Agenda item

Purpose: To review the implementation and progress of Health in all Policies across West Berkshire Council.

Steven Bow (Public Health Consultant, West Berkshire Council) presented the report on the Council’s Health and Wellbeing in All Policies (HiAP) approach and programme update, supported by a short slide presentation. The report set out a shared understanding of HiAP as an organisational approach (rather than a discrete service), explained why it was needed, summarised progress in phases one and two (foundations, tools, skills and processes), described the projects funded to date, and outlined phase three priorities focused on embedding HiAP as business-as-usual, strengthening governance and decision-making, and improving measurement of impact and sustainability.

During the debate the following points were discussed:

·         It was raised that embedding HiAP required a training and education approach for both officers and elected members, as people can be focussed in their own workstreams and may find it difficult to apply a health lens to routine decisions; Steven Bow confirmed training and workshops had been delivered (including LGA leadership workshops and systems thinking workshops) and that phase three would focus on embedding the approach through organisational change.

·         It was raised that planning policy and the built environment are critical levers for health, and that historically it had been difficult to influence the local food environment (e.g., fast food outlets) because of planning constraints; Steven Bow responded that progress had been made by including health and wellbeing requirements in the Local Plan, and that further work was underway to provide clearer guidance to developers and strengthen implementation.

·         A question was asked whether a tracker could be provided for HiAP-funded projects, including timelines and how the committee would know whether individual initiatives are progressing and whether they are successful; Steven Bow stated that tracking projects was an aim for the year and that a performance workstream had been established to balance local ownership of projects with central oversight and reporting.

·         It was discussed that measuring public health success was inherently difficult because prevention benefits may not be visible for years and because it is hard to demonstrate “what was prevented”. Steven Bow acknowledged the challenge and confirmed phase three included a focus on measuring performance/impact of funded projects and building a stronger approach to evidencing outcomes.

·         It was raised that the “health in all policies” approach should not become purely theoretical and needed to translate into tangible benefit for residents; Matt Pearce (Director of Public Health, West Berkshire Council) acknowledged the recurring challenge of “bringing it to life”, noted that some impacts were “soft influence” (e.g., health inequalities being actively discussed in decision-making), and stated that further work was needed on an outcomes framework.

·         It was raised that the report referenced environmental interventions in homes with damp and mould and that there had previously been issues with outdated measurement equipment compared to private providers; Steven Bow stated the project was led by Environmental Health and he could seek further information on the technology/equipment being procured, as he did not have the detail to hand.

·         A question was asked about the new Public Health Planning Liaison Officer post (two-year fixed term): whether the officer would see every planning application, and how applications that may not support healthy, sustainable communities would be escalated to that role—particularly concerns about HMOs and older/converted properties rather than new developments; Steven Bow responded that the current focus is on new developments and reviewing health impact assessments, but that the role also included broader planning policy work and that there was a recognised gap/complexity in influencing existing stock.

·         Steven Bow reported collaborative work with the University of Reading to explore what legal and policy levers are available locally to influence planning and health outcomes, reflecting the need to bring planning and public health expertise together.

·         Matt Pearce reinforced that Health Impact Assessments (HIAs) were forward-looking by nature, and that retrospective application to existing environments was challenging; he emphasised the importance of understanding available levers, particularly for more deprived wards where limited new build may occur.

·         It was raised that climate change was altering housing risks and that overheating (particularly in flats and office-to-residential conversions) should be considered alongside damp and mould; Matt Pearce responded that HIA criteria include factors such as connectivity/active travel, access to green space, garden size, trees, and insulation, and stated that the key was ensuring HIAs were validated rather than treated as a “tick-box” exercise.

·         It was discussed that the Council needed to determine the threshold for when developers must submit HIAs, given the workload and volume of developments; Matt Pearce indicated that the threshold question was still under consideration (e.g., whether it should apply from a certain number of homes), noting the potential burden if applied to very small developments.

·         It was noted that national planning policy (National Planning Policy Framework) was increasingly moving in the direction of healthier development expectations, including the emerging approach to restricting fast food outlets near schools; Matt Pearce stated that national policy was “starting to catch up” but there is still significant local shaping that can be done.

·         A question was asked about how the Low-Income Family Tracker (LIFT) worked and where the data came from; Matt Pearce stated he did not have the full details to hand but described that outcomes data was being produced showing identification of residents eligible for benefits who were not receiving them and subsequent signposting leading to increased uptake, including improved Healthy Start voucher access (noting he did not want to quote figures without certainty).

·         A question was asked what “GPAW” refered to (referenced in the report in relation to the remit of the new prevention board); Paul Coe (Executive Director, Adult Social Care and Public Health, West Berkshire Council) explained the Council’s four strands of work; Growth , Prevention , Assets , and We Can (culture/organisational attitude and capability for change).

·         It was suggested that planning-related thresholds should consider not only the number of dwellings but also the type of development (e.g., HMOs, conversions to flats, properties not designed for residential use), given associated health risks; Matt Pearce agreed there was a need to strengthen the evidence base and understanding to influence decisions and withstand planning inspection challenge.

·         A specific local example was discussed where a fast food outlet application was said to be impossible to resist on the basis of distance from schools, despite large numbers of pupils passing the site daily; Matt Pearce responded that public health needed to strengthen evidence to support refusal/conditions and suggested options such as a supplementary planning document on fast food takeaways, noting other areas had developed such approaches.

·         It was discussed that while fast food outlet density was not high in West Berkshire compared with national benchmarks, that does not mean localised issues do not exist; Matt Pearce also noted national interest in other environmental harms such as gambling outlet concentration.

·         A question was asked about the status of “HiAP champions” and whether members should be more aware; Matt Pearce stated the champions approach was still in development, with scoping underway for a short training programme at service director level to build shared understanding, improve access to and use of data, and identify relevant service pipeline projects, with the ambition to cascade throughout the organisation over time.

·         It was discussed that current HiAP-funded projects appeared to focus on underserved/needier communities, and it was asked whether there was scope for broader prevention initiatives that benefit the whole population, including: 

o   working with schools on citizenship education/resilience so young people better understand systems, rights and how to seek help, thereby improving confidence and long-term wellbeing; and

o   improving children’s access to and confidence in using the local countryside (e.g., orienteering and mapping skills) to encourage physical activity and nature access; and

o   making access to leisure centres more affordable for people on benefits and increasing youth access.

·         Matt Pearce responded that schools delivered PSHE (personal, social, health and education) and that there may be a role for public health to support it further; he explained that the previous HiAP project list arose from a council-wide call for proposals aligned to public health outcomes, and similar calls could be repeated; he suggested potential partnership with Get Berkshire Active and referenced existing walking programmes and partner organisations (e.g., ramblers). He also stated that leisure services were exploring increased access for younger people and that concessionary rates for those on benefits likely exist, but he would need to confirm details.

·         It was noted that some secondary schools delivered GCSE Citizenship Studies and that the Council has hosted Year 10 citizenship groups in the council chamber (with more planned), demonstrating existing links with schools and civic education.

·         The committee noted the recommendations in the report: to note current status and proposed phase 3 priorities, to provide comments/advice on oversight and development, and to request further information if needed to assure effective embedding and sustainability of the HiAP approach.

Action: Steven Bow to seek and provide further information on whether the damp and mould project includes investment in up-to-date measurement equipment/technology.

Action: Public Health bring back a report once they have developed improved oversight of HiAP-funded projects and an outcomes/impact framework so performance can be monitored and reported back.