The Strategic Director, Health and Wellbeing will submit a report (Document “AK”) which provides an overview of respiratory health in Bradford District and outlines what partners across the NHS and local authority are doing to improve outcomes for people in the District.  There is a specific focus on asthma and chronic obstructive pulmonary disease (COPD) as these conditions account for a significant amount of the poor health and subsequent costs associated with respiratory disease in the District.

Recommended –

That the Committee note the information provided in the paper and support ongoing work seeking to address the main challenges going forward.

(Toni Williams – 01274 437401)

The Consultant in Public Health submitted a report (Document “AK”) which provided an overview of respiratory health in the Bradford District and outlined what was being done to improve outcomes for people.  Members were informed that Bradford was a poor performer and was the second worst District in Yorkshire and Humber.  Respiratory disease was the leading cause of people dying early in the Bradford District and 25% of these deaths were preventable.  The associated health problems had a significant impact on the person’s quality of life and resulted in high attendance at hospitals. 

In relation to chronic obstructive pulmonary disease (COPD), the Consultant in Public Health confirmed that over 13,000 people across the District had been diagnosed as having the disease, however, not all sufferers had been identified and it was believed that the actual number of people with COPD was closer to 19,000.  It was a challenge to proactively seek people with COPD, as the proportion of those undiagnosed varied across the Clinical Commissioning Groups (CCGs) and between GP practices.  The estimated total number had been identified through complicated modelling which looked at similar areas and the makeup of the District’s population.  COPD could not be cured but could be managed, however, it affected older people who had other conditions and were complex cases to cope with.

The Consultant in Public Health reported that over 40,000 people across the District had been diagnosed with asthma, however, it was believed that this was also underestimated and there was a variation in how it was managed in primary care.  The key risk factor was smoking, which was one of the main causes of COPD and according to surveys, one in five people in Bradford smoked.  Air quality was considered in relation to respiratory disease and it was an issue in urban locations.  The Consultant in Public Health stated that the management of the disease needed to continue and a great deal of work had been undertaken regarding the cessation of smoking in workplaces and hospitals.  Smoking in pregnancy had also been a priority for a number of years.    

The representative from NHS Englandexplained that the Bradford Breathing Better programme covered adults and children.  It was noted that the diagnosis of COPD was a key factor and if not diagnosed early it was harder to treat.  A stakeholder workshop had been held in January that approximately 80 people had attended and considered the four work streams of: self care; prescribing and formulary; clinical template; and pathways.  There were also dedicated nurses or GPs in practices across Bradford that were the clinical leads for the programme.

With regard to Airedale, Wharfedale and Craven’s Respiratory Action Plan, Members were informed that they were looking at inhaler techniques and had hospital nurses working in the community.  A trial of a GP practice using Telehealth for COPD cases was being considered along with the early discharge of patients from hospital with support provided in their own home.  It was noted that the next step was to hold a COPD and asthma day in September.  In relation to enhanced and complex care, there were 16 practices and the patients’ care needed to be tailored to their requirements.

The Consultant in Public Health confirmed that the Council had signed up to the West Yorkshire Low Emissions Strategy and was awaiting the outcome as to whether parts of Bradford would become clean air zones.  The key challenges for the District were smoking, smoking in pregnancy and to raise awareness around the prevention of smoking.

The Chair highlighted a newspaper article in relation to smoking issues in Bradford and lung cancer.  In response the Consultant in Public Health stated that lung cancer was difficult to treat and the longer a person smoked the higher the risk of lung cancer.  There was a need to focus on stopping people smoking and preventing people from starting smoking.   

Members then raised the following comments:

·         GPs and nurses needed to ensure that inhalers were used properly.  Smaller inhalers were easier to use.

·         When would the actual figures be available for COPD?

·         Was work with young people being done in ways that would engage them?

·         There were many ways in which technology could be utilised in communication.

·         Young people may take more notice if a person with COPD promoted their own story.

·         There was no cure, so prevention was key.

·         Could best practice be used from other regions?

·         How were air quality areas identified?

·         To what extent was the Council dealing with emissions?

·         Could bus and lorry routes be reduced in order to lessen impacts on schools?

·         Why was respiratory disease not diagnosed earlier?  If a patient consulted a GP with the same symptoms more than once per year this should be picked up.

·         People had stopped smoking but had started ‘vaping’ instead.

·         There was a great deal of advertising on television regarding other medical issues.  Could something be done on breathing difficulties?

·         Bradford had older public transport vehicles and it would help if newer vehicles were used.

·         Explosions had occurred in eight homes where oxygen was used and people smoked and this needed to be publicised.    

·         Smoking was still prevalent in young people and ‘vaping’ was fashionable and promoted.

·         Was ‘vaping’ 95% safer than smoking?

·         People still smoked in confined spaces, even though there was a smoking ban and the vapour exhaled by ‘vaping’ still affected asthmas sufferers.

·         There were no figures regarding smoking cessation in the report.

·         Were there records of Council employees that smoked?

·         How could the information be quantified when planning permission had been granted for an incinerator plant in Keighley?

·         Was the Council using best practice? Did all the public and emergency service vehicles have diesel engines?

Members were informed that:

·         It was an interesting point about inhalers and NHS England wanted to ensure that every clinician had the same level of understanding.  ‘My Health’ apps had videos that showed the correct usage of inhalers and there was a need to reinforce how the medication was used at the review stage.  Pharmacists also asked patients how they used their inhalers. 

·         There were two measures in relation to COPD, prevalence and incidents, however, the figures were more like a benchmark and not what was expected.

·         Efforts needed to be focussed on children and young people and there were many different schemes, as well as the opportunity to be taught in schools.

·         There was a ‘Health Talk Online’ website where people discussed their own health issues.

·         ‘NHS Right Care’ was being utilised, which looked at similar demographics and organisations and this had proved beneficial.   

·         Air quality areas were routinely monitored.  The issue had been discussed at the Environment and Waste Management Overview and Scrutiny Committee where a couple of roads had been identified in relation to air quality.  Both Leeds and Bradford had to have a low emission zone and the issue needed to be investigated.  Diesel vehicles were the problem and would have to pay to enter certain zones. 

·         Buses and lorries were an issue due to the diesel engines and the danger Wards were located in the inner city.  Public health was linked to planning and if there was a negative impact mitigating actions could be requested.  Trees could also absorb particles and noise.

·         It was too early to tell what the impact of ‘vaping’ would be.  A Council motion had been put forward in relation to the permitting of ‘vaping’ in buildings.  

·         Bradford District did tend to get older public transport vehicles, however, they had been retro fitted.

·         There was no evidence to state that people were smoking and ‘vaping’ and swapping between the two as yet.  It was acknowledged that ‘vaping’ was marketed to younger people and it was not a healthy alternative.

·         All the publications stated that ‘vaping’ was 95% safer than smoking.

·         There was a great deal of work ongoing surrounding passive smoking.

·         The report did not provide the level of detail regarding smoking cessation, however, it could be submitted to a future meeting if required.  Work was ongoing with regard to how to target limited spend on smoking cessation and key areas such as smoking in pregnancy and manual workers were being focussed upon.  The information required could be circulated to Members following the meeting.

·         There were no records in relation to Council employees that smoked.  The Council had to improve the wellbeing of its employees and there was being focussed on.  The Healthy Weight Board, a sub-group of the Health and Wellbeing Board, would become the Healthy Lifestyle Board and was trying to launch initiatives in Bradford to get people involved.

·         Planning permission had been granted for the incinerator, however, the company would now have to apply for a permit.  A local assessment had to b undertaken and many mitigations had been put forward.  A permit request had been submitted to the Environment Agency but had not been granted as yet.

·         It was important to look at all the issues.  Air quality was high on the Council agenda and should be for every other organisations.

Resolved –

(1)       That an update report be submitted in 12 months and the recently appointed clinical lead and service users be invited to the meeting.

(2)       That a report on smoking cessation be presented to a future meeting.

Action: Consultant in Public Health