
those
committees,
but
they
were
the
actual
kpi's
did
you
get,
can
be
refined
and
it
can
be
adapted
to
algae?
C
Oh,
you
want
it
as
there
there's
a
meeting
of
the
chairs
of
vice
chairs,
of
all
the
committee's
on
the
post
of
July
there's.
Also,
all
members
have
access
to
the
council's
open
dare
to
sides
and
on
their
there
are
thousands
of
kpi's
that
you
can.
You
can
have
a
look
at
the
danger.
Sometimes
of
of
having
such
detailed
performance
report
is
that
it
leads
to
specific
questions
on
general
issues
and
that's
probably
not
always
the
best
best
use
of
committee.
So
if
there
are
questions
on
on.
C
Issues
that
are
raised
in
the
performance
indicators,
it
might
be
best
to
to
contact
the
the
relevant
officers
outside
of
a
committee,
because
sometimes
there's
only
a
finance
officer
here
to
give
the
information-
and
you
might
not
have
the
background
knowledge
to
give
you
a
satisfactory
answer,
and
so
we
do
only
email.
You
afterwards
anywhere.
A
Yeah
we
do
receive
the
reports
quarterly
generally
and,
as
has
happened
in
the
past
and
previous
counselors
colleagues
have
asked
for
things
to
be
presented
in
a
different
way
or
ask
for
other
things
to
be
included
in
so
it's
kind
of
being
refined
a
little
bit
as
we've
gone
along
and
I
expect
that
to
continue.
If
there's
anything
specific,
you
think
that
ought
to
be
there
that
you
don't
think
is,
please
do
say.
C
A
You
have
a
handout
in
front
of
you.
That's
just
been
presented
this
afternoon.
I
wasn't
aware
we're
gonna
get
this
one
thing
I
will
say
is
normally
I.
Don't
encourage
verbal
reports.
I
do
prefer
that
we
have
written
reports
in
advance
that
members
can
to
take
it
in,
and
that
probably
forms
what
some
of
the
questions
that
we
want
to
us.
That
then
see
the
information
in
advance
rather
than
presented
at
committee.
A
Although
the
in
saying
that
the
report
that
Sharon's
got
are
the
presentations
going
to
give
today,
I
think
is
potentially
going
to
be
very
useful
to
varying
among
were
largely
a
new
membership.
So
it's
more
informal
perhaps-
and
we
would
expect
to
see
more
formalized
reports
in
future
Thank
You
Sharon.
H
H
Workplaces
all
have
an
impact
on
public
health
of
one
sort
or
another,
and
so
this
w-h-o
definition
I
think
chose
to
tries
to
capture
that
so
just
an
overview,
then
of
the
statutory
public
health
responsibilities.
So
these
are
mainly
set
out
in
the
Health
and
Social
Care
Act
2012,
and
it
was
that
act
that
transferred
Public
Health
responsibilities
from
the
NHS
so
previously
as
such,
with
primary
care
trusts
in
to
ensure
councils
and
the
high-level
responsibility
is
described
there
that
local
authorities
have
a
duty.
H
Has
someone
like
me
appointed
the
DPH
role
is
a
little
different,
I
think
to
some
other
director
roles
within
the
council,
because
it's
of
jointly
appointed
well
so
I
have
two
letters
of
appointments,
one
from
the
chief
executive
of
the
council
and
another
from
the
public
health
England's,
acting
on
behalf
of
the
Secretary
of
State,
and
so
it's
a
joint
appointment
and
the
reason
it's
done.
That
way
is
to
try
and
give
the
Doretta
of
public
health
a
level
of
Independence
and
I.
Think
that's
quite
difficult
in
many
ways
as
an
employee
of
the
council.
H
Demonstrators
in
practice,
really
I
suppose
and
then
the
other
responsibilities
is
local
authorities
receive
a
Public
Health
grant
from
the
government
for
delivery
of
Public,
Health
Services,
and
so
local
authorities
have
to
declare
how
they
are
spending
their
Public
Health
grants.
So
that's
another
Duty
there
so
going
on
then
there's
quite
a
long
list
of
things
that
we
have
to
do
as
as
a
council
I'm
not
going
to
go
through
this
list
in
any
detail,
but
just
to
pick
out
a
few
areas.
H
H
The
healthy
child
program
for
no.25
is
predominantly
concerned
with
health
visiting
services
to
families
and,
as
part
of
that,
there
were
five
mandated
contacts
that
our
health
visitors
have
to
make
with
families,
starting
in
the
antenatal
periods
and
going
up
until
our
charges
two
to
two
and
a
half
years
of
age.
We
have
to
report
nationally
on
our
performance
against
those
indicators
and
public
health,
England
benchmarks,
our
performance
against
all
other
councils.
H
Across
England-
and
this
is
a
lesser-known
area
healthy
starch-
so
the
Healthy
Start
program
nationally
can't
remember
the
actual
act.
It's
got
quite
old-fashioned
wording
because
he
talks
about
welfare
foods,
but
essentially
the
Healthy
Start
program
is
a
program
that
is
aimed
at
improving
the
nutrition
of
pregnant
women
and
their
children
in
low-income
families.
So
this
is
a
targeted
program
to
low-income
families
and
it's
comprised
of
two
elements.
One.
H
Batch
Piratas
and
then
also
families
who
meet
the
criteria
are
also
eligible
for
vouchers
that
they
can
exchange
for
milk
and
fruit
and
vege
as
as
well.
This
is
one
of
our
priority
areas
in
York
at
the
moment,
and
we
have
reasonably
good
take-up
of
the
welfare
foods,
but
we
don't
have
a
very
good
uptake
of
vitamins,
so
this
is
an
area
that
we're
particularly
focusing
on
at
the
moment.
The
other
is
then
the
national
child
measurement
program,
which
I'm
sure
many
of
you
will
be
aware
of.
H
So
this
is
where
we
weigh
and
measure
the
height
and
weight
of
all
children
in
reception
class,
so
four
to
five
year
olds
when
they
enter
school
in
reception,
and
then
we
measure
them
again
in
year,
six,
its
I
would
say
not
an
especially
popular
program
with
all
the
families
and
it
isn't
compulsory.
So
even
though
was
a
council
we're
mandated
to
offer
it,
families
can
observe
if
they
choose
to.
H
The
other
area,
then,
is
sexual
health
and
contraception
services,
so
our
current
provider
for
us
specialist
sexual
health
services
in
York
is
York,
Ospital
trust,
but
we
also
commissioned
contraception
services
from
GP
practices
as
well
NHS
health
checks.
This
is
a
program
that
is
a
screening
program
of
healthy
adults
aged
between
40
to
74
years,
who
may
be
suffering
from
or
at
high
risk
of
diabetes,
high
blood
pressure
or
heart
disease.
H
So
if
we
had
someone
an
Ebola
case
or
or
some
other
novel
virus,
we
have
to
have
plans
in
place
to
be
able
to
respond.
That
another
area,
then,
is
the
provision
of
specialist
public
ill
health
advice
to
NHS
commissioners,
so
that
is
predominantly
the
Vale
of
York
CCG
for
us
in
York,
but
also
that
could
be
NHS
England
as
well,
and
so,
for
example,
I
am
a
non-voting
member
of
the
CCG
governing
body
and
I.
Also.
A
H
That
would
be
able
to
escape
challenge
and
criticism
if
they
weren't
to
ensure
they
had
those
services
in
place,
so
they
are
effectively
mandated.
There
are,
then,
over
the
page,
a
number
of
non
mandated
Public
Health
responsibilities.
Now
what
we
mean
by
non
mandated
is
that
we're
not
required
in
any
public
health
regulations
to
provide
these
services.
These
are
really
intended
to
be
based
on
local
need,
so
by
doing
means
assessments
of
our
population
or
indeed,
the
political
priorities
of
any
council.
H
So
that's
one
example
where
we
have
shared
responsibilities:
obesity
you'd,
be
surprised
if
you
didn't
see
healthy
weight,
their
public
mental
health
and
suicide
prevention,
so
again
our
public
health
responsibilities
and
not
a
commissioned
mental
health
services
and
that
we
are
responsible
for
population
prevention.
So
one
example
of
that
locally
is
the
work
that
we
do
with
York
CVS
around
hundred
change,
which
is
challenging
stigma
around
mental
health
and
mental
mental
illness,
and
so
that's
an
example
of
the
work
that
we
do
there
and
increasing
physical
activity.
H
This
is
not
just
a
responsibility
for
Public
Health.
The
council
already
does
a
great
deal
to
increase
physical
activity
and
our
I
travel
team
in
in
in
the
transport
team
do
a
lot
of
work,
for
example
around
promoting
walking
in
cycling.
So
this
is
a
shared
responsibility
across
different
teams
within
the
council,
healthy
lifestyles.
So
this
is
the
stuff
that
people
traditionally
think
of
as
public
health.
H
You
know
nannies
states
work
on
encouraging
people
not
to
drink
too
much
to
eat
healthily,
to
exercise
more,
that's
what
we
call
healthy,
behavior
change,
and
but
we
don't
do
it
because
we're
Nonis
States.
We
do
it
because
we
know
that
that's
the
best
way
of
preventing
cancer
and
heart
disease,
for
example.
So
there
is
a
positive
outcome
that
we're
aiming
to
achieve
their
workplace.
H
Partnerships
coordinator,
Public
Health,
leads
on
the
development
of
the
joint
health
and
well-being
strategy,
and
the
board
has
three
statutory
things
that
it
needs
to
do.
It
needs
to
develop
a
strategy
it
needs
to
undertake
a
joint
strategic
needs
assessment
and
a
pharmaceutical
needs
assessment
and
public
health
and
lead
on
those
pieces
of
work,
although
obviously
they
will
involve
other
other
partners
and
then
I'm,
leading
on
a
piece
of
work
across
the
council
in
developing
a
workplace,
health
and
well-being
strategy
working
quite
closely
with
occupational
health
and
human
resources.
H
So
it's
fair
to
say
that
in
York
our
health
indicators
are
better
than
the
national
average
in
most
areas
and
our
life
average
life
expectancy
for
men
and
women
is
higher
than
the
national
average.
So
for
men
in
York,
it's
a
2.2
years
nationally.
It's
seventy
nine
point,
five
years
so
a
little
bit
higher
in
York
for
women.
Average
life
expectancy
in
your
Gaetti
3.5
years
and
nationally
is
eighty
three
point
one
so
for
women.
H
There
isn't
that
much
difference,
but
that
is
an
unequal
picture
across
the
city,
and
so
we
have
a
gap
of
just
under
nine
years
and
just
over
five
years
for
men
and
women
respectively,
between
at
least
and
most
deprived
areas.
So
we
know
that
we
are
in
unequal
City
in
in
in
that
regard.
We
also
know
that
people,
even
though
life
expectancy
may
be
increasing
people,
are
living
longer
with
life
with
limiting
health
conditions.
So
when
you
look
at
healthy
life
expectancy,
you
can
see
that's
significantly
reduced.
H
Sixty
four
point:
seven
years
for
women
in
sixty
five
point
three
years
for
men,
men
are
do
better
on
healthy
life
expectancy
than
women
in
York,
and
the
main
reasons
for
that.
When
we
examine
what's
causing
that
gap
in
healthy
life
expectancy,
we
know
that
we're
largely
looking
at
three
key
areas,
so
you're
looking
at
cardiovascular
disease
and
cancers,
particularly
lung
cancer.
H
Lung
cancer
is
traditionally
associated
with
smoking,
but
we're
seeing
an
increase
in
lung
cancer
in
people
who
have
never
smoked
and
when
that's
not
just
in
York
that's
nationally,
and
no
one
quite
understands
the
reason
for
that.
There
are
all
sorts
of
emerging
theories,
but
more
research
needs
to
be
done
around
that
and
then
increasingly,
dementia
is
is
also
a
significant
cause
of
a
gap
in
healthy
life
expectancy
and
I've
searched
they're
common
risk
factors,
because
we
know
that
smoking,
alcohol,
diet
and
physical
activity
feature
very
strongly
in
all
of
those.
H
So
our
prevalence
in
York
is
lower
than
the
England
average,
but
we
are
seeing
an
increasing
trend
in
obesity
in
reception
year,
and
that
is
a
concern
because,
as
you
can
see
from
the
figures,
the
level
of
obesity
doubles
between
reception
and
year
six.
So
in
year,
six
children
are
1011
being
measured
again.
So
we
need
to
understand
so
that
we
know
how
to
intervene,
to
be
able
to
address
that
rise
in
in
obesity.
H
But
what
is
very
worrying
is
the
the
definite
trend
we're
now
seeing
in
increasing
levels
of
the
beast
in
reception
children,
because
if
the
trend
continues
and
that
still
doubles
by
the
time
children
get
to
year,
six
we're
going
to
be
left
with
a
significant
obesity
problem
as
a
city.
So
this
is
something
that
I'm,
certainly
very
concerned
about
and
then
going
on
to
some
other
challenges.
Alcohol-Related
hospital
admissions
York
is
an
outlier
for
the
number
of
people
that
we
have
admitted
to
hospital
for
alcohol,
related
issues
we're
an
outlier
for
self-harm
for
all
ages.
H
So,
whether
you
look
at
children
or
whether
we're
looking
at
adults,
we
have
higher
levels
of
admissions
related
to
self-harm
than
the
national
average
and
even
though
our
suicide
rate
has
plateaued
a
bit
we're
still
higher
than
we
should
be
in
York.
So
these
are
both
areas
that
we're
doing
a
lot
of
work
on
at
the
moment,
smoking
in
pregnancy.
Again,
if
you
looked
at
the
national
figures
for
York,
you
would
wonder
why
I've
identified
this
as
a
priority,
because
York
as
the
city
has
low
levels
of
smoking
in
pregnancy.
H
So
we
have
to
find
different
ways
of
addressing
this
around
20%
of
our
population
and
Yorker
students.
That
figure
is
predicted
to
increase
as
York
University
expands,
and
that
brings
particular
challenges
for
us
as
a
city
in
ensuring
that
our
services,
and
particularly
our
health
services,
are
responsive
to
the
needs
of
students.
So
that's
another
area
of
focus.
H
H
This
is
an
interesting
one
for
us
as
a
council,
because
we're
not
responsible
for
these
services,
so
we
can
identify
that
there's
an
issue,
but
then
we
need
to
work
with
our
NHS
partners
and
in
this
case,
NHS
England,
and
try
and
influence
their
commissioning
so
that
our
citizens
have
access
to
those
services.
So
this
is
an
interesting
area,
that's
emerging
as
a
priority.
At
the
moment
we
know
we
need
to
do
more
to
promote
uptake
of
vaccinations
and
screening
programmes.
H
One
area
where
focus
for
us
with
screening
is
cervical
smear
and
cervical
smears,
so
we've
seen
testing
of
women
and
for
cervical
cancer
and
that's
an
area
that
we
need
to
do
more
on
and
we
are
doing
planning
a
campaign
around
that
this
year,
there's
more.
We
need
to
do
around
uptake
of
seasonal
flu
vaccine
and
our
uptake
of
MMR.
It
has
been
low
most
recently,
so
we're
working
with
GP
practices
and
public
health
England
and
we'll
be
doing
a
campaign
again
this
year
on
promoting
up
Jacob
MMR.
H
The
other
challenge,
then,
is
really
around
capacity
and
resources.
So
all
the
local
authorities
got
a
6.2
percent
in
year
reduction
of
their
public
health
grants
in
2014-15
and
that's
been
followed
by
a
3.9
percent
year-on-year
reduction
on
average
for
the
last
four
years
for
York.
That
means
we've
lost
about
2
million
out
of
our
public
health
budget
for
commissioning
public
health
services,
which
has
been
significant
because
York
was
below
our
target
allocation
at
the
start,
so
we
had
a
low
public
health
budget
and
then
to
lose
2
million.
H
Out
of
that
has
been
a
significant
Charlie
for
us
and
the
future
of
the
grant
is
unclear.
So
the
government
announced
some
time
ago
that
they
were
tailing
off
the
local
authority,
Public
Health
grant
allocation,
and
we
were
told
that
this
year,
1920
would
be
the
last
year
for
the
public
health
grants,
with
an
expectation
that
local
authorities
funded
their
Public
Health
Services
out
of
business
rates
retention
from
next
year.
H
H
So
the
graph
over
the
page
really
just
tries
to
explain
a
little
bit
about
what
I
mean
by
health
in
all
policies.
Some
of
you
may
already
be
familiar
with
with
this,
so
health
NOLA
policies
is
based
on
a
recognition
that
our
greatest
health
challenges
and
so,
for
example,
tackling
health
inequalities
or
spiraling
health
costs,
complex
issues
and
they
require
Solutions,
and
these
issues
are
often
linked
to
the
social
determinants
of
health,
which
is
what
this
diagram
tries
to
show.
H
So
all
of
the
areas
that
I
are
identified
here
have
an
impact
on
someone's
health
and
well-being.
So
we
can't
take
one
of
these
out
and
treat
them
individually.
They
all
interrelate,
it
is
widely
accepted,
and
some
research
that's
been
published
by
the
Health
Foundation
actually
shows
that
only
about
10%
of
our
health
is
impacted
on
by
the
NHS.
H
That
surprises
some
people,
because
they
think
the
proportion
would
be
much
greater
than
that,
but
it
is
only
10%.
All
of
these
other
issues
have
a
much
greater
impact
on
health,
so
the
health
and
all
policies
approach
is
really
about
how
we
can
work
together
to
improve
health
and
health
equity.
That's
giving
everybody
an
equal
chance
to
good
health
and,
at
the
same
time
as
we're
focusing
on
improving
health,
we
will
be
working
on
improving
educational
attainment,
improved
housing,
green
spaces,
environmental
sustainability,
job
creation,
etc.
H
That
all
of
those
things
are
about
public
health
and
about
health
and
well-being
and
I.
Think
one
of
the
greatest
challenges
for
us
as
a
council
is
how
we
work
with
our
partners
to
embed
that
approach
into
all
of
our
policies,
which
is
really
what
the
health
and
all
policies
is
about.
It's
about
trying
to
say
that
if
we're
going
to
have
a
healthy
population
and
a
productive
economy,
then
everything
needs
to
work
together
with
a
focus
on
either
improving
health
or
dunno.
Do
no
harm
and.
H
I've
been
having
some
initial
conversations
with
people
about
this,
and
it's
kind
of
feels
too
big.
So
what
some
local
authorities
have
chosen
to
do
is
focus
on
just
one
or
two
areas
that
they
want
to
try
this
this
this
approach,
and
just
my
suggestion
for
some
areas
that
we
might
want
to
look
at
in
in
York
and
and
for
the
committee
to
think
about
what
your
role
might
be
around
this
one.
Is
that
tackling
that
issue
of
children's
healthy
weight?
H
H
That
is
it's
a
really
burning
issue,
for
us
at
the
moment
is
alcohol
and
how
we
developed
a
sensible
approach
as
a
city
around
reducing
alcohol
harms,
which
is
linked
to
the
scrutiny
task
group
review
that
was
done
into
the
previous
administration
and
is
an
area
that
regularly
is
raised
by
our
NHS
colleagues
by
the
police,
people
falling
into
the
river
ayuk
cetera,
et
cetera.
So
those
are
just
two
areas
that
I
think
might
lend
themselves
to
a
health
policy
approach
that
the
chemistry
might
want
to.
A
A
H
If
you
were
to
ask
me
where
could
we
put
in
our
efforts
that
would
deliver
long
term
impacts
for
those
individuals,
and
so
children
and
their
families
and
the
health
of
the
city
for
generations,
then
certainly
focusing
on
children,
because
if
we
were
to
focus
on
an
approach
to
children's
healthy
weight?
The
way
that
we
would
approach?
That
is
a
holistic
approach.
So
we
would
be
focusing
on
all
areas
of
that
child's
health.
We
will
be
focusing
on
what
they
were
eating.
H
So
those
of
you
who
read
The
Guardian
may
well
have
faith
with
an
article
that
was
published
in
The
Guardian,
either
this
year
or
towards
the
end
of
last
year
about
an
approach
that
leads
have
adopters
and
they're
the
only
city
in
England
who,
who
have
being
able
to
demonstrate
that
they're,
making
some
successes
in
this
area
and
when
I
was
reading
some
of
the
quotes
from
those
families
the
impact
on
those
parents
on
their
self-esteem.
Their
health
and
well-being
has
been
really
quite
incredible.
And
so,
by
focusing
on
the
child.
H
We
are
working
with
a
family,
and
then
there
are
all
of
the
added
benefits
to
improved
educational
attainment
as
well.
If
we
have
a
child
that
is
more
healthy
and
is
in
the
best
place
to
learn
so,
yes,
it
would
be
high
up
there
on
our
own
online
list
of
priorities,
more
so
than
putting
in
weight
management
programs
for
adults,
because,
even
though
they're
important
in
health
economic
terms,
the
the
long-term
value
that
we
would
get
out
of
working
with
children
and
families
as
much
greater
than
we
would
get
by
just
working
with
adults.
H
No
so
I
have
a
business
case
that
I
have
already
discussed
with
the
executive
member
for
adult
social
care,
and
health
and
she's
asked
for
further
information
about
that,
and
obviously
there
are
always
challenges
around
funding,
but
that
will
be
have
to
be
considered
by
the
council
as
part
of
the
budget
setting
process.
Okay,.
H
H
That
picture
of
that
increase
between
reception
and
year
six
is
is
a
national
picture
by
a
large,
although
I
will
be
investigating
a
little
more
be
meeting
with
the
Director
of
Public
Health
in
Leeds
to
understand
a
little
more
about
what
they've
done.
However,
York
should
be
better
than
us.
You
know
we
don't
have.
You
know
largely
as
I
said
at
the
start.
You
know,
York
does
pretty
well
across
a
range
of
health
indicators.
We
have
families
living
with
low
incomes.
H
We
have
levels
of
deprivation
in
York,
but
we
don't
have
it
on
such
a
scale,
as
some
other
parts
of
the
country
have,
and
so
I
would
expect
York
to
look
better
than
that,
and
so
it's
the
level
of
our
aspiration
really
as
and
our
level
of
aspiration
as
a
city
for
our
children.
So
if
you
looked
at
pure
numbers
and
I
can
let
you
have
that
the
numbers,
if,
if
the
committee
would
like
like
to
see-
because
sometimes
numbers
are
easier
to
understand
them
for
centuries
on
them?
H
H
We
don't
want
to
medicalize
this
and
children
who
were
so
obese
that
they're
having
breathing
difficulties
or
they're
starting
to
have
pains
and
their
joints
and
significant
physical
impacts
as
a
result
of
their
way
will
be
referred
to
the
hospital
pediatric
team.
But
then
you
know
other
than
medical
interventions,
which
don't
work
was
a
family
cry.
Often
the
success
is
with
those
children
is,
is
quite
limited
and
then
they
stay
with
their
weight
problem
until
they
become
old
enough
for
bariatric
surgery.
H
So
this
is
really
one
of
those
areas
where
we
need
to
be
focusing
on
prevention
and
starting
from
birth,
so
that
we
are
supporting
now
our
health
visiting
service
and
our
children
services
are
working
with
families
to
equip
them
with
the
knowledge
and
the
skills
to
be
able
to
feed
their
children
healthy
and
not
stigmatizing.
But
you
know
focusing
on
what
we
can
practically
do.
B
Thank
you
for
a
very
full
answer
and
I
for
one
would
be
delighted
if
this
scrutiny
committee
over
these
these
next
months
and
years
could
play
any
helpful
role.
I'd,
be
delighted
that
that
would
be
the
case
and
I
really
hope
that
we
would
be
able
to
look
back
in
four
years
time
and
say:
we've
really
made
some
progress.
Thank
you.
I
And
thanks
very
much
throughout
the
presentation
is
really
really
useful,
I'm
new
to
this,
so
you
just
have
to
bear
with
me.
If
I
some
sort
of
stupid
questions,
just
can
you
will
you
be
able
to
put
the
committee
in
the
direction
of
where
we
can
get
an
idea
of
what
your
overall
budget
is
kind
of
the
areas
that's
spent
on
I?
I
Don't
want
sort
of
the
answers
now,
because,
obviously,
if
we
are
going
to
concentrate
more
resources
on,
for
example,
child
obesity,
then
presumably
some
other
things
are
going
to
have
to
drop
off
the
radar,
and
you
know
we'll
be
good
to
have
some
sort
of
a
balanced
view
on
that.
The
other
sort
of
question
is
jumping
out
to
me
from
your
forties
in
terms
of
the
alcohol-related
hospital
admissions,
which
is
one
of
the
other
big
areas
of
concern.
Do
you
have
statistics
on
how
many
of
those
people
are
your
presidents
and
how
many
aren't
Thanks.
H
Yes,
on
the
budget
and
I
have
that
information
I'll
be
a
very
happy
to
circulate
it
to
members
of
the
committee
that
that's
that's
not
a
problem
in
terms
of
the
alcohol-related
admissions
this
that
we
can
pull
out
this
information
for
York
one
of
the
challenges
with
it,
though,
is
it's
often
quite
out
of
date.
So
one
of
the
issues
with
quite
a
lot
of
public
health
data
is
the
way
that
it's
collected.
It's
it's
collected
at
source.
It
goes
mash
nationally.
H
They
cleanse
it
and
do
various
things
with
it,
and
then
it's
published
and
made
available
to
local
authorities
and
an
alcohol-related
admissions
is
one
of
the
areas
where
there
can
be
or
two
or
three
year
time
lag
before
we
get
some
of
this
information.
So
we
are
working
with
your
cos,
Patrol
Trust
to
try
and
get
real-time
data
from
them,
which
we
are
hoping
that
we're
going
to
be
able
to
do
the
issue
is
they
have
to
have
the
resource
to
be
able
to
collect
this
information
in
a
slightly
different
way?
H
One
of
the
reasons
why
identified
it
as
an
area
that
we
might
want
to
look
at
as
a
health
and
all
policies
approach,
because,
even
though
the
local
authority
has
responsibility
for
commissioning
alcohol
treatment,
services
and
alcohol
is
one
of
those
complex
issues
and
actually
it
involves
a
whole
range
of
partners,
and
so
by
adopting
a
citywide
approach
with
our
partners.
For
this
I
think
it
would
give
us
access
to
different
sources
of
data
that
would
help
us
have
a
much
richer
understanding
of
what
the
issue
was.
A
A
E
Those
have
been
changed
to
the
30th
of
July
and
that's
going
to
be,
has
already
been
updated
on
mudguards
and
the
17th
of
September
remains
and
there's
only
one
other
change
on
says:
they're
Tuesday,
the
22nd
should
be
Wednesday.
The
23rd
of
October
and
I
believe
sure
that
there
may
be
some
problems
in
November
because
you
won't
be
available
and
perhaps
yeah.
A
The
November
could
be
an
issue
because
of
my
work,
commitments
and
and
council
a
court
that's
likely
to
be
away
the
same
time
so
we'll
need
to
discuss
what
we
do
with
that
date.
So
there
might
be
a
change,
November
2,
that's
only
the
that
the
dates
up
to
an
including
October,
correct
on
the
website,
I
believe
on
it
on
the
so
they
gave
the
council
calendars
correct,
including
October,
and
hopefully
well,
certainly
until
the
end
of
the
municipal
year,
we
will
be
sort
of
very
soon.
A
Obviously,
the
the
the
July
meeting,
there's
already
a
fairly
substantial
agenda,
I,
would
say
that's
more
typical,
looking
health
scrutiny
meeting
in
terms
of
quantity.
'no,
I
won't
really
want
to
see
more
than
that,
because
that
there
are
a
lot
of
agenda
items
there
already
and
I.
Think
that
probably
gives
an
indication
of
what
challenge
it
was
when
we
had
how
was
in
Community
Safety
as
part
of
the
scrutineers
Committee
as
well.
A
Obviously
we'll
be
keen
to
hear
from
members.
If
you
have
any
specific
areas
you
wanted
to
look
at
then
obviously
put
your
eye.
You
could
put
your
ideas
through
David
and
we'll
do
our
best
to
try
and
combinate
them.
Obviously
there
are
other
organizations
over
the
coming
months
will
want
to
invite
organizations
CSH
aid
teaser
scan
where
Valley,
who
provided
our
mental
health
on
the
majority
of
mental
health
services
in
York-
and
they
have
you
know,
come
to
our
meetings
fairly
frequently
over
recent
years.
Just.
E
With
respect
to
the
work
plan
in
July,
perhaps
you
may
want
to
consider
moving
some
of
the
items
further
down,
potentially
the
safeguarding
but
potentially
item
seven
and
six
safeguarding
portable
Huddle's
and
angular
assurance
in
the
six
monthly
quarterly
monitoring
report
for
residential
nursing
and
home
care,
because
that
looks
like
a
very
large
meeting
and
agenda
clicking,
especially
if
we've
got
the
executive
member
coming
to
speak
on
to
iTunes
and,
of
course,
the
end
of
your
finance
and
performance
monitoring
report.
It
could
be
a
very
substantial
long,
a
meeting.
A
J
So
you
know
Indies
where
they
want
to
position
things
but
I
think
having
a
putting
that
in
a
meeting
where
we've
got
longer,
perhaps
to
reflect
on
some
of
those
issues
and
what's
happening
about
them
might
be
useful.
Because
of
these
you
said
they're
there.
You
know
there
are
particular
issues
around
there's
a
financial
risk
and
also
about
maintains
they
took
the
quality
of
care
and
in
the
current
market.
So
you
know
that
would
be
my
my
advice
and
Max
would.
B
Chair
thanks,
yeah
I
think
it's
only
good
to
put
at
least
one,
if
not
both
of
those
item-
six
and
seven
on
2
September,
provided
that
we're
not
anticipating
that
the
September
meeting
would
have
to
carry
too
many
other
items
at
the
moment,
work
line
is
quite
open,
but
we
know
how
things
can
suddenly
pull
up
and
I
think
that
if
we
were
to
do
that,
we
would
certainly
take
up
a
suggestion
that
we
asked
the
executive
member
to
make
reference
to
this
as
part
of
the
report.
I
think
it
will
be
of
a
concern.
A
G
Sorry
about
that,
so
I'm
I
just
wanted
to
ask
em
when
I
was
going
through
the
minutes.
There
was
reference
to
a
task
unfinished
group
that
councilor
kragle
had
suggested
for
the
mental
health
provision
for
community
model
and
it
doesn't
sort
of
appear
on
the
work
plan.
I
think
the
suggestion
was
that
it
would
be
in
the
new
municipal
year,
but
I
just
wanted
to
check.
If
that's
something
that
would
be
going
forward.
A
E
Members
who
are
considering
to
perhaps
bring
that
to
the
committee
at
some
point
may
be
having
a
meeting
with
Michael
to
come
up
to
speed
with
what
went
on
and,
of
course,
speak
to
councilor
crackle
as
well
in
the
interim.
That
could
be
a
way
forward
if
Mike
will
be
willing
to
maybe
to
brief,
or
to
do
so.
J
So
I
think
just
in
terms
of
a
general
offer
in
terms
of
the
firm
forward
plan
and
getting
the
information
which,
which
you
need
as
a
committee
in
terms
of
priorities
and
things
like
that.
I
would
very
open
to
conversation
and
meeting
and
given
the
information
that
I
have
to
help
you
we're
planning
populate
that.
As
you
need
see,
there
is
quite
a
lot
happening
in
terms
of
mental
health,
so
we
recently
had
a
citywide
event
to
look
at
developing
a
different
community
offer,
and
certainly
from
my
fur
today
around
so
pre
scrutiny.
J
There
may
be
something
which
might
want
to
come
back
here
for
a
discussion
about
what
some
of
those
plans
might
be
about
a
different
community
offer
or
seeing
it
that
you'd
want
to
balance
that,
against
the
other
priorities
yield,
you
would
have
on
the
work
plan.
That's
certainly
very
welcome
to
having
a
discussion
to
give
you
any
information
which
you
need
to
help
plan
that
going
forward.
A
K
A
I
A
It
could
be
a
session,
that's
open
to
other
counselors
as
well.
Obviously,
it'd
be
it'd,
be
committee
members
that
must
keen
to
attend
but
and
I.
Think
of
it.
Perhaps
if
we
look
at
availability
as
a
bit
of
a
round
robin
amongst
this
group
first
and
then
open
it,
you
know
to
wider
councilors
more
widely
than.