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Solihull Director of Public Health Annual Report 2013/14

Fair Solihull, Healthy Lives – One Year On


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Solihull Director of Public Health Annual Report 2013/14

Fair Solihull, Healthy Lives – One Year On Foreword As Director of Public Health I am responsible for reporting on the health of Solihull and making recommendations about how it can be improved. As in previous reports, this year’s report contains much that we can be proud of. People are living longer, healthier lives. Local people from the community and organisations are working together to improve health and wellbeing. As ever, there are also considerable challenges – not least ensuring that everyone in Solihull has an equal chance to be healthy. April 2013 saw the most significant reforms of the English public health system for many years. The theme of this year’s Annual Report is how the opportunities presented by these reforms have been used to tackle our local health priorities. It also focuses on the priorities set by the Health and Wellbeing Board: • Give every child the ‘Best Start in Life’ • Prevent people from becoming ill, improve the quality of people’s lives and reduce inequalities. • Work with and support communities to improve their health. • Maximise the impact on health of our programmes, policies and investment.

Dr Stephen Munday Director of Public Health

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Contents 1.

The Reformed Public Health System – One Year On

4

2.

The Health of Solihull – Overview

8

3.

Lives not Services – Focusing our Resources on Improving Health

16

4.

Health priorities:

20

4.1 Best Start in Life

20

4.2 Ill Health Prevention:

24

• Improving Access to Healthy Lifestyle Services

24

• Cancer – strategy priority/initiatives

28

• Mental Health

31

4.3 Healthy Communities and Healthy Place:

34

• Connecting Communities • Health Impact Assessment & Planning

36

5.

Summary - Recommendations

38

6.

References

39

7.

Acknowledgements

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1. The Reformed Public Health System in Solihull – One Year On April 2013 saw the most significant reforms of the English public health system for many years. These reforms were set out in the English Public Health Strategy ‘Healthy Lives, Healthy People’, and the necessary legislation enacted through the Health and Social Care Act 2012. The reforms transferred responsibility for improving the public’s health from the NHS to Local Government and created new local NHS bodies, Clinical Commissioning Groups, who are responsible for local health services. More fundamentally, the Government’s strategy was to pursue a radical new approach to improving health that empowers local communities, enables greater professional freedom and places health and wellbeing central to all we do. Of great importance was getting the right balance between action taken by national and local government, individuals, families, communities and business. This Director of Public Health Annual Report 2013/14 describes how we have we have used the opportunities that have been presented by these reforms to tackle our local health priorities. More importantly the report identifies what still needs to be done to improve health and makes recommendations for further action. The report describes what is being done to: • Give every child the ‘Best Start in Life’ • Prevent people from becoming ill, improve the quality of people’s lives and reduce inequalities. • Work with and support communities to improve their health. • Maximise the impact on health of our programmes, policies and investment.

Our Aspirations for the Health and Wellbeing of Solihull The Council and the Solihull Clinical Commissioning Group, along with other partners from the Police, Fire, community, voluntary and private sectors are working together to ensure that the people of Solihull have an equal chance to be healthier, happier, safer and more prosperous. What do we mean by healthier? Health is much more than the absence of disease - our aspiration is that: Solihull people will live longer and healthier lives; choose healthier and active lifestyles; be supported to live healthier by their social, economic and environmental conditions; and that improvements will be fastest in those communities whose health is poorest.

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Working in Partnership – the Health and Wellbeing Board The Council and the Clinical Commissioning Group will not be able to achieve their aspirations for improving health in isolation, but will need to work as part of a broader coalition of partners including the community, voluntary and private sectors and more importantly with the community itself. Leadership from the Council will be crucial to maintain and develop this coalition for health improvement. One way that this is being done is through the Health and Wellbeing Board, which comprises GPs, councillors, senior council officers, police and representatives of the community. The aim of the Health and Wellbeing Board is to: Improve the health and wellbeing of the population of Solihull from pre-birth to end of life, reduce inequalities, and improve the quality of health and social care services. Promoting a strategy of prevention, early intervention, re-ablement, and rehabilitation; supported by community based public health programmes, education, health care and social care. It is an influential body responsible for improving health and wellbeing; it does this by promoting integrated commissioning and partnership working across health care, social care, education and public health. The Board has developed a comprehensive strategy to improve health and wellbeing, based on the Policy Objectives proposed within the Marmot report ‘Fair Society, Healthy Lives’. It is using this strategy to challenge the commissioning and funding plans of local agencies to ensure that they are tackling local health and care priorities. The Board has also agreed priority actions that it will focus on in the first year in order to support implementation of the strategy: • Best Start in Life • Healthy and Sustainable Place and Communities • Preventing Ill Health and Improving Health • Integrated Care and Support Aspects of the first three of these priorities are explored in greater depth later in this report.

Solihull Council – A Public Health Council The Council is re-focusing the Council Plan onto its core purpose of improving people’s lives; improving health and wellbeing is a crucial element of this. Services can be essential to this purpose but they are only a means to an end – ‘Lives not Services’ must be the priority. What are the characteristics of a great ‘public health council’? It would be a council that improves health by: • Enabling people to adopt healthier lifestyles, influencing the wider factors that affect health, protecting people’s health and supporting improvements in the quality of health and care services. • Focusing on the health of the entire population but ensures that services are taken up by the community in proportion to need. • Ensuring that health and health equity are at the core of its policies - so that each decision or action seeks the most health benefit. • Advocating for health across its networks and contacts - ensuring that ‘every contact counts’ for health and wellbeing.

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• Promoting the health and wellbeing of its staff. • Acting as a ‘Corporate Citizen’ using its procurement powers to improve health. • Encouraging healthy environments through the use of its planning and licensing powers. • Supporting local communities to improve their own health and wellbeing, using effective community development approaches. • Commissioning integrated lifestyle and ‘wellness’ services that holistically meet people’s needs and are easily accessible to the community. The transfer of responsibility for the health of the public as part of the Government’s public health reforms provides the Council with a huge opportunity to become a great ‘public health’ council and significantly improve the health of Solihull and so improve people’s lives. Over this last year, the Council has made good progress with: • Establishing and using the commissioning process to maintain and improve the quality of services, e.g. substance misuse and the health trainer services have been successfully re-tendered; the evidence-based healthy eating programme for children (‘Food Dudes’) has been expanded. • Expanding the provision of lifestyle services e.g. with a new third sector organisation working in the Borough from April 2014. • Improving cost-effectiveness by focusing its resources on programmes that achieve good outcomes, address local priorities and have a good evidence base. • Working with and supporting communities to take action to tackle their issues in the ways that are meaningful to them. • Building on its previous achievements by further strengthening the health benefits of the North Solihull regeneration programme, the Local Development Plan, its leisure services, neighbourhood management and children services.

Solihull Clinical Commissioning Group Solihull Clinical Commissioning Group (CCG) is a critically important part of the local public health system and is making a significant contribution towards improving health and wellbeing in Solihull. It has set out its vision for the future of health and health care and how it will make improvements in its Strategic Delivery Plan 2013-15. Its mission is to help people to live healthier, longer lives; its vision for the people of Solihull is that they should have the same opportunities wherever they live; be able to grow old without the fear of getting old; have access to safe, high quality effective care, delivered locally. It is focusing on five health priorities: • Preventing illness and improving health • Frailty • Mental health and Learning Disabilities • Managed care • Care in a crisis

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Working in partnership with patients, the community and other local organisations is given high priority; the CCG knows that it cannot deliver healthcare improvements alone as so many factors affect health that are the responsibility of other agencies. Supporting patients and community groups to improve their own health and wellbeing is known to be effective in ways that statutory services are not. The CCG values the support provided by the Council and its public health team, which continues to: • Lead on the Ill Health Prevention programme • Provide public health intelligence to inform commissioning • Provide public health expertise to support commissioning of health care interventions.

Recommendations The Council and its partners should: • Ensure that their policies, plans decisions and proposals support and enable the implementation of the Health and Wellbeing Strategy. • Embed improving health and wellbeing within priority work programmes so as to make the maximum contribution to improving health in Solihull.

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2. The Health of Solihull – Overview Health in Solihull is good – over 80% of people describe their own health as good or very good and this has improved over the last 10 years. Health in Solihull compares well with similar communities elsewhere in the country – people are healthier and live longer than many areas across England. Longevity is important but so too is quality of life – ‘Adding Life to Years’ as well as ‘Adding Years to Life’; the measure of ‘Healthy Life Expectancy’ is one way of assessing this (Figure 1). Figure 1 – Healthy Life Expectancy; comparison of Solihull with England and ‘statistical’ neighbours

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Health has improved in many ways over the last 10 years • 1030 fewer premature deaths have occurred from cardio-vascular disease • 750 fewer premature deaths have occurred from heart disease • 330 fewer premature deaths have occurred from cancer • Men are living 3.7 years longer and women are living 2.8 years longer • Teenage pregnancy has reduced by 28% • 12,000 smokers have been helped to quit • 10,000 fewer people smoke • 20,000 more people report their health to be good.

Health Concerns The health of Solihull people can be improved further - there is no room for complacency and many health risks remain. Of greatest concern is that life expectancy has not increased at as fast a rate in the less affluent sections of the community, which has resulted in a gap in life expectancy (Figure 2). Figure 2 – Slope Index of Inequality; Solihull compared with England (2001 – 2011)

The gap in life expectancy is measured by the Slope Index of Inequality – this compares the life expectancy of the most deprived 10% of the population with the 10% least deprived. The gap in life expectancy measured in this way is almost 10 years for men and 12 years for women. This life expectancy gap has been increasing since 2001 although has reduced for men over the last 5 year period (2006-2011). Unfortunately this has not been the case for women, where the gap has continued to increase. It is extremely disappointing that greater progress has not been made in reducing this gap however experience is similar to this elsewhere in the country.

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Of particular concern is that the poorest third of the Solihull population will not reach retirement age without some form of disability (Figure 3). Figure 3 - Life expectancy and disability free life expectancy by ward

In men cancer, circulatory disease and chest diseases account for over 60% of the life expectancy gap. The specific causes of death are: heart disease (25%), lung cancer (10%), chronic chest disease (8%) and liver disease (6%). In women, the position is similar however cancer accounts for a greater proportion of the life expectancy gap: 31% of the gap in women compared with 20% of the gap in men. The specific causes of death in women are: lung cancer (15%), heart disease (9%) and chronic chest disease (8%). The causes of these diseases that contribute to the gap in life expectancy are closely linked with lifestyle particularly smoking – action to reduce the gap in life expectancy will therefore need to prioritise action to tackle these lifestyle issues. Levels of smoking remain high and are responsible for approximately 15% of the gap in life expectancy one in four people from routine and manual groups continue to smoke (Figure 4); however the social, economic and environmental influences on people’s lifestyles are also important.

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Figure 4 Smoking Prevalence in Routine and Manual Groups 2011/12 compared with England

Cancer is also a cause for concern - premature mortality from cancer has reduced at a slower rate than for heart disease and is now the largest cause of premature mortality. In particular, incidence and mortality from breast cancer and skin cancers are higher than national and regional averages (malignant melanoma has trebled since 1985). People are becoming older and with increasing age come higher levels of frailty, long term conditions and poor mental health. Long term conditions are common particularly in older people and are more prevalent in deprived communities. 17% of the population report long term limiting illness and this rises to over 80% in the 85+ age group (Figure 5). Prevalence of long term conditions may have increased over the last 10 years (although this could be explained by changes to the question used in the Census). Figure 5 Limiting Long Term Illness by age group 2001 - 2011

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Obesity is an example of a long term condition which limits activities of daily living and we know that levels have been increasing. Diabetes is a condition associated with obesity which has also increased over the last 10 years (Figure 6). Some of this increase may be due to increased detection of diabetes within primary care. Figure 6 Prevalence (%) of Diabetes 2005 – 2013

Mental ill health is relatively common affecting 1 in 5 adults; emotional and behavioural problems are also common in young people. Dementia affects 20% of the over 85’s and is increasing in prevalence as the population ages. It can be prevented by reducing smoking and alcohol consumption and by reducing cardio-vascular disease risk. Care and support for people affected by dementia and their families will need to increase.

Wellbeing Health status is important but increasingly we are interested in assessing and improving people’s wellbeing. Information on wellbeing is available from the ONS National Subjective Wellbeing Survey, which measures wellbeing on the dimensions of life satisfaction, anxiety levels, feelings that things are worthwhile and happiness. Levels of wellbeing on these measures in Solihull are similar to the England average and there has been a small (although not statistically significant) improvement over the last year (Figure 7).

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Figure 7 Subjective Wellbeing – Annual Population Survey 2012-13 Life satisfaction Solihull

Worthwhile

Anxiety

Happiness

Lifestyle Unhealthy behaviours continue to cause poor health. Smoking is the single most preventable cause of ill health and although levels have decreased over the years one in eight people continues to smoke (Figure 8). Smoking addiction usually starts in young people; action to reduce the uptake of smoking needs to be targeted at young people.

Figure 8 Smoking prevalence (% adults who smoke); trends 2003 – 2012.

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Drinking alcohol hazardous to health is common which causes ill-health, premature deaths, admission to hospital and social disorder. Maintaining recommended levels of physical activity throughout life and eating a balanced diet are of critical importance to health and wellbeing.

Causes of the Causes Over the years several authoritative reports, most recently the Marmot Report, have emphasised the importance of the ‘causes of the causes’ of poor health, i.e. poverty, housing, transport, education and the environment. These influences are important in Solihull also. Having insufficient money to lead a healthy life is a significant cause of health inequalities; this is particularly the case for people who are vulnerable e.g. children, people with disabilities, frail elderly or people with mental health problems. One indicator of relative poverty is the proportion of children living in a low income household; in some communities within Solihull over a third of children are in this position (Figure 9). Figure 9 Children living in low income families (%) – 2011

Being in good employment is protective of health; unemployment contributes to poor health. Levels of unemployment increased over the period 2007 – 2009 and is therefore of concern. It is encouraging that levels have subsequently fallen (Figure 10), however the gap in unemployment between the wards in the north of Solihull and those in the south has widened over this period, which emphasises the scale of the challenge that is faced in reducing health inequalities. The quality of jobs is also important and in particular ensuring they are suitable for lone parents, carers or people with mental or physical health problems.

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Figure 10 Claimant Unemployment Rates 2007 – 2013

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3. Lives not Services – Focusing our Resources on Improving Health Why is this important? It is a fact of life that there are not enough resources to meet all the health demands, or even the needs, of the population. While the case for prevention of ill health has been made in reports such as Wanless (2002) and Marmot (2010) the spend overall on public health interventions remains ‘relatively low compared to other advanced economies’ (Health England, 2007). If our focus is to be on ‘Lives not Services’ then it is a prerequisite that we make sure scarce resources are deployed in such a way as to achieve maximum impact on the health and wellbeing of our population. The Council and the Clinical Commissioning Group fund a variety of services and activities that impact on health. Specifically, the Council has received since 2013 a financial allocation in the form of a ring-fenced public health grant. The conditions imposed on this grant mean that it must be used to significantly improve the health of the people of Solihull and to commission mandatory services (such as sexual health services, Health Checks programme and the Child Measurement Programme). The starting point for assessing relative priorities for investment and disinvestment is the Health and Wellbeing strategy; the contribution of the Council and the Clinical Commissioning Group to addressing these priorities is set out in the Council Plan and the CCG Strategic Delivery Plan (2013-15). In addition, all decision making should follow a systematic approach which is centred on the needs of individuals but which fairly distributes services across different population groups. It can only do so if all decision making is based on clearly defined evaluation criteria and follows clear ethical principles. These are often captured within an ‘ethical framework’, which: • provides a coherent framework for decision making; • promotes fairness and consistency in decision making; • provides a means of expressing the reasons behind decisions that have been taken; • includes the criteria that should be applied in order to assess relative priorities.

How is it being tackled? At a local level the intention was to establish a robust and transparent process to guide investment and disinvestment decisions in relation to health improvement and in particular to guide the allocation of the Public Health Grant. The criteria for assessing relative priorities included within the Health and Wellbeing Strategy were then incorporated within a priority setting tool (based on the Portsmouth Score Card Approach) against which any proposed intervention or service could be scored.

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These are as follows: • Is there a legal requirement to provide the intervention or is it part of a mandated service? • Does it meet a local priority (e.g. priority within the Health and Wellbeing Strategy, Council Plan or the CCG plan)? • Does it meet a national target (e.g. contained in the Public Health Outcomes Framework PHOF) • Is there good evidence of effectiveness? • How many people will benefit? • What is the likely impact on health inequalities? • What is the overall cost-effectiveness? These criteria are then weighted to reflect their relative importance in achieving the desired health outcomes. The information necessary to undertake the assessment is provided in the form of ‘Business Cases’ that support application for investment. The overall process is then coordinated and undertaken by a multi-disciplinary Prioritisation Advisory Panel.

Successes so far Twenty business cases have been assessed in the current financial year and these were all scored using the amended Portsmouth Score Card and of these 16 proposals were supported. The benefits of using such a process have been: • the public health commissioning portfolio is aligned with agreed Health and Wellbeing Board (HWB) and Council objectives and is based on good evidence • the process of setting priorities has been transparent and inclusive (e.g. two people scoring each business case has meant that a wide number of people have been involved in the process) • the discipline of completing the template for business cases has helped to focus attention on those criteria critical to improving health and ‘Lives not Services’. Challenges have been to ensure that judgements are as objective as possible, the lack of available high quality evidence across the breadth of public health (and in particular the lack of robust evidence of the effectiveness of community based multi-component interventions).

What needs to be done next? The next steps are to expand the approach to look at services and interventions that are already in place, i.e. examining existing areas of expenditure. This will also require the approach to be extended to disinvestment decisions. The first part of this process will be to assess at a high level the level of spend on different public health programmes, adopting a Programme Budgeting approach. Comparison with other local authorities in England using the Revenue Account budget returns may be one way of approaching this. This will highlight any significant differences in relative spend across the commissioning programmes which may be worthy of further investigation. The second stage will be to apply the Portsmouth Score Card approach to individual services and interventions contained within each programme. In the first instance, services will be ‘screened’ by undertaking a rapid assessment of service provision against the evidence base, using the 47 areas of public health guidance produced by National Institute for Health and Care Excellence (NICE).

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Box 1 Outcome of Assessment of Business Cases The table below gives guidance on how to score a proposed intervention Factor Identified as a local priority within strategic plan (eg H&WB, PDM, CCG plan)?

National target (eg PHOF)

18

Scale Low

Medium

High

5

20

40

Meets few objectives

5

Strength of evidence (eg NICE)

5 Experimental, case series, opinion

Number of people who will benefit (% of population eligible for the intervention)

5 Under 0.5% (<1,000 people)

Meets some objectives in CCG and Council Plan

Meets numerous objectives described in PDM

20

40

20

40

Single RCT

Multiple good quality RCTs, systematic review

20

40

Under 5% (<10,000)

More than 10% (20,000 +)

Impact on health inequality

3

10

30

Cost effectiveness (is the service development cost saving in the short, med or long term?)

5

20

40

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No cost savings identified

Evidenced long term savings

Evidenced short/medium term savings


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The table below shows an extract from the results of the scoring of business cases ranking those that scored > 100 points. The maximum score possible is 230 points. Box 2 Outcome of Assessment of Business Cases Business case priority score

Cost

Business case priority score

Integrate access to wellness services within Solihull Connect (Single Point of Contact project)

£10,000

210

Devise and deliver tailored Make Every Contact Count training for 10 staff groups within SMBC and voluntary sector

£50,000

190

Jointly commission a menu of Parenting Programmes

£75,000

170

Healthy Schools initiative

£50,000

170

Adventure Play workers in Meriden Park

£27,000

140

Emergency hormonal contraception: Introduction of more cost-effective therapy (Ulipristal acetate)

£14,000

128

Pilot early intervention service to support people to remain in work and implement a Workplace Wellbeing Charter for Solihull employers

£36,000

115

Breastfeeding peer support provision

£46,000

100

Recommendation The Council and its partners should: Ensure that decisions about how resources are allocated to improve health and wellbeing follow a systematic approach based on clearly defined evaluation criteria and ethical principles, which fairly distributes resources and benefits across Solihull.

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4. Health Priorities 4.1 Best start in life Why is this important? What happens early in life – indeed in foetal life - affects health and wellbeing in later life. We have always known this, but new information about neurological development and the impact of stress in pregnancy and further recognition of the importance of attachment, all make early intervention and prevention an imperative. The crucial nature of the early years has been repeatedly stressed in a range of reports in recent years (for example, Wanless, Marmot, Allen) such that the policy debate has reached a tipping point. Marmot in his hugely influential report into health inequalities ‘Fair Society, Healthy Lives’ has declared: ‘Action to reduce health inequalities must start before birth and be followed through the life of the child. Only then can the close links between early disadvantage and poor outcomes throughout life be broken. For this reason, giving every child the best start in life (Policy Objective A) is our highest priority recommendation.’ A powerful economic case for investment in the early years has been made by the Nobel Prize winning economist James Heckman. He argues that financial returns on early years’ investments are highest for age 0-3 and diminish progressively as children become older and concludes that currently society is demonstrably under-investing in the early years. The Early Action Foundation talks of the ‘triple dividend – thriving lives, costing less, contributing more’.

How is it being tackled? On many of the indicators of infant and early years’ health Solihull performs well (e.g. low birth weight babies, hospital admissions due to injury, infant mortality). However, there are other measures where there is room for improvement. Inequalities in health outcomes across the borough are also of concern.

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Solihull’s performance on key children and young people health indicators compared to England and nearest neighbours (all figures are %s) Indicator

Data period

Solihull

Smoking at time of delivery

2012/13

12.4

10.8

12.6

8.4

Breast feeding at 6-8 weeks

2012/13

42.3

39.4

47.2

51

34.2

Children 2011/12 achieving a good level of development at age 5

72

64

69

75

62

64

21.7

19.3

21.8

22.2

Obese children (aged 4-5)

2012/13

18.9

Cheshire W& Chester

24

Stockport

Trafford

Warrington England

10.9

12.7

47.2

Key: Statistical comparison with England benchmark Worse Similar Better The return of public health responsibilities to local government has presented opportunities for closer working with children’s services and education. Furthermore the establishment of a multi-agency Early Help Board has encouraged those who commission and provide child and family services to work together to ensure an integrated approach. The Children’s 0-5 Task Group reports to the Early Help Board and is looking at the future service offer of children’s centres in Solihull and the creation of an early help outcomes framework. A multi-agency, prevention and early intervention approach should reap rewards in achieving better outcomes such as those shown in the grid below. Short term

Medium term

Long term

Increase in numbers of children who are ‘school ready’

Improved school attendance

Reduction in rates of under 18 conceptions and births

Reduced obesity in reception children, and improved oral health in 5 year olds

Reduction in families reaching the threshold for the Families First programme.

Improved qualification and skills levels (GCSE, A level, workforce qualifications).

Reduced reports of domestic violence in households with pre-school children.

Reduction in children with Emotional Behavioural and Social Difficulties (EBSD).

More resilient communities

Improved outcomes on post-natal depression assessments

Reduction in children subject to a Child Protection Plan

Reduction in health inequalities

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Investment in parenting – joint commissioning of parenting programmes has enabled wider provision of the evidence based ‘Understanding Your Child’s Behaviour’ programme and more targeted provision e.g. for parents of children with autism. These parenting programmes are based on the Solihull Approach which has underpinned the training of professionals who work with children and families in Solihull for more than a decade. Breastfeeding – increased investment in breastfeeding support services has enabled Solihull Community Health Services to achieve UNICEF baby friendly full accreditation in December 2012 (a status enjoyed by only 22 other authorities in England). Two breastfeeding peer support workers are working with mothers in those areas in the north of the borough where breastfeeding rates are particularly low. Box 3 - Successes So far Healthy Start is a voucher scheme intended for families on low income for money off fruit, vegetables, milk, infant formula milk and the provision of free vitamins. The Chief Medical Officer in her recent report ‘Our Children Deserve Better: Prevention Pays’ has expressed concerns about the link between low uptake of Healthy Start vitamins and the rise in cases of vitamin D deficiency in children. In Solihull a proactive approach has been taken to increase vitamin uptake: • Expanding the number of locations that have readily available stocks of vitamins: all children’s centres now stock Healthy Start vitamins • From July 2013 all pregnant and breastfeeding mums will receive free vitamins. The aim is that this will foster a culture of supplementation among new parents. • A new delivery service has been arranged with NHS Property Services which should ensure that stocks are replenished on time and the vitamins do not go out of date The implementation of these measures has seen the uptake of maternal vitamins rise to 12% of eligible mums (up from 1% in April 2013). Children’s vitamins have more than doubled but are still less than 3% of those eligible. A new initiative to get health visitors to remind parents of Healthy Start vitamins for their children at the 8-12 month check should help increase uptake further.

Box 4 – Successes So Far Midwives have been trained to deliver ante-natal parenting classes. This is a new initiative that aims to provide a more holistic version of the traditional antenatal classes. It has been supported by the Council and Heart of England NHS Foundation Trust. The programme consists of five sessions and covers areas such as parenting (‘Understanding Your Child’s Behaviour Programme’) and breastfeeding. Evaluation is being carried out by the Solihull Approach team.

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What needs to be done next? Solihull’s Early Help Board has developed proposals for two demonstration projects: these are the creation of an early help place (alternatively known as a ‘children’s zone’) and the ‘Leksand Parenting Model’ (Paterson, 2011). The latter builds on some of the strengths already present in Solihull such as strong evidence based parenting programmes (both ante and postnatal), a good network of children’s centres and the establishment of community parenting organisations such as PLUSH and CHASE (see Chapter 4.3 ‘Connecting Communities’). Under the Leksand model, expectant parents are invited ante-natally to join a group within their local community and this group provides the hub for everything that follows. At the end of the antenatal course, rather than being disbanded, the group continues to meet over the first few years of the children’s lives (up to the age of 5) to provide a platform for parenting education programmes as well as a network for mutual support and advice. A community development approach that supports families in finding their own solutions will be crucial to the success of the Leksand model. Another priority in the next 12 months is to work with the area team of the NHS England (NHSE) to ensure a smooth transition of commissioning functions around health visiting and family nurse partnerships to the local authority. Good progress has been made by establishing effective working relationships with NHSE, health visitors and midwives and developing innovative 0-5 years projects such as ‘Read Me Well’, Healthy Start, and organisation of a conference on Sudden Infant Death Syndrome. Finally, the establishment of joint commissioning arrangements with the clinical commissioning group for children’s community services presents considerable opportunities to fashion a coordinated multi-agency approach to children’s health and wellbeing. Drawing together a range of health, social care and education services around the needs of the child will be a key driver of work in the coming year.

Recommendations The Council and its partners should: • Continue to give priority to ensuring that every Solihull child has the ‘Best Start in Life’. • Deliver ‘Best Start in Life’ programmes that are multi-agency, based on principles of prevention and early intervention, and provide holistic support to families and communities.

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4.2 Health Priorities: Ill Health Prevention Improving Access to Healthy Lifestyle Services Why is this important? Reducing the burden of preventable disease is a priority within the Solihull Health and Wellbeing Strategy. Unhealthy lifestyle behaviours create a huge financial and resource burden on the NHS, the Council, local businesses and society as a whole. They are a significant reason for the inequalities in health in Solihull – for example, smoking alone is responsible for half of the 10 year life expectancy between north and south Solihull. One study (Khaw, 2008) found that people who smoke, eat unhealthily, don’t exercise and drink excessively (which represents around 5% of the population) live on average 14 years less than people who lead a healthy lifestyle. Moreover, unhealthy lifestyles often mean increased likelihood of several years suffering disability and disease before death. Improving people’s health by promoting healthy lifestyles and reducing behaviours that are risky to health requires a multi-faceted approach involving a range of interventions, services, policies and agencies. Action at both national as well as local level is also important. Healthy lifestyle services (e.g. stop smoking services) have an important contribution to make however their effectiveness is often limited by low levels of uptake, particularly from those in the community who are most likely to benefit from them. The provision of information, advice and support that is accessible and tailored to individual needs is a crucial part of this approach.

How it is being tackled? There are three initiatives that are being taken forward in Solihull to tackle support this programme: • Establishing a Single Point of Engagement for accessing lifestyle services • Establishing Healthy Lifestyle and Wellbeing ‘Hubs’ • Making Every Contact Count

Solihull Connect – Single Point of Engagement From January this year the Solihull Council’s ‘Connect Centre’ acts as a single point of contact for anybody wishing to access lifestyle services in Solihull. Weight Management, Stop Smoking and Physical Activity services can be accessed via the ‘Connect’ telephone number, website or by visiting either of the two ‘Connect’ centres. On contacting Solihull Connect, the individual is asked which lifestyle service they are interested in and the relevant information is given or booking made. This makes accessing services easier and avoids the need to fill out numerous registration forms or make several calls to access a service. The new system also maximises opportunity for cross-referral, for example, if a caller asks about the Stop Smoking Service, the person who takes the call will ask if they would also like support losing weight or becoming more physically active.

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The service is currently covering Stop Smoking, Weight Management and Physical Activity but there are plans to expand the service to include signposting and information about Cancer Screening, NHS Health Checks and Alcohol Services if appropriate for the individual caller.

Healthy Lifestyle and Wellbeing ‘Hubs’ Solihull established its first 'Health Lifestyle Hub' at the ‘You+ Shop’ in Chelmsley Wood Town Centre. ‘You+’ offers an integrated approach with a variety of healthy lifestyle services to the community under one roof. Since ‘You+’ was established, a number of other initiatives such as the asset based and co-production approach of ‘Connecting Communities’ has been evolving (see Chapter 4.3 ‘Connecting Communities’). Furthermore, the transfer of additional public health responsibilities to the Council has provided new opportunities. More negatively, the community is experiencing an adverse financial climate e.g. through the impact of welfare reform and the recession. These issues have contributed to the need for a radical new approach to the provision of ‘You+’ in the future. The vision for the future 'Health Lifestyle and Wellbeing Hub' in Solihull is now much broader than the predominantly health focus of the ‘You+’ Shop. It is more important than ever to embed a more holistic and social determinants approach to health and wellbeing within the ‘Hub’. This will also factor in the learning and achievements of Connecting Communities along with the opportunities of integrating other Council, NHS and voluntary sector services. This provides a platform for joined up health services, social care services and all other health and community related services at a local level. The future 'Healthy Lifestyle and Wellbeing Hub' will continue to address unhealthy lifestyle behaviours, but in addition, 'the causes of the causes' of health inequalities will also be addressed. To ensure we achieve this vision, we need to continue to pursue an assets based and co-production approach across organisations, associations, and individuals. We need to support people and communities to build capital (mental, financial, human and social) and thus self-confidence. Achieving this could be through social interaction, friendship, solidarity and support, sense of progress through gaining new skills and knowledge, sense of progress in physical health, fitness and healthy eating. There will be some challenges, such as finding the right venues, sustaining engagement (particularly with target groups) and ensuring everyone involved is signed up to the same vision. Creating the conditions in which individuals and communities have control over their health and lives and participate fully in society will be an essential part of the strategy.

Making Every Contact Count in Solihull Every day, the NHS, the Council and Voluntary organisations across the Solihull have thousands of opportunities to improve the health and wellbeing of service users, the public and colleagues by Making Every Contact Count (MECC). Making Every Contact Count (MECC) is an evidence based initiative originally developed by the NHS in order to utilise its human resources, to inform and enable people to make positive changes to their lifestyles. MECC is about encouraging patients, service users and staff themselves to make healthier choices to achieve positive long-term behaviour change for better health and wellbeing. MECC is achieved through the systematic delivery of health improvement messages using consistent and simple healthy lifestyle brief advice combined with appropriate signposting to lifestyle services (Figure 11 on page 26).

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Figure 11

Most commonly, but not exclusively, a lifestyle issue will be about encouraging people to stop smoking, eat healthily, maintain a healthy weight, drink alcohol within the recommended daily limits, or undertake the recommended amount of physical activity. However, it could equally be about offering brief advice on issues such as keeping warm in the winter, managing money, how to avoid a fall or domestic abuse. Broadening the scope of issues that are tackled will be important because many of these issues are linked â&#x20AC;&#x201C; for example, heavy smokers on a low income are likely to be spending a high proportion on tobacco. MECC requires that frontline staff are trained appropriately in order to deliver the intervention confidently and effectively. It entails systematically promoting the benefits of healthy living across the organisation and ensuring organisational policies and procedures support it. Therefore, organisations need to build a culture and operating environment that supports and encourages continuous health improvement to help to reduce health inequalities. Any implementation model to make this happen needs three core components: organisational readiness; staff readiness and enabling and empowering their staff and the public. MECC has a focus on staff health and well-being too. In learning how to encourage other people to make lifestyle changes, staff are invited to reflect on any changes they would like to make for themselves, and to consider how health and well-being can be more visibly promoted in their own working environment. MECC conversations are also being used to support carers, both to help the carer themselves cope better with the stresses they face and also to support carers to provide a healthier environment (e.g. by not smoking in the house, or providing healthier meals) and to encourage the person whom they care for to adopt healthier lifestyles. The Health and Wellbeing Board has identified MECC as a priority and is supporting implementation of the MECC Strategy across Solihull. This is an important strategic approach to increasing healthy life expectancy of Solihull residents and significant progress in achieving this has already been made during the 12 months.

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Box 5 â&#x20AC;&#x201C; Successes So Far Making Every Contact Count A Council worker engaged in a home visit noticed a mother smoking in front of her 2 small children. The children were copying their mum's smoking using straws as makeshift cigarettes. The worker was able to engage the mum in a conversation about not smoking in front of her children and getting some support for herself to quit. A Council worker in a home visit was able to talk to an older person about keeping warm in the cold weather by eating regular healthy meals and keeping as active as possible. A person who received MECC training has made changes so that he has a healthier diet and drinks less alcohol as a result of coming onto the training and reflecting on his own health behaviours

Recommendations The Council and its partners should: â&#x20AC;˘ Support people to adopt healthy lifestyle behaviours through its information, advice and support services; these should be multi-agency, co-produced with the community, provide holistic support and based on a social model of health.

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4.2 Health Priorities: Ill Health Prevention Cancer â&#x20AC;&#x201C; strategy priorities/initiatives Why is this important? Cancer has now overtaken circulatory conditions as the most common cause of premature death in the Solihull population (Figure 12). Whilst this is true both within the West Midlands and England, cancer has been the major cause of premature mortality in Solihull since 1994. The current high proportion of cancer mortality is due in part to success that has been achieved in reducing mortality from heart and circulatory conditions. This success should now give encouragement to renewing our efforts to reduce cancer premature mortality. Scope for improvement is also evidenced by the geographical variation within Solihull with regard to cancer screening uptake, late diagnoses and quality of life following treatment. This shows the inequalities across the borough between the most affluent and most deprived areas. Also, breast cancer and malignant melanoma have been identified as cancers that have relatively high incidence and mortality within Solihull compared with similar populations. Figure 12 Premature mortality from Cancer and CVD Trend 3 year rolling average

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How is it being tackled? Developing an Integrated Approach to Cancer In order to see a dramatic reduction in cancer mortality and morbidity, a multi-faceted approach will be required, focusing on: • Raising awareness of the risks of cancer, cancer signs/symptoms and what can be done to reduce risk • Prevention, early detection and screening • Strengthening Primary and Secondary care interventions • Targeting services to improve outcomes • Improving the quality of life of cancer survivors and preventing recurrence • End of Life care. These 6 elements have formed the basis of a strategy to reduce cancer mortality, morbidity and inequalities. The strategy has been further developed and refined using a variety of Lean quality improvement methods. Key features of the deployed methods include: • Adopting an ‘end to end’ pathway approach, mapping the ‘cancer journey’. • Engaging with service users, clinicians, and professionals at all stages of the pathway. • Using workshop style events involving key stakeholders to map the pathway, identify the desired cancer outcomes and where improvements are required. • Using a ‘Policy Deployment’ method (see Box 6) to bring greater discipline and precision to the process of objective setting, action planning and identifying improvements. This ‘action oriented’ approach to developing the strategy was felt to be more productive than the traditional approaches. Box 6 - Policy Deployment Matrix: Strategy on a Page In recognition of the broad effort required to improve cancer outcomes, a steering group of relevant stakeholders was created to develop an action oriented programme to reduce the burden of cancer. One of the benefits of closer working with the Council on health improvement is that it can share the tools that it uses to facilitate transformational change. One of these tools is the Policy Deployment Matrix (PDM), which captures on a single page the overarching three year objectives for a programme. This is further distilled into specific twelve month goals, tactics (actions required to achieve the goals) and impact measures (what are the intended outcomes) so that success can be measured. All members of the steering group felt that the PDM approach was helpful in bringing greater clarity and precision to the quality improvement work and that it provided a greater degree of accountability for delivery. Good progress has been made with achievement of the tactics and milestones, delivery being actively monitored by the steering group.

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What needs to be done next? The priority for the next 12 months will be to ensure that the actions to improve cancer services in the 2013 plan are completed and that the health outcomes for cancer sufferers and their carers are achieved. The momentum created and the information gathered over the last year has put Solihull in a good position. Specific priorities include: • Implementing the population based programme of raising awareness of how cancer can be prevented and how symptoms can be recognised at an early stage. • Development of information, advice and support services for the general population, cancer patients and their carers drawing on the findings from the social marketing work that has been undertaken (see Box 7). • Improving the continuity of care for cancer patients, e.g. by improving follow up in primary care of people who have been discharged from specialist services and improving support for cancer survivors. Box 7 – Service Users’ Experiences of Information, Advice and Support Provided Throughout their Cancer Journey Information, advice and support are vital in both health prevention and care service provision. To ensure these services meet local needs, it is essential that residents have the opportunity to express their views on their experience of current services, as well as to suggest improvements for the future. In order to explore these issues, focus groups and in-depth interviews were undertaken with past and present Solihull cancer patients and their carers. The outcomes of the focus groups demonstrated that people’s experience of information and support varied in terms of the level and nature of support provided, how sensitively information was provided and the extent to which people themselves were ‘allowed’ or encouraged to engage in the process. A particular gap that the participants identified was assistance and support in the post-treatment period. In addition, people’s experiences varied according to a whole range of external factors, e.g. the site of their cancer, their hospital, GP or consultant. People interviewed also had very different expectations and preferences about how they wanted to receive information. The conclusions that can be drawn from this work are that the quality of information, advice and support needs to be improved and more importantly it needs to be personalised to the individual service user – this being particularly valued by cancer sufferers. In fact, a potential solution to the variable quality of information, advice and support was a specific request from the participants for a local cancer centre or ‘hub’ that offered this service for all types of cancer.

Recommendations The Council and its partners should: • Give greater priority to reducing poor health and premature death from cancer by supporting implementation of the cancer strategy. • Support the development of information, advice and support services that particularly meet the needs of people at risk of cancer or who have developed cancer.

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4.2 Health Priorities: Ill Health Prevention Mental Health Why is this important? One in four people in England will suffer a mental health problem in the course of a year, the cost of mental health problems to the economy have recently been estimated at £105 billion and treatment costs are expected to double in the next 20 years. In recognition of mental health as a priority a cross-governmental strategy ‘No health without mental health’ was launched in 2011. This strategy recognises that mental health is everyone’s business and that individuals, families, employers, educators and communities all need to make a contribution. Good mental health and resilience are fundamental to our physical health, our relationships, our education, our training, our work and to achieving our potential. Moreover, good mental health and wellbeing also bring wider social and economic benefits: tackling issues in employment, homelessness, education, safety and crime reduction, reducing drug and alcohol dependence and homelessness will be more successful if accompanied by improvements in mental health.

Local picture Community mental health profiles have been developed for each local authority in England (Figure 13). These profiles are designed to give an overview of mental health risks, prevalence and services at a local and national level so that comparisons can be made and areas for improvement identified. Indicators within these profiles are categorised as Wider Determinants, Risk Factors, Levels of Mental Health and Illness, Treatment and Outcomes. With respect to Wider Determinants, Solihull’s community mental health profile is comparatively positive with most indicators being significantly better than the rest of England. The number of people in drug treatment programmes is lower, but this may be because less people are in need of drug treatment programmes than in other areas or if there is likely to be people in need of treatment who are not receiving it. The profile includes four indicators considered to be Risk Factors for mental illness (homelessness, long term illness, entry into youth justice system and not doing recommended level of physical activity). In Solihull rates of homelessness are higher than the national average and all other indicators are better or comparable. Solihull homelessness rates are also significantly higher than our statistical neighbours, the difference being even more marked than when compared to England. The reasons for this are complex and a number of explanations are being explored, for example people moving to Solihull in search of accommodation, levels of rent prices and impact of domestic violence. Whatever the cause of the homelessness however this remains a risk factor and there is likely to be an impact on people’s mental health. In the Levels of Mental Health section the ratio of observed to expected dementia cases is significantly worse than the England average (indicating that cases are not being diagnosed). A dementia strategy has been developed, which includes producing information packs for health professionals and the general public in order to raise

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awareness and increase early diagnosis. Work needs to be done with primary care in order to understand the reasons behind the apparent under-diagnosis of dementia and how this can be improved. The percentage of adults diagnosed with depression is significantly greater than the England average however the Solihull level is lower than the majority of Solihull’s statistical ‘neighbours’. The picture is more positive for Treatment and Outcomes, with all Solihull indicators being comparable or better than national equivalents. However the indicators of service utilisation (e.g. rates of people using adult and elderly NHS secondary mental health services, contacts with community psychiatric nurses and total mental health service contacts) are all significantly lower than the rest of England. This is comparable to our statistical neighbours where most of these indicators are also lower than the England average. The low rates of contact with specialist services in Solihull is partly explained by the good links that exist between adult social care and mental health services resulting in early intervention which can avoid the need for admission to specialist acute services. Nevertheless it has been recognised that there is an issue with the number of specialist beds available locally especially those in highly specialised units. Problems of inappropriate referrals have been highlighted which may explain the low rate of contact with community psychiatric nursing. An improved pathway which includes a new referral form, a single point of referral into specialist psychiatric services and correct triaging of patient at point of entry into the system is currently being implemented. It is hoped that this will result in greater efficiency and subsequent increase in the numbers of people having access to community psychiatric nurses.

Data source: Community Mental Health Profile, NEPHO, 2013

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Bath and NE Somerset

Trafford

Statutory homeless households, rate per 1,000 households, 2.03 0.92 0.52 3.7 all ages 2010/11 Ratio of recorded to expected prevalence of dementia 2010/11 0.37 0.42 0.44 0.45 Percentage of adults (18+) with depression, 2011/12 12.65 11.68 13.68 15.4 Numbers of people using adult & elderly NHS secondary 2.5 2.2 2.7 0.6 mental health services, rate per 1,000 population, 2010/11 Number of contacts with Community Psychiatric Nurse, 89 139 169 81 rate per 1,000 population, 2010/11 Number of total contacts with mental health services, 280 313 222 171 rate per 1,000 population, 2010/11 Numbers of people (aged 18-75) in drug treatment, 3.4 5.2 4.3 5 rate per 1,000 population, 2010/11 Where no perceived polarity Significantly lower than England Significantly higher than England Significantly worse than England Where perceived polarity Significantly better than England Not significantly different to England

Cheshire West and Chester

Stockport

England

Solihull

Mental health and illness indicator

Cheshire East

Figure 13: Selected indicators from Solihull’s Community Mental Health Profile compared to Statistical ‘Neighbours’

0.53

1.35

1.45

0.44 0.35 0.37 14.89 13.15 12.15 3.4

2.1

2.6

121

132

164

191

273

371

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What needs to be done next? Solihull’s community mental health profile highlights areas for consideration which should be used to improve mental health and mental health services. ‘Closing the gap priorities for essential change in mental health’ has recently been published and highlights 25 aspects of mental health care which have been identified as priorities. This document is also being used to guide prioritisation of local mental health improvement initiatives. Based on identified national and local priorities next steps are: • Work in partnership with primary care to ensure frontline staff are aware of the early signs of mental illness and are aware of the referral pathways in place, particularly with respect to self-harm and dementia • Ensure that gaps in services are identified and filled to ensure equitable access to services • Ensure that in supporting development of work place charters for local businesses, sufficient emphasis is put on supporting those with mental illness to remain in employment or return to work as early as appropriate • Develop a programme of mental health promotion and improving emotional wellbeing. Box 8 below describes one of a number of such novel projects. Box 8 - Warwickshire Wildlife There is a growing body of evidence that shows that active engagement with the environment plays an important role in influencing human health and well-being. Much of this evidence suggests that physical activity in green spaces is strongly associated with positive mental and physical health benefits, which in many cases exceed those experienced from exercising in indoor environments. A report from the UK Faculty of Public Health (2010) calls for GPs to use more alternatives to medication to treat mental illness. They recommend that GPs should provide advice about physical activity in green spaces as an alternative to medication for patients with mild depression or anxiety. In response to this Warwickshire Wildlife Trust has been commissioned to deliver ‘Your Wild Life’, a North Solihull based health project. This project will work with local people in Fordbridge, Kingshurst, Chelmsley Wood and Smiths Wood on a range of outdoor focused activities. The aim of the project is to deliver physical and mental health benefits to those that participate in the project. ‘Your Wild Life’ will deliver these health benefits through the following types of outdoor activity: practical conservation work (such as cutting down trees), wildlife surveying and guided walks. The project will focus on key green sites across North Solihull, such as Babbs Mill and Meriden Park, as well as working in community green spaces, such as Three Tree’s Community Centre in Chelmsley Wood. The project will deliver sessions on a weekly basis over a 9 month period. The project is open to anyone who would like to participate, however it will be targeting those with poor mental health, particularly people with mild depression, anxiety or low self-esteem.

Recommendations Solihull Council and its partners should: • Ensure that improving mental health and preventing mental ill health is embedded within its health and wellbeing improvement programmes and initiatives; this should be informed by ‘Closing the Gap – Priorities for Essential Change’.

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4.3 Healthy Communities and Healthy Place: Connecting Communities

Why is this important? There is now compelling evidence that where people lack a sense of control or influence over where they live, this can lead to catastrophic health outcomes. Becoming a passive recipient of services is a powerful pre-determinant to poor mental and physical health and overall levels of well-being. Local Authorities and voluntary sector organisations have a role to play in helping people and communities develop social capital. There is a growing recognition that although disadvantaged social groups and communities have a range of complex inter-related needs, they also have assets at the social and community level and can help improve health and strengthen resilience to health problems. Several Local Authorities are pioneering these community assets based approaches to improving health and building resilience for wellbeing.

How is it being tackled? Connecting Communities (C2) offers an evidence-based 7 step method, delivering neighbourhood governance, where residents lead supported by service providers and other local agencies. It has 15-year track record of consistently breaking through longstanding barriers to deliver sustained transformative outcomes. C2 demonstrates that when residents are seen as the solution, not the problem and they become coproducers of services, their health improves dramatically. The C2 methodology was originally brought to Smith’s Wood in North Solihull in 2010, before being expanded to support communities in the whole of the North Solihull regeneration area (Chelmsley Wood, Fordbridge, Kingshurst and Smith’s Wood). A steering group of residents and local partners is currently working together to strengthen and coordinate resident led self-managing neighbourhood partnerships in North Solihull such that they become creative hubs for on-going health and wellbeing.

PLUSH and CHASE PLUSH (Parents, Listening, Understanding, Supporting and Helping) and CHASE (Community Help & Supporting Everyone) are two proactive resident led Community Groups in North Solihull. One group operates in Chelmsley Wood (PLUSH) and the other in Smith’s Wood (CHASE). The groups predominantly, but not exclusively, consist of young mothers whose children attend local schools. Both CHASE and PLUSH are facilitated by Community and Family Development Officers who help at the initial stage to ensure that the groups function effectively. Both groups now work together seamlessly on projects. Since the emergence of CHASE and PLUSH their numbers and their voice has grown stronger and members have gone from attending Partnership Events for Connecting Communities, to co-facilitating, presenting and challenging the status quo of statutory agencies operating within the area.

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Local residents have a crucial role to play in delivering information, advice and support and frequently report providing this to their peers on a variety of topics. As an example, several members are currently being trained to be peer to peer supporters to victims of Domestic Abuse. This peer to peer advice and support is incredibly important in communities where it is often perceived as the most credible source of information and where professionals often find it difficult to engage with vulnerable people.

What needs to be done next? The groups have gone from strength to strength and an indication of how successful they are is evident from the levels of engagement and proactive outreach now seen from the members. Although it is clear that the groups are now becoming more sustainable, new members and new groups emerging require the same level of support to get them started in the same process. This requires continued support from the Community and Family Development Officers. Box 9 – Resident Led Community Groups Members of PLUSH and CHASE have met with service commissioners to suggest alternative services to better meet community needs. Examples of such coproduction have included ‘Bums & Tums’, where CHASE members decided where, when and how this service would take place. This pilot initiative ran for several months and has been shown to be effective. There are now plans to extend this type of initiative and to ensure sustainability a member of PLUSH is in the process of being trained as a fitness instructor to deliver fitness sessions to other local residents. CHASE and PLUSH community and family volunteers have also requested training in topics such as, Make and Taste, Cancer Awareness, General Healthy Lifestyles and Making Every Contact Count (MECC). One member has become a health ambassador and recruited other volunteers to sign up for sessions on smoking reduction and weight loss. Members of CHASE and PLUSH have recently branched out to provide a service offering recycled furniture, such as mattresses to people in crisis. The members negotiated with local hotel chains to recycle unwanted mattresses and with the council to provide storage and transport facilities. The Service, now called Force Furniture has since gone on to become a successful Social Enterprise. CHASE and PLUSH are expanding at a rapid rate and there are several other new health and wellbeing co-production initiatives in the pipeline which they have led and supported (for example netball and an outdoor gym in Meriden Park).

Recommendation The Council and its partners should: • Support co-production and asset based approaches to improving health and wellbeing in local communities, using evidence based methods such as the ‘Connecting Communities’ programme.

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4.3 Healthy Communities and Healthy Place: Health Impact Assessment and Planning Why is this important? The wider determinants of health are increasingly being accepted as factors influencing people’s health. Marmot in his review ‘Fair Society, Healthy Lives,’ made a key recommendation to support the development of healthy and sustainable communities, in order to address health inequalities caused by wider determinants of health. The National Policy Planning Framework acknowledges that the planning system can play an important role in facilitating social interaction and creating healthy, inclusive communities. Furthermore, the government’s public health strategy ‘Healthy Lives, Healthy People’ notes that “health considerations are an important part of planning policy.” Local authorities have enormous influence over the built environment and its ability to improve health and reduce the extent to which it promotes unhealthy behaviours. Through the additional public health responsibilities included within the Council’s wider role, there is a great opportunity to develop an effective and integrated approach to tackling the wider social and economic determinants of health.

How is it being tackled? Solihull Council recognises that it is in an ideal position to support a place based approach to health and wellbeing improvement. Work is being undertaken to integrate public health concerns that focus on lifestyle and behaviour with spatial planning and design to improve health and wellbeing through two complementary approaches. This should ensure that the environment promotes healthy lifestyles, as well as limiting or mitigating developments that have harmful impacts. There are very few policies or actions which do not affect health in some way. Spatial planning and the design of homes, buildings, public spaces, neighbourhoods and transport routes can help promote or hinder other upstream health factors such as crime, physical activity and access to healthy food. Within the Council, its Public Health team is working closely with Planning Policy and Development Management to consider how planning decisions impact on local health and wellbeing priorities. An integrated work programme is being developed which includes consideration of health impact at every stage of the development process from policy and strategy through to engagement, to support health-promoting environments. This is important because it is recognised that a coherent and integrated approach focused on places and people is the most sustainable way forward. An integral part of this is consideration of how best to work with designers and developers to ensure that health is considered at all stages of the development process.

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What needs to be done next? The evidence base on planning interventions and links to health is currently being consolidated and opportunities for collaboration identified through a number of internal Council workshops. Officers from Public Health, Development Management and Planning Policy will continue to meet to outline a consistent approach to applications that may have an adverse impact on the populationâ&#x20AC;&#x2122;s health and well-being, primarily through a Health Impact Assessment approach, which can take into account all the mitigating circumstances. 10 key issues have been identified locally for focus in order to shape development to support health and wellbeing. These are: 1.

Ensure new streets are pleasant, attractive and safe for people of all ages and abilities to walk and cycle in.

2.

Ensure new streets have pleasant places for people to sit and rest or chat at regular intervals.

3.

Ensure people of all ages and abilities in new housing developments can walk safely to a fresh food shop, primary school, GP and bus stop / station.

4.

Ensure the streets in new housing development are safe for children to play in by keeping vehicle speeds low and ensuring there is good overlooking from buildings.

5.

Ensure people in new housing development have easy and convenient access by walking and cycling to play areas, parks and open space.

6.

Ensure new homes are energy efficient to keep fuel bills down.

7.

Ensure that a wide range of employment opportunities are accessible by public transport, walking and/or cycling from new and existing housing development.

8.

Support the provision of new healthcare facilities in locations where local communities can easily access them on foot and by bicycle.

9.

Ensure new housing has adequate privacy.

10. Ensure all new development has well overlooked and well lit public spaces and streets and avoid the use of alleyways and other public areas that are not overlooked. The next steps are to agree how we can shape development (particularly larger scale) through the local plan, to help address the key challenges to health and wellbeing in Solihull. Developing Solihull as a dementia and child and young person friendly place will go some way towards this.

Recommendation The Council and its partners should: â&#x20AC;˘ Ensure that the future development of Solihull and its environment maximises the opportunities to improve health and wellbeing and is informed by an assessment of health impact.

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5. Summary - Recommendations The Council and its partners should: • Ensure that their policies, plans, decisions and proposals support and enable the implementation of the Health and Wellbeing Strategy. • Embed health and wellbeing within priority work programmes so as to make the maximum contribution to improving health in Solihull. • Ensure that decisions about how resources are allocated to improve health and wellbeing follow a systematic approach based on clearly defined evaluation criteria and ethical principles, which fairly distributes resources and benefits across Solihull. • Continue to give priority to ensuring that every Solihull child has the ‘Best Start in Life’. • Deliver ‘Best Start in Life’ programmes that are multi-agency, based on principles of prevention and early intervention, and provide holistic support to families and communities. • Support people to adopt healthy lifestyle behaviours through information, advice and support services; these should be multi-agency, co-produced with the community, provide holistic support and based on a social model of health. • Give greater priority to reducing poor health and premature death from cancer by supporting implementation of the cancer strategy. • Support the development of information, advice and support services that particularly meet the needs of people at risk of cancer or who have developed cancer. • Ensure that improving mental health and preventing mental ill health is embedded within its health and wellbeing programmes and initiatives; this should be informed by ‘Closing the Gap – Priorities for Essential Change’. • Support co-production and asset based approaches to improving health and wellbeing in local communities, using evidence based methods such as the ‘Connecting Communities’ programme. • Ensure that the future development of Solihull and its environment maximises the opportunities to improve health and wellbeing and is informed by an assessment of health impact.

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6. References Healthy Lives, Healthy People: our strategy for public health in England; DH; 2011. Health and Wellbeing Strategy; 2013; SMBC Wanless, D: Securing our Future Health: Taking a Long-Term View; 2002 Marmot, M: ‘Fair Society, Healthy Lives’; 2010. Allen, G: Early Intervention: the next steps; HMG; 2011. Health England: ‘Prioritising investments in preventative health’; 2009; Health England. Strategic Delivery Plan: 2013; Solihull CCG. Early Action Taskforce: The Triple Dividend; Community Links; 2011. Chief Medical Officer: Prevention Pays – our children deserve better; DH; 2013 Paterson, Chris: ‘Parenting Matters: early years and social mobility’; 2011; Centre Forum. Khaw KT, Wareham N, Bingham S, et al. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med 2008;5:e12. No Health Without Mental Health; DH; 2011. Closing the Gap: Priorities for Essential Change in Mental Health; DH; 2014. National Planning Policy Framework; DCLG; 2012. Faculty of Public Health: Great Outdoors: How our Natural Health Service Uses Green Space To Improve Wellbeing – An Action Report; Faculty of Public Health: 2010

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7. Acknowledgements Editor:

Stephen Munday

Chapter Authors:

Ian Mather

Lives not Services â&#x20AC;&#x201C; Focussing our Resources on Improving Health Best Start in Life

Alison Trout

Improving Access to Healthy Lifestyles Connecting Communities

Manisha Sharma

Cancer

Sangeeta Leahy

Health Impact Assessment and Planning Connecting Communities

Valerie DeSouza

Mental Health

Epidemiological analysis: Angie Collard Design:

David Georgeson

Proof reading:

Katherine Allen, Angie Collard

We would like to thank the following people who have also made valuable contributions: Gary Baker; James Roberts; Deryn Bishop; Katherine Allen; Sarah Barnes; Julia Phillips

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Fair Solihull Healthy Lives â&#x20AC;&#x201C; One Year On


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Solihull Director of Public Health Annual Report 2013/14  

Solihull Council's Director of Public Health's Annual Report for 2013/14

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