1. health and fitness

HEALTH AND WELLBEING BOARD
THURSDAY 30 APRIL 2015
HEALTH AND WELLBEING PRIORITIES – ANNUAL UPDATE 2015
SUMMARY
This report provides an update on the Health and Wellbeing priorities for Bexley, as set out in the
Bexley Health and Wellbeing Strategy. The actions being taken to address priorities are set out in
section two.
An APPENDIX to this report provides current performance against the Public Health Outcomes
Framework (PHOF) or another suitable comparative framework. Because of the time delay in
national reporting care should be taken when comparing performance and local actions to reverse
trends.
The Bexley Health and Wellbeing Board is asked to:

1.
Consider and comment on the progress achieved, and note on going work relating to each
of the priority areas.
Context and Background
On 9 July 2014 the Bexley Health and Wellbeing Board considered the findings of a new Joint
Strategic Needs Assessment. The JSNA analysed the health needs and wellbeing needs in
Bexley to inform and guide the commissioning and design of health, well-being and social care
services.
The JSNA process concluded that the current disease priorities outlined in the Bexley Health
and Wellbeing Strategy remain relevant for the local population, albeit work relating to the
mental health and emotional wellbeing of children might be added.
It should be noted that the priorities chosen by the Health and Wellbeing Board were based on
those conditions where high numbers of people are affected in Bexley, where the problem is
worsening over time, and there is action that can be taken to address the issues.
The current priorities are:
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2.
Tackling Childhood and Adult Obesity
Supporting people with addictions – including smoking, alcohol and drugs
Diabetes
Mental Health and Emotional Wellbeing of Children
Dementia
Update on each priority
Since the publication of the Health and Wellbeing Strategy work has commenced on a number
of delivery plans. The remainder of this report provides an overview of the developments for
each priority area, adding performance data which is currently available as an APPENDIX. It
should be noted that some national data sets are only updated annually and may therefore not
provide an in year demonstration of progress.
(a)
Tackling Childhood and Adult Obesity
Work on the obesity plan ‘Healthy Choices, Healthy Weight’ has made some good
progress. There are some actions (partly due to reprioritisation) that are unlikely to be
completed in this financial year. A full review of all the actions in the plan will be
conducted in April 2015.
The following is a summary of the actions taken:
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Commissioning a tier 2 adult weight management and care pathway development
Healthy Catering Commitment
Now’s The Time Project (Community Activation Fund)
Cross departmental work with schools
Workplace health
The development of a multi- agency communications plan
NHS Health Checks lifestyle information
Commissioning a child weight management service
Development of curriculum resources to support schools delivery healthy eating,
healthy weight and healthy lifestyles
Exercise on Referral scheme
Adult weight management
This service was commenced in September 2014 and is being delivered by Slimming World and
Weight Watchers. Residents can access the service by referral only from a health professional.
The offer is 12 weeks free access to either Slimming World or Weight Watchers. To date 465
referrals to the scheme have been made and an average weight loss of 6% has been achieved.
Healthy Catering Commitment
7 businesses have signed up to the scheme and have received support materials. From 2015-16
an alternative way of delivering this project will need to be explored, an allocated budget of
£10,000 will support this programme.
Community Activation Fund (Now’s the Time)
The sport and leisure team secured a grant from Sport England of £240,000 along with
partnership funding and contributions for a 3 year, £400,000 project based in Thamesmead.
Now’s the Time aims to tackle high levels of physical inactivity and address the perceived and
real barriers relating to the reason why people are not choosing to be more active. Analysis of
Sport England’s market segments show that inactivity is closely linked to social economic
deprivation and that whilst high proportions of inactive people live in the Thamesmead area, an
extensive consultation with Thamesmead residents last summer proved there was a high level of
latent demand and a wish to be more active for health, weight and social benefits. A programme
has been devised and targeted at the most inactive section of the population and will be
launched at the end of March 2014. This is the first geographical based targeted programme to
be operated in the borough for many years and Bexley Council as the lead partner is supported
by Royal Borough of Greenwich, Trust Thamesmead, Peabody and Gallions Housing
association who will work together to tackle inactivity and bring about better health outcomes for
residents. The programme is based on a behaviour change model and includes motivational
interviewing techniques.
At the end of March approximately 1,500 adults who live or work in Thamesmead have
registered to ‘Now’s the Time’ which has resulted in over 7,000 visits to the range of sport and
physical activity opportunities.
Work with schools
The Public Health team updated the Health Improvement for Schools booklet following its
successful implementation in 2013-14. The booklet has been sent to all schools.
This action will need to be reviewed in April. Cross- departmental work will continue.
Workplace health
The programme of lifestyle drop-ins and workshops has been completed for 2014-15 and 354
members of staff attended the events held at the Civic offices and Blackfen library. The results
from the drop-in sessions indicated that 58% of those measured were overweight or obese and
48% of that measure had pre or high blood pressure readings. The option to offer workplace
adult weight management from Weight Watchers is being arranged.
Multi- agency communications plan
Work with partners to raise awareness of healthy weight and physical activity opportunities
available will continue and will link to the new campaign from Public Health England (specifically
targeted at adults) when it is released. Localisation of the national ‘Change 4 Life’ campaign will
help target messages to families. The brand has high levels of recognition and provides
opportunities for families to sign up to the campaign. The London Borough of Bexley is
capitalising on this and will review the effectiveness. Use of the ‘Active Bexley’ brand for
physical activity opportunities continues to help raise the profile of the wide range of
opportunities available locally.
NHS Health Checks
After an extensive review in 2013/14, the NHS Health Check programme has been completely
revised in 2014/15. This includes the contracting of all GP practices to provide NHS Health
Checks for patients within their own practice, and the introduction of a flat fee per NHS Health
Check completed. A programme of training was implemented to ensure all Practice Nurses and
Health Care Assistants had appropriate levels of training to deliver an NHS Health Check.
Furthermore, a Public Health Vascular Nurse was recruited to provide clinical expertise within
the programme. From April 2015, a new Bexley template on GP IT systems has been
introduced which will feed into a new data reporting system for the programme. As the data
reporting becomes more robust further information will be available and will be included in NHS
Health Check updates. Up to the end of Quarter 3 14/15 (Dec 2014), 9850 invites have been
sent for NHS Health Checks (14.7% of the eligible population), 2616 patients have taken up the
offer and received an NHS Health Check at their GP practice (26.6% uptake rate).
GPs are expected to invite 20% of their registered eligible registered patients each year. Eligible
patients are those aged between 40-74 who are not already being treated for a diagnosed long
term condition.
Child weight management
Procurement of this service has been delayed due to its inclusion in the integrated
commissioning for children and young people. The combined tier 2 and 3 service is expected to
begin procurement in May 2015 and the service is expected to be in place by September 2015.
The ‘HENRY’ programme which focuses on families with children under 5, has been
commissioned and will be delivered by health visitors and outreach workers in Children’s
Centres from June 2015.
Prevention of Type 2 Diabetes (‘Walk away from Diabetes’)
As a ‘fast start’ to the Physical Inactivity and Prevention Programme in Bexley, a pilot
intervention aimed at patients who are at risk of Type 2 Diabetes was introduced at Lakeside
Medical Practice in Thamesmead in January 2015. Thamesmead is a community at high risk of
developing the condition. Each ‘Walking Away from Diabetes’ session provides 3.5-hours of
structured group education, delivered by two trained Educators. The session offers participants
the opportunity to explore their personal risk and to identify the changes they need to make to
their levels of physical activity and diet in order to reduce their risk.
Previous providers of the courses in Thamesmead have indicated that uptake has been very low
in the past and so the courses have been integrated into the ‘Now’s The Time’ physical activity
programme. This allows the participants to benefit from the motivational support for behaviour
change that the programme offers. This has resulted in 41 people attending the eight courses
offered to date. The pilot programme will run until the end of April 2015.
An innovative bid was submitted by the team for external funding of £253,000 to support a major
project in the borough to target those at risk of type 2 diabetes. The bid builds on the pilot work
undertaken in Thamesmead and the programme aims to show people how being physically
active can have a major impact on preventing the onset of these conditions and that small life
style changes can have a positive impact on your health. The Bexley project aims to bring
together a range of partners from sport, public health, the private and voluntary sector to really
tackle the burden of health and help residents to stay healthier for longer. This was a very
competitive bidding process and the outcome of the bid will be known in May/June.
Exercise on Referral scheme (Steps to Health)
A review has been taken place of the ‘Exercise on Referral’ schemes that operate in the borough
with particular emphasis on the ‘Steps to Health’ programme operated as part of the Leisure
Centre contract by Parkwood Community Leisure. The review has included looking at the
criteria for the scheme and the current main reasons for referral by GP’s. The review is also
undertaking a modelling of increasing demand and looking at how the scheme can be shaped to
support wider Council health objectives.
In February 2015, Steps to Health was chosen by UK Active to pilot a national project examining
the effectiveness of exercise on referral. The pilot will include approximately 300 participants and
will consider the impact of adding “physical activity counselling” to exercise with a view to
influencing long-term behavioural change.
(b)
Supporting people with addictions – including smoking, alcohol and drugs
A public consultation will take place on the Addictions Plan in June. Updates against the
key priorities within the plan are as follows:
Priority 1 – To tackle the incidence and prevalence of addiction in Bexley
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An alcohol needs assessment is to be carried out during 2015/16 and will build on the
information contained within the JSNA.
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Bexley’s substance misuse treatment system remodelling project is underway. Both
adult community contracts have been extended until March 2017 to allow a year to
pilot new ways of working prior to a retendering process during 2016/17.
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Smoking prevalence in Bexley has risen over the last year from 17.7% to 18.2%.
This can be attributed to the fall nationally of people accessing their local stop
smoking service for quit support. There is indisputable evidence to show that signing
up to the local Stop Smoking Service is the most effective way to beat tobacco
addiction. One of the reasons people are not using their local stop smoking service is
due to the rise in the use of e-cigarettes/vaping devices as a means of cessation.
Currently there is no evidence to show that these devices are effective in helping
smokers quit but local Stop Smoking Services are monitoring this and reporting back
to the HSCIC on success rates. In Bexley we are encouraging smokers using these
devices to also access motivational quit support from one of the many community
stop smoking advisors in the borough so that we can gauge the efficacy of this route
to quit. In order to reduce prevalence of smoking in Bexley all GP have been set
individual practice targets for 2015/16 based on their 18+ list size. It is important that
smoking cessation remains a key priority for Bexley as without sustained promotion
of the Stop Smoking Service smoking rates will inevitably start to rise. The Quit
Target has been increased to 1300 for 2015/16. At the end of Q3 2014/15 Bexley
was on target to meet the 2014/15 target but it is unlikely the target of 1245 will be
reached at year end. This is due to disinvestment in smoking in order to achieve cost
savings.
Priority 2 – Addictions and Mental Health
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Operational protocols and processes for dual diagnosis (substance misuse and
mental health) are being updated. Once finalised, engagement with senior
stakeholders within mental health services, Bexley CCG and LBB will be required to
ensure appropriate strategic direction and oversight.
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Smoking rates in mental health service users are much higher than in the general
population. Bexley Stop Smoking Service is working with SLAM to address smoking
addiction in this client group. Drug and Alcohol workers will be trained to offer one to
one support for their clients during 2015/16.
Priority 3 – Protecting Children from Harm
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A contraception service has been launched within Signpost (one of Bexley’s
community treatment providers). Staff training is now complete and uptake of the
service is being promoted and closely monitored.
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A programme of training in parental substance misuse has been incorporated into the
BSCB training plan. The aim is to provide this to all children’s social workers to
ensure that issues of parental substance misuse are identified and that appropriate
action (including referral into adult treatment provision) is taken to contribute towards
the safeguarding of children.
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All secondary schools in Bexley are offered 15 minute assemblies on the harmful
effects of smoking. This prevention programme is on-going and is well received by
the students. Anonymous questionnaires distributed to those attending the
assemblies regarding uptake of smoking by young people show that prevalence of
smoking in young people is around 8.5%. The Public Health Outcomes Framework
(PHOF) target is to reduce smoking prevalence in young people to 15% or below (in
2014). This information would indicate that smoking rates in young people are lower
than suspected and with continued input to young people about the harm of tobacco
use we hope to further reduce smoking rates.
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Bexley Stop Smoking Service is working with Children’s Centres in Bexley to engage
those registered as smokers with the centres to sign up for effective quit support.
Uptake of this offer is disappointingly low. Children Centre staff are being
encouraged to complete on-line smoking cessation training on how to offer brief
advice on the dangers of secondhand smoke to their clients. This should help them
to promote the smokefree homes and cars message and encourage smokers to seek
professional evidence based support to quit.
Priority 4 – To effectively promote responsible messages and communicate key campaigns
(c)
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Bexley Stop Smoking Service has used the national ‘Stoptober’ and ‘No Smoking
Day’ campaigns to actively promote smoking cessation across Bexley. All GP
practices and pharmacies were provided with free resources supplied by Public
Health England and these were distributed by the team. Monthly promotion of the
service in the News Shopper will discontinue from April 2015. However, the service
will be regularly promoted by the London Borough of Bexley Communications Team
via the Council website, Bexley Magazine and Bexley Stars magazine.
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Smoking in cars carrying children under the age of 18 will be illegal from October
2015 and the Stop Smoking Service is promoting this message in all GP practices,
pharmacies and Children’s Centres.
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Information regarding supporting smokers using e-cigarettes/vaping devices has
been provided to all community Stop Smoking Advisors and is included in all training
events. This is in line with NICE and NCSCT guidance.
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The London Borough of Bexley has updated the Smokefree Policy to exclude the use
of vaping devices in the workplace.
Diabetes
The work relating to Diabetes Plan Development is being undertaken in partnership
between the London Borough of Bexley Health Policy Team and the Bexley Clinical
Commissioning Group Redesign Team. The following actions have been taken:
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A multi-agency group ‘the Bexley Diabetes Plan Development Group’ has been
established and has met on three occasions so far. The group includes patient
representatives, Diabetes UK, the GP Lead for Diabetes, London Borough of Bexley
Sports Team, Bexley CCG, Hospital representatives, diabetes service providers, the
Health Innovation Network and public health.
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The group is currently considering how services for those at risk of developing
diabetes, and those with the condition, can be better supported with a view to
redesigning services (in accordance with the financial envelope available). The
priority areas which will be included in the Diabetes Plan have been agreed as:
o Prevention
o Supporting those with Diabetes
o Informing decision making and improving services
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A clinical group aligned to the Diabetes Plan Development Group is developing a
care pathway. This work will be considered and developed alongside the plan to
ensure clinical pathways and delivery of actions to achieve the Diabetes Plan are
aligned.
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(d)
On 31st March 2015 at a meeting of the Building Health Partnerships Programme
(which is funded by NHS England and jointly delivered by Social Enterprise UK
(SEUK) and the Institute for Voluntary Action Research (IVAR) it was decided that
Diabetes is an area where better partnership working with the voluntary sector could
help to develop a range of activities and innovative approaches particularly in terms
of prevention. As a result The Bexley Diabetes Plan Development Group membership
will be widened to include other voluntary sector groups.
Mental Health and Emotional Wellbeing of Children and Young People
Following the Health and Wellbeing Board decision to make ‘Children’s Emotional
Wellbeing and Mental Health’ a local priority, a multi-agency steering group has been
established, with terms of reference, to develop a local evidence base and action plan.
The steering group (comprising of key partners - including the Bexley CCG, the London
Borough of Bexley, Oxleas NHS Foundation Trust and schools) has set the scope of this
work and is now progressing with two key strands of work.
1.
Reviewing a recent needs assessment carried out by the London Borough of
Bromley and applying its high level findings to Bexley’s population data. This
element also includes a review of the clinical evidence base.
2.
Mapping of local services and seeking feedback from service users and
professionals who work with children and young people. This will aid the
development of care pathways and gap analysis.
The Integrated Commissioning Unit plans to align the commissioning cycle of children
and young people’s mental health and emotional wellbeing services with this work
(where possible) as it is expected the steering group’s findings will better inform the
planning and design of services.
The Local Safeguarding Children’s Board has a task and finish group specifically looking
into how self-harm and suicide of young people and children is addressed operationally
in the borough. The two groups are working closely to ensure good information sharing
and prevent duplication of resource.
(e)
Dementia
In addition to delivering current services for those with dementia, and delivering the new
responsibilities of the Care Act, a new multidisciplinary group will be established in May
chaired by the Cabinet Member for Adult Social Care. The priorities for the group will be
to set out an action plan in relation to the following priorities:
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(f)
Developing a Dementia Action Alliance
Dementia Friends in Bexley
Creating and promoting dementia friendly environments, working with hospitals and
local businesses
Better support for carers
Cross Cutting activity (including sexual health services and work with schools)
Whilst sexual health is not identified as one of the five Health and Wellbeing Priorities, a
number of strands cut across other priorities, therefore for completeness details are
included in this report. Activity is as follows:
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Workforce Development – one of the recommendations from the Young People’s
Sexual Health Review was a general lack of knowledge and skill in being able
address young people’s needs over a number of issues related to sexual health. As
a consequence, a series of work force development training days to plug these gaps
have been initiated. On 14th January, a training workshop on Sexual Violence and
Young People was held to equip professionals with the knowledge and skills in being
able to identify signs and symptoms, how to effectively talk to young people and how
to handle disclosure in suspected cases. In addition, a Theatre In Education (TIE)
performance entitled ‘Chelsea’s Choice’ by the AlterEgo theatre company hosted at
Oakwood School on Monday 16th March to raise awareness about Child Sexual
Exploitation (CSE). There were three performances – one for young people, one for
associated professionals (i.e. school nurses) and one for teachers and staff working
in schools. All secondary schools in Bexley will be invited to send a delegation to all
performances to ascertain if ‘Chelsea’s Choice’ would be appropriate for their school.
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Chlamydia Screening – all Chlamydia screening sites now have dual testing kits for
distribution. We are seeking to engage with GP Practices that are not participating in
the screening programme to garner their full support.
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All Bloods’ HIV Testing – there are some governance issues to be resolved;
however, the project is essentially ready. Once these issues have been resolved the
project will start in earnest.
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HIV Diagnosis Audit – A GP trainee is leading an HIV Diagnosis Audit that will
investigate all HIV diagnoses over the last two years. The investigation will cover in
particular any previous contact with primary care (PC), the nature of the presenting
complaint, any specialist referrals etc. in an effort to determine if there were any
‘missed opportunities’ have diagnosed HIV earlier. This exercise will look at how the
London Borough of Bexley can better support PC to ensure that HIV testing
becomes more routine as appropriate. This is a companion piece of work to the new
GP registrations and ‘All bloods’ HIV testing pilot work streams mentioned
previously.
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LARC (long-acting reversible contraception) – the nursing PDGs for LARC
methods have or are about to expire. These PDGs enable nurses to administer
LARC devices without the need for an individual prescription issued by a doctor.
However, after consultation with the national lead on PDGs, nurses working in the
GP setting should not be using PDGs as they are not necessary, as they are working
under the direct supervision/guidance of a GP at their place of work. PDGs for LARC
methods are to be used by nurses working in integrated services or Sexual and
Reproductive Health (SRH) services on a ‘seek and treat’ basis. Care in the GP
setting is planned care and therefore outside the scope of PDGs. This issue is to be
discussed at the next LMC meeting for clarity. Currently, as part of the LARC
agreement between the London Borough of Bexley and GP Practices, all relevant
practitioners must submit Letters of Competence (LoC) to fit IUS/Ds before being
eligible to participate in the scheme. This however is an ‘open’ scheme, meaning that
any practice or practitioner can join the scheme at any point once they are able to
provide all the relevant qualifications to do so. 51% of GP Practices provide LARC
methods under this scheme, with a couple more practices set to join the scheme in
the future.
3.
Overview of performance against the Public Health Outcomes Framework
Each quarter Public Health England publish an update to the Public Health Outcomes
Framework, a dataset on around 160 measures within 5 domains which set out performance
over time across Local Authorities in England in protecting and improving the health and
wellbeing of its residents.
Although most of the measures are only refreshed annually, they work to different timescales i.e.
some are refreshed at the end of each financial year, some at the end of a calendar year and
others at the end of a school year. Therefore each quarterly PHOF update provides refreshed
data for only some of the measures contained within the dataset. It should be noted also that
depending on the original source of the data there can be a considerable time lag in Public
Health England making the latest data publicly available and so some of the most recent data
available on certain measures refers to periods of up to 4 years ago.
On 3rd February 2015 Public Health England published the latest quarterly update to the Public
Health Outcomes Framework.
Of the 158 indicators for which data is provided for Bexley, London and England, there were 65
updates made across 53 indicators.
In order to calculate Bexley’s average ranking in London across the full set of indicators (LPI
1180), Bexley’s relative position in each indicator has been determined, taking account of
whether a higher or lower figure is more favourable in each. The result of this calculation is that
Bexley’s average ranking is now 12.93. This is an improvement on the November 2014 figure of
13.55, the August figure of 13.20 and the May figure of 13.39. However it is very important to
sound a note of caution when using this figure as this calculation can be misleading for a
number of reasons including huge disparity from one authority to another in terms of priorities,
resources aimed at particular initiatives, the demographic make-up and epidemiology and
prevalence of certain conditions. Other influencing factors include the quality and volume of data
flowing between authorities and CCGs. Additionally, not all 33 London Boroughs provide data for
every indicator.
Bexley is performing better than the London average for 57.6% of the indicators and better than
the England average for 65.1% of the indicators. Bexley’s individual ranking in London is also
higher in 69% of indicators than the South /East London average ranking. We perform less well
in the domains of Health Protection and Health Improvement but perform well in terms of health
care and reducing premature mortality.
There are 13 PHOF indicators in which Bexley is in the Bottom 5 of London Local Authorities
(the same number as in the previous quarter although the order has shifted a little). These are:
o
o
o
o
o
o
o
o
2.16 - People entering prison with substance dependence issues who are
previously not known to community treatment
1.06i - Adults with a learning disability who live in stable and appropriate
accommodation (Female)
3.04 - People presenting with HIV at a late stage of infection
1.09ii - Sickness absence - The percent of working days lost due to sickness
absence
1.09i - Sickness absence - The percentage of employees who had at least one
day off in the previous week
2.12 - Excess Weight in Adults
3.02i - Chlamydia detection rate (15-24 year olds) - Old NCSP data
1.06i - Adults with a learning disability who live in stable and appropriate
accommodation (Persons)
o
o
o
o
o
4.10 - Suicide rate (Persons)
2.23iv - Self-reported well-being - people with a high anxiety score
4.10 - Suicide rate (Male)
2.03 - Smoking status at time of delivery
2.06i - Excess weight in 4-5 and 10-11 year olds - 4-5 year olds
With reference to indicator 3.04 - People presenting with HIV at a late stage of infection - there is
a great deal of work taking place to address many of the issues however due to the inevitable
time lag in the publication of data by Public Health England the impact of local actions will not be
reflected in the latest update.
Across South East London, the 5 measures with the poorest performance are:
o
o
o
o
o
Under 18 conceptions (rate per 1000)
Smoking status at time of delivery (%)
Under 16 conceptions (rate per 1000)
Smoking prevalence - routine & manual workers
Self-reported wellbeing (%)
Bexley is performing considerably better in all of these (with the exception of smoking status at
time of delivery).
There are 7 areas of the PHOF where Bexley is the ‘top’ (or joint top) performing Local Authority
in London. These are as follows:
o
o
o
o
o
o
o
1.04 - First time entrants to the youth justice system
1.13ii - Re-offending levels - average number of re-offences per offender
2.20ii - Cancer screening coverage - cervical cancer
3.03x - Population vaccination coverage - MMR for two doses (5 years old)
3.03vi - Population vaccination coverage - Hib / Men C booster (5 years)
3.03vii - Population vaccination coverage - PCV booster
1.11 - Domestic Abuse
The attached APPENDIX provides detail on those PHOF indicators (and other framework
indicators) which most closely relate to the Health and Wellbeing priorities for Bexley.
4.
Summary of Legal, Financial and Other Implications
There are no legal, financial and other implications arising from this report.
Local Government Act 1972 – section 100d
List of background documents
Public Health Outcomes Framework update, Public Health England.
Contact Officer:
Shanie-Louise Dengate, Policy and Health Integration Officer
[email protected]
Reporting to:
Dr Nada Lemic, Director of Public Health / Sue Robinson, Head of Health
Policy
[email protected] / [email protected]
Performance Data: Jamie Dickie, Data and Research Analyst – Public Health
[email protected]