People in Essex enjoy good health and wellbeing

Report
People in Essex enjoy good health
and wellbeing
Essex County Council Commissioning Strategy
Version: consultation draft
Contents
page
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Indicators, Principles and Leads
Summary Slides
Relationship with other Outcomes and Strategies
Overarching Strategic Actions
Quality Criteria
People in Essex have a healthy life expectancy
Reduced differential in life expectancy across different areas of Essex
Prevalence of Healthy Lifestyles
Percentage of Children Achieving at School
Percentage of Working Age People in Employment
Percentage of People living in Safe and Suitable Housing
Percentage of Households living in Fuel Poverty
Prevalence of mental health disorders amongst Children
Prevalence of mental health disorders amongst Adults
Teenage Pregnancy Rates
Customer/User Views
Our Partners and our Relationship with them
Category Strategy
Risks and Mitigations
Delivering Change within our financial envelope
Information Governance and Information Technology Strategies.
2
5
7
8
9
11
13
16
34
37
41
45
50
54
58
63
64
68
72
73
75
2. People in Essex enjoy good health and wellbeing
Group
Agreed indicators (and groups)
Group Lead
People in Essex have a healthy life expectancy
Reduced differential in life expectancy across different areas of Essex
A
Prevalence of healthy lifestyles
Percentage of Essex residents who consider themselves to be in good health
Mike Gogarty
supported by
the ICDs
Life satisfaction rates (ONS condition of wellbeing)
Percentage of children achieving at school
B
C
Percentage of working age people in employment
Percentage of families living in safe and suitable housing
Percentage of households living in fuel poverty
Tim Coulson
Paul Bird
Helen Taylor/
Mike Gogarty
D
Prevalence of mental health disorders among children and adults
Barbara
Herts/ Helen
Taylor
E
Teenage pregnancy rates
Mike
Gogarty/
Barbara Herts
Roles and responsibilities
Lead commissioner(s):
Mike Gogarty
Supporting Commissioner(s):
Chris French
People in Essex have a healthy life expectancy, Prevalence of healthy lifestyles, Reduced differential in life
expectancy across different areas of Essex, Percentage of households living in fuel poverty
,
Jane Richards
People in Essex have a healthy life expectancy, Prevalence of healthy lifestyles, Reduced differential in life
expectancy across different areas of Essex, Percentage of children achieving at school, Prevalence of mental
health disorders among children and adults, Teenage pregnancy rates
Tim Coulson
Percentage of children achieving at school
Paul Bird/Helen Morris
Percentage of working age people in employment
Helen Taylor,
Percentage of families living in safe and suitable housing, Prevalence of mental health disorders among
children and adults
Percentage of families living in safe and suitable housing
Simon Harniess
Prevalence of mental health disorders among children and adults, Teenage pregnancy rates
Barbara Herts
Ben Hughes
Maggie Pacini
People in Essex have a healthy life expectancy Prevalence of healthy lifestyles, Reduced differential in life
expectancy across different areas of Essex
People in Essex have a healthy life expectancy , Reduced differential in life expectancy across different areas
of Essex, Prevalence of mental health disorders among children and adults
Ian Wake
Krishna Ramkhelawon
Danny Showell
Physical Activity
Jason Fergus
Jacquline Wells/Juliette
Arnold
IS
SUMMARY People in Essex enjoy good health and wellbeing
Why is it important for the people of Essex to have good health and wellbeing?
ECC are responsible for the health of the public we serve. Health may be seen as a “good” or right for people and is essential if people are to achieve
their potential and to live a long life. We embrace the WHO (World Health Organisation) definition of health as a state of physical, mental and social
wellbeing not just the absence of illness.
What is the strategy?
We are able as a whole County Council working with a range of partners to influence, impact and address all the key drivers for health. Our strategy is to
recognise a broad definition of public health and to ensure public health considerations inform our commissioning decisions. Delivery of other
Outcomes will be key to delivering this one as they are key drivers of health. Additionally we will commission bespoke public health interventions to
enable individual s and communities to make the right lifestyle choices together with commissioning clinical interventions that improve health and
prevent illnesses.
Financial Challenge
To deliver the Strategy and to meet any financial challenge will require us to pursue the DH with vigor through all possible routes to secure our fair share
of the public health national resource in line with the ACRA formula. Robust and challenging commissioning will continue to secure efficiencies from the
grant that will enable progress towards delivery of the strategy and to meeting financial challenge. Delivery in full would be not be possible with a level
of funding 40% below our target (sum of distance from target. Savings made to date and a further 20% savings). The securing of the additional grant is
therefore critical and is a key strategic action if we are to deliver on both the Outcome and financial challenge
Measuring progress
Many of the indicators supporting this outcome are infrequently measured and published data, which requires central collection and collation is often
several years out of date. Some of the indicators will take some years to change even with optimal interventions and sometimes the link between
specific agreed action and the change in an indicator can be hard to exactly ascribe. These issues are common to all preventive interventions. It is
proposed that by using interventions where there is a strong evidence based link between that intervention and a given outcome, that delivery of
relevant process measures, that can be recorded in real time, is a strong proxy that we are on track to deliver an agreed indicator..
SUMMARY How will the strategy secure improved health and wellbeing for the people of Essex?
• ECC are responsible for the health of the public we serve. While this was formalised with the shift of responsibility for public
health from the NHS in April 2013, it has long been a recognised Council Outcome.
• Much of what we do impacts on public health whether it is a direct use of the public health grant to commission a specific service
or the impact of our broader policies around social care, education , the economy and the environment and communities. Indeed
the shift of public health responsibilities to the Council was driven by a national recognition of the critical importance of these
factors in enabling good health and wellbeing. We will need to further integrate public health and public health skills and thinking
into the organisation to best influence this broad agenda.
• Good health underlines and is interlinked with many of the other outcomes in our strategy. Material wealth and employment are
critical drivers of health and depend on both a vibrant economy and education and learning. Similarly both a sense of control and a
safe environment reduce stress and support health. Fundamentally future experience of health starts to be formed from
conception and action in early years is crucial to ensuring optimal lifetime health and wellbeing. Links will be made to these
outcome strategies, rather than replicating that here.
• Improving public health will require also a focus on lifestyle choices around smoking. alcohol, diet, physical activity, drugs and
sexual health. This will involve both supporting the population to make healthy choices and helping them address unhealthy ones
and their consequences.
• Additionally we must ensure clinical interventions that improve health such a s blood pressure, cholesterol and depression
management are systematically available and of high quality.
• Public Health principles in Essex have been set by a Member’s Reference Group and include a focus on addressing inequalities.
This is an important driver in our actions to deliver this outcome. While generally an affluent county, the most deprived area in the
whole of England lies within Essex and there are particular vulnerable groups within the Essex population who suffer poor health
outcomes. Our strategic response needs to address this. We need to ensure that services are available to the whole population but
are particularly targeted at those with the greatest needs who are often less likely to engage. We also need in some areas to have
extra bespoke services addressing the specific needs of these people.. This approach is called Proportional Universalism
• The indicators chosen to support this outcome are varied and reflect the breadth of action required to deliver improved health. It is
important however that our actions are focused broadly on delivery of the outcome rather than slavish adherence to chasing what
is in effect a sample of indicators. Indeed there are a number of process measures that we should consider in ensuring progress
towards this outcome. .
• Delivery of this strategy will be within the financial envelope of the public health grant. To deliver under financial pressure we
must ensure Essex receives its full fair share grant.
• Success in this work will require close work with other key partners who have a major impact on public health, these include the
NHS, district , borough and city councils, schools, police, fire services and voluntary sector groups, local employers and
communities. We will need to develop strong new links with DC/BC and City Councils.
6
Relationship with other Outcomes and Strategies
Delivery of this Outcome is inextricably linked with other agreed outcomes.
•
Longer term health and wellbeing will be delivered through material wealth in the population accompanied by sound lifestyle
choices. The former will be delivered through action under our Outcomes around best start and around education and Lifelong
learning , both ensuring young people can achieve their potential. The latter will be aided by action in early years and schools
around healthy behaviours around diet, exercise, risk taking behaviours and sexual health.
•
Health is similarly linked to the economy and employment so progress around our economic growth outcome will be crucial. It
is likely that measurable geographical improvements in reducing measured inequality in areas such as Tendring will ONLY be
possible through focussed economic action. Similarly the health of specific vulnerable groups such as those with mental health
issues will require action in this area.
•
There are numerous links with our safe communities outcome. Children in care have poorer educational outcomes and lifestyle
choices than average and higher levels of poor mental health. Action to deliver reduced numbers of young people in care will
therefore improve health. Similarly accident prevention has a link to health and action in this strategy around falls will help with
indicators within the safer outcome. Victims of Domestic abuse suffer considerably in terms of both mental and physical health
and action in this area will again improve health.
•
High Quality sustainable environment overlaps directly in terms of the fuel poverty indicator. Our environmental Outcome has
an indicator around cost of energy to homes, one of the key drivers of fuel poverty. Additionally access to open spaces can
impact on physical activity and mental health and wellbeing.
•
“People can live independently and exercise control over their lives “is closely linked especially around the proportion of
people who can live independently. The ability to live independently is positive to wellbeing but crucially achieving this will
require delivery of the actions outlined in this strategy to reduce vascular diseases and strokes, to reduce mental health issues
including depression that predispose to dependency, and to reduce falls, diabetes, and lung diseases related to smoking.
Strategic Actions ~ Overarching
Action
Lead
Resource
Issues addressed
Timetable
Members and Officers will work
with partners and MPs to ensure
Essex receives its fair share
public health grant
Joanna Killian
PH grant
Optimise baseline resource
required to deliver strategy in
financially testing environment
Deliver by April
2015
Public Health Tier 4 staff to be
fully engaged in all strategic roll
out
Mike Gogarty
PH grant– this
is resourced
within the
current MTRS
Recognise and optimise ability of
all Essex outcome strategies to
impact on public health.
Ensure opportunities for public
health solutions in other strategic
areas are identified
Commence
May 2014
Develop public health skills of
commissioning workforce through
new Commissioning Academy
Maggie Pacini
PH grant - this
is resourced
within the
current MTRS
Enable recognition of impacts on
public health of commissioning
activity.
Ensure skills such as evidence
based practice underline
commissioning decisions
September
2014
Re establish fit for purpose public
health links to districts and
boroughs
Mike Gogarty
PH Grant - this
is resourced
within the
current MTRS
DC/BC have key role and interest
in ensuring local public health. We
need to align and support this
work. Ability to do this is a gap in
T2.
August 2014
8
Quality Criteria
The discussions that have taken place with operational teams on future plans;
• This strategy will largely be delivered through procurement from external providers. While they have not as yet had sight of the strategy, they are
aware of thinking around specific elements relevant to them.
• Where there is an implication for ECC operational colleagues, they too have been aware of discussions eg Adult Ops colleagues in discussing
involvement of social workers in screening older people for depression.
The research and analysis (e.g. benchmarking) that has been carried out to support the proposed strategic direction;
• Where available national data has been used related to the Indicators. In a number of areas this has been insufficient to allow a trend to be
developed so alternative measures have been used where historic trend is available to set direction. All proposed actions are evidence based .
The range of commissioners and members who have been involved in the development of the Strategy document;
• The document has been shared with and benefitted from input from a wide range of People and Place commissioners including leads for all
other Strategic outcomes as well as a range of Tier 3 and Tier 4 managers.
• It has been developed throughout with input from Cllr Naylor and has been shared with a number of cabinet members including Cllr. Madden,
Aldridge, Bentley and Gooding. It was also presented to Member’s Reference Group although attendance was low.
• Externally It has been shared with CCG Accountable Officers and NHSE Executives with comments received from some. It has been shared with a
number of DC/BC and there has been a presentation to Members in Tendring DC. Comments received from 3 CCGs and Chelmsford City (to date)
have informed the text.
Governance arrangements for taking decisions on the issues highlighted by the strategy – in cases where partnership governance is an issue, this
should be accompanied by an assessment of how strong the partnerships are, and what we will do to strengthen them;
• We need to ensure the benefits of a County Council approach to public health are fully realised without losing the historic links to NHS
commissioning and the need for local solutions in many instances.. This will involve ensuring the County Council as a whole recognise and
embrace their public health role and that is recognised in our governance structure and system.
• We need to recognise when a Essex wide approach to commissioning makes sense and when an integrated approach with resources aligned to
CCGS is the right solution and consider in each case the appropriate governance arrangement.
The direction of travel for ECC and partner activity;
• Links with CCG colleagues and public health have been well maintained since the transfer of Public Health to ECC.
• Links to DC/BC/city while initially strengthened have slipped during T2. Going forward, if we are to best deliver this strategy we will need to re
establish vibrant . Proactive and locally focused public health links with DC/BC/City.
• We will retain and develop our links with the Police and Crime Commissioner and with provider representative bodies such as the LMC.
9
The high-level timetable for the strategic actions proposed
• This is within the text
How the Strategy could help ECC to address its future funding gap.
• The Strategy could help ECC funding gap through both driving efficiencies from use of the public health grant through delivering enhanced
services while challenging the market hard. The timescale for this will be determined by the agreed length of existing contracts inherited
from the NHS and will not have a full impact until 2016/17.
• The strategy will also deliver savings through reduced demand on services in both ECC and CCGs with a short term gain possible within 1-2
years around initiatives around depression and blood pressure management.
10
Strategic analysis and insight – the story behind baseline position
People in Essex have a healthy life expectancy
This is a new composite measure looking at both life expectancy and self assessed sense of health from survey
Healthy Life expectancy, Essex 2009-11, Males 64.7, Females 66.7, England Males 63.2, Females 64.2
As we have no trend data on this, below looks at total rather than healthy life expectancy
People in Essex have a healthy life expectancy
The Baseline and the Story behind it.
•
•
•
•
•
•
•
While the chosen indicator is Healthy Life expectancy, this is a new measure with no trend data. We therefore use life
expectancy to understand context and to set trajectory.
We have been seeing an increase in Life expectancy over recent years at Essex level. While still ahead of England, the
improvement has been relatively poorer of late with levels now below Regional average. This is likely to reflect particular issues
in more deprived districts and boroughs. (see below)
Drivers include broad determinates such as material wealth, employment and poverty and these are in turn are driven by
education and the economy as well as access to benefits. Other drivers are healthy lifestyle choices as well as preventative and
curative clinical interventions. Changes to the drivers may take decades to impact on this measure eg Education, others
especially clinical ones, as well as some lifestyles changes such as stopping smoking and undertaking physical activity may act
quicker.
Key causes of death , as elsewhere in the developed world, remain cancers and cardiovascular disease including stroke with ill
health additionally being caused by mental health issues together with frailty in the aging population.
We would expect to see continuing improvements in this measure as the economy improves and as we develop better public
health services.
It must be remembered however that the key determinate of health is age and that an older population will tend to suffer
poorer health than a younger one. It is likely then that absolute need for health and social care services will continue to grow
as the population profile shifts to include a higher proportion of older people.. However we expect as the population ages , the
health of an older person in the future will be better than that of an older person of the same age now mitigating to some
extent the impact of aging on care needs.
With respect to healthy life expectancy we need especially need to consider the impacts of frailty, mental health issues, and
stressors such as deprivation, debt, fear of crime and social isolation. These overlap with Outcomes around Safety, the
Economy and Independence.
The Curve we need to Turn
•
We would wish to see a proportional increase in the Life expectancy in Essex similar to that seen elsewhere in the Region and
nationally. This is not a quick win and data is collected historically and takes several years to become available. The most recent
data shows where we stood 3-5 years ago and given the often long term nature of interventions, it may take several years
before any impact becomes visible.
•
We need to track progress then through clear process and impact measures and these will link to the raft of actions we take to
deliver this indicator that are outlined in the Strategic Action section.
Reduced differential in life expectancy across different areas of Essex
Reduced differential in life expectancy across different areas of Essex
The Baseline and the Story behind it
•
The indicator above looks at geographical variation across DC/BC which is easy to measure. We also can and will look at the
differences between more and less deprived small areas (MSOAs). However, in addressing inequalities we need to also look at
differences between certain vulnerable groups who experience inequalities in life expectancy including people with mental
health issues, people with learning difficulties, gypsy and traveller groups and people who are homeless. These will be hard to
measure locally but this must not detract from our endeavours to address these inequalities.
•
Clearly life expectancy (LE) is related to deprivation. The populations who suffer most material deprivation, and unemployment
have lowest life expectancy. Separately from this issue, they also often make poorer lifestyle choices and find it harder to
engage with services. All these issues need to be addressed.
•
While as expected from national trends most areas and groups in Essex are living longer lives, this is worryingly not true in
Harlow and especially Tendring were LE is shortening. Similarly Rochford has not seen an increase ( but higher starting point).
The issues in Tendring in particular highlight the increasing deprivation of the area. It must be remembered the LE seen is the
result of decades of population experience of broader, lifestyle and clinical factors rather than quick impacts and where there is
population movement , those dying now in the area may have spent most of there lives elsewhere and have experienced the
socioeconomic impacts prevalent in that area.
The Curve we need to turn
•
We wish to see continued improved LE in all areas but this indicator is around reducing the differences between areas. We will
need to start as well to look at changes across deciles of deprivation but in the absence of historic baseline data , setting a
trajectory will be problematic although given data lags we will likely have more historic data available to help inform this before
we need to demonstrate the long term impacts of interventions described in this strategy.
•
In the interim we can look at DC/BC data as attached. For Tendring (and Harlow) we would expect to see further deterioration ,
given the historic nature of data and time taken to intervene ,for several years to come before we can slow and reverse this
trend.
•
Early success will be through clinical activity and some lifestyle action . It is recognised these populations are at risk due to many
years of deprivation and quickest action will involve addressing clinical risks such a high blood pressure and cholesterol
followed by tackling lifestyle factors such as smoking.
•
Addressing the broader underlying determinates takes decades to see an impact and evidencing this depends on a static
population. An influx of people from deprived London areas to Tendring or migration out of professional groups would lead to
continued deterioration in LE.
•
Interventions need to address broad societal, lifestyle and clinical issues. The principle of proportional universalism will be
followed with increased weighted access to the full range of interventions offered elsewhere as well as bespoke local
interventions
•
Partnership work with the local district s/ borough and CCGS as well as local voluntary sector groups will be crucial
•
Addressing educational attainment will be key. Evidence suggests that educational performance in the more affluent areas is even better than
would be expected given the wealth of the area but educational performance is even worse than expected given the level of affluence in the more
deprived areas. This will drive a long term INCREASE in inequalities if not addressed through focussed action on areas performing less well
Issues to address in order to turn the curve
Delivering improved public health needs to recognise the breadth of intervention required. Some will be narrow and clinical where intervention prevents
death and disability eg blood pressure management. Some will require specific interventions to improve lifestyle choices eg smoking services, others will
address the wider societal context to improve lifestyle choices eg trading standards and highways. More fundamentally we need to optimise health
through improving material wealth through educational attainment and economic growth and through access to benefits to those who need them.
As well as tackling the health needs of the whole population , we also need to address unacceptable inequalities in health across Essex both
geographically and within vulnerable groups. This will involve Proportionate Universalism, a term derived in the Marmot report. It involves additional
focus of the interventions described above targeted at the most vulnerable eg extra resources for health checks in deprived populations as well as
specific initiatives directed at vulnerable groups eg ECTU (Essex County Travellers Unit,) Reach Out project in Jaywick.
In order to turn the curve we need to address people's attitude and the culture towards health and wellbeing. Individuals need to be encouraged to take
responsibility for their health and the wider community also need to take some of that responsibility. There is a need to address some of the wider
issues relating to the food, drinks and tobacco industry.
Key issues for public health commissioners will be:• Address the high level of heart and stroke deaths and disability through commissioning evidence based preventive clinical interventions
• Address morbidity related to mental health through improving lifestyle risk factors and access to screening, prevention and management in those
who suffer, and addressing broader issues through improving employment and housing in this group.
• Address common causes of ill health in older people including falls prevention, continence care, social isolation, depression and dementia.
• Address the needs of vulnerable groups including those who misuse substances , prisoners, travellers , the homeless , people with learning
difficulties, care leavers and looked after children
• Improve lifestyle choices through services and system changes to support choices and address issues around smoking, alcohol, physical activity, diet,
substance misuse and sexual health using universal and targeted interventions.
However the above will be of limited value without full involvement of People and Place colleagues to:• Optimise parenting and early years support
• Improve educational attainment
• Support the economy and reduce unemployment
• Support vulnerable groups including through floating support, ECTU, benefits advice, and social care input
• Ensuring a safe environment , safeguarding vulnerable people, reducing domestic abuse and other crime
• Developing an environment conducive to healthy choices around exercise and diet.
Prevalence of healthy lifestyles:Smoking Prevalence
Reduced Smoking Prevalence
The Baseline and the Story behind it
•
Smoking is the biggest preventable cause of ill-health, disease and death and the single most important lifestyle factor affecting
health inequalities. In Essex the adult smoking prevalence is 18.7%, but this varies across the localities and between those in
the general population and those in routine and manual groups (R&M) with prevalence rising as high as 39% in R& M groups in
Colchester
•
We have seen a decrease in smoking prevalence over recent years at an Essex level, but this has slowed recently. Essex still
has lower rates than the national prevalence figure (20%) and the regional figure of 19.6%
•
Despite witnessing a decrease in overall prevalence, evidence suggests that certain population groups should be targeted.
There needs to be a focus on increasing the number of quitters from those population groups who face the greatest barriers to
giving up smoking
– R&M groups
– Children & young people under the age of 19
– Black and Minority Ethnic Groups
•
Nationally 4% of 11-15 year olds are regular smokers and this is replicated in Essex. Smoking in pregnancy is associated with
poor pregnancy outcomes and needs special focus.
•
There is a strong link between smoking and deprivation and a danger that a single universal approach will better tackle those in
more affluent areas. The principle of proportional universalism therefore needs to apply with services targeted in the most
deprived MSOAs
•
Particular vulnerable groups such a s people with mental health issues have high rates of smoking and will benefit from
particular focus.
The Curve we need to turn
•
We wish to see a year on year reduction in smoking prevalence.
•
We want to see a reduction in smoking prevalence in the population groups outlined above.
Issues to address in order to turn the curve
•
In order to achieve reduced prevalence there needs to be a combination of a wider tobacco control agenda as well as providing
local Stop Smoking Support Services (SSSS)
•
Addressing inequalities will in part be achieved by targeting SSSS in the most deprived areas and at the relevant population
groups. The principles of proportional universalism will be followed.
17
Obesity in Adults and Children
18
Obesity in Adults and Children
The Baseline and the Story behind it
• Adult obesity continues to rise nationally, but the rate of increase appears to be slowing. The causes and drivers are complex
and linked to changes in lifestyle linked to diet and physical inactivity. Around two thirds of adults are overweight or obese.
• Prevalence within Essex is similar to England, however, there are variations between local authority districts. PHE data in
February 2014 shows adult overweight and obesity levels within Essex ranging from 62% in Chelmsford to 73% in Castle Point.
Although a comparatively small sample size with a wide confidence interval, this places Castle Point within the highest 10
districts in England.
• Current adult weight management services within the county, previously commissioned by the 5 Essex PCTs vary widely, with
inequity of provision between areas. Some areas have specialist services for morbidly obese adults only, others have lifestyle
weight management services for the overweight and obese, whereas Castle Point and Rochford have no services for adults.
• Child obesity measured through the NCMP programme shows a flat trend in recent years for both age groups following a
strongly rising trend in recent decades. This is in line with national trends.
• Current child (family) weight management services, like adult services similarly show variations in provision, with some areas
having none.
The Curve We Need to Turn
• We need to reverse the rising tide of obesity in adults. Preventative initiatives are often very long term and require action in
childhood to impact on subsequent generations. We can expect little positive change to the population for some years but
will see process measures demonstrating better access to weight management support and outcomes
Issues to address in order to turn the curve
• The establishment of a clear county-wide obesity intervention pathway is a priority. A key element is the further development
of partnership working with Clinical Commissioning Groups, focusing on the overweight or those at risk of being overweight, as
opposed to the whole population.
• Current geographical inequity of adult weight management service needs to be addressed through the commissioning of a
county-wide Tier 2 model, aligned with CCG Tier 3 provision for the morbidly obese.
• Interventions to ensure county-wide equitable provision of child (family based) weight management services, linked closely to
the 5-19 pathway is an on-going priority.
• Obesity interventions need to be closely aligned with interventions associated with increasing physical activity.
• Specific commissioned services need to be supported by a raft of population wide activities around breast feeding, increased
physical activity, healthy schools, school meals, improved access to healthy food choices and reduced access to unhealthy,
19 options and both population and focussed education around cooking and eating.
Physical Activity
Adult participation in sport and active recreation (NI8)
APS6/7 (Oct 2011 - Oct 2013). % of people taking part in 0
days in activity last 28 days.
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
Essex
Uttlesford
Tendring
Rochford
Maldon
Harlow
Epping Forest
Colchester
Chelmsford
Castle Point
Brentwood
Braintree
20
Basildon
0.0%
Physical Activity: Increasing levels of Physical Activity in Essex and its associated boroughs
The Baseline and the Story behind it
• Evidence shows only 37.1% of Essex residents participated in at least 4 sessions of at least moderate intensity activity for 30 minutes in the
previous 28 days. Also, 44.7% of residents take part in no sport or active recreation (NI8 APS 2011-13).
• Physical inactivity is a significant, and independent risk factor for numerous physical and psychological conditions. It is associated with a
greater risk of developing coronary heart disease, osteoporosis, hypertension, stroke, non-insulin dependent diabetes mellitus, obesity and
depression. People who are physically active reduce their risk of developing such long-term diseases (coronary heart disease, stroke and type II
diabetes by up to 50%, and premature death by 20-30%).
• On average, an inactive person spends 38% more days in hospital than an active person, and has 5.5% more GP visits, 13% more specialist
service and 12% more nurse visits than an active person (Sari, 2008).
• Helping and supporting inactive people to move to a moderate activity level will produce the greatest reduction in risk of ill health and will
contribute to reduction in risk of coronary heart disease and obesity, hypertension, cancer, osteoporosis, depression and anxiety (Physical
activity in childhood has a range of benefits including healthy growth and development, maintenance of energy balance, mental well-being and
social interaction. (Department of Health, 2004)
• Increasing the amount of physical activity/ sport in a variety of settings, from active travel/ recreation and sporting environments is shown to
create behavioural change and embedded lifelong participation, passed down into the next generation.
• Increasing physical activity levels is a key component of reducing cardiovascular disease (CVD), cancer and diabetes; and obesity.
Interventions focusing on behaviour modifications provide short-term benefits. Educating people and informing their lifestyle choices by
promoting opportunities to participate and communicating the many health benefits of an active lifestyle is key.
• The current evidence base recognises that for long-term benefits social, structural and economic factors need to be addressed, a range of
complex factors combine to influence levels of sedentary behaviours, physical activity and sport participation.
The curve we need to turn
We as elsewhere are starting from a very low base. We want to improve the numbers taking ANY exercise as well as the numbers undertaking
nationally recognised amounts. Progress will be slow at best a percentage point a year
Issues to address in order to turn the curve
• Place - Targeting environments to encourage and facilitate physical activity in public open space, cycle paths, schools, sports facilities &
buildings, safer roads and communities.
• People - Targeting groups with levels below recommended guidelines, eg Children and Families (who do not have a familial culture of
physical activity), people living in areas of deprivation, Older people, Women, Black and Minority Ethnic Groups, people with learning
disabilities and targeted early years settings, primary and secondary schools .
• Essex requires a multi-agency approach to develop and direct holistic physical activity and sport.
• Active Networks action plans should incorporate multi agency services for evidence based universal interventions (Tier 1) and targeted
lifestyle interventions (Tier 2).
• Active Essex will support and lead Active Networks to work with CCGs to maximise the opportunities at Tier 2.
• Tier21
1 and Tier 2 commissioned interventions to ensure impact on outcomes & indictors through performance measures.
• District, Borough and City Councils are key partners in this endeavour.
Alcohol
2,200
Braintree
2,000
Brentwood
1,800
Castle Point
Chelmsford
1,600
1,400
1,267
22
Colchester
1,200
1,000
2009-2010
2008-2009
2010-2011
1,163
895
2007-2008
800
2006-2007
DSR per 100,000 population
Admission episodes for alcohol-attributable conditions
(previously NI39): All ages
Basildon
2,380
2,400
Epping
Forest
Harlow
Maldon
Rochford
Tendring
Hospital Admissions due to Alcohol
The Baseline and the Story behind it
• The indicator above looks at the rate per 100,000 of admissions to hospital. This is calculated by applying certain criteria to
Hospital Episode Statistics in relation to 47 conditions of which 13 are wholly attributable to alcohol consumption and 34
partially attributable
• These include hypertensive diseases, mental and behavioural disorders and cardiac arrhythmias. In 2010 alcohol use was the
third leading risk factor contributing to the global burden of disease after high blood pressure and tobacco smoking
• Average alcohol consumption has gradually fallen in many OECD countries between 1980 and 2009 with an average overall
decrease of 9%. The United Kingdom however, has seen an increase of over 9% in these three decades .
• Additionally drinking in pregnancy is associated with increased fetal and infant mortality and morbidity including fetal
alcohol syndrome.
• In England in 2011/12 there were 49,456 hospital admissions for alcohol-related liver disease, which is the only major cause
of mortality and morbidity which is on the increase in England whilst decreasing in other European countries
• The most effective strategies to reduce alcohol-related harm from a public health perspective include, in rank order, price
increases, restrictions on the physical availability of alcohol, drink-driving counter measures, brief interventions with at-risk
drinkers, and treatment of drinkers with alcohol dependence
• The picture in Essex closely follows that seen nationally with some occasional variations.
The curve we need to turn
Following several years of seeing significant rates of increase in Alcohol related hospital admissions we would be looking to see a
reduction in the rate of increase before reducing the rate This is in the main due to the fact that many of those conditions
considered will have significant delays in presenting themselves and effects of local investment and development have a reasonably
long “lead time” before impact. Is seen.
Issues to address in order to turn the curve
• Historic investment locally in the provision of many interventions and treatment services has been patchy and service provision
and service utilisation rates are significantly below those recommended by the Department of Health .
• Early wins will be seen by monitoring a number of indicators and performance measures and developing a system of support and
treatment that starts to meet the national minimum expectations and builds towards matching the system provided to address
drug misuse issues
• Building on the work with Trading Standards in relation to age related sales and supply of alcohol and with District/boroughs
around work on Licensing, Community Safety, e.g. alcohol out reach, licensing traffic light system, reducing the strength project
Commissioning a treatment system that addresses issues of dependence and also engages with hazardous and harmful drinkers at
earlier stages
• Developing a range of Brief Interventions strategies through ALL public facing provision and multi media/platform applications
• Developing an Alcohol Harm Profile for Essex and acting on the intelligence gathered therein to impact on supply through licensing
Successful completion of drug treatment
% of Successful Completions as a proportion of all clients in treatment
70.0%
60.0%
50.0%
40.0%
Opiates
Non-Opiates
30.0%
All Drugs (18+)
20.0%
10.0%
0.0%
24
25
Successful completion of drug treatment
The Baseline and the Story behind it
•
Drug misuse is a complex issue. While the number of people with a serious problem is relatively small, someone's substance
misuse and dependency affects everybody around them.
•
The most harm is associated with dependence in relation to Opiates (Illicit, prescribed and Over the Counter (OTC) ) and this is
the major focus of treatment activities.
•
In Essex there are predicted to be in excess of 4500 Opiate users (as calculated using the Glasgow Estimate from Public Health
England/DH). Measuring penetration into this population and the numbers of All Adults and Young People engaging with
effective treatment allows us to see how our services and the system is engaging with drug users across the county.
•
It is shown that treatment works (various data and research products provided by the National Treatment Agency/Public Health
England) and successful completion of drug treatment (within a recovery focussed system) is a useful measure to indicate a
reduction in the harm caused by drug misuse.
•
In time we will also be measuring the numbers exiting treatment in a planned way and not representing to treatment within six
months of discharge thereby providing more evidence of the reduction in harm.
The curve we need to turn
•
As we have seen a significant increase in the numbers accessing and engaging with effective treatment we have seen this
impact upon the “proportion” completing successfully. We have noticed a slight increase in the numbers leaving treatment in
an unplanned way.
Issues to address in order to turn the curve
•
We need to ensure we are working with commissioned treatment providers to reverse the decline and the curve we need to
turn is to see an increase in the proportion of those in treatment completing successfully.
•
Work is already underway to review data collection and reporting and this has seen us halt the decline and we now need to
target our joint efforts to ensure that clients are being managed effectively into recovery and “exited” from structured
treatment more effectively and into recovery support provision.
26
Life Satisfaction Rates
Life Satisfaction
Life Satisfaction is determined by a range of interlinked factors as well as levels of expectation .
Improvements to this trajectory will be sought and delivery will depend on overall progress across all outcomes in this strategy.
The curve we need to turn
Data above suggests a decline in life satisfaction in Essex while nationally satisfaction is improving. We wish to reverse this curve
and see a rate of improvement in excess of that seen nationally to regain our relative difference in improvement.
Strategic Actions (given existing resource envelope)
n
People In Essex have a healthy life expectancy
Life satisfaction rates (ONS condition of wellbeing)
Percentage of Essex residents who consider themselves to be in good health
Strategically the above will be addressed through a combination of identification and management of people at high risk or with conditions, addressing
lifestyle (discussed below) and addressing broad determinates..
Key to success is to develop and deliver a public health strategy that recognises:• The Broad range of determinates that affect health, and hence the wide range of areas in which ECC can influence outcomes
• The role of all agencies , communities and individuals in delivering this agenda
• The need to balance local , Essex and national solutions
• The need to recognise process and output measures as relevant as we strive to achieve often very long term improvements in outcomes
• The need to balance short term health gains and productivity with initiatives delivering crucial health gains often decades from now
The actions outlined below are key initiatives in delivering these outcomes
Broad Determinates
•
School Achievement (below and in our Best start in life and education
and life-long learning commissioning strategies),
•
Employment (see below and our commissioning strategies for
economic growth),
•
Giving children best start ( see our best start in life commissioning
strategy) ,
•
Safe community ( see our safer communities commissioning strategy)
Strategic Actions ~ Management High Risk
Action
Lead
Resource
Issues addressed
Timetable
National cardiovascular Health
checks programme and local
senior health checks and atrial
fibrillation programmes.
Chris French
PH grant – this
is resourced
within the
current MTRS
Short to medium term reduction
in heart attack and stroke deaths
and disability from stroke.
In place,
extension
required
£2.1m savings (to be delivered in
2014/15 and 2015/16)are built
into the Adult Operations care
budgets with the MTRS
predicated on delivery of this
action.
Depression in older people . Many
older people have depression and
are not identified or managed.
Ian Wake
PH grant – this
is resourced
within the
current MTRS
This will identify people with
depression and allow best
management
September
2014
Potential £0.5m of benefits in
year 1 and 350k recurrently not
already within the MTRS realisable in our independent
living commissioning strategy
Commission a range of services
to prevent alcohol misuse,
29
Ben Hughes
PH grant– this is
resourced within
the current
MTRS
Identify and reduce harm in those
drinking to harmful levels and
develop services for dependent
drinkers
£1.3m savings (to be delivered
between 2014/15 – 2016/17)
are built into the Adult Operations
care budgets within the MTRS
predicated on delivery of this
From April 2014
Strategic Actions ~ Management High Risk
Action
Lead
Resource
Issues addressed
Timetable
Commission evidence based falls
services
Maggie Pacini
PH grant– this is
resourced within
the current
MTRS
Identify those at risk and prevent
falls and the harm that ensues.
From April 2014
£200,000 savings (to be
delivered in 2014/15 are built into
the Adult Operations care
budgets within the MTRS
predicated on delivery of this
action.
Ensure best identification and
management high blood pressure
Ian Wake
PH grantfunding needs to
be found from
PH grant, year 1
cost , 1.4m, year
2 cost approx.
800k , no further
recurrent cost
Reduce stroke and other disease
through better management high
blood pressure
From April 2015
Work with CCGs to secure
evidence based continence
services
Krishna
Ramkhelawon
PH grant – this
is resourced
within the
current MTRS
Manage and reduce the harm
caused by incontinence both to
those who suffer and their carers.
£1.2m savings (to be delivered
between 2014/15 – 2016/17)
are built into the Adult Operations
care budgets with the MTRS
predicated on delivery of this
action.
Full
implementation
2015, part
implementation
through 2014
30
Action
Lead
Resource
Issues addressed
Timetable
Work with CCGs to ensure
best treatment of strokes .
Maggie Pacini
PH grant – this is
resourced within
the current MTRS
Ensure people receive the best
possible evidence based care
after a stroke to ensure best
recovery.
From April 2014
£2m savings (to be delivered
between 2014/15 – 2016/17)
are built into the Adult
Operations care budgets within
the MTRS predicated on
delivery of this action.
.
Addressing the issues above will deliver short and medium term gains in delivering the commissioning strategy
for helping people maintain independence. The total savings targets built into the MTRS within the Adult Operations
budgets up to 2016/17 is £6.5m. This is predicated on delivery of these key actions.
From depression initiative above we could save 500k in year 15/16 and 350k recurrently
From Hypertension initiative above there is potential to deliver an additional £1.5m subject to identifying non-recurrent set
up costs.
31
Reduced differential in life expectancy across different areas of Essex
Action
Lead
Resource
Issues addressed
Timetable
Value of contracts will be weighted to take
account of deprivation eg Healthy Schools
Programme,
Jane Richards, Ben
Hughes, Chris
French.
PH grant
Sept 2014 and as
contracts end
Resource Specific Targets around numbers of
smoking quitters from deprived wards
Chris French
PH grant
More resource and
focus in areas of
greatest need with
emphasis on agreed
deprived groups
through proportionate
universalism
Differential remuneration for Health Checks
undertaken in deprived groups
Chris French
PH grant
Bespoke Health check services aimed at
vulnerable groups
Chris French
PH grant
Targeted obesity and physical activity services for
vulnerable and high risk groups
Jane Richards,
Jason Fergus
PH grant
Targeting lifestyle support through volunteer
health champions at high risk groups including
people with mental health issues
Chris French, Ian
Wake
PH grant
Targeted services via third sector eg Reach Out
Jane Richards, Ben
Hughes, Chris
French
PH grant
Reducing impact broad
determinates including
debt
Ongoing, ideally
role out 2015
Bespoke services for vulnerable groups eg ECTU,
LD football , sexual health and mental health
support for Looked After Children
Jane Richards, Ben
Hughes, Chris
French , Ian Wake
PH Grant
Reduce risks of ill
health and social
isolation in very high
risk and hard to reach
groups
Continue to
develop 2015
April 2014
Ongoing
Reduced
cardiovascular risk,
diabetes, obesity and
strokes in defined
hard to reach groups
Increased focus
from 2014
From Sept 2014
From Sept 2014
All the above are resourced within the existing MTRS. The savings being delivered against these actions relate to re-procurements. There is a
total Public Health procurement saving within the MTRS of £2.1m up to 2015/16.
32
Prevalence of healthy lifestyles
Action
Lead
Resource
Issues addressed
Timetable
Smoking Cessation services and broader
action on tobacco.
Chris French
PH grant
Reduce harm from smoking
Continue to develop,
refocus 2014
Obesity initiatives . This needs to include both
ensuring a county and partner wide approach
to addressing weight issues as well as
commissioned bespoke tier 2 weight loss
services.
Jane Richards
PH grant
Reduce harm due to excess weight
and obesity in the Essex population
including those at most risk.
Sept 2014
Improved physical activity . This needs to
include both ensuring a county and partner
wide approach to improving physical activity
as well as commissioned bespoke services to
improve physical activity in high risk groups.
Also the current actions within the Sustainable
Environment outcome strategy
Jason Fergus
PH grant, ECC
Baseline
Funding
external funding
for projects
Improve health through increased
physical activity impacting on
physical and mental health
Sept 2014
Sensible alcohol use ,education, prevention
and management. Working with Community
Safety Partnerships
Ben Hughes
PH grant
Reduce harm to individuals and
population through alcohol misuse
Ongoing, developments
from April 2014
Sexual health services . We will develop a
range of in line with best practice that are
accessible and provide a range of support,
advice and treatment to all .
Jane Richards
PH Grant
Ensure positive sexual health and
reduced related disease.
Sept 2014
Commission a range of evidence based
services for people who Misuse Substances,
developed with input from service users
Ben Hughes
PH grant
Ensure those who need these
services are able to access them
reducing harm to population
From April 2015
Work with Schools colleagues to optimise
impact of Healthy Schools on lifestyle choices
Chris French
PH grant
Improve healthy Lifestyle choices
in young people
April 2014
Work with employers including key public
sector orgs. to support healthy lifestyles
Chris French
PH grant
Improve lifestyle choices of people
at work
Sept 2014
The savings being delivered against these actions are in relation to re-procurements. There is a total procurement saving within the MTRS of £2.1m up to
33
2015/16 – There is potential for over delivery against this target by £1.2m that could help mitigate a 10% resource reduction
34
Percentage of Children Achieving at school
The Baseline and the Story behind it
•
Health is in large part determined by socio-economic factors throughout life. These factors including employment and housing
are in large part related to material wealth and this in turn is driven by educational attainment.
•
Educational outcomes in Essex (measured by GCSE results) are now just above the national average in Essex and Statistical
neighbours and are improving.
•
Evidence suggests that educational performance in the more affluent areas is even better than would be expected given the
wealth of the area but educational performance is even worse than expected given the level of affluence in the more deprived
areas. This will drive a long term INCREASE in inequalities if not addressed through focussed action on areas performing less
well.
•
School readiness levels in Essex have been poor but again are improving with most recent data on readiness at the end of
reception year now slightly above the England average at 52.5%. There is clear evidence that early years development in large
part determines future academic progress and high levels of school readiness are essential
•
The high proportion who are not school ready (nearly 48%) suggests action needs to be directed universally to families as well
as the specific focus needed on those with greatest needs. This requires universal support for strong effective parenting and
preschool education.
•
Essex is far from homogenous with some areas of real excellence and others where educational attainment is poor. Tendring
schools are currently doing less well relative to other areas of Essex. Areas which used to have poorly performing schools, eg.
Basildon and Harlow, which have had recent ECC support have improved.
•
Details of what needs to be done and the action planned both to address school readiness and parenting is described through
our “Children in Essex get the best start in life” strategy and action to improve educational attainment within schools is
described through our “People have aspirations and achieve their ambitions through education, training and lifelong-learning”
commissioning strategy.
The Curve we need to turn
•
Essex wants to be in top quartile nationally for standard national benchmarked data for educational attainment .
•
These are described in detail through our commissioning strategies for Best Start in life and for education and life-long learning
Issues to be addressed to Turn the Curve
•
These are described in detail through our commissioning strategies for Best Start in life and for education and life-long learning
35
Strategic Actions ~ Percentage of Children Achieving at school
Action
Lead
Resource
Issues addressed
Timetable
Actions around improving parenting
and nursery education addressed
under Outcome for best start in life
Chris Martin
Childrens’
commissioning
improve school readiness
see
Commissioning
strategy for best
start in life
Actions around Educational
attainment is discussed under
Outcome for education and life-long
learning
Tim Coulson
Schools Budget
Improve educational
attainment
see
Commissioning
strategy for
education and
life-long learning
36
Percentage of working age people in employment
Good to be…
High
5 Year Performance Trend:
Essex England
Employment rate (16-64)
Employment rate
74.5
74
73.5
73
72.5
72
2008
2009
2010
2011
2012
SN
2008 74.4%
-
-
2009 73.9%
-
-
2010 73.1%
-
-
2011 73.2%
-
-
2012 73.9%
-
-
Percentage of Working Age People in Employment
The Baseline and the Story behind it
•
Employment is absolutely key to health. Studies have shown that unemployment has a serious detrimental impact on all
aspects of the physical and mental health not just of the person who is unemployed but on their whole family.
•
This essential indicator of health and wellbeing will be tackled under our “Sustainable economic growth for Essex communities
and businesses” outcome.
•
There are particular issues around levels of unemployment in population sub groups. Much of the harm to health in people with
mental health issues is around their high levels of unemployment that is not directly related to the mental health issue.
•
Linked to the modest rate of economic growth in recent years there has been relatively slow growth in the number of jobs in
Essex. Key locations for growth are Basildon, Braintree, Chelmsford, Colchester and Harlow. Key sectors are advanced
manufacturing, low carbon and renewables, logistics, life sciences and healthcare, digital, culture and creative. The
employment rate for December 2012 (73.9%) showed a continued trend of improvement since 2010 . It was slightly down on
the East of England region (74.6%), but compared relatively well to Kent where employment rates continue to fall . The Essex
figure was also greater than the National rate (70.9%).
•
The unemployment rate also increased in Essex in 2012 (7.2) compared to 2011 (6.7) reversing the improving picture identified
between 2010 (7.3) and 2011 and bringing the unemployment rate back to just below 2010 levels. By contrast, East of England
authorities showed general improvement in 2012, compared to a period of decline in 2011. Overall, whilst there may have
been some year on year variation in results the East of England picture suggests that unemployment rates in general are back in
line with 2010. Nationally 2012 rates (8.0) were higher than 2010 (7.8) although down slightly on 2011 (8.1).
•
Between July 2012 and June 2013 Harlow (9.8%), Tendring (9%) and Basildon (8.9%) had the highest unemployment rates of all
the Essex districts. Unemployment hotspots in parts of the county are also worst affected by youth unemployment. The highest
unemployment rate in Essex for Jul 2012 to Jun 2013 was for the age group 16 to 19 years (29.2%). This was not significantly
different from the East of England and England rates. Nearly 8,000 16-24 year olds in Essex are claiming Job Seekers Allowance
as of May 2012 - an increase of 12% since the same time last year. A further 6,720 are claiming other out of work benefits.
•
The actual number of unemployed in Essex increased significantly from 2011 (46,900) to 2012 (51,300),recording the highest
level for many years.
•
To sustain economic growth in the context of substantial demographic growth between 2014 and 2021, we will need to secure
an additional 33,000 jobs and an additional 34,000 homes
38
The Curve we need to turn
•
This is described in detail under our outcome for economic growth
•
Job growth and employment rates have begun to rise and we need to continue to support this direction of travel.
•
Continue efforts to reduce NEET figures under economic growth and education and life-long learning outcomes
•
There is a need to help people with mental health issues to keep or find work.
•
Reduction in health inequalities between geographic areas especially Tendring requires economy focused action and is unlikely
to succeed without this.
Issues to address in order to turn the curve
•
This is described in detail under our outcome for economic growth
39
Strategic Actions ~ Percentage of Working Age People in Employment
Action
Lead
Resource
Issues addressed
Timetable
Detailed action is described through our
economic growth commissioning strategy
Paul Bird
Financials in
relation to
these actions
are addressed
in our
Economic
Growth
Commissionin
g Strategy
Improve employment
opportunities so
improving health across
population including
vulnerable groups and
high risk geographical
areas.
As per our
Economic
Growth
Commissioni
ng Strategy
40
41
Percentage of families living in safe and suitable housing
The Baseline and the Story behind it
•
Homelessness, the threat of homelessness and poor quality accommodation can have a serious health impact on health
and wellbeing. Unsuitable housing can have a detrimental effect on health (e.g. hypothermia), exacerbate ill-health (e.g.
from dampness), pose risks (e.g. falls or accidents) and can cause anxiety and stress (e.g. fear of becoming homeless or
overcrowding) leading to mental health conditions.
•
Numbers of homeless people will be a key measure to demonstrate the Council and partners’ commitment to reduce
homelessness . This should include the number of housing brokerage supported by social workers to cater for vulnerable
groups (e.g. people with learning disabilities, sensory or physical impairments).
•
Numbers of statutory homeless as attached is not the full picture. Many people will not be included such street homeless
and people who are “sofa surfing” with friends or relatives.
•
Safe and Suitable Housing should include [i] Rented properties – advice on housing condition [ii] Housing Association
support [iii] Supported and Sheltered accommodation [iv] Safety at Home and bogus caller support – fire, fall/accident
prevention, DV, Telecare, Listed traders [v] Homebuy advice – debt prevention, mediation [vi] Home adaptations –
older/disabled people [vii] Energy advice – heating, grants, tariff switching, low income families [viii] Homelessness [ix]
Affordable Housing development
•
There are particular serious needs in those who are street homeless. These have been discussed in our Homeless needs
assessment. These include high levels of mental health issues, alcohol and substance misuse and poor access to primary
care services.
•
Families in temporary accommodation with insecure tenure face a different set of needs related to overcrowding and
safety as well as a lack of continuity with an impact upon attachments to the community and fragmented school
experience
•
People present as homeless to Districts and Boroughs. We need to ensure their needs are appropriately met.
•
We need to work to prevent housing crises especially in vulnerable groups including ex offenders, people with mental
health issues or who misuse substances , people with a learning disability, care leavers and those living chaotic lives.
•
We need to ensure suitable quality private rented accommodation
•
Local Authorities can now discharge their housing responsibilities through private sector rented housing. People placed
will almost certainly have less security of tenure, and possibly fewer rights compared with social housing. The quality of
private rented housing is also variable, especially in regards to structural stability of houses, dampness, safety and
efficiency of heating.
•
Any increase in mortgage repossessions should be viewed as a proxy measure for those at risk of less safe and suitable
housing.
The curve we need to turn
•
We need to develop our understanding of available data. Discussion with partners and stakeholders on which sub cohorts of
the population are at greatest risk will be important.
•
We will reverse the increase seen recently in statutory homeless
•
We will reduce the number of people with mental health issues at risk of homelessness
Issues we need to address to Turn the Curve
•
This is crucially the role of Districts and Boroughs. We need to ensure an effective forum for addressing housing issues with
providers and housing strategy leads within the districts.
•
Establish a COG to look at and address issues around housing and homelessness
•
Work with the Domestic Abuse COG will ensure appropriate accommodation and support options for those suffering DA.
Regarding refuges, we need to pay specific attention to supporting families at risk through the locality options that are
available, all of which will impact upon young children and the quality of school preparedness
•
We need to ensure acceptable quality of private rented accommodation. This will include the ECC Private sector landlord
accreditation scheme
•
We need to consider with partners the management and allocation of Disabled Facilities Grants (DSGs) in supporting families
caring for a disabled loved one, to have the optimal environment to learn and to live more independently.
•
Interventions include commissioned floating support service which directly supports vulnerable adults with housing needs, eg
debt liaison, discussion with landlords , people at risk of domestic violence as well as the Council using its legal powers to
protect tenants from harassment and unlawful eviction.
•
We will develop a strategic approach to the prevention and management of homelessness including a focus on risk groups such
as people with mental health issues
•
We need to ensure the right level of provision for affordable housing, housing (e.g. ‘extra care’) to support people live more
independently and the appropriate level of residential care home.
•
We need to Increase in the number of landlords claiming the Landlord’s Energy Saving Allowance (LESA) which will be an
indication that they are making energy saving improvements
43
Strategic Actions ~ Percentage of families living in safe and suitable housing
Action
Lead
Resource
Issues addressed
Timetable
In partnership with District and Borough Councils we
will develop and implement a homelessness strategy
and action plan
Simon
Harniess
Housing Budget
Coordinated approach to
homelessness across agencies
March 2015
Review the existing housing strategy for those with
additional needs
Simon
Harniess
Housing Budget
ensure plan remains relevant. This
will link to our Independent living
commissioning strategy
September 2014
Work with DC and BC around ensuring a flexible
approach to people who are chaotic
Simon
Harniess
Housing Budget
Prevent clients losing tenancies and
being labeled “intentionally
homeless”.
March 2015
Ensure the ECC Private sector landlord accreditation
scheme
Gwyn Owen
Housing Budget
Ensure quality of tenancies
Review July 2014
Ensure a fit for purpose commissioned floating
support service
Simon
Harniess
Housing Budget
direct support for vulnerable adults
with housing needs, eg debt liaison,
discussion with landlords etc.
Review July 2014
Review the commissioned Triangle Tenancy
Sustainment scheme - whereby vulnerable tenants
have their rent paid by ECC and where ECC liaises
with landlords. This scheme could be rolled out to
include other more vulnerable groups
Simon
Harniess
Housing Budget
To ensure sustainable tenancy for
those with substance misuse issues
and who are offenders and other
vulnerable groups
Review Extension
June 2014
Engage with Housing partners to ensure the
proportion of housing development that is expected
to be delivered as ‘affordable’ housing. Review the
ned for and provision of ‘extra care’ housing and
agreed with stakeholders
Simon
Harniess
Ensure appropriate housing to meet
population needs
Commences July
2014
Housing Budget
Gary
Heathcote
Financials in relation to these actions are addressed our Independent living Commissioning Strategy
44
Implement changes
April 2015
Percentage of Households living in Fuel Poverty
The Baseline and the Story behind it
•
Excess winter deaths are associated with poorly heated homes and this in turn is associated with fuel poverty.
•
Fuel poverty and poorly heated homes are also associated with increased levels of poor mental health.
•
Fuel Poverty historically occurs when 10% of income is needed to heat the home to accepted standards. It depends on income,
fuel price and how easy the home is to keep warm.
•
Particular cohort at risk are older people, including those who come into the social care system. Also those on benefits and low
income families. Fuel poverty may be worse for people in private rented accommodation, and people who are single occupiers.
•
Fuel costs continue to rise at a rate exceeding inflation
•
Changes to the benefits system particularly aimed at working age adults may mean that some of these adults are drawn into
fuel poverty. Also the increased threshold for single room rate means that more of the population group are affected and
potentially subject to fuel poverty. The £500 per week benefits cap may impact on a small number of families in Essex .
•
The condition of the housing stock in Essex is also relevant. There are a large number of owner occupiers in Essex but some of
these may be asset rich but cash poor. The condition of private rented accommodation is also relevant because private rented
accommodation quality is often poorer than social housing. Tariffs for those on payment meters are also higher than tariffs for
those who can pay on direct monthly debit.
•
Home insulation grants are now less available than they have been in the past, (for example, the Warm Front initiative expired
a year ago).
•
Conversely more people are in employment although average wages have not increased in line with inflation but the minimum
wage has increased.
•
There is variable information on home improvement information to reduce fuel poverty, so part of the role of Home
Improvement Agencies (HIAs) is to help customers navigate this process
•
Given all the above it is hard to understand why the data suggests a reduction in the numbers in fuel poverty.
.
.
.
46
The Curve we need to turn
•
While data suggests a reduction in numbers in fuel poverty, it is unclear why this should be the case given the economic
downturn and the increasing cost of fuel. We need to better understand the trend but continued improvement may be a
challenge in the short term and we might expect a continuing rise in numbers.
•
Improvements in the Essex economy will help address the numbers in fuel poverty so action under our commissioning strategy
for economic growth is critical.
Issues to address in order to turn the curve
•
Responsibility for housing is primarily with district , city an d borough councils and ECC needs to work in close partnership . A
number of initiatives led by the district and borough councils are underway linked to their role in environmental health and
housing. These tend to take an education raising role, making residents and landlords aware of the problems and solutions
available to them. One example is the work underway at Chelmsford City Council, who in December 2013 organised an
information seminar to discuss the impact of cold and damp homes. This is likely to be an area of increasing focus for district
and borough councils as the legislation around housing quality tightens.
•
From 2016 private residential landlords will be unable to refuse a tenants reasonable request for consent to energy efficiency
programmes; whilst from 2018 it will be illegal to rent out a residential or business premise that does not reach a minimum
energy efficiency standard to be set at Energy Performance Certificate (EPC) rating E. Currently nearly 9000 (14%) of Chelmsford
homes are in bands F or G, and will not be legal to rent out when the legislation comes into force.
•
ECC are working with districts and boroughs to implement the Green Deal within Essex through the Essex Energy Partnership. .
•
We also need to work closely with private sector landlords as well as housing providers.
•
We have little control over fuel costs, we can address economic growth and support employment in some to get people out of
fuel poverty and we can ensure access to benefits where appropriate ( this will alleviate the effects but not address the fuel
poverty per se).
•
We also need to support improvements in housing stock.
•
We need to recognise that initiatives in the short term will need to focus on vulnerable groups to mitigate the impacts of fuel
poverty rather than reduce fuel poverty per se.
•
ECC's sphere of influence to address fuel poverty is more with private rented accommodation and owner occupiers, and these
should be priority groups for interventions, as they are relatively less well regulated. The key role of housing means we need to
work with districts, city and boroughs in this area.
•
We need to ensure help reaches the most vulnerable clients. This will involve floating support
•
We need to ensure all services in contact with the population identify households at risk of fuel poverty , can offer simple advice
47and support or can appropriately refer. This may include proactive action in times of risk .
•
Continue to work with CVS to implement schemes to alleviate fuel poverty in those hardest hit.
Percentage of Households living in Fuel Poverty
Action
Lead
Economic improvement
Issues
addressed
Timetable
See economic growth commissioning
strategy
Increasing income of
households will reduce fuel
poverty
See economic growth
commissioning strategy
Joint work with DC,BC and City
Simon Harniess
Nil required
Coordinated response
across agencies
From Sept 2014
Work with district and borough councils linked to
their role in environmental health and housing
linked to Outcome on sustainable environment
including ensuring education and information to
people on saving fuel costs.
Chris French
See sustainable
environment
commissioning
strategy and PH
grant
Improved education on how
to keep warm and reduce
fuel costs
From Sept 2014
Work linked to Outcome for sustainable
environment around reducing household fuel
costs. ECC are working with districts and
boroughs to implement the Green Deal within
Essex through the Essex Energy Partnership
See sustainable environment
commissioning strategy
reduce fuel costs
The first Essex County
Council Community Energy
Switching scheme was
launched in January 2014
with over 3900 residents
registering
48
Resource
Percentage of Households living in Fuel Poverty
Action
Lead
Resource
Issues
addressed
Timetable
commissioning home improvement
agencies
Sheila Norris,
Simon
Harniess, Jane
Richards
Through existing
Grant process
Rapid adaptions to reduce
fuel costs
From Sept 2014
Use of whole workforce to identify and
signpost those at risk due to fuel poverty.
Simon Harniess
/Chris French
Nil required.
Identify those at risk and
enable advice and support
to be directed as required
From September 2014
Ensuring access to benefits including
grants for improving housing stock
Simon Harniess
External sources
Improved insulation and
cheaper fuel needs
Ongoing
Commissioning floating support services
Simon
Harniess,
Housing Related
Support
Improve support for
vulnerable groups
From Sept 2014
Focused initiatives via CVS targeting those
most vulnerable
Chris French
PH grant
resourced within
current MTRS
Target support for those at
risk of poor health
outcomes through fuel
poverty
Winter 2014
Also the current actions within the
Sustainable Environment commissioning
strategy’
Peter Kelsbie
As per our
sustainable
environment
commissioning
strategy’
Improved education,
reduced fuel costs to heat
homes.
As per sustainable
environment
commissioning strategy
49
Prevalence of mental health disorders among children and adults
Children
The Baseline and the Story behind it
•
National research highlights that good emotional and mental health is fundamental to the quality of life and productivity of individuals and families.
Poor emotional wellbeing and mental health can lead to negative outcomes for children including educational failure, family disruption, poverty,
disability and offending. These can lead to poor outcomes in adulthood such as low earnings, lower employment levels and relationship problems
which can in turn affect the next generation.
•
Research has also shown that half of lifetime mental illness arises by the age of fourteen; that the most crucial influence on a child’s emotional
wellbeing and mental health is parenting influence within the first year’s of a child’s life and that early attachment and bonding between
parents/carers and their babies is vital for a child’s development.
•
Essex surveys of schoolchildren show that pupils with poor emotional wellbeing are twice as likely to say they are afraid to go to school because of
bullying and that they have been a victim of crime; they are significantly less likely to enjoy school and more likely to want and need more help from
teachers.
•
CAMHS services are complex and fragmented and commissioning is not joined up. The CAMHS Tier 2 service for those with emerging mental health
issues Is commissioned and delivered by ECC; the 7 CCGs commission NEPFT to deliver Tier 3 for those with mental health issues in North Essex and
SEPT to deliver Tier 3 in South Essex.
•
There is a continuing focus on early intervention based on national evidence that this saves costs upstream with support for school and community
based provision .
•
The 2013 JSNA for Children’s Emotional Wellbeing and Mental Health found that fewer than the expected number of children needing a service at
both Tier 2 and Tier 3 level were receiving support.
•
It concluded that there is a complex, fragmented and poorly understood set of services in place across Essex with a high degree of concern among
professionals about access to CAMH Services. There is differing access criteria and service delivery across Essex with a lack of clarity on pathways
between services.
•
Estimated need and demand levels are generally static (Child and Maternal Public Health Observatory CHiMAT estimate 7% children have a Tier 2 level
mental health need and 1.85% children have a Tier 3 level need); however the complexity of referrals is increasing while resources are not. We are
therefore seeking efficiencies through evidence based commissioning, reduced management costs, improved joint working with other services and
increased support provided from universal services.
•
National benchmarking data shows that across Essex health invest less than the average health investment in CAMHS across England.
.
Prevalence of mental health disorders among children and adults
Children
The Curve we need to turn
We currently have no data t around the actual number of young people in Essex who have mental health issues. We only have likely
numbers based on extrapolation from national surveys that do not provide a basis for a measurable trajectory. The 2013 JSNA for
Children’s Emotional Wellbeing and Mental Health shows that some 14.5% Tier 2 need and 75% of Tier 3 need is met through direct
intervention- though the Tier 3 level is very variable across the County. Experience and feedback from providers shows that the complexity
of cases is increasing.
Issues to address in order to turn the curve
• Ensure the best start through strong parenting support and pre school education as outlined in best start in life Outcome
• Work with schools to improve resilience and reduce harm through stresses such as bullying
• Integrate commissioning across ECC and the CCGs
• Develop and implement a redesigned Service Model which simplifies access to and provision of interventions
• Improve performance management of provision
• Improved joint working with other services and an integrated holistic approach to ensure improved wellbeing
• Easier access to CAMHS support for children and professionals with a quicker response to needs.
• More children have appropriate evidence based support that results in improved emotional wellbeing and mental health.
• Prioritisation for Children Looked After and care leavers with support for emotional wellbeing at all stages of their care journey.
.
Strategic Actions ~ Prevalence of mental health disorders among children
Action
Lead
Resource
Issues addressed
Timetable
Optimise early years support around
parenting and preschool education as
per best start in life commissioning
strategy
Chris Martin,
Barbara Herts
ECC and health
budgets
Strong secure attachment and
emotional development
As per best start in
life commissioning
strategy
Re-commissioning and integration of
services jointly across Southend,
Essex and Thurrock and the 7 CCGs.
Barbara Herts
CAMHS
commissioning
budget (ECC and
health) ECC
contribution
resourced within
MTRS
Develop best model for services
and address the gaps highlighted
by the external JSNA, such as
therapies for behaviour, ASD and
Autism, Self- harming and support
for looked after children on the
edge of care
Nov 2015
Work with Healthy Schools
Tim Coulson,
Chris French
Healthy Schools
Budget, PH grant
- resourced
within the current
MTRS
address issues such as bullying
and help develop resilience in
young people.
Ongoing, develop
2015
52
Strategic Actions ~ Prevalence of mental health disorders among children
Action
Lead
Resource
Issues addressed
Improve transition to adult mental
health services.
Barbara Herts
CAMHS and
Adult MH
budgets resourced within
the current
MTRS
Improve experience for service
users
Commission specific support for those
at high risk including children who are
looked after and those leaving care
Ian Wake
PH grant resourced within
the current
MTRS
Mental health needs of care
leavers
53
Timetable
April 2015
Prevalence of mental health disorders among children and adults
Adults
The Baseline and the Story behind it
•
•
•
•
•
•
Mental Health issues are the key cause of ill health in the population. Amongst older people over a third are likely to suffer from depression
People with mental health issues live 10 to 20 years shorter lives than those without ( depending on condition)
75% of mental illness other than dementia starts by a persons mid 20’s
There is a strong link with deprivation and socio economic factors.
Debt and workplace stress are causes of poor mental health
Mental health issues are strongly associated with employment. Loss of work leads to increased mental health issues and those with mental health
issues often find it hard to secure or maintain existing employment. The current economic climate has impacted on need.
•
Amongst older people, social isolation is a key cause of mental health issues
•
Carers are at particular risk of mental health issues
•
Dementia is an increasingly important and common issue within the population with numbers expected to rise rapidly in coming decades
•
Number of total contacts with mental health services, rate per 1,000 population - latest figure 256.
•
In-year bed days for mental health, rate per 1,000 population - latest figure 221
•
Directly standardised rate for hospital admissions for mental health - latest figure 197
•
There are two key specialist mental health providers, SEPT and NEPFT.
There is a joint S Essex commissioning strategy including the Unitaries which is changing the shape of future services. In N Essex, the strategy is at sign
off stage, due to be implemented later in 2014. Change drivers include the need to move toward an outcome and recovery based services, and financial
constraints. The later has led to a marked reduction in 3rd sector, often preventative service ,funding. Similarly health partners funding has reduced.
The Curve we need to Turn Adult Mental Health
While we have some service utilisation data we have no sense of the local prevalence of mental health issues in adults although we are aware of the
scale of the problem through extrapolation from national surveys and studies. It is therefore not possible currently to establish a baseline or a
measurable trajectory. (see key issues to address in slides)
Issues to address in order to turn the curve (see key issues to address in slides)
• Early years initiatives are key in protecting mental health in adults and are described elsewhere
• Seamless and sound Transition from children to adults services is essential. There are particular issues around access and quality
of CAMHS services
• There is a need to address the broader determinates that drive metal health prevalence. These include addressing poverty, debt
and unemployment as key drivers of poor mental health. Economic growth commissioning strategy activity will help in this area.
• There is a specific issue around low employment for people with mental health issues who suffer harm from the ensuing hardship
more than their mental health issue.
• People with mental health issues need focused support around access to benefits and housing . These issues link to our
economic growth outcome (housing)
• People with mental health issues are at high risk related to poor lifestyles and need focused support around smoking, alcohol,
diet and exercise .
• Up to 30% of older people are depressed but only 1 in 6 has raised this with their GP and of those who have only half are being
treated. There is a need to, with health colleagues, identify people especially older people with depression and to manage the
condition .
• We need to consider opportunities around ACL (Adult Community Learning ) and libraries in supporting particularly older people
and helping address mental health needs
• We can provide resources to enable people to develop resilience within their community including through libraries and
workplaces.
• We need to optimise our communities potential to reduce social isolation and provide support - linked to our independent living
Outcome
• Informal carers are crucial to supporting our population and are often under considerable mental stress. We particularly need to
consider their needs.
• As dementia becomes more common, we need a clear joined up approach with health colleagues to its management
• We need to ensure intensive enablement packages for those who are most in need and have the most re-enablement potential.
• The development of personal budgets and personal health budgets, means that individual packages of care can be commissioned
to meet individual outcomes and deliver efficiencies.
• People need to be enabled to live as independently as possible with appropriate support. The principle underlying commissioning
should be a recovery focus. Key will be ensuring appropriate housing so people can move from hospital and residential care
through intensive reablement to supported living options that maximise their independence
• Efficiencies and quality gains will be delivered by the accommodation strategy. We will do this by e.g. supporting people back into
employment, reduction in medication, getting people out of hospital.. Care and Support (£1.5m) savings are dependent on an
appropriate provider being found for a new Intensive Enabling housing contract
• We are working to achieve the outcomes in the MH framework . From a policy perspective the key driver is “No Health Without
Strategic Actions ~ Prevalence of mental health disorders among adults
Action
Lead
Resource
Issues addressed
Timetable
Early years initiatives are key in protecting mental health in adults and are described elsewhere
Seamless and sound Transition from children to adults services is essential. There are particular issues around access and quality of
CAMHS services
Address the broader determinates that
drive mental health prevalence including
economic growth as detailed in our
economic growth commissioning
strategy with specific additional focus on
employment for people with mental
health issues.
Helen Taylor
/Ros Dunn
See
commissioning
strategies for
economic growth
and independent
living
Financial hardship and
unemployment are key
causes ill health and
early death in people
with mental health
issues
April 2015
Ensure those with mental health issues
are supported around access to benefits
and housing as well as focused lifestyle
advice around smoking, alcohol, diet
and exercise as described in our
economic growth commissioning
strategy (housing) and this
commissioning strategy (health and
wellbeing)
Helen Taylor,
Ian Wake,
MH budget, PH
grant - resourced
within the current
MTRS
As above, access to
housing and support
around lifestyles
especially smoking is
important
Sept 2014
There is a need to, with health
colleagues, identify people especially
older people with depression and to
manage the condition .
Ian Wake
PH grant resourced within
the current MTRS
Reduce burden of
depression in older
people and people with
long term conditions
Sept 2014
Optimise the potential of communities
in line with “Who Will Care” to reduce
social isolation
and provide support
56
linked to our independent living
Sheila Norris
As per our
independent
living
commissioning
Reduce social isolation
2014-15
Prevalence of mental health disorders among adults
Action
Lead
Resource
Issues addressed
Timetable
Commission with partners a joined up approach to
managing dementia
Helen
Taylor
As per our
independent
living
commissioni
ng strategy
Better support and
management for people with
dementia, their families and
carers
Sept 2014
Mental Health Demand Management will be
delivered through the Accommodation Pathway and
Accommodation Strategy and care package reviews
& housing brokers.
Helen
Taylor,
MH Budget
as detailed in
our
independent
living
commissioni
ng strategy
Appropriate accommodation for
people with mental health
issues – financial benefits of the
Accommodation Strategy are
described in our independent
living commissioning strategy
Oct 2014
Commission intensive enablement packages for
those who are most in need and have the most reenablement potential.
Helen
Taylor
MH budget
as detailed in
our
independent
living
commissioni
ng strategy
Ensure optimal independence
linked to our independent living
commissioning strategy
– financial benefits of Intensive
Enablement are described in
our independent living
commissioning strategy
Jan 2015
Partnership agreements are in place to ensure
integrated commissioning. In S Essex there is a
virtual team of commissioners working to implement
the agreed strategy. We are considering whether
this team will become a joint team with a pooled
budget, or will continue as a virtual team with a
written agreement in place defining how the team
57
will work.
Helen
Taylor,
Nil required.
Better services through a
coordinated approach to
commissioning
2014-15
Teenage Pregnancy
Teenage Pregnancy by District/Borough/City
Under 18 conceptions
Area of usual
residence
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
% change in rate from
1998 to 2012
2012
Basildon
59.6
52.8
47.9
48.4
56.7
53.7
39.8
46.0
36.2
40.0
45.8
42.0
41.1
39.5
34.9
-41.4%
Braintree
37.1
28.9
32.8
33.2
22.8
31.9
27.2
31.7
37.1
28.7
30.0
30.0
27.8
21.1
23.0
-38.0%
Brentwood
22.1
23.8
20.5
21.1
27.3
19.7
19.0
15.6
15.6
14.2
14.4
20.9
11.0
19.4
12.0
-45.7%
Castle Point
30.7
32.5
34.6
28.1
30.2
33.0
31.4
32.7
30.6
35.1
30.1
30.3
28.1
29.7
20.8
-32.2%
Chelmsford
28.7
26.6
26.7
22.4
25.2
22.7
25.3
21.5
28.3
28.3
27.4
22.0
26.3
20.4
19.4
-32.4%
Colchester
40.5
37.7
43.0
42.0
38.8
31.1
32.6
36.8
36.2
31.7
32.6
29.6
30.3
35.1
27.5
-32.1%
Epping Forest
28.2
28.9
29.8
25.0
21.3
24.7
29.8
22.6
26.6
29.8
26.3
28.4
22.2
24.4
21.7
-23.0%
Harlow
48.8
44.8
54.3
40.7
42.3
52.4
55.2
40.9
50.8
49.9
33.3
36.4
38.2
40.6
37.1
-24.0%
Maldon
27.3
19.4
24.2
19.7
24.3
21.6
23.2
25.5
22.3
19.9
27.5
29.5
33.7
31.0
16.6
-39.2%
Rochford
25.3
33.6
27.5
27.9
26.8
21.4
22.2
23.2
21.7
27.5
27.5
28.8
22.3
17.6
15.0
-40.7%
Tendring
45.7
45.7
41.0
43.7
48.1
37.0
35.1
34.7
41.4
47.0
38.2
42.8
35.2
39.7
32.4
-29.1%
Uttlesford
19.5
16.6
11.6
13.2
16.0
12.2
13.2
13.5
19.3
22.8
14.8
22.3
18.7
12.9
9.8
-49.7%
Essex
36.9
34.5
34.7
32.6
33.5
31.8
30.5
30.4
31.9
32.4
30.7
30.9
28.8
28.3
23.9
-35.2%
East of England
37.9
36.4
35.1
34.2
34.6
33.1
32.4
32.4
33.1
33.0
31.1
30.7
29.1
26.6
23.2
-38.8%
England
46.6
44.8
43.6
42.5
42.8
42.1
41.6
41.4
40.6
41.4
39.7
37.1
34.2
30.7
27.7
-40.6%
59
Teenage Pregnancy Rates
The Baseline and the Story behind it
•
Under 18 conception rates have been steadily declining. Rates in Essex are 23.9 per 1000 which is marginally higher than the
East of England rate, but lower than the England rate of 27.7. There are differences across Essex with the highest rates in
Harlow, Tendring and Basildon.
•
This indicator has been long standing with information being captured from 1999 to present. Previously it had a high profile but
latterly it has reduced in priority. This culminated in the loss of the ECC Teenage Pregnancy Coordinator post and a reduction in
the resources allocated to this outcome (previously it had been heavily resourced). Whilst conception rates are steadily
declining in Essex abortion rates have been increasing.
•
There is a strong association between teenage conception rates, low educational attainment, low aspirations and poor
employment prospects. In addition there is evidence in some areas of a culture of acceptance around teenage pregnancy.
•
The Public Health Outcomes Framework 2013-16 sets the national policy context for the drivers for change and teenage
pregnancy was also mentioned as one of the four key priorities in the government’s 'A framework for sexual health
improvement' which was published in March 2013.
•
ECC's Sexual Health Needs Assessment (SHNA) provides detailed information on commissioning requirements which will
influence the baseline. Other drivers for change may include Healthwatch who are interested in this area.
•
It is anticipated that the future trend will see the decline continuing, but this will need to be closely monitored. A reduction in
the role of the Youth Service and pressure on SRE in schools and particularly the ability to influence academies going forward
may have a bearing on the future trends. Current provision and gap analysis (where commissioning intentions are outlined) is
provided in the Public Health Commissioning Intentions Plan (this is embedded in the section on current actions). The SHNA is
also available which discusses the issues.
The Curve we need to turn
Teenage pregnancy rates are declining in Essex therefore the curve is currently moving in the right direction. However the rate of
reduction nationally increased from 2007 but Essex has seen no such acceleration. Renewed vigour is required locally to turn this
curve.
Issues to address in order to turn the curve
•
It is important to ensure this is back on the agenda in schools and the Youth Service.
•
We need to work with schools, linking this issue into the wider 'Risky behaviour' work and wider SRE provision as well as lifting
aspirations in young people.
•
We must commission to ensure access to services at appropriate times and locations for young people.
•
Work needs to be focused on changing young people's attitudes to teenage pregnancy.
60
Teenage Pregnancy Rates
Action
Lead
Resource
Issues
addressed
Timetable
The Public Health Commissioning Intentions
Plan and SHNA demonstrate current and
future actions.
Jane
Richards
PH Grant resourced within
the current MTRS
Accessible service offering
evidence based care
Sept 2014
onwards
Commission appropriate, accessible sexual
health services that meet the needs of young
people as detailed in the above Strategy.
Jane
Richards
PH Grant resourced within
the current MTRS
Work with schools and the Youth Service to
ensure teenage pregnancy risks are
addressed
Jane
Richards/T
im
Coulson
PH Grant resourced within
the current MTRS
Better education and
improved resilience reducing
risk
Sept 2014
Work with schools, linking this issue into the
wider 'Risky behaviour' work and wider SRE
provision as well as lifting aspirations in
young people.
Jane
Richards
PH Grant resourced within
the current MTRS
Ongoing education opportunities for teenage
mothers linked to our education and lifelong
learning commissioning strategy,
Jane
Richards/T
im
Coulson
PH Grant resourced within
the current MTRS
61
Ongoing role out
Enable best life chances and
achieved potential in this
group
April 2015
Teenage Pregnancy Rates
Action
Lead
Resource
Issues
addressed
Timetable
All sexual health service specifications to
include KPIs focusing on increasing
access to contraception and other related
sexual services targeting young women
aged under 18
Jane
Richards
PH Grant resourced within
the current MTRS
Appropriate accessible
services
From Sept 2014
Service specifications for the 5-19 Healthy
Child Programme (HCP) include KPIs
requiring providers to demonstrate action
taken to contribute to reducing teenage
pregnancy rates through provision of
appropriate health promotion and
education interventions and signposting to
specialist services where required.
Jane
Richards
PH Grant resourced within
the current MTRS
Better education and
improved resilience reducing
risk
From Sept 2014
Roll out of Risk Avert programme to
increased number of Essex schools
Jane
Richards
PH Grant resourced within
the current MTRS
Ongoing
Joined up approach between
commissioned services and Essex Youth
Service to improve access to health
improvement and education
Jane
Richards
PH Grant resourced within
the current MTRS
April 2015
Active engagement of voluntary and
community sector organizations who are
well placed to deliver interventions with
young people
Jane
Richards
PH Grant resourced within
the current MTRS
62
Allow access to hard to reach
groups
April 2015
Service user / customer views
Views, opinions and preferences of:
•
the general population;
As part of the “Who Will Care?” commission, a group of residents were asked to look at priorities for spend of health and social care resources in terms
of the current spend and the proportion of the budget that should be spent in that area. Public health was second only to pharmacies as the area where
more spend was needed. This public view reflects the drive in both health and social care commissioners to increase the focus on prevention of ill
health.
Public health principles in Essex were developed by a members reference group drawn from across the council. The group felt the principles should
include:- A local approach, address inequalities, recognition of the broad determinates of health and should involve evidence based solutions.
•
specific population groups;
•
Housing and Homeless ness - We have undertaken a survey of people who are street homeless that informed our needs assessment and
provides valuable information on gaps in services and required service provision.
•
Substance Misuse – we will continue to operate the successful Carers, Users and Families (CUFs) Network across the county to ensure the
operation of the current “You Said; We Did” process of engagement with this historically hard to reach care group. In addition we will
continue to explore opportunities to involve clients and families with the commercial activity involved when procuring new service provision
and managing and monitoring the continuous improvement agenda through the regular Performance Monitoring Review (PMR) process.
•
Mental Health in Children – Consultations with service users and their families have highlighted the need for improved awareness of
services and of mental health issues and for easier access to services that they can trust and that make them feel comfortable. Users are
being involved in the redesign process.
•
For Adults with mental health issues we are currently getting service user engagement through MH trusts following loss of funding to
existing arrangements. Access to advocates generally are commissioned jointly across social care, not just MH contracts.
Our Partners and our Relationship with them
Name of key partner or
partnership
NHS including CCGs, NHS
England
Primary care, community,
mental health and acute
providers.
Districts, Boroughs and City
64
How they will contribute to achieving the
outcome/addressing the issues
We will need to work with NHS Commissioners to ensure
a shared agenda and a joined up response to
commissioning in a number of the areas where action is
needed to deliver the Outcome.
We will develop strong contractual relations underlined by
mutual respect and understanding as well as a common
purpose to ensure optimal delivery of commissioned
services. as well as a joined up approach to addressing
lifestyle risks. They may also have a role in identifying at
risk groups eg Community Health Providers have frontline
staff such as a district nurses who are able to identify
households in circumstances of fuel poverty.
Meeting many of the health outcomes will require
extensive District/Borough Council involvement
particularly, but not limited to, physical activity housing,
planning, licensing, and the economy. District and
Borough Councils are partners in general economic
growth activity and national government in the
development of national initiatives, as well as lobbying for
inward investment. The districts, city and borough councils
have statutory responsibility for housing stock and have a
key role around fuel poverty, quality of housing and
homelessness.
How we will work with them
(including who the lead contact is if
known)
Leads will be the Heads of Health
Improvement, the CPH and the ICDs
alongside the DPH. CPH are part of the CCG
executive groups and work will be through
these bodies as well as the Health and
Wellbeing Board and its Business
Management Group.
Leads will be the ICDs, Heads of
Commissioning: Public Health and Wellbeing
and Tier 4 colleagues. Meetings will be with
providers and will be both informal and formal
contract meetings.
There are variable links with DC/BCs.
Currently public health links have waned and
will need to be redeveloped. There are links
around housing with Tier 4 lead involved and
leads around Economic growth
Name of key partner or
partnership
Police and Crime
Commissioner, Police,
Probation (including any
future Community
Rehabilitation Company)
and Prison. Community
safety partnerships.
Voluntary sector
65
How they will contribute to achieving the
outcome/addressing the issues
Addressing mental health, alcohol, substance misuse,
domestic abuse and the needs of offenders and ex
offenders will require close links with these bodies.
Community safety partnerships, as district specific
groups which come together to review broadly
defined community safety could address housing
safety
Delivering bespoke targeted services to vulnerable
groups who engage poorly with statutory services will
mean we need to develop the voluntary sector as a
key group of providers. Links with the Voluntary
sector are needed to encourage development of
provision aimed at skills development, work readiness
etc. targeted to specific groups. Wrt Housing
Children's charities, such as Barnardo's may be able
to identify those at risk of homelessness..
How we will work with them
(including who the lead contact is
if known)
Lead: Head of Commissioning: Public
Health and Wellbeing. This work will be
managed through a number of meetings
and fora including the Reducing Reoffending Commissioning Group, the
Integrated Substance Misuse
Commissioning Group, Prison Healthcare
Partnership meeting (with NHS England),
Domestic Abuse Board and
Commissioning Group. Links will be
developed with Community Safety Leads
across the County.
ICD Lead ,Place heads of around
Economy, Lead Heads of Health
Improvement working with ICD lead and
Tier 4 People Commissioning colleagues
Name of key partner or
partnership
How they will contribute to achieving the
outcome/addressing these issues
How we will work with them
(including who the lead contact is if known)
Essex Citizens
The people of Essex will need to be supported to be able to
make the right life style choices through empowerment and
through information. We will need to develop a range of
methods to ensure strong engagement. Delivering Who
Will Care demands a different and growing role for Essex
communities,
ICD lead, Leads tier 4 Commissioners including
Heads of Health Improvement.
User fora
Where we commission specific services, we need to ensure
they meet the needs of the target groups. This is especially
important in areas where users are reluctant to engage with
services eg people who misuse substances
Partners in Education
Job Centre Plus
66
We have very good partnership links with schools. Other
partners include Her Majesty's Inspectorate (HMI) and
Ofsted and again relations are good with ECC.
There are productive working relationships between ECC
and headteachers associations for primary secondary and
special schools.
To deliver Employment we need to work with Education and
Training Providers to encourage development of provision,
and in partnership with employers to ensure provision is
aligned to need
We need to look at the contribution of ACL and libraries to
improving lifestyle choices
We need to work with Job Centre Plus to ensure provision
is appropriately targeted to need, that unemployed workers
are appropriately channeled towards vacancies, and to
ensure employed workers are provided with relevant skills
development opportunities. Job Centres are increasingly a
site for health checks and lifestyle advice.
Leads Tier 4 Heads of Commissioning including
Heads of Health Improvement.
Tier 3 education lead and tier 4 heads of, Place
economy lead and public health heads of health
improvement. Heads of Leads for ACL and early
years
Place lead for Economy, ACL lead commissioner,
Health Improvement Head
Name of key partner
or partnership
How they will contribute to achieving the
outcome/addressing these issues
How we will work with them
(including who the lead contact is if
known)
South East Local
Enterprise Partnership
(and other relevant
regional partnerships)
Partnership is required to foster economic growth
Economy lead, Place Commissioning
This will encourage job growth and development, identify skills
shortages and encourage partnerships with education and
training providers to ensure these are addressed. We need to
work with employers around workplace opportunities for people
with mental health issues and those with learning difficulties.
We need to explore the workplace and workplace health
champions in improving health through health checks and
lifestyle choices. The role of major public sector employers
such as LA and NHS is key
Economy lead, Place Commissioning, MH and
WAA commissioning lead and head of health
improvement.
Employers
Housing Providers
Essex County Council
Environment Team and
Essex Energy Partnership
67
Partners in addressing homelessness and poor housing
include all types of housing providers, as well as internal ECC
partners (such as children’s operational teams who are
important routes by which families at risk can be identified).
Registered housing providers//housing associations and
private sector landlords are key partners in addressing fuel
poverty.
Help in addressing fuel poverty.
Housing Lead Tier 4
Through sustainable environment outcome
leads
Public Health Category Strategy – Current Contractual Arrangements Map
Public Health Contractual Arrangements & Extension Provisions
Contracts ECC either holds or is party to
Community Services Contracts (CCG Led) covering various PH services
Various Public Health Services
Master Public Health Contracts covering various PH services
Acute Sexual Health Services (CCG Led)
Chlamydia Screening Service
Obesity / Weight Management Service
Various Public Health Services
Various Public Health Services
Criminal Justice Interventions Service
Integrated Recovery Management Services
Structured Drug Interventions Services
Substance Misuse - Triangle Tenancy Service
Prison Substance Misuse Counselling Service
2017 Provider(s)
2010
2011
2012
2013
2014
2015
2016
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
Community Interest Companies (ACE & Provide)
Local Authorities
NHS Trusts (NELFT & SEPT)
Acute Hospitals (5)
Preventx Limited
More Life
GP (209) & Pharmacies (250)
Voluntary Sector
Westminster Drug Project Ltd
Open Road Visions Ltd & The Children's Society
Open Road Visions Ltd & The Children's Society
Nacro Community Enterprises Ltd
The Atrium Clinic & Therapy Ct
Structured Alcohol Interventions Service North, West & South West
WEADS & Phoenix Homes & Synergy
Structured Alcohol Interventions Service Mid & South East
Specialist Prescribing Service
Community Rehabilitation Service
Substance Misuse - Support, Advice and Mentoring Service
Choices (Open Rd & TCS) & Synergy
SEPT & NEPFT
Action On Addiction
Foundation66
= contract review / procurement alert
68
Public Health Category Strategy – Current Contractual Arrangements Context
Break down of Services under Master contracts
in map on previous page
Supplier
Anglian Community
Enterprise CIC
NHS Health Checks Programme
Health Improvement & Wellbeing
Nutrition, Obesity & Physical activity
Tobacco Control & Smoking Cessation
Children 5-19 School Health Service
Health Trainers
Breastfeeding Support
Sexual Health Services
Central Essex Community
Services CIC
Sexual Health Services
Health Trainers
Breastfeeding Support
Children 5-19 School Health Service
Tobacco Control & Smoking Cessation
Health Improvement & Wellbeing
Falls Prevention
5-19 Healthy Child Programme (School
Nursing/Healthy Schools)
Sexual Health Services (including GUM)
Adults & Children's Weight Management
Programmes
NHS Health Checks
5-19 Healthy Child Programme (School Nursing)
Sexual Health Services
Children's Weight Management programme
NELFT
SEPT
LARC/IUCD Insertion (Sexual Health Services)
GP’s
Pharmacies
69
Health Checks
Shared Care Opiate Misuse
Chlamydia Screening/EHC
Supervised Consumption
Needle Syringe Provision
Health Checks
Business Transfer Agreements & Impact on Commissioning Intentions
Some of the long term contracts with suppliers were created when the
provider arms were split from the primary care trusts. Some of these contain
business transfer agreements that limit the value of services that can be
reduced, terminated or subjected to competition.
Provide (CECS)
Contract Commenced 01/04/2011; Duration 5 years so expires 31/03/2016
Allows for 5% of services to be contested in year 1 with and additional 2.5%
cumulative each year
Not more than one major service can be contested in any one year.
Ability for flexibility where “any willing provider” model is used.
12 months written notice to terminate a service
ACE
Contract commenced 01/04/2011 ; Duration 5 years so expires 31/03/2016
Allows for a value of services to be contested each year on a cumulative
basis based on the total PCT business. Using baseline this could be
interpreted as % as follows :
11/12 = 4.8% ;12/13 = 30% ; 13/14 = 55% ; 14/15 = 80% 15/16 = 100%
12 Months written notice required to terminate service.
New Contracts
1 year contract period or 6 months notice (includes Acutes, SEPT and NELFT)
New contracts for DAAT services let in 2012 – already on ECC terms.
Other Contracts
All other contracts have 6 months notice.
Public Health Category Strategy – Sub-Categories covering provision of Public Health
In Scope
Sexual Health
Nutrition obesity and
physical activity
Out of Scope Scope
All sexual health services including Family
Planning, Testing and treatment of Sexually
transmitted diseases, and advice prevention and
promotion
Weight management interventions and prevention
and promotion
Physical activity interventions , community based
recreational activities, school based activities and
prevention and health promotion.
Tobacco Control and
Smoking Cessation
Stop Smoking services and interventions ,
smoking uptake prevention, smoke free places ,
enforcement and regulation of tobacco supply ,
prevention and health promotion and promotional
activities.
Drugs and Alcohol
services
Substance misuse, Drugs and alcohol misuse
services
Breastfeeding support
Support and advice for mothers and parents,
education , training for healthcare professionals
Children 5-19 Health
Programmes
School health promotion and improvement , school
nursing, health child programme, promotion and
prevention activities.
Health Improvement and Health Improvement and Wellbeing preventative
measures.
wellbeing
Health Trainers
Health trainers, community safety and other
general prevention
Health Checks
Aims to help prevent heart disease, stroke,
diabetes, kidney disease and certain types of
dementia. Everyone between the ages of 40 and
74, who has not already been diagnosed with one
of these conditions or have certain risk factors, will
be invited (once every five years) to have a check
to assess their risk and will be given support and
advice to help them reduce or manage that risk.
70
Sexual Health
Treatment of HIV
Services provided by Clinical Commissioning
Groups and Public Health England
Public Health Category Strategy
The current Public Health Category Strategy is outdated and will be
refreshed in line with this commissioning strategy. The data within this
strategy forms the basis for identification of the business requirements
within the Category Strategy.
Comprehensive spend and market analysis the next step now that full 13/14
spend data is available in May 14.
The output of the Category Strategy will be detailed short, medium and long
term commercial plans to deliver the Public Health commissioning intentions
and ensuring best value.
Part of this work will include consideration of the outcomes covered in this
strategy that are not directly delivered as services by the Public Health grant
and how these could be contributed towards through building Social Value
throughout the Strategy and any resulting sourcing processes. The market is
not mature in this area and will require support and encouragement through
small steps and changes to develop their capacity to deliver added value –
and or their ability to communicate what they already do in a way which
scores highly during a tender process. Some of this is about how we
construct our specifications and selection and award criteria. Commercial
Market Development can also support in pre-tender market engagement,
particularly with the Voluntary Sector to instigate these discussions.
Social Value Act Requirements within Public Health Category Strategy
Social value has been defined as “the additional benefit to the community from a commissioning/procurement process over
and above the direct purchasing of goods, services and outcomes”
•
There is no authoritative list of what these benefits may be
•
Social value is best approached by considering what is what beneficial in the context of local needs or the
particular strategic objectives of a public body.
An example of procuring deliberately for additional Social Value within the guidance - A health contract which, based on consultation with service
users, includes criteria such as investing in employees, the ability to evidence training, improved motivation and outcomes, and also the ability to
meet the desires of the community. – All of which ECC can demonstrate through it’s own recent contracts.
The specific requirements upon us in delivering the Public Health Strategy –
Public bodies must consider how the services they commission and procure might improve the economic, social and environmental wellbeing of the
area.
•
The Public Services (Social Value) Act does not take a prescriptive approach to social value. It simply says that a procuring authority
must consider:
• How what is proposed to be procured might improve the economic, social and environmental well-being of the relevant area.
• How, in conducting the process of procurement, it might act with a view to securing that improvement.
The benefits?
•
Seeks to create maximum benefit for the community and drive up service quality
•
Lead to cross-departmental savings; and
•
Support community organisations to enter the market
•
Supports Social Economy
•
Widens the pool of suppliers in many areas of public services
•
Supports commissioners to combine their economic, social and environmental objectives and embed them across all the strategic
procurement functions instead of approaching them in silos. (through Category Management)
•
Aligns Social Value with local needs
•
Local economic growth & wellbeing
Commercial will support Public Health to deliver added Social Value through comprehensive Corporate Impact Assessments at both a strategy &
individual project level, support and guidance in specification writing and development of appropriate selection and award criteria and also through
earlier engagement with the Provider market to raise awareness and stimulate innovation so that offers made through tendered submissions can be
incorporated into contracts and measured through Supplier Performance, thus creating a golden thread from intention through to implementation.
1
Cause / Triggers
Impact /
Consequences
Review period
Details of Risk
Event
continued
economic decline Failure to address
in areas such as broader
determinates
Tendring
On-going poor life
expectancy and
health
Inward migration
Increased
of at risk and
deprivation in outward migration
Essex or parts low risk
populations
Current
Assessment of Risk
Risk
Owner
Likelihood
Mitigating Actions /
Controls
Treat
Tolerate
Transfer
Termina
te
Current controls in place
Impact
Mitigat
ion
Appro
ach
Risk
Rating
Strong focus of activity
around economic
regeneration. Also around
lifestyle interventions and
clinical risk factors in this
population
yearly
Risk No.
major possible
Review period
Risks and Mitigations
Control Owner
With ALL controls in place
Impact
Likelihood
Risk
Rating
Mike Gogarty
Ros Dunn
Mike gogarty/Ros
Tolerate
dunn
6
Controlled
Assessment of Risk
major possible
6
moderate unlikely
2
See
commissioning
strategies for
these outcomes
tba
of Essex
Robust Market analysis and
understanding. Strong
commissioning .
2
Failure to
secure funding
resource from
savings in PH
grant
Unforeseen
Inability to invest in
pressures on PH new initiatives and
grant
realise savings
on-going
Failure to secure
VFM
procurements
from market
major
possible
6
Mike Gogarty
Treat
Mike Gogarty
Innovative approaches to
invest to save opportunities
and education
and lifelong
learning
outcomes
Probability
3
See
commissioning
Failure to deliver strategies for Poor long term
best start in life these outcomes outcome for children
tba
Tim Coulson, Chris
Martin
See
commissioning
strategies for
these outcomes
tba
Chris Martin, Tim
Coulson
Treat
See commissioning
strategies for these
outcomes
Impact (Negative)
Minor
Moderate
Major
1
2
3
4
Almost Certain
Medium (4)
High (8)
Very High (12)
Very High (16)
3
Likely
Medium (3)
High (6)
High (9)
Very High (12)
2
Possible
Low (2)
Medium (4)
High (6)
High (8)
1
Unlikely
Low (1)
Low (2)
Medium (3)
Medium (4)
4
Critical
Delivering change within our financial envelope (1/2)
Summary
The Essex Public Health grant is already over 5% below target. Additionally, we
have already made corporate savings and have needed to return resources to
partners (e.g. CCGS). The workings below show that if we can attract our “fair
share” capitation we might be able to deliver this strategy. We could not manage
this with a further 20% reduction that would leave us 40% below capitation.
2014/15 Financial Position
In 2014/15 Public Health budget aligned to this outcome is wholly funded by
grants and other income. The gross expenditure budget for Public Health services
is £51.7m. The breakdown of this budget is shown in the adjacent table.
MTRS position
All planned expenditure on Public Health initiatives will be fully funded from
within the allocated grants.
An element of the grant has and will continue to be used to fund invest to save
schemes aimed at reducing the demand for residential care. The financial benefits
from these initiatives will accrue in our People in Essex can live independently.
Commissioning strategy.
The following are included in the latest MTRS position
•
£1.5m of overheads will be funded from Public Health grant on a permanent
basis
•
£2m of procurement related savings related to Public Health contracts have
been planned (£1.3m in 2014/15 and an additional £700,000 in 2015/16)
•
£841,000 in 2014/15 increasing to £1.1m in 2015/16 will be transferred to
CCGs to align funding with commissioning responsibilities.
•
From 2015/16 there is a risk that the Public Health grant allocation will be
reduced by a £1.1m as a result of formula adjustments and the reallocation
of resources across partners.
The above represent a 11% reduction of the funding originally available by
2015/16.
Budget area
2014/15
Original
Budget (£m)
Public Health
- Expenditure
£51.7m
- Income
-£2.7m
- Grant Income
Net Total
-£49.3m
-£0.3m
It should be noted that to fully claim the Public Health grant we
must be able to demonstrate that the monies have been used in
accordance with the grant criteria, therefore we must be able to
identify appropriate expenditure that is currently funded from
ECC base budget to effectively support any corporate budget
reduction.
Delivery of many indicators in this outcome largely depend on
commissioning activity elsewhere especially around:
• early years,
• schools, economy,
• safer Essex and with housing partners.
The financial delivery of these aspects will be discussed under
the relevant Outcome Strategy.
Delivering change within our financial envelope (2/2)
Impact of reduced resources on Strategy delivery
The strategy is based on an assumption that the funding available will be in line with the MTRS although we know the reality is that in 2015/16 and
subsequent years there is a gap between current budget requirement and the available funding that will need to be addressed.
Scenario
Reduction
£m
10% reduction
2015/16
funding
available
£m
44.5
4.5
Revised
2015/16
funding
available £m
40.0
20% reduction
44.5
8.9
35.6
Baseline
The strategy detailed can be delivered within the existing MTRS
envelope through sound procurement and investment decisions.
This will include “invest to save” schemes which will release savings to
ECC, in particular Adult Operations and potentially to CCGs although
these benefits have not been fully calculated.
10% reduction in Resource
It should be possible to deliver the Outcome strategy as laid out within this document with a 10% reduction in resources dependent on:
•
Driving savings from service reconfiguration and the provider market (anticipated up to £3.2m)
•
Exceed existing the £2m savings target in the current MTRS by 1.2m.
20% reduction in Resource
The key factor here governing success will be political and officer pressure to secure Public Health funding for Essex which aligns with the
targeted spend per head of population on Public Health Services
• Even without the resource loss to CCGs and Thurrock detailed above we are 5% below target.
• Securing a settlement on this basis would potentially enable delivery of the Strategy and allow a 20% reduction in baseline. ACTION IN THIS
AREA MUST BE A PRIORITY
Without this resource delivery of a 20% reduction would be very challenging given the statutory requirement for
services in sexual health, substance misuse and school nursing. These areas have been subject to severe funding cuts
and efficiencies have been driven out where possible.
The remaining resource is focussed on lifestyle improvement and addressing inequalities - it would likely be this area
that would have to look at with a view to considering alternative approaches to service delivery or decommissioning.
This would result in a negative impact in the short term on delivering lifestyle gains and in the longer term on life
expectancy and be challenging politically.
74
Information Governance and Information Technology Strategies.
•
This commissioning strategy will be supported by Information Services, and the approach applied will be consistent across all Outcome
Strategies. All initiatives resulting from the Outcome Strategies will be analysed and reviewed to ensure that the appropriate information
and technology needs are identified and clearly defined; and to ensure that they are in line with, or influence, the Information Governance
and Information Technology Strategies.
As part of this analysis, key programmes underway will be mapped and utilised as appropriate to avoid duplication of solutions, reuse our
technology architecture where possible and optimise economies of scale for technology investment. Additionally, part of the Information
Services Strategy function will horizon scan, identifying technology opportunities which may benefit the future operations of the
organisation or those of alternative delivery vehicles and partners. Where technologies are identified as having capabilities to underpin or
deliver the outcomes then Information Services will take appropriate action to ensure the best fit strategic solution is delivered for Essex.
Where new projects are required to meet the needs of any initiatives, these will be set up by Information Services, following standardised
internal processes and link into the other key programmes as appropriate. Key programmes currently underway include:
Information Services Delivery Programme (ISDP)
Transforming Corporate Systems (TCS)
Customer Programme
Next Generation Access and Broadband UK (NGA and BDUK)
Social Care Case Management (SCCM)
Future for Essex Support Services (FESS)
With regard to this Outcome Strategy, other work underway for data sharing and technical integration with our partner organisations will be
considered and reused as appropriate. IT will engage with the Commissioning Groups to analyse requirements and to recommend useful
•
•
•
•
•
•
•
•
•
solutions. For example the use of App technology and Assistive Technologies
75
.
This report has been prepared by
Essex County Council’s Place/People Commissioning and
STC functions
Essex County Council,
PO Box 11, County Hall, Chelmsford, Essex CM1 1QH

similar documents