Sandwell jhws 2013-15 by Alex Hawley

Sandwell JHWS 2013-15

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Sandwell Health and Wellbeing Board Joint Health and Wellbeing Strategy

2013 to 2015

Version

Date

30/01/2013

06/02/2013

V3 V4 V5

08/02/2013 15/02/2013 25/03/2013

Draft to HWB March 2013

26/04/2013

Draft to HWB May 2013

22/05/2013

Final draft for consultation

14/06/2013

Final Draft JHWS

21/06/2013

Final Strategy

05/07/2013

Sandwell JHWS 2013-15

Comments

Final draft to HWB July 2013

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Contents Introduction .................................................................................................................................. 3 Vision........................................................................................................................................... 5 Purpose and Scope ..................................................................................................................... 6 A Profile of Sandwell .................................................................................................................... 7 National Policy ........................................................................................................................... 10 Health and Wellbeing Board Partnership Priorities..................................................................... 12 Partnership Working Arrangements ........................................................................................... 13 Monitoring delivery..................................................................................................................... 15 Delivery Partners ....................................................................................................................... 16 Health and Wellbeing Board Key Priorities..................................................................................... 17 Early years and adolescent health: Key Priority 1 (KP1) ............................................................ 17 Long term conditions and integrated care: Key Priority 2 (KP2) ................................................. 20 Frail elderly and dementia: Key Priority 3 (KP3) ......................................................................... 22 Alcohol: Key Priority 4 (KP4) ...................................................................................................... 24 Joint Health and Wellbeing Strategy Objectives............................................................................. 26 A. Give every child the best start in life .................................................................................... 26 B. Enable all children, young people and adults to maximise their capabilities and have control over their lives............................................................................................................................ 30 C. Create fair employment and good work for all ..................................................................... 34 D. Ensure a Healthy Standard of Living for All ......................................................................... 37 E. Create and develop healthy and sustainable places and communities ................................ 40 F.

Strengthen the role and impact of ill health prevention ........................................................ 44

G. Ensure people receive the care and support they need across the whole life course .......... 48 References .................................................................................................................................... 52

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Introduction Sandwell experiences significant inequalities. On average, the people who live in Sandwell do not live as long as people in other areas of England and spend more of their lives ill or disabled. These inequalities exist within and across Sandwell. The most marked inequalities are between Sandwell and the rest of England1, however there are significant inequalities in health and wellbeing between different sections of the population within Sandwell. These variations are related to a number of factors including ethnicity, age and gender. There has been a long history of partnership work in Sandwell to improve the health and wellbeing of Sandwell and reduce these inequalities. The organisations that make up the Sandwell Health and Wellbeing Board are committed to building on past success and working together to improve the health and wellbeing of Sandwell and reduce inequalities. As part of this commitment, Sandwell Metropolitan Borough Council applied for membership of the UK Healthy Cities Network and was accepted as a member in December 2012. The UK Healthy Cities Network is part of a global movement for urban health that is led and supported by the World Health Organization (WHO). Its vision is to develop a creative, supportive and motivating network for UK cities and towns that are tackling health inequalities. Member councils pledge to put health improvement and health equity at the core of all local policies. The health map shown in figure 1 shows the different factors that affect peopleâ&#x20AC;&#x2122;s health and wellbeing. The individual factors such as a personâ&#x20AC;&#x2122;s age, sex and hereditary factors are nested within the wider social and environmental determinants of health.

Figure 1: The social determinants of health and wellbeing (Barton and Grant 2010)

The evidence from the Marmot Review of Health Inequalities2, published in 2010, shows clearly that the largest influences on health inequalities are the physical, social and economic environments into which people are born, live and grow old. The World Health Organisation describes these as the social determinants of health3. Sandwell JHWS 2013-15

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There are determinants of health and wellbeing that are beyond the direct influence of the organisations represented on the Health and Wellbeing Board. An important example of this is the impact of welfare reform in Sandwell. Mitigating these impacts will need joint working across the council, health, the police, housing providers, education and local employers. Examples can also be found in the importance of crime as a determinant of health and the role of business in increasing employment opportunities and the income of people in Sandwell. The Health and Wellbeing board will need to influence the work of the partners and organisations that can influence these wider determinants, such as the Police Service, the Fire Service and the Local Enterprise Partnership The Marmot Review contains a detailed analysis of health inequalities and their causes in England. It also provides a comprehensive analysis of the evidence for needs to be done at national, local and community levels to tackle the social determinants of health, improve health and wellbeing and reduce inequalities. The Sandwell Health and Wellbeing Board have agreed that the Marmot Review of Health Inequalities provides a robust and evidence based framework for the Sandwell Joint Health and Wellbeing Strategy. From the review there are six high level policy objectives for improving health and reducing inequalities. The Health and Wellbeing Board identified that a seventh objective is required to ensure that current partner priorities around older people and end of life are explicitly included within the strategy. This objective is based on the life course approach which is central to the Marmot Review. The seven high level objectives for the Sandwell Health and Wellbeing Board Joint Health and Wellbeing Strategy (JHWS) are therefore; A. Give every child the best start in life B. Enable all children, young people and adults to maximise their capabilities and have control over their lives C. Create fair employment and good work for all D. Ensure a healthy standard of living for all E. Create and develop healthy and sustainable places and communities F. Strengthen the role and impact of ill-health prevention G. Ensure people receive the care and support they need across the whole life course The preparatory strategy contained thirty-seven priorities across these seven objectives. The HWB agreed that the final strategy should continue to cover all of these but that the board needed to focus on a smaller number of key priorities in greater detail. Following publication of the preparatory JHWS the health and wellbeing board consulted with stakeholders and identified four key priorities which will be addressed within the framework of the seven high level objectives set out above. 1) Early years and adolescent health 2) Long term conditions and integration of care 3) Frail elderly and dementia 4) Alcohol

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Vision The Vision for the Sandwell Health and Wellbeing Board is; “Working with local people to improve health and wellbeing and reduce inequalities for everyone who lives and works in Sandwell.”

Definition of Terms Health and Wellbeing The World Health Organisation defines health as; “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”4 At a public ‘Shaping the Future of Health and Well-Being in Sandwell’ event in Sandwell in March 2008 local people and other stakeholders developed a definition of health and wellbeing as; “Fulfilling individual and community physical, social, emotional and spiritual potential”. Health Inequalities For this strategy the definition of health inequalities is drawn from the World Health Organisation statement which describes them as; “The unfair and avoidable differences in health, wellbeing and length of life”

Signatures

……………………………………………………………………………………………….. On behalf of Sandwell Metropolitan Borough Council

………………………………………………………………………………………………… On behalf of Sandwell and West Birmingham Clinical Commissioning Group

………………………………………………………………………………………………… On behalf of Sandwell Health Watch

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Purpose and Scope The Sandwell Health and Wellbeing Board (HWBB) have agreed that the strategy will be; • A high level strategy that spans the local authority, NHS, social care and public health commissioning • A concise summary of how the health and wellbeing needs of the population will be met and how health inequalities will be reduced • A description of how local authority, NHS, social care and public health commissioners need to consider the social determinants of health when developing commissioning plans • A framework to identify determinants of health and well being that are beyond the scope of the Health and Wellbeing Board partners and to influence partners, stakeholders and organisations that can influence these determinants. In setting out the overarching framework for the commissioning plans for the NHS, social care, public health and other relevant services the strategy will; • Define the priorities for the HWBB and providing a framework for commissioning to improve health and wellbeing and reduce inequalities. • Develop an understanding of joint areas of interest for improving health and wellbeing and reducing inequalities, tackling the social determinants of health will be a key consideration. • Specify the principles for commissioning across health, social care, local authority services and public health based on the evidence for the most effective use of available resources • Support a review of current strategies and commissioning to identify opportunities for aligning commissioning or moving to joint commissioning arrangements • Demonstrate how the JHWS will be delivered through the commissioning and delivery plans of the partner organisations and how these will improve health and wellbeing and reduce inequalities • Describe how commissioning and investment planning cycles will be coordinated across health, social care and public health commissioning • Quantify what this will achieve against the identified priorities including the SMBC scorecard and the NHS System Plan • Achievement in delivering the JHWS will be monitored and reported through the partner organisations performance management systems and a Health and Wellbeing Board dashboard of key indicators. • Describe the partnership working arrangements including the partnership arrangements for shared and aligned resources. The strategy will also; • Support the development of the HWBB and understanding of the roles of each of the partners. • Support the development of the HWBB governance and understanding of how the board will hold partners to account for delivery of their contribution to the strategy The strategy will not; • Provide detailed plans for front line health or social care services, though the strategy will have implications for the commissioning of front line services by the partner organisations that make up the Health and Wellbeing Board.

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A Profile of Sandwell Population5 The 2011 Census estimates that Sandwell has 308,063 residents, a rise of 8.9% since 2001. This compares with a rise of 7.8% in England and Wales. This increase reverses the previous decline experienced since 1971. 151,592 (49.2%) of these residents are male and 156,471 (50.8%) female. Since 2001, the largest percentage increase has been amongst males (+11.1%). In terms of age groups, in 2011: • Under 5’s now make up 7.4% of Sandwell's population, compared with 6.2% in England and Wales. • The largest percentage increases have been in the numbers aged 20-24 (+33.2%), 45-49 (+30%), 85 and over (+27.4%) and under 5s (+24.8%). • Since 2001, the greatest increases in actual numbers of residents are amongst those aged 20-24 (+5,188) and 45-49 (+4,937). • Few age groups have seen a fall in population, but the largest falls are in the numbers aged 75-79 (-7.4%) and 30-34 (-5.8%). • Overall, Sandwell's age profile is younger in comparison with the Black Country and national averages (more than 20% of Sandwell's population is aged 0-14 compared with 17.6% in England & Wales). • Sandwell is below average in terms of those over retirement age, with only 8% aged 65- 74 and 7.3% aged 75+, compared with 8.9% & 7.9% in the Black Country overall, and 8.7% and 7.8% nationally. The ethnic makeup of Sandwell has seen extensive changes since 2001. Just under two-thirds of Sandwell residents now class themselves as being of White British origin, and a further 4.1% are of Other White origin (which includes Irish and Gypsy Travellers). 30.1% of Sandwell’s population are from other ethnic backgrounds. • Since 2001, the only group to see a decline in numbers is those of White British background (this excludes Irish and Gypsy Travellers). • The largest increases have been amongst those of Arab and Other Ethnic origin (+781.5%), Black African (660.6%) and Other Asian groups (+230.1%). However, these groups still account for a low proportion of Sandwell residents overall (1.6%, 1.4% and 2.1% respectively). • With the exception of White British, the largest single ethnic group in Sandwell is Asian Indian, with just over 10% of residents considering this to be their ethnic background. Life expectancy Life expectancy provides a good summary measure for all deaths from all causes and it reflects the overall health of the population. Figure 2 shows that while life expectancy has improved for both Sandwell and England, it remains significantly lower than the national average for both men and women in Sandwell. The gap has remained fairly stable for women but for men it has widened between 2000 and 2010, though it has narrowed again since 2008. It is likely that this increase is associated with a recent focused programme of early identification and treatment of heart disease in primary care. Figure 2 also highlights an inequality related to gender. Men in Sandwell live, on average, around six years less than women.

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Figure 2: Life expectancy for males and females, Sandwell and England and Wales, 2000-201034

Within Sandwell the inequality in life expectancy between the worst and best areas is 9.6 years for men and 6.4 years for women. Life expectancy provides a measure of the overall health of a population. Another measure, disability free life expectancy, provides an indication of how long people live before they suffer a disability or a health condition that limits their quality of life. Figure 3 shows that people in Sandwell do not live as long without a disability as people in other areas of England. Not only do people in Sandwell, on average, not live as long, they also tend to experience more illness and disability. Figure 3: Life expectancy and disability-free life expectancy at birth, by neighbourhood income level, England and Sandwell 1999- 2003

The Marmot Review Team, now the Institute for Health Equity, have selected ten inequality measures and produce annual profiles for all unitary and upper tier local authorities. These ten indicators are split into health indicators and social determinant indicators. Figure 4 is the profile for Sandwell JHWS 2013-15

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Sandwell for 2012. This shows that Sandwell is experiencing significantly more inequality when compared to the rest of England and the West Midlands region. Sandwell is the 12th most deprived local authority in England The health indicators where Sandwell is close to the regional or national levels are those that measure the inequality within Sandwell. This may reflect the fact that Sandwell is fairly uniformly deprived. The key challenge for Sandwell is therefore to reduce the inequalities between Sandwell and England. Figure 4: The Ten Marmot indicators for Sandwell 20126

Other key findings from the 2010 overarching Joint Strategic Needs Assessment34were; • The main killers remain circulatory disease (CHD, Stroke), lung cancer, and chronic respiratory disease • Deaths related to alcohol misuse are increasing. • Smoking, obesity, exercise and alcohol all remain significant causes of ill-health. • Infant mortality remains stubbornly 50% higher than the national average at 7.8 per 1,000 live births. More needs to be done to: • Reduce teenage pregnancies (identified in the adolescent and young person’s needs assessments as priority areas) • Reduce smoking in pregnancy (still underperforming as identified in the smoking health equity audit) • Reduce maternal obesity • Improve access to maternity services • Health services and the Local Authority are the third largest employment sector and therefore need to strive to continue to demonstrate best practice in healthy workplaces and provide employment opportunities and attract skilled workers to live in the area. • If we are to change the pattern of ill-health across Sandwell, the population will have to be convinced to change their lifestyles, something they have been reluctant to do in the past. • Many of the lifestyle habits that come to plague adult health are made whilst a child. It is therefore important that we strive to give children the best start in life. • Opportunities for a substantial number of children remain stilted and a marker of this, teenage pregnancy, remains high despite real improvements in educational attainment in the last few years.

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National Policy The role of the Health and Wellbeing Board is to improve health and wellbeing and to reduce inequalities. Achieving this will require partnership working across health, social care, public health and across the majority of the functions of the local authority. This wide scope means that nearly all policy documents relating to health or to local authorities will, to some degree, be relevant to this Joint Health and Wellbeing Strategy. These range from health and social care policy and reform to policy on housing, transport, education and waste collection. For the purpose of this strategy the major national policy documents and strategies will be identified; those strategies where the main focus of the document is directly related to the work of the Health and Wellbeing Board. Key Policy Documents Healthy Lives, Healthy People: Our Strategy for Public Health in England7 Health and Social Care Act 20128 Localism Act 20119 Outcomes Frameworks Adult Social Care Outcomes Framework10 Public Health Outcomes Framework11 The NHS Outcomes Framework12 The Operating Framework for the NHS in England13

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Equality The Health and Wellbeing Board is committed to ensuring that delivery of this strategy will improve health and wellbeing for everyone who lives and works in Sandwell. This includes reducing the inequalities in health between Sandwell and the rest of England. It is equally important to reduce the considerable inequalities in health outcomes and in access to services that exist for different sections of the population. Some of these variations are identified in the relevant sections of the strategy. For example, higher rates of infant mortality amongst Asian residents, lower income levels for BME communities and higher numbers of strokes amongst African Caribbean residents. There are sections of the population who experience inequalities where the information available is limited. It is therefore essential that the Health and Wellbeing Board ensures that all sections of the community are included in stakeholder and community engagement. An example is the lesbian, gay, bisexual and transgender community (LGBT). A review of LGBT health in the West Midlands identified that the health needs of this group are poorly understood.14 The Equality Act 201015 brought together existing legislation on discrimination and equality and placed a number of duties on all public sector bodies. The aim of the legislation is to protect people from discrimination in the workplace and in wider society. The act defines nine protected characteristics that must be considered in everything the council provides or commissions. • Age • Disability • Gender reassignment • Marriage and civil partnership • Pregnancy and maternity • Race • Religion and belief • Sex • Sexual orientation Work is underway to understand the information that is already available to identify inequalities between groups and areas where more effort is needed to understand the inequalities in health and in access to services. The UK Healthy Cities Network advocates the wider use of health impact assessments. These impact assessments are a powerful tool which assesses the health effects of changes to policy, services or regeneration and urban development. This includes an assessment of the impact on different sections of the population. With Public Health now a part of the council this provides an opportunity to develop the use of health impact assessment within the council.

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Health and Wellbeing Board Partnership Priorities The purpose of the preparatory Joint Health and Wellbeing Strategy 2012-2013 was to agree the vision for the Health and Wellbeing Board and to develop a framework for future partnership working to improve health and wellbeing and reduce inequalities in Sandwell. The priorities for the preparatory Joint Health and Wellbeing Strategy were drawn from the priorities and strategies of the existing organisations including Sandwell Council, Sandwell Primary Care Trust, the Children’s Trust Board and Right Care Right Here. The Right Care Right Here programme is a large scale partnership that represents the Sandwell Health and Wellbeing Board partners and a wider group of key partners and stakeholders working across Sandwell and West Birmingham. The priorities also included the findings and recommendations from the Joint Strategic Needs Assessments. In preparing the preparatory strategy it was agreed that the framework for the joint work of the board would be the Marmot Review of Health Inequalities2. This Joint Health and Wellbeing Strategy has been written at a time of significant system and structural change. Some of the organisations involved in the preparation of the preparatory strategy no longer exist and their functions have passed to new organisations. The Health and Wellbeing Board (HWB) held developmental workshops where the partner organisations reviewed the existing priorities and determined where the board needed to focus its attention for the next two years to improve health and wellbeing and reduce inequalities in Sandwell. The preparatory strategy contained thirty-seven priorities across the seven objectives. The HWB agreed that the final strategy should continue to cover all these priorities but that it needed to focus on a smaller number of key priorities in greater detail. In October 2012 there was a large stakeholder engagement event where the HWB consulted on future priorities with a wide range of stakeholders and local people. From this workshop emerged four key priorities for the HWB for the next two years. 1) 2) 3) 4)

Early years and adolescent health Long term conditions and integration of care Frail elderly and dementia Alcohol

These priorities cover large areas of services and commissioning by the HWB partner organisations. The purpose of the JHWS is not to duplicate existing strategies, it is to set out the overall vision and strategy and specify what each of the HWB partners will contribute to delivering the priorities. For the JHWS to be meaningful it needs to concentrate on where the HWB can make the biggest difference. The four key priorities therefore need to be further refined. To achieve this it is useful to revisit the purpose of the HWB, which is to; • Secure better health and wellbeing outcomes, promoting independence, choice and control for the whole population • Ensure a joined-up approach on commissioning priorities across NHS, public health, social care for adults and children and related services • Encourage greater integration across health, social care and related services to improve health and wellbeing outcomes The focus is on integration across the HWB partners and aligning of commissioning. Within each of the priorities there will be areas of delivery that are solely by one organisation and other areas that rely on joint working. The JHWS needs to concentrate on the areas within the key priorities where integration and aligned or joint commissioning will deliver the greatest benefit for Sandwell. This is the ‘bit in the middle’ where the HWB partner organisations, through working together and with the people of Sandwell, can make the biggest difference. Sandwell JHWS 2013-15

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Partnership Working Arrangements Shared and Joint Resources The partners represented on the Sandwell Health and Wellbeing Board are committed to working together to improve health and wellbeing and reduce inequalities in Sandwell. The focus of the board is on the areas of shared influence where the board can have the greatest impact. In figure 4 below this is shown by the areas marked A and B. Figure 5. Partner commissioning and influence

Delivery of the Joint Health and Wellbeing Strategy objectives will be dependent on the board partners agreeing the shared use of resources. With the changes to health commissioning organisations the existing governance structures are no longer relevant. The Health and Wellbeing Board partners are developing new governance structures to agree and manage joint and shared resources. This will be through a Joint Partnership Board with strategic representation from health and social care. The Joint Partnership Board will be a forum where the partners can agree the use of resources to tackle the board priorities. This will include financial, staff and wider resources. The aim is to review existing structures and streamline them where appropriate to fit in with these new governance structures. Currently this includes mental health, learning disabilities, carers support and reablement. The Joint Partnership Board will establish specific partnership commissioning groups which will be mandated to manage shared resources in defined service areas. The individual partner organisations will ensure that the business of the Joint Partnership Board is fully embedded within their core organisational structures and functions. Commissioning for children and families across the partner organisations will be coordinated through a Joint Childrenâ&#x20AC;&#x2122;s Commissioning Group. This group will report to the Joint Partnership Board which reports to the Health and Wellbeing Board. The purpose of this group will be to bring together Sandwell Council including Public Health, Sandwell and West Birmingham Clinical Commissioning Group (SWBCCG) and NHS England to share commissioning plans across cross cutting themes.

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Delivery Mechanisms Delivery of the objectives within this strategy will be through the commissioning plans of the individual partners. Where there are joint arrangements this may be reflected in shared commissioning plans. This will require partner organisations to align their commissioning processes, including the annual commissioning timescales. Figure 5 below shows the relationship between the commissioning cycle, joint strategic needs assessment and the joint health and wellbeing strategy. Figure 6: How the commissioning cycle, JSNA, and JHWS fit together16 (DH 2012)

The Health and Wellbeing Board has agreed that monitoring progress and performance will be through the relevant commissioning plans of the partner organisations and will be reported to the Health and Wellbeing Board as part of an agreed annual work and reporting plan. There are existing partnership arrangements which are already delivering the objectives set out in this strategy and these need to be maintained and built on in the future. The Right Care Right Here programme is redesigning health and social care across this wider area and will be essential to achieving the Joint Health and Wellbeing Strategy objectives. This redesign includes the building of a new hospital in Smethwick, the Midland Metropolitan Hospital. Within the new structures Right Care Right Here is a work stream of the Sandwell and West Birmingham Clinical Commissioning Group.

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Monitoring delivery The overarching framework for the work of the HWB is the Marmot Review and the seven high level objectives set out in the preparatory strategy. The priorities for action and the interventions under each of the seven high level objectives have been developed through an analysis of the shared priorities across the Health and Wellbeing Board partner organisations. These have been aligned with the recommendations for interventions within the Marmot Review. The outcome measures against each priority are drawn from the plans and strategies from the partner organisations and the relevant outcomes frameworks listed below. These measures have also been informed by evidence within the Marmot Review. National Outcomes Frameworks • Adult Social Care Outcomes Framework • Public Health Outcomes Framework • The NHS Outcomes Framework Local Strategies • Sandwell Scorecard • Sandwell and West Birmingham Clinical Commissioning Group priorities • Children and Young People’s Partnership Board priorities Delivery will be through the commissioning plans of the HWB board partners and through partnership working with wider partners including the voluntary sector. Monitoring of delivery will be through the same mechanisms. There will not be a separate delivery plan for this strategy, it will be monitored through the shared and organisation specific commissioning and delivery plans of the partner organisations. Within the framework of the seven objectives the focus of the Health and Wellbeing Board for the next two years is on the four key priorities. For these priorities detailed outcome measures and targets are being identified through partnership working groups and through consultation with wider stakeholders. The outcome measures for each of the four priorities have been incorporated within the action tables of the most relevant of the seven objectives Action on each of the four key priorities will often require action across more than one of these high level objectives. For example, tackling the frail elderly and dementia priority will also require work on housing issues, tackling alcohol misuse will require action across a number of objectives and will influence early years, adolescent health and long-term conditions. This will be indicated where appropriate through cross-referencing back to the four key priorities within the action tables. A dashboard of key outcome measures will be developed to enable the health and wellbeing board to monitor progress. This will include the most significant outcome measures that demonstrate progress within the four priorities. It will be reported to the board as part of a planned programme based on the frequency of reporting for each of the outcome measures.

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Delivery Partners The most important partners in the delivery of this strategy are the people of Sandwell. One of the key messages in the Marmot Review is that effective local delivery requires effective participatory decision making at a local level. This can only happen by empowering individuals and local communities. This requires an ‘asset based approach’ to working with people and communities to improve health and wellbeing and reduce inequalities. This approach requires a move away from a deficit approach which identifies only the problems and challenges for a community. Instead, the asset-based approach also recognises their social, cultural and material assets and the potential these provide for tackling the challenges they face. Through this wellbeing is promoted by building social capital and encouraging citizen participation and control. The recent documents ‘A Glass Half Full’17 and ‘What Makes Us Healthy’18 provide a framework for the asset based approach. An important stage in the asset-based approach is the mapping of available assets. One way of doing this is through a Joint Strategic Asset Assessments which would be complementary to the Joint Strategic Needs Assessment. Community health profiles have been produced which provide a summary of the population and health needs of each of the electoral wards in Sandwell19. These profiles include an initial assessment of some of the assets within each ward. In Sandwell the development of Friends and Neighbours provides a local example of a successful asset based approach to working with communities20. Friends & Neighbours is led by local residents and has developed a local community run organisation which will broker support for vulnerable residents. Unlike many approaches to health and social care, the vulnerable residents are the direct clients, who decide what services they need and how they can best be supported. Within this strategy there is an indication of which Health and Wellbeing Board partner organisations will have the key roles in delivery of each of the priorities. This identifies which partners are likely to take the lead for that area of work. Improving health and wellbeing and tackling inequalities requires a joined up approach across all partners and across a wider range of stakeholders. Therefore, all board partners will need to be involved in planning and in commissioning decisions across all the priorities. With some objectives the actions required will be delivered by partners not represented on the Health and Wellbeing Board. The role of the lead board partner in these cases will be to work with these organisations or stakeholders to influence their commissioning or delivery in order to achieve the Health and Wellbeing Board priorities. Key to delivery partners abbreviations: SMBC: Sandwell Metropolitan Borough Council SWBCCG: Sandwell and West Birmingham Clinical Commissioning Group PHE: Public Health England NHSE: National Health Service England

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Health and Wellbeing Board Key Priorities Early years and adolescent health: Key Priority 1 (KP1) Background The health and wellbeing board agreed that early years and adolescent health is a priority for concerted action across all partners. The Marmot Review clearly demonstrates that the first few years of life can influence how well a child achieves at school, their employment opportunities, how long they live and how much of their life they spend with a long-term illness of disability. There is a more detailed discussion of early years and adolescent health in the sections on the high-level objectives A (give every child the best start in life) and B (enable all children, young people and adults to maximise their capabilities and have control over their lives). In Sandwell there has been a long-term investment in joint working across a wide range of partners and stakeholders, including local young people and families. This has delivered real change and improvement in outcomes for children and young people in Sandwell, for example improvements in educational attainment and reductions in teenage pregnancy. However, stakeholders and local families still report that the services available are complex and difficult to navigate. Families have to contact many different services and repeatedly give their information to different professionals in different services. They also reported that it is difficult to access the information they need and that this information is often inconsistent. The stakeholders said that there needs to be much better coordination between services and agencies must break down the barriers between themselves and between them and young people and families. Sandwell Position • The health and well-being of children in Sandwell is generally worse than the England average. • The infant mortality rate is worse than the England average and the child mortality rate is similar to the England average. • The level of child poverty is worse than the England average with 32% of children aged under 16 years living in poverty. • Children in Sandwell have higher than average levels of obesity, 11.2% of children in Reception and 25.7% of children in Year 6 are classified as obese. • 44.8% of children participate in at least three hours of sport a week which is lower than the average for England. • The teenage pregnancy rate in Sandwell is higher than the England average. In 2010/11, 2.3% of all births were to teenage girls. This is higher than the England average. However Sandwell has established a downward trend and reduced inequalities across some high conception rate wards. • In 2011 there were 1,470 acute sexually transmitted infection diagnoses in young people aged under 24, similar to the rate for England. • The hospital admission rate for alcohol specific conditions is higher than the England average. The percentage of children who say they have been drunk recently is lower than the England average. • There were 605 children in care at 31 March 2013 which is higher than England rate. Current Provision The central principle in supporting children and families in Sandwell is to ‘Think Family’. To move away from services that focus on either children or the parents and develop flexible support that provides what the families need in a coordinated way across all services. Many problems experienced by children and families arise in the transitions between services, for example between maternity services and health visitors, or between early years and adolescent services. Early identification of families needing help and providing them with the support they need will help prevent future problems and will help families to improve their situation. The evidence supporting Sandwell JHWS 2013-15

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this early help and early intervention approach is extensive. The Marmot Review summarised much of this evidence and recent reviews have reinforced this message21 22. Sandwell Council is working with its partners to deliver an Early Help strategy that will work with families to identify when they need help and provide this as early as possible. This Early Help approach is defined as; “Delivering services at the right time and in the right way to help families help themselves to meet the needs of their children.” Early help will include; • A single gateway and access point for services • An integrated approach to family support • A coherent range of services to help families • Development of community operating groups to provide early help and support to families Sandwell also has a Family Nurse Partnership programme, currently commissioned by NHS England and provided by Sandwell and West Birmingham Hospitals NHS Trust. This is a programme of intensive support, advice and information offered to young, first-time mothers living in Sandwell. This voluntary programme recognises that the parent is the most important person in the baby’s life and supports the young person to be the best parent they can be. There have been independent reviews and evaluations of the Family Nurse Partnership programme in the USA and more recently in the UK. These have shown that is an effective programme that helps young parents to improve their parenting skills and that it has significant benefits for children and families23. The Early Help programme, Family Nurse Partnership and other services acknowledge the importance of considering the family within the context of their environment. They recognise the need to consider the wider factors that are essential for healthy families. These include appropriate and good quality housing, employment and an adequate income and feeling productive and a part of their community. It will also fully recognise the key role of those who work with children outside the healthcare system, such as teachers and the young people workforce delivering universal and targeted services. Maternity services are commissioned by SWBCCG. Health visiting services are commissioned by NHSE until 2015 when this will be the responsibility of Sandwell Council. Sandwell Council commissions the majority of other services for children and young people, including school nursing. Commissioning for children and families will be coordinated across the partners through a Joint Children’s Commissioning Group; this will report to the Joint Partnership Board which reports to the Health and Wellbeing Board. The purpose of this group will be to bring together Sandwell Council including Public Health, SWBCCG and NHS England to share commissioning plans across cross cutting themes. Priorities for action The emotional well being, mental wellbeing and resilience of children and parents is central to family health and functioning. Without good emotional and mental well being parents and children are much less able to manage the stresses of everyday life. This is especially important when there are increasing pressures on families, for example, from the economic downturn and welfare reform. Poor mental wellbeing and mental illness also carry significant costs to communities and wider society. These costs come from young people not achieving their potential in education, families unable to support each other, risk taking behaviours such as drinking excessively and other poor health choices such as obesity and smoking. They can also be associated with anti-social behaviour and loss of community cohesion. Services that support emotional and mental wellbeing will be integrated throughout the care pathways for families and children. Sandwell JHWS 2013-15

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Through the health and wellbeing board Sandwell Council will work with Sandwell & West Birmingham CCG, maternity and child health services and key stakeholders including voluntary sector and children and families to identify and meet the needs of the Sandwell population. The public health, children’s services and SWBCCG children’s commissioners working together via a children’s partnership commissioning group will facilitate this. • • • • • • • • •

Children and young people must be at the core of commissioning and service planning decisions New commissioning arrangements must be built around the needs of children, young people and their families Better provision of easily accessible, coordinated, comprehensive and consistent information for children, young people and families. Joint priority setting and planning based on local, shared data about need between health and local authorities Child health services are designed across collaborative pathways of care Children and young people’s health and public health services are developed within an outcome-based framework guided by quality standards and evidence based guidance Commissioning services with clear remits for safeguarding children An integrated approach to tackling risk-taking behaviour s that recognises how they are linked Services targeting those most at risk, through knowledge of the population, and access to early help and early intervention.

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Long term conditions and integrated care: Key Priority 2 (KP2) Background This priority applies across the life course; it includes children and young people with long-term conditions as well as adults and older people. As such, it cuts across many agencies and services. The definition of long-term conditions includes any condition that limits a person’s ability to undertake the normal activities of daily living. This includes learning disability, physical disability and life limiting illnesses. There has been considerable work and investment to join up services for people with long term conditions in Sandwell. However, local people and organisations have told us that navigating a complex and disjointed range of support provided by a range of different organisations is still a major challenge for individuals, families and carers. This is associated with people needing speak to many different agencies and services and having to provide their information and describe their needs repeatedly to different professionals. Local people and organisations told us that there needs to be a single easily accessible source of information on the support and services provided by all agencies including voluntary and community support. There needs to be clear and understandable routes into and through care to avoid individuals and families falling between services, especially in the transition between services. For example from children’s services to adult services or between health and social care services. One of the main responsibilities of the Health and Wellbeing Board is to align commissioning and integrate services. This provides a real opportunity to tackle the problems identified by stakeholders and residents of Sandwell. This will require action across the Health and Wellbeing Board partners and work with wider partners, the voluntary sector, communities and people who use services. This integration is needed across all services, not just for people with long-term conditions. Tackling this priority will influence work in all aspects of the strategy, especially for the frail elderly and for children, young people and their families. The goal must be to enable people to maintain their independence and enable them to maximise their capabilities and have control over their lives. This support is best provided from within communities wherever possible. As the resources in the public sector reduce it is essential that there is investment to build the capacity within communities to support each other when appropriate. From the HWB workshop and the stakeholder consultation event the priorities for action are; • Early identification of people who need support and clear pathways to provide the support they need. • Provision of lower level support as soon as people need it to help them maintain independence and avoid needing more intensive support or services. • Recognising the value and contribution of carers. • Making the most of the support and help already available within communities. Building on and supporting existing community assets and capacity. Developing of a one-stop-shop approach including a single source of information, advice and support across all partners Future Commissioning The current commissioning of health services for people with long term conditions is often based on individual conditions, for example diabetes, heart disease or respiratory disease. However many people have multiple interrelated conditions and it is this that has the most impact on their lives and their ability to remain independent. Services also need to be designed to help people manage their own conditions. People with long term conditions manage their own conditions for the majority of the time and spend relatively little time in contact with health and social care services.

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Commissioning of social care services is based on people’s support needs rather than their health conditions. This ranges from a wide range of support in people’s homes through to alternative accommodation such as extra care housing and residential care. Adult services also commission support services for carers. Services are commissioned from a large number of providers including voluntary organisations and private sector providers. There will be significant financial pressures on these services during the life of this strategy and commissioning decisions will need to reflect these changes. The role of the HWB is to align and coordinate the commissioning of services across the board partners. There has been joint working between health and council commissioners in the past, however there have been significant recent changes in organisations and structures. There are also major financial pressures across all services which will continue for the medium to long term. Future commissioning needs to take account of these influences. It is essential that the HWB partners work together to ensure best use of available resources to commission the services that will enable people to remain healthy and independent. The future approach to commissioning services will recognise the complexity of people’s lives and conditions and also that they self-manage their conditions for the majority of the time. Commissioning will be designed to meet people’s real life needs rather than being based on individual long-term conditions. Central to this approach will be the development of clear pathways of care that span community, primary care, hospital care and social care services. If this is to be achieved, it is essential that people who receive services, their carers and voluntary and community organisations are fully involved in designing the pathways, a co-production approach. This will build on current examples of co-production within both primary care and local authority services, for example Friends and Neighbours and the work undertaken by Smethwick Medical Practice. If this approach is to fully reflect the complexity of people’s lives and support needs it will need to include consideration of the wider influences that affect people, for example housing and access to transport. Housing conditions and suitability have a large impact on people’s ability to manage their conditions and stay independent. Cold or damp housing will exacerbate many long-term conditions; unsuitable housing may lead to an increased risk of falls. The care pathways will therefore need to be comprehensive and cover the social determinants of health, for example housing issues and alternative provision such as extra care housing. Next Steps • During 2013, the HWB partners will work with local people to understand and design the cross cutting care pathways. This will be achieved through a series of workshops with a wide range of local people, community and voluntary organisations and provider organisations. • The outcomes from these workshops will be an implementation plan for developing the care pathways across all partners. This will influence the commissioning of services by the HWB partners for 2014 -15. A priority in this will be to better align commissioning between the partners, especially between SWBCCG and Sandwell MBC. • During 2014, the care pathways will be implemented and evaluated. This will identify what works and what needs to be further developed to provide better and more integrated care. Depending on the learning that emerges from this there may be a move towards more coordinated commissioning between the partners in subsequent years.

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Frail elderly and dementia: Key Priority 3 (KP3) Background Sandwell, in common with the rest of England, has an ageing population. People in Sandwell, on average, have poorer health compared with other areas. An ageing population therefore means that more people in Sandwell are going to need healthcare and social support and will be at risk of experiencing frailty as they age. This has been raised as a priority for action by older people, for example through Agewell Sandwell, a group that represents over 1000 older people in Sandwell. There are a number of different descriptions and definitions of frailty and frail elderly, the Health and Wellbeing Board has agreed to use the definition set out in the frail elderly Joint Strategic Needs Assessment24. Under this definition, a frail elderly person is someone over 65 years old with an associated long-term health condition. The overall aim must be to improve the health and wellbeing of the whole population from children through to adulthood. A healthier population will decrease the number of people at risk of frailty. However, this improvement will take time. It is therefore a priority to ensure services for older people are appropriate and provide the support needed. The goal must be to enable people to maintain their independence and enable them to maximise their capabilities and have control over their lives. This support will be for the individual, their family and carers and is best if it is provided from within communities wherever possible. Stakeholders and local people have told us that individuals, families and carers need to be helped to take control of people’s care and provide the support they need to lead healthier lives and stay independent. They also said that that dignity and respect must be central to all services, respecting the individual and their wishes and needs. Recognising the contribution of carers is seen as essential, they are central to helping people maintain independence and they also reduce reliance on statutory services. Stakeholders have told us that despite considerable investment and work to improve and align services people still experience many complex services spread across a range of organisations which are difficult to navigate. They also told us that there are no consistent, comprehensive and easily accessible sources for information about support and services. The information available is often piecemeal, inconsistent or inaccurate, only available from a number of different sources and difficult to access. For people with dementia a timely diagnosis is important. This will help people living with dementia and their carers to be better prepared to cope with their condition. Appropriate post diagnosis care will help people to maintain their independence for as long as possible and improve their quality of life. Sandwell Position24 • In Sandwell, the proportion of the population who are aged 65 years and over is projected to grow to 20% (61,700 people) by 2033. • There is a predicted 42% increase in the estimate of people in Sandwell over 65 years of age who experience dementia by 2030. Currently nine out of ten persons aged 65+ are classified as White. This ratio is expected to decrease up until 2030 with more of the population coming from Asian and Black ethnic groups. • Income deprivation affecting older people is high in Sandwell, approximately one third of adults aged 60+ are entitled to pension credit. • Approximately 25% of carers are over 65 years old. Approximately 58% of carers provide over 20 hours of care each week. • Older people are three times more likely to live in cold housing compared to all households (47% compared to 14%). • Around 5,000 older men and 12,000 older women live alone in Sandwell. If you are a woman aged 75+ you are nearly three times more likely to live alone than a man. Sandwell JHWS 2013-15

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A third of people (over 65?) in Sandwell report having poor general health and two thirds have a long-term illness. The majority of people receiving domiciliary care, day care, meals and respite care are frail elderly or have a physical disability. People in Sandwell are less active as they get older, 13% of men and 5% of women drink more than the recommended limits per week. A high number of people being admitted to care homes or in sheltered housing may be undernourished.24

Priorities for action There are strong links between this priority and that for long-term conditions and integrated care (KP2). The shared priority is the joining up of care across agencies and the community so that people can receive the care where and when they need it. This approach needs to be central to providing the necessary support for frail elderly, people with dementia and their families and carers. The priorities for commissioning within this key priority are; •

• •

• • • •

• •

•

Develop clear and comprehensive pathways of care for people at risk of frailty or who have dementia and for their families and carers. These pathways must cross all agencies and include the support provided by the voluntary and community sector. To take a prevention based approach to enable people to stay healthier, independent and living within the community for longer. Early identification of people who are at risk of needing increased support and targeted interventions to maintain them at their lowest level of need. Sandwell is one of the areas in the West Midlands with the highest levels of early diagnosis of dementia. However this still only identifies half of people with dementia and there is a lack of support that can delay the condition or enable individuals, their families and carers to better manage the condition. To ensure that people with dementia receive a timely diagnosis and the best available treatment and care, including support for carers. To support people with dementia and their carers to be better able to cope with the condition. Fully involving older people, carers and voluntary and community organisations in the design, commissioning, delivery and monitoring of services. Addressing social isolation and loneliness is a priority in reducing frailty in old age. Isolation and loneliness are important factors that can mean someone experiences frailty and can make dementia symptoms worse. On average, people with strong social networks are healthier and make less use of health and social care services. Measures to tackle loneliness are relatively low cost and can help to strengthen communities. Providing support to unpaid carers and recognising their contribution. Provision of consistent, accurate and comprehensive information and advice across statutory, third sector and community providers. Development of a ‘navigator’ role to help people find their way through the available care and support. Use a ‘dementia friendly communities’ approach to link up and promote access to a wider network of services. Working across council and health services, communities and the voluntary sector. Ensure plans include consideration of the wider determinants of health and their contribution to comprehensive services. For example, housing and the development of well designed environments for an ageing population.

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Alcohol: Key Priority 4 (KP4) Background Alcohol is a regular part of many people’s lives. When used within the recommended limits for safe drinking this does not present a significant risk to health. However, for people who drink more than is recommended there are major health risks including liver disease, dementia, cancer and obesity. Alcohol is also associated with mental health problems and can cause problems for unborn children such as foetal alcohol syndrome. This has an impact on the individual, their family and community and on health and social care services. There has long been a culture of heavy drinking across the industrial West Midlands and Sandwell reflects that culture. This pattern of heavy drinking has arguably been made worse by cheaper and more widely available alcohol. Whereas 40 years ago most drinking was by men in pubs drinking beer, there is now a pattern of drinking before people go out to pubs or clubs (pre- loading)and drinking at home supported by cheaper alcohol in off sales and supermarkets. This has also seen a decline in Sandwell’s ‘local’ pubs. The impacts of alcohol misuse are felt widely across the community. It is associated with a wide range of social problems including family breakdown, domestic violence, violent crime, teenage pregnancy and sexually transmitted disease25. High levels of alcohol intake are also linked to unemployment, homelessness and mental health problems. Alcohol therefore has a direct influence across all of the seven JHWS objectives and each of the other three HWB key priorities. In England; • 85% of adults drink alcohol • 21% of adults in England drink more than the Government's lower-risk guidelines • Around 5% of adults drink at higher-risk levels Sandwell Position The Local Alcohol Profiles for England published by the North West Public Health Observatory show that Sandwell is significantly worse than the rest of England and the region for deaths from alcohol specific conditions, deaths from alcohol related conditions and hospital related admissions26. Estimates of those who are underage and drinking are available from the Joseph Rowntree foundation27. It is estimated that within Sandwell we would expect approx 12,774 children aged 1316 years to have drank alcohol. Based on the drinking weekly estimates there are approx 768 children in Sandwell aged 13 and 1586 children aged 16 who have drank in the last week, a total of 4708 if an average is used from 13-16yrs. Of these 606 children aged between 13/14 drank more than 7 units and 1230 children aged 15/16 drank over 11 units of alcohol. Approximately 1836 children in Sandwell are drinking at hazardous levels. For adults figures for drinking levels come from estimates based on the Alcohol Concern State of the Nation estimates applied to Sandwell population figures28: • Binge Drinkers: 20% population 23,600 Men 24,917 women in Sandwell. • Hazardous Drinkers/ Low risk: 20-23% men (by age) 10-23% women (by age) 30,679 Men 22,419 women • Harmful Drinkers/ Increasing risk (IR): 20% men & 13% women 23,600 Men 16,196 women • Dependant Drinkers/ High Risk (HR) 8.7% men & 3.3% women 10,266 Men 4,111 women There are variations in alcohol intake by ethnicity. Black Caribbean people have higher levels of drinking than people from South Asian and Chinese backgrounds but lower levels than people from white backgrounds and the general population. Sikh men have high rates of heavy drinking and have higher than average rates for cirrhosis of the liver.29 Alcohol is responsible for 8% of all hospital admissions nationally • This rose by 12% between 2009/10 and 2010/11 Sandwell JHWS 2013-15

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Alcohol misuse contributes to 48 conditions 13 conditions are wholly attributable to alcohol consumption 35 conditions are partially attributable to alcohol consumption Areas of highest deprivation (compared to more affluent areas) have:30 o 2 to 3 times higher loss of life o 2 to 5 times more admissions to hospitals

Current provision • There is a Local Enhanced Service which rewards primary care providers who assess for alcohol misuse using the AUDIT tool. In the future this will be commissioned by the NHS Commissioning Board. • An open access alcohol service provided by Swanswell offers brief advice, extended brief advice and support to people who may need help with stopping drinking, including working with those who need detoxification support. • An alcohol case Manager provides support to those who want to stop drinking. This work reflects the multi-agency approach required for tackling alcohol related issues and is supported by three specialist workers from Criminal Justice, Safeguarding and alcohol workers for the elderly (community matrons) Identified gaps Work is underway to develop a better understanding of alcohol use, current costs of treatment and gaps in knowledge and services in Sandwell. Involvement of stakeholders There is an active partnership group which includes commissioners, providers, third sector organisations and service users. The Sandwell Drug and Alcohol Partnership Group meets monthly to discuss all aspects of substance misuse strategy including alcohol. Members are drawn from Children’s services, Trading Standards and Licensing, Police and Probation. Specific contracts commissioned by the Drug and Alcohol Action team are discussed here as well as in contract meetings with providers. There is an operational pathway group for providers to meet, facilitated by the alcohol strategy manager. Priorities for action The priorities for tackling alcohol misuse reflect the wide-ranging impacts it can have across individuals, families and communities. This will involve joint working across health, local authority services, local people, the voluntary sector and the police and criminal justice system. Alcohol is a risk factor for domestic fires and the West Midlands Fire Service is exploring how it can contribute to this work. This is likely to include implementation of an ‘every contact counts’ approach and building on existing joint work between their vulnerable persons officers and health and council officers. • Early identification of individuals with alcohol problems must be a priority if the impact of these problems on the individual, their families and communities is to be minimised. All front line staff should, where appropriate, have the skills and confidence to ask key questions and provide information on the support available. • Direct services for local people will include providing information and support to help people drink safely, services for people who require support with managing their alcohol intake and support for people who are alcohol dependent. As well as direct services for individuals and families, there must be a joint approach to managing legal access to alcohol. This includes the role of the council in licensing; health is now a consultee in licensing issues for alcohol.

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Joint Health and Wellbeing Strategy Objectives A. Give every child the best start in life Marmot Review Priority Objectives • Reduce inequalities in the early development of physical and emotional health, and cognitive, linguistic, and social skills. • Ensure high quality maternity services, parenting programmes, childcare and early years education to meet need across the social gradient • Build the resilience and well-being of young children across the social gradient This objective is central to the delivery of one of the health and wellbeing board key priorities; • Early years and adolescent health The experiences a child receives and their social environment in their first few years of life have an effect on nearly every aspect of their physical, emotional and intellectual development. It is therefore essential that children get the best possible start to life. Achieving this will have the largest impact on health inequalities in Sandwell. Investment in a child’s early years has a greater potential for improving their long-term outcomes than at any other time of their lives2. For every child to have the best possible start in life the underlying principle must be that families are at the centre. Services delivered or commissioned by statutory services can only provide part of the picture, their main role is to support families and communities in providing the stable and loving environments that children need to grow up and achieve their potential. For this to be successful, we need to take an asset based approach that harnesses the strengths, skills and experiences of parents, wider families and the community. Services, especially for families with more complex needs, require the co-ordinated involvement of a range of organisations and of families and communities. Effective partnership working is therefore essential. Wherever possible services should provide families with a ‘one stop shop’ so they can access all the support they need from one location. This is the approach upon which children’s centres have been developed and it is important to maintain this approach in future service models. Services must also address the difference in health between different sections of the community. For example, low birth weight is associated with worse health and with a lower life expectancy. There is considerable variation in rates of low birth weight babies in different ethnic groups, Indian, Pakistani and Bangladeshi infants are 2.5 times more likely to be low birth weight compared to white infants.31 This support for families will range from universal provision such as Health Visiting and children’s centres through to early identification and intensive support for families with multiple complex needs. This support must address all the family’s needs and recognise the importance of environmental factors such as housing. The majority of families will access the universal services with only occasional contact with other services, most often through primary health care. Sandwell Position Figure 7: The child population in Sandwell (source ChiMat)32 Children 0-4 years % of total population Children 0-19 years % of total population Children 0-19 years % of total population predicted 2020 % of school age children from a BME group % of children living in poverty Life expectancy at birth: Boys Girls Sandwell JHWS 2013-15

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Sandwell 7.6% 26.4% 26.5% 43.2% 32.0% 75.5 80.8

W Midlands 6.4% 24.6% 24.1% 27.7% 24.6% 77.9 82.2

England 6.3% 23.8% 23% 24.6% 21.9% 78.6 82.6 26

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Educational attainment provides a measure of how well children are achieving and is one of the best predictors of long-term health and life expectancy33. The Marmot Review clearly demonstrates the association between deprivation, poor attainment in education and life outcomes. The Early Years Foundation Stage Profile is completed by registered early years childcare providers and is intended to provide reliable information on a child’s early development. This provides an indication of how well children are achieving in Sandwell in their early years. Figure eight shows that since 2008 the gap between Sandwell and the rest of England in the number of children achieving a good level of development at 5 years has narrowed significantly. Figure 8. Achievement at Early Years Foundation Stage: Sandwell and England34 % of children achieving a good level of development aged 5 years 70

% of children

60 50 40

Sandwell

England

20 10 0 2008/09

2009/10

2010/11

2011/12

Academic Year

Detailed information on the current outcomes for children in Sandwell can be found on the Sandwell Trends children and young people’s theme pages. http://www.sandwelltrends.info/themedpages/Children_Young_People Achievements • Sandwell Council is leading an Early Help programme. This provides coordinated support for the most vulnerable families with a single access route and family support from Children’s Centres • Sandwell has reduced the gap between the lowest achieving 20% in the Early Years Foundation Stage and all pupils from 38 percent in 2008/09 to 33 percent in 2011/12. • The percentage of children achieving a good level of development in Sandwell in 2011/12 was 59 percent compared to 45 percent in 2008/09. Performance in Sandwell has improved at a faster rate than seen nationally and is now in line with the national performance on this measure. • The percentage of pupils achieving 78 or more points across all assessment areas of the foundation stage profile has also improved, in Sandwell an extra 7 percent of children achieved this measure in 2011/12 compared to 2008/09, nationally the improvement was 4 percent. • A new Breastfeeding Support Service has been commissioned by Public Health extending the support to available to expectant mothers. • Following a Workshop for Children Centres on children’s health outcomes, health leads have been identified for each Children Centre and a group established to facilitate action across Children Centres in relation to public health outcomes.

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A. Give Every Child the Best Start in Life: Sandwell Health and Wellbeing Board Priorities A1 A2

Priority Children have the best start in life Ensuring high quality and easily accessible maternity services

Interventions - Overarching outcome indicator -

Provision of ante-natal care and home visiting Commissioning of maternity services based on the needs of the population (SWBCCG) -

All families have the support they need when they need it and children are prepared for education

Delivery of the Sandwell Early Help Strategy for families below the threshold for social services intervention Coordinated universal information, advice and support services for families according to their needs Early identification of families needing more support through the Early Help Programme Evidence based parenting programmes Commissioning of sufficient childcare services Collaborative working across all partners to ensure vulnerable families receive coordinated support Evidence based parenting programmes Intensive social and behavioural programmes Early identification and intervention with families experiencing problems with alcohol (KP4) Support for young carers (KP2) Joint working protocols between adult and children’s services in place with joint assessment as routine practice Families and Communities Together (FACTS) Programme Implement Make Every Contact Count programme Smoking cessation Support with safe drinking and use of alcohol

All children remain safe and vulnerable families receive coordinated support

Providing families with the support to choose healthier lifestyles

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Outcome indicators - Infant mortality

Women’s experience of maternity services Rate of low birth weight full term babies Admission rates of full term babies to neonatal care Achievement of at least 78 points across the Early Years Foundation Stage Childcare sufficiency survey Children achieving a good level of development at age 5 School readiness Children and young people reach their expected developmental goals

Delivery partners All SWBCCG NHSE Public Health SMBC SWBCCG Public Health NHSE

Initial assessments for children’s social care carried out within 35 days Percentage of children on a child protection plan not allocated a social worker Reductions in childhood accidents Numbers of Looked After Children School attendance Rates of repeat referrals to specialist and acute children’s services Reduction in crime Reduction in anti-social behaviour

All

Breastfeeding rates Smoking status at delivery Children overweight and obese in reception class

All

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Immunisation and screening

Provide early help for families in need of support

Ensure coordinated support for families with a child with a disability or long term condition (KP2)

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(KP4) Healthy eating programmes and improve access to healthy food Increase physical activity Improve and support emotional and mental wellbeing Increase numbers of parents who have planned successful exits from drug and alcohol services Commissioning of relevant screening programmes Commissioning and delivery of all relevant immunisations Development and delivery of the partnership Early Help Strategy and delivery plan Commission an early help offer based on a comprehensive needs analysis and evidence for best practice Commission integrated provision to meet the needs of children and young people who have a disability or long term condition (KP2) Establish integrated support for children with disabilities (KP2)

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29 -

Tooth decay in children aged 5 years Uptake in healthy start vitamins

Screening rates Immunisation rates

All

Reduction in number of looked after children Numbers of successfully completed comprehensive assessment frameworks Numbers of families who are deescalated in universal services.

All

Delivery plan and milestones for development of the early help offer to families Length of time for ASD assessments

All

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B. Enable all children, young people and adults to maximise their capabilities and have control over their lives Marmot Review Priority Objectives • Reduce the social gradient in skills and qualifications • Ensure that schools, families and communities work in partnership to reduce the gradient in health, well-being and resilience of children and young people • Improve the access and use of quality lifelong learning across the social gradient This priority is central to the delivery of two of the health and wellbeing board key priorities; • Early years and adolescent health • Long term conditions and integrated care There is increasing evidence of the importance of the first few years in a child’s life. If children fall behind in early cognitive development they will continue to fall further behind at subsequent educational stages and this may also affect their emotional and social development. Children from lower socio-economic groups perform consistently worse than children from higher socio-economic groups throughout education. They are also less likely to gain high quality employment, have a shorter life expectancy and spend more of their lives ill or with a disability2. This reinforces the vital importance of giving all children the best start in life. The evidence from the Marmot Review is that this gap in educational attainment is not due to any differences in intelligence or effort between the children and families from different areas. Instead, it is related to their environment and the opportunities they have available. Children with higher educational potential from an area of deprivation can be passed in educational attainment by the age of 6 years by children with lower educational potential but who grow up in a less deprived area. High quality education is wider than the provision of good teaching; it also includes ensuring that children and young people have the support they need to make best use of this teaching. This needs to build their social and emotional resilience and will include the prevention of violence and bullying. Education should not stop when a young person leaves full time education. Life-long learning enhances people’s ability to secure employment opportunities and improve personal well-being. This needs to be available across the social gradient, however there also needs to be targeted action to support vulnerable groups to gain literacy and other basic skills. Learning in older age is also important, it can help people stay independent for longer and improve their ability to care for their own needs. For people of all ages to have control over their lives they need to have the knowledge, skills and capacity to manage their own lives and their health. A good quality education will provide the basis for developing these. Local services must also be designed to support people in managing their own lives rather than creating dependence. This is a ‘self care’ based approach which builds on people’s and communities strengths35. This fits well with the personalisation approach and individual budgets, providing people with the means to have real choice over the services they use to maintain independence and well-being. Enabling people with long-term conditions or a disability to have control over their lives will mean supporting the people that support them. This means providing comprehensive and effective services for carers including information, advice and enablement and access to flexible support. Recent analysis has shown that the economic value of carers in the UK is £119 billion per year and the return on investment in carers support services may be as high as £14 for every £1 invested36 Sandwell Position Sandwell is a borough with a higher than average proportion of children of young people. The latest statistics suggest that 21.2% of the population is less than 16 years of age (ONS estimates 2010). Detailed information and analysis on key indicators for children and young people in Sandwell, Sandwell JHWS 2013-15 05/07/2013 30

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including educational achievement and child poverty, can be found on Sandwell Trends at; http://www.sandwelltrends.info/themedpages/Children_Young_People Figure 9: Educational achievement at Key Stage 4 34

Achievements • Sandwell schools are working in Core Offer Partnerships (CoOPs) which provide access to a wide range of services for Sandwell families. • There have been real successes in improving educational achievement for young people in Sandwell. A greater proportion of pupils in Sandwell achieved 5 or more A*-C grades in 2011/12 than was the case nationally with Sandwell exceeding the national figure by 2.4%. As shown above there has also been significant improvement in the proportion of pupils who gained 5 or more A* to C GCSEs including English and maths. In 2007/08 this was 32%, by 2011/12 this had increased to 54%. This reduced the gap between Sandwell and national levels from 17% to 5%37. • A self-care approach is central to Sandwell Council’s prevention strategy. Self-care is being developed across council, health and third sector organisations through the Right Care Right Here programme. • Sandwell council and health services have demonstrated a joint commitment to supporting carers with joint strategy and funding for carers support programmes. Carer support is included within the council scorecard for measuring excellent council performance. • Whilst Sandwell’s teenage conception rate remains high, Sandwell has established a downward trend with an overall reduction of -19.2% in conception rates between 1998 and 2010.

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B. Enable all children, young people and adults to maximise their capabilities and have control over their lives Priority B1 Improve educational achievement for children and young people

B2 Children and young people remain safe & vulnerable families receive coordinated support B3 Reduce teenage conceptions

Intervention - Ensure adequate provision of school places - Work with schools to improve teaching standards - Whole school approaches to prevent bullying and violence - Review and commission a comprehensive of School Nursing Service (SMBC) - See priority A4 - Support and identification of young carers

B4 Children and young people are supported to make healthy lifestyle choices -

B5 Children and young people receive the mental wellbeing support they need

Provision of sexual health and relationship education Comprehensive sexual health services Implement Make Every Contact Count across all services Commissioning of a comprehensive substance misuse service (KP4) (SMBC) Provision of a community alcohol service Provide comprehensive lifestyle services o Smoking cessation o Physical activity o Healthy eating o Alcohol (KP4) Regulatory and licensing services to control access to alcohol and tobacco (KP4) Provision of School Nursing services and the Healthy Child Programme 5-19 Provision of comprehensive confidence and mental wellbeing services for young people Targeted youth support services Commissioning of emotional wellbeing services at levels 2 and 3

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Outcome Measures - Achievement at level 4 or above in Maths and English at Key Stage 2 - Achievement of 5 or more A* to C grades at GCSE (inc English & Maths) - Pupil absence rates - See priority A4

Delivery Partners SMBC

SMBC SWBCCG NHSE

Under 18 conception rates

All

Obesity among school age children in year 6 Smoking prevalence under 16 yrs Frequency of alcohol use reported by 12-15 yr olds (KP4) Proportion of 12-15 yr olds reporting cannabis use Chlamydia rates and prevalence

All

Young offenders engaged in suitable education

SMBC SWBCCG NHSE

Sandwell JHWS 2013-15 B6 Support young people so they can contribute positively to their communities

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B7 Provision of support for carers

B8 Tackling child poverty

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Provision of appropriate support at key transition points Provision of comprehensive and targeted youth support services Engage with young people as part of community based development projects Investment in carers support services Provision of information, advice and support for carers

From Child Poverty Needs Assessment and Sandwell Anti-Poverty Strategy • DOMAIN A Children in Sandwell • DOMAIN B Education, Health and Families • DOMAIN C Housing and Environment • DOMAIN D Skills and Employment • DOMAIN E Income and Poverty

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Participation of 17 yr olds in education and training Apprentices trained in level 1,2 & 3 NEET indicators

SMBC

Percentage of carers receiving needs assessment or review and a specific carer’s service or advice and information. N16

SMBC SWBCCG

All

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C. Create fair employment and good work for all Marmot Review Priority Objectives • Improve access to good jobs and reduce long-term unemployment across the social gradient. • Make it easier for people who are disadvantaged in the labour market to obtain and keep work. • Improve the quality of jobs across the social gradient Unemployment, especially long-term unemployment has a significant negative impact on both mental and physical health. There is strong evidence that being in employment has a strong protective effect on people’s health38. Whether this applies to any employment or only good quality employment is not yet certain. Two of the main challenges for Sandwell are historical low educational achievement and the high proportion of the workforce employed in the public sector. The recent and planned changes to public services nationally and locally will lead to lower numbers of public sector jobs. There will need to be support available to minimise the impact unemployment has on people’s health and wellbeing. This includes lifestyle services and support to develop individual and community resilience and maintain wellbeing. Reducing public sector employment will need to be balanced by increases in private sector employment. However, attracting inward investment into Sandwell to create these jobs has proved to be difficult. This is partly due to the low skills base. The significant improvements in educational attainment in Sandwell over recent years will help to tackle this in the longer term but in the short to medium term this will remain a major challenge. The central approaches to creating fair employment for the population of Sandwell will be to; • Maximise employment opportunities for local people. • Work with people to improve their skills and employability. • Support local people to gain and maintain employment. • Identify areas where Sandwell can provide opportunities for business and for local people. Sandwell Position In many deprived urban areas over the past decade, including Sandwell, there has been a large increase in the proportion of the population employed in the public sector39. The current reduction in public sector workforce will therefore have a disproportionate effect on employment opportunities in Sandwell. Figure 10 shows the proportion of the working age population claiming job seekers allowance in Sandwell compared with the West Midlands and Great Britain. This shows that unemployment in Sandwell follows the national and sub-national trends but Sandwell has significantly higher levels of unemployment

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Figure 10: Job Seekers Allowance claimants May 2008 to September 201234

More detailed and current information on unemployment in Sandwell can be found on Sandwell Trends at; http://www.sandwelltrends.info/themedpages/Unemployment Achievements • There have been significant improvements in educational attainment in Sandwell • The regeneration of West Bromwich and the development of a new supermarket will provide local jobs. This regeneration has been awarded £4.2 million from the European Regional Development Fund. A new British Telecom call centre has provided 450 jobs • Tesco is recruiting for the new supermarket in West Bromwich through a regeneration partnership initiative which will help people experiencing long-term unemployment back into work. • Sandwell has a strong track in attracting external funding for regeneration including the Regional Growth Fund. This has helped local business to invest in growth leading to the creation of new jobs. • The Growing Places fund, through the Local Enterprise Partnership, is supporting infrastructure development to support new and existing businesses with growth and job creation. • Find It In Sandwell is a council supported business development community. This provides support to local businesses in finding suppliers and customers within the local area. • ThinkLocal is council provided service which places more than 80 young people into work based training and 200 local people in employment in the construction industry each year. • Economic regeneration, planning, public health, environmental health, trading standards and anti-poverty have developed a new approach to providing support to new businesses and to support business growth. The Black Country LEP is exploring how this can be adopted over a wider area.

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C. Create fair employment and good work for all Priority

Interventions

Support new businesses to set up in Sandwell

Support people with entering into employment

Outcome indicators

Target advanced manufacturing, business services and green industries as key growth areas Set up apprenticeships Think Local to develop local employment

Number of new businesses in Sandwell

Number of apprentices trained in levels 1, 2 & 3 Number of people supported into employment Number of new business loans Businesses assisted with advice and support

Work with local businesses to identify the support they require to develop and innovate

Ensure people are able to maintain employment

Ensure all people can access appropriate employment

Sandwell JHWS 2013-15

Sandwell business loans Provision of advice for businesses including property and new opportunities Find it In Sandwell to support local business in gaining contracts Support employers with ensuring that they have a healthy workforce through prevention of physical and mental health problems at work Support people at risk of unemployment through ill health Provide lifestyle support and health care to help people return to work after ill health Support with safe drinking and alcohol problems (KP4) Programmes to support people with illness or disability to gain and maintain employment Programmes to ensure public sector employment reflects the population of Sandwell

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Delivery partners SMBC Public Health SMBC Public Health

SMBC

Employment for people with a long term health condition or disability, including learning disabilities Sickness absence rates Adults obtaining employment for a minimum of 26 weeks

SMBC Public Health SWBCCG

Employment for people with a long term health condition or disability, including learning disabilities Proportion of local authority employees from ethnic minority communities

SMBC SWBCCG Public Health

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D. Ensure a Healthy Standard of Living for All Marmot Review Priority Objectives • Establish a minimum income for healthy living for people of all ages. • Reduce the social gradient in the standard of living through progressive taxation and other fiscal policies. • Reduce the cliff edges faced by people moving between benefits and work. Much of the influence over these priority objectives will come from national policy, including that relating to income and taxation. At a local level it will be necessary to identify what interventions can contribute to maximising income and minimising inequalities. The main determinants that will influence this are education and employment. Ensuring that people in Sandwell are able to gain the knowledge and skills they need and to gain long-term high quality employment and independence. This will also provide them with the means to make informed choices about individual lifestyles throughout their lives. It is therefore essential that people in Sandwell receive the education they need, however for this to have the greatest impact there will need to be suitable employment opportunities available locally. This reinforces the importance of priority objective 3, creating fair employment and good work for all. If a minimum income is to be guaranteed for all people there will also need to be provision for people who need additional support, whether due to illness and disability or unemployment. This is especially important for vulnerable groups but should be available across the social gradient. Wherever possible the approach should be to support people in gaining suitable employment. When this is not possible people should be supported to ensure they are receiving the support and benefits they need and are entitled to. The approach to achieve this is set out in the Sandwell antipoverty strategy. Ensuring a healthy standard of living for all must consider the differences between different sections of the population. For example, around 40% of people from ethnic minorities live in low income households. This is twice the rate for white people. Within this there are large variations by ethnic group, 70% of Bangladeshis and 50% of Black Africans live in low income households. Welfare Reform Nationally a major programme is underway to reform welfare provision. This includes the review of a wide range of welfare benefits and combining them into a single universal credit welfare payment. Analysis these reforms has forecast that they will result in £100million less being received as benefit payments in Sandwell by 2015. This includes development of local systems to manage council tax rebates and the social fund. A recent report has calculated that the welfare reforms will mean that Sandwell loses £610 per working age adult per year. This report also found that Sandwell will have the fourth largest impact from tax credit changes of all the local authorities in England40. The Institute of Health Equity has published an analysis of the impact of these welfare reforms on public health41. This showed that welfare reform has the potential to have a significant negative effect on the health of Sandwell. The short-term impacts are likely to be; • Increase in mental health problems including depression, suicides and attempted suicides • Possible increases in domestic violence and homicides • Worse infectious diseases outcomes such as tuberculosis and HIV The longer-term health impacts of the reforms could potentially include the effects of poverty, poor quality housing and an increase in unhealthy lifestyles. These impacts could be felt for several decades. The families experiencing the effects of welfare reform include both workless families and those with members in low paid or part time work. The goal must be to minimise the impact of the welfare reforms in Sandwell through building community resilience to the changes. This will mean reducing the number of people affected by Sandwell JHWS 2013-15

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welfare changes, helping local people improve their financial literacy and building capacity within communities to provide support. In reducing the number of people affected by the reforms this needs to go beyond getting people into work, it also needs to tackle in-work poverty which is due to part time work and low pay. Sandwell Position Figure 11 shows the average pay for people in Sandwell between 2002 and 2012 compared to the West Midlands and Great Britain. This shows that the average weekly pay in Sandwell has been consistently lower than both the West Midlands and Great Britain. Figure 11: Average weekly pay in Sandwell for full time workers compared to West Midlands and Great Britain Source: Office for National Statistics42

Child Poverty According to mid 2011 estimates 31.8% of the children in Sandwell, 24,000 children, are living in “relative” poverty. This is defined as living on less than 60% of the median national income. In the last 4 years child poverty has risen in Sandwell by a total of 1.2%. At ward level child poverty in Sandwell ranges from 19% to 44% of children43. • Sandwell ranks 25th nationally in the list of authorities with the highest rates of child poverty, this is within the worst fifth of all authorities in England. • More than half the small areas in Sandwell have increased their child poverty levels above the borough average between 2006 and 2009. • At ward and neighbourhood level the information shows that child poverty is becoming more acute in areas where traditionally it has not been identified as a priority. Achievements • The Welfare Rights service has helped local people claim over £40 million in additional benefits over two years. • Sandwell Council and partners, including public health, have developed the Friends and Neighbours project. A community based project that builds on existing community involvement to support vulnerable residents and improve the capacity in the community to improve the neighbourhood and improve health and wellbeing. • Through a joint pilot food sector project across economic regeneration, public health, planning and anti poverty a new cross council model for business support has been developed. This provides local businesses with a comprehensive and coordinated range of support to enable business growth and to increase local employment opportunities. Locally the most important contribution to ensuring a healthy standard of living will come from increasing employment and the quality of the jobs in Sandwell. Supporting this approach is the Sandwell Council Anti Poverty Strategy 2010-201344 and the Sandwell Economic Prospectus45.

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D. Ensure a Healthy Standard of Living for All D1 D2

Priority

Interventions

Increase employment opportunities in Sandwell Reduce child poverty

Outcome indicators

See Priority E: Create fair employment and good work for all Improve access to financial services Improve understanding of money matters amongst children, young people and parents Identify gaps and develop child care provision to enable parents to return to work

See priority E

Proportion of children in poverty in Sandwell Inequality in income for children (IMD 2010) Monetary value of benefits assisted by the Welfare Rights Service Number of people assisted to claim extra benefits by Welfare Rights Service Proportion of people in receipt of means-tested benefits Proportion of population in fuel poverty Number of people supported with income maximisation Local indicators for the impact of welfare reform in Sandwell are under development

Maximise residents income

Minimise the health and wellbeing impact of welfare reform in Sandwell

Sandwell JHWS 2013-15

Programmes to tackle debt including welfare advice services Interventions to reduce the impact of fuel poverty Maximise the uptake of benefits

Ensure detailed knowledge/ awareness of the impact of welfare reforms across Sandwell. Ensure claimants stakeholders and partners are fully prepared for the reforms and engaged in developing a practical way forward. Ensure support arrangements are in place for vulnerable clients. Ensure pathways into work are linked to the development of local enterprise and services. Ensure HWB partner plans and service delivery reflects the requirements arising from a reformed welfare system.

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Delivery partners All SMBC Public health SWBCCG

SMBC Public Health SWBCCG

SMBC SWBCCG Public Health

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E. Create and develop healthy and sustainable places and communities Marmot Review Priority Objectives • Develop common policies to reduce the scale and impact of climate change and health inequalities. • Improve community capital and reduce social isolation across the social gradient. The aim within this objective is to ensure that people live in healthy environments. Well-designed urban environments and housing are essential to support a range of other strategic priorities46. Poor quality housing is associated with poor health and excess winter deaths47. If we want people to use more active travel they need safe roads designed to support walking and cycling and accessible public transport. Wherever possible, urban areas need to be designed to allow people to use active travel to their work. The services they need should also be easily and locally accessible. The Sandwell Healthy Urban Development Unit brings together the main partners who can influence these factors in Sandwell. For people to be able to sustain behaviour change to a healthier lifestyle they need the environment in which to do it. They need access to high quality green space and opportunities for enjoyable physical activity and they need to be able to buy healthy food near to where they live. As is made clear within the Marmot Review, reducing inequality and improving health and well-being is closely associated with the sustainability agenda. This is especially true in designing and building healthy urban areas and environments. The steps set out above to develop healthy environments are often the same steps needed to move to more sustainable urban environments and lifestyles2. Sustainable healthy urban development also has the potential to support other strategic goals. For example, the potential for ‘green jobs’ in sustainable industries, an area of considerable growth and opportunity where investment could have significant long term benefits. It can also contribute to reducing poverty through, for example, efficient housing reducing fuel poverty. There is good evidence for the positive impact of good quality green space on health and wellbeing. A review by the Faculty of Public Health and CABE identified the role green space can play in tackling obesity and cardiovascular disease and in promoting mental wellbeing. Green space also has a role to play in reducing health inequalities and in tackling wider determinants such as antisocial behaviour48. Sandwell has a strong track record of providing good quality green space and we need to build on these successes. Within this objective the majority of the work to deliver the priorities will be through partnership working. Some of this will be through commissioning of services but much will be delivered through better alignment of existing services. The key message to commissioners is to maintain the capacity needed in the relevant organisations and departments to deliver on these priorities. The recent publication of the National Planning Policy Framework and the Localism Bill make clear the role of neighbourhood planning in providing local people with the power to influence developments within their area. For this to be effective, local people and communities need to be able to engage with the planning process. This will require work to support communities in understanding how they can influence planning and building community capacity so they are able to engage effectively. Alongside healthy places, this objective includes creating and developing healthy and sustainable communities. This means improving the social and economic environment in which people live. This will be achieved through an asset-based approach to working with communities. Friends and Neighbours is based on the asset-based approach and this initiative demonstrates how this can work. This initiative was developed with local people who had been involved in developing the Windmill Eye Masterplan, an example of neighbourhood involvement at the centre of local planning policy.

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Achievements • Sandwell council has invested in improving the green space within the borough. Seven of Sandwell’s parks now have the Green Flag award, including the first cemetery in the West Midlands to receive this award. • Sandwell has a number of development plan documents aimed at regeneration within the borough. This includes protection of sites for key regeneration developments such as employment and open spaces. • The local community was fully engaged in the development of the Smethwick Windmill Eye Neighbourhood Plan. This provides a model for developing future neighbourhood plans using an asset based approach. • The Black Country Core Strategy is built around ensuring accessibility to essential services, facilities and employment. It is the only core strategy to include a measure of access to healthy food. This will form the local plan under the new National Planning Policy Framework. • Sandwell has established the first Environmental Public Tracking system in Europe, a development acknowledged as innovative good practice by the World Health Organisation. The system integrates data and other intelligence on environmental hazards, exposures and health effects to quantify and characterise the impact of the environment on health and enable the effective targeting and monitoring of interventions • Sandwell has developed the first risk coefficient for exposure to NO2, the most important air pollutant in the Borough Sandwell Housing and Health Group have been operating since 2007. • A successful project to develop links between housing and health has delivered multiagency training on health and housing, this training is now being repeated • Development of Healthy Homes Advocates that provide links between health and housing and refer in to other agencies through the Sandwell Hub • Focused work to improve the quality of housing in the private sector • Development of a handyperson and energy efficiency services SHUDU provides a formal route for engagement between health, local authority planning services and other stakeholders that have influence over the wider determinants of health. SHUDU has been working to • Ensure there is a public health input into urban planning and regeneration • Control the introduction of fast food outlets and work with local business to improve the quality of food in Sandwell. A Hot Food Takeaway Supplementary Planning Document has been adopted by the council and is being implemented. • Actively exploring the potential for greening urban canyons to reduce the health impact of areas with high levels of air pollution. Traffic related air pollution kills an estimated 630 people each year in the West Midlands49. • Support the development of urban planning to promote active travel. Refreshing of the Sandwell Walking Strategy including consultation with local people on the priorities for promoting walking. • Develop community agriculture and link it to local regeneration and community development • Developing a partnership approach to tackling the health and wider risks posed by shisha bars, working with public health, planning, environmental health, trading standards, the Police and the Fire Service. Friends and Neighbours have developed a true asset based approach to community development. • A network of residents has established a Community Interest Company to develop the initiative further. • More than 50 local people have already offered their services as volunteers and good neighbours. 24 local residents with related skills want to provide more in depth care and support for their “neighbours” as personal assistants. • Pathways into training and work are being created for residents, which directly deliver improved services to vulnerable residents. Sandwell JHWS 2013-15

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E. Create and develop healthy and sustainable places and communities E1

Priority

Interventions

Improve the health impact of the environment on health in Sandwell

Outcome indicators

Integrate public health, planning, transport, housing and environmental services Prioritise interventions that improve sustainability and reduce inequalities Influence wider planning and transport policy Strengthen the role of local people in influencing planning

Improve the food environment in Sandwell

Control fast food outlets and improve food quality Develop community growing & agriculture Coordinate a comprehensive food systems approach to improve access to healthy food

Improve active travel in Sandwell

Improve good quality green spaces

Improve the quality of local housing

Sandwell JHWS 2013-15

Improve the environment for active travel Initiatives to increase active travel Integrate active travel planning into new building and regeneration Implement the plans for the Local Sustainable Transport Fund Walking strategy for Sandwell Ensure new developments and regeneration initiatives include access to good quality green spaces Improve the quality and use of Sandwell green spaces Improve energy efficiency in housing Tackle fuel poverty Work with all housing sectors to improve housing quality with a focus on improving private sector housing

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Air pollution indicators Proportion of population affected by noise and other public health nuisances Recycling and landfill measures Carbon control measures Demonstrable influence from health impact assessments Food quality and access measures Longer term improvements in levels of obesity and other dietary related diseases Killed or seriously injured casualties Statutory homelessness Active travel measures for cycling and walking and improvements in uptake

Delivery partners SMBC Public Health PHE

SMBC Public Health

SMBC Public Health PHE SWBCCG

Utilisation of green space for leisure and exercise Number of parks with a Green Flag

SMBC Public Health

Excess winter deaths Decent homes standards in public and private sectors Number of affordable homes

SMBC Public health

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Support locally developed and evidence based community development programmes

Sandwell JHWS 2013-15

Provision of Healthy Homes Advocate service to provide links between health, housing and lifestyle services Develop and expand the Friends and Neighbours approach to asset based community working Remove barriers to community participation and action Initiatives to reduce social isolation and ensure all members of the community are able to contribute positively

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Under & over occupation figures Social connectedness Reduction in crime Reduction in anti-social behaviour

All

F. Strengthen the role and impact of ill health prevention Marmot Review Priority Objectives â&#x20AC;˘ Prioritise prevention and early detection of those conditions most strongly related to health inequalities. â&#x20AC;˘ Increase availability of long-term and sustainable funding in ill health prevention across the social gradient. This objective is central to the delivery of one of the health and wellbeing board key priorities; â&#x20AC;˘ Alcohol The role of primary care, led by General Practitioners, is central to increasing the impact of ill health prevention covering physical, mental and emotional health2. This is through their roles as both commissioners through Clinical Commissioning Groups and as the coordinators and providers of primary care. Ill health prevention can be seen as primary, secondary and tertiary prevention. Primary prevention is helping people stay healthy and preventing ill health. Secondary prevention is the early identification of people who are developing ill health and supporting them to manage and maintain their health. Tertiary prevention is helping people with a long-term health condition to manage their condition and maintain their independence50. Key to secondary and tertiary prevention is ensuring that people are receiving the best, evidence based, clinical care to manage their condition and minimise its impact on their lives. The impact of this approach is shown by the recent improvement in male life expectancy in Sandwell. A significant part of this increase has come from focused work in primary care to identify people at risk of cardiovascular disease and ensure they are receiving the appropriate treatment1. There are significant inequalities between ethnic groups that need to be considered in commissioning of services. For example, diabetes and cardiovascular disease are significantly higher amongst Asian populations and African Caribbean people experience higher rates of high blood pressure and strokes than the white population. There are also variations by gender with men having, on average, higher rates of cardiovascular disease. It is important to continue to work with people to help them choose and maintain healthier lifestyles and through this prevent ill health. The focus on this to date has been on health services providing health promotion and lifestyle services. However, for this to have the largest possible impact it needs to ensure that every front line contact with the public is seen as an opportunity for ill-health prevention and health promotion. The largest number of such contacts is within local authority services. The movement of public health into the local authority therefore provides excellent opportunities to develop ill-health prevention across all services. The role of the public sector as a major employer must be recognised. All public sector organisations must commit to introducing policies and initiatives to improve the health of their workforce. This can include initiatives to encourage staff to increase physical activity, to stop smoking and to eat a healthy diet. Examples include programmes to support staff in adopting cycling and walking and to use the stairs instead of lifts. Existing programmes working with other employers from the private and voluntary sectors need to be developed. These programmes need to help these employers to ensure they have a healthy workforce.

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Health protection is the protection of the population against infectious and non-infectious environmental hazards and risks. This includes emergency planning for public health incidents and outbreaks and the surveillance and management of infectious disease. In the future, the responsibility for protecting the population of Sandwell will be shared between Sandwell Council and Public Health England. All partners must be involved in developing shared health protection and emergency plans for Sandwell. This includes tackling healthcare acquired infections and ensuring comprehensive vaccination and immunisation programmes for all people in Sandwell. All partners also need to be involved in the planning for comprehensive, open access and confidential sexual health services. Sandwell Position Figure 12: Male and female life expectancy at birth, Sandwell and England

Achievements - Life expectancy in Sandwell is increasing faster than the national rate, narrowing the gap between Sandwell and the rest of England - Teenage pregnancy rates are decreasing faster than they are nationally - Healthcare acquired infections are significantly reduced o MRSA close to zero o Clostridium difficile down by over 30% - All childhood immunisations are now over 90% - Tuberculosis infections have reduced by 20% since 2005 - Brief intervention treatments for alcohol have doubled - Deaths from fractured hips are down by 20% in 5 years - Through screening â&#x20AC;&#x201C; 2000 people have received treatment to reduce their risk from cardiovascular disease, 1000 from diabetes, 500 from heart failure and 1000 from chronic respiratory disease - Smoking cessations services have helped 5741 people to quit over the last 3 years

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F. Strengthen the role and impact of ill health prevention F1

Priority Strengthen the role and impact of ill-health prevention

Interventions Overarching outcome measures

Prioritise joint investment across all partners on those conditions most closely related to health inequalities

Provide high quality, evidence based, primary care services that deliver primary, secondary and tertiary prevention

Reduce the harms associated with alcohol misuse in Sandwell

Sandwell JHWS 2013-15

Joint working to tackle lifestyle related illhealth o Cardiovascular disease o Obesity o Smoking o Alcohol misuse o Mental health and wellbeing Partner commissioning of comprehensive lifestyle services Implement Make Every Contact Count with all partners and as part of all commissioning Build the NEF / Foresight Report “5 Ways to Wellbeing” into health promotion and lifestyle services Enforcement of smoke free legislation Early identification of people at risk of ill health and referral to relevant lifestyle programmes Focused risk stratification programmes to identify people at risk of developing illhealth and ensure they receive appropriate care Ensure people with long term health conditions receive the best, evidence based, primary medical care Align licensing and regulatory services with health promotion e.g. for alcohol and tobacco control Work with NTA/Public Health England to ensure all opportunities for service 05/07/2013

Outcome indicators - All age, all cause mortality – males and females - Life expectancy - Disability free life expectancy - Mortality from preventable causes o Cardiovascular disease o Respiratory diseases o Liver disease o Cancer - Excess under 75 mortality in adults with serious mental illness - Lifestyle measures o Excess weight in adults o Smoking prevalence in adults o Physically active adults - Hospital admissions due to alcohol - Recorded diabetes - Take up of NHS Health Check programme

Delivery partners All

All

Quality Outcome Framework measures

SWBCCG

Numbers of test purchases and training carried out Young people’s survey results -numbers of young people drinking in Sandwell Number of front line staff trained

All

provision are provided

Reduce the mortality and morbidity associated with substance misuse Improve the health of the working population

Protect the health of the population from infectious and non-infectious environmental hazards and risks

Sandwell JHWS 2013-15

Increasing and improving the scale and treatment of substance misuse programmes Introduce healthy workforce initiatives to improve the health of the public sector workforce Work with private sector and voluntary sector employers to help them improve the health of their workforce. Effective surveillance and management of infectious diseases including healthcare acquired infections Commissioning of comprehensive, openaccess, accessible and confidential sexual health services Assurance of effective levels of vaccination and immunisation programmes Comprehensive health protection planning across all partners Integrated working between infection prevention and environmental health services Characterisation of the relationship between environmental contamination and health risk and development of appropriate and effective interventions Environmental public health tracking of infectious and non-infectious environmental hazards and risks

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Tier 3 work undertaken as identified by NATMS Rate of alcohol related hospital admissions/ alcohol specific admissions Numbers of people screened and referred to services from A&E Substance misuse prevalence figures Effectiveness of substance misuse treatment services Sickness absence rates Numbers of people or businesses supported with healthy workforce programmes

Agreed partnership health protection plans in place Progress towards immunization targets Compliance with healthcare acquired infection targets Effective management of all disease outbreaks Effective management of all chemical and radiological incidents Proportion of young people accepting Chlamydia screening Infection rates across all sexually transmitted diseases, terminations of pregnancy and under 18 year old conceptions

All

SMBC PHE Public Health SWBCCG

G. Ensure people receive the care and support they need across the whole life course Marmot Review Priority Objectives • Provide comprehensive prevention services to enable people to remain healthy and independent • Provide services that are based on a self care approach and which give the care and support required while maintaining independence • Enable people at the end of their lives to retain control and have choice over where they die This priority is central to the delivery of three of the health and wellbeing board key priorities; • Long term conditions and integrated care • Frail elderly and dementia • Early years and adolescent health The first priority within this objective must be to promote wellbeing and resilience. This will help people to maintain their independence and prevent ill health. The aim of prevention is to help people stay healthy for longer and prevent avoidable ill health and disability. This includes providing appropriate lifestyle services for people of all ages and for people who have a long-term health problem or disability. It also needs health education and support for health literacy to enable people to access and make best use of services. When people do start to need more support it is essential that they are identified as early as possible so that help is available to prevent or delay the time when they need more intensive support and services. This includes early identification and provision of appropriate support for frail older people and the growing number of people with dementia. Older people are at a higher risk of isolation and loneliness and this is associated with deterioration in health and wellbeing and a loss of independence51. A self-care and asset based approach must be central to all services. This means recognising the assets people already have and enabling them to maintain and manage their own health and wellbeing. Where people do experience ill health or a disability then need to be provided with the support they need to manage their health conditions themselves and therefore maintain their independence for as long as possible. This includes building on the considerable successes to date in helping people with learning disabilities to remain independent and gain paid employment. An important part of this approach is providing individuals and carers with easily accessible and understandable information. . Another key priority is embedding self-care and empowerment principles in care pathways and professional practice, and supporting a culture change within staff groups and organisations. When people do need support or care, services need to be comprehensive and integrated across all partners to ensure seamless care and prevent duplication of services. It is essential that these services give people the help and care that they need while encouraging self-care and enabling people to recover their independence following an episode of care. This includes investment in reablement and rehabilitation. It must also recognise the central role of housing in maintaining independence, people need appropriate high quality housing and support with adaptations that may be required for them to stay in their own homes. Primary care has a central role in providing care and support. This comes from the clinical and wider support provided by primary care and also from the role of the Clinical Commissioning Group as a commissioner of services.

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All partners must recognise the important contribution of carers in providing support and enabling people to maintain their health and independence. This includes providing comprehensive information, advice and support for carers. Being a carer brings with it a high risk of ill health and increasing care needs. Carers must therefore be a priority group for health promotion and support52. For people at the end of their life it is important that there are comprehensive and integrated services across all partners that enable people to remain as independent as possible for as long as possible. These services must address the needs of the individual and those of their families and carers. The key aim is to help people have a good death in the place of their own choosing. Sandwell Position Figure 14. Support for older people: Proportion of older people that receive the support they need to live independently at home by age of respondent 2008/0934

Figure 15. Carers receiving assessment or review and a specific carerâ&#x20AC;&#x2122;s service or advice and information: West Midlands34

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G. Ensure people receive the care and support they need across the whole life course

Priority

Interventions

Comprehensive and clear care pathways operating across community based, council, primary care, and hospital services

Comprehensive prevention services for all residents of Sandwell

Support people to manage their own health and wellbeing

Sandwell JHWS 2013-15

Series of facilitated workshops with all relevant stakeholders to understand and design combined care pathways and implementation plan Aligning of partner commissioning intentions for 2014-15 based on implementation plan Evaluation of pathways and further development for 2015-16 Lifestyle services appropriate for all age groups and levels of need Early identification and intervention with people at risk of needing increased support Identification of key life course ‘touch points’ where early intervention can reduce or delay adverse outcomes Falls prevention services Services to support frail older people and their carers and to reduce isolation and loneliness Early identification and support for people with dementia and their carers Services for people with mental illness or learning disability to help them maintain independence Comprehensive information and advice services Support people to understand and manage their own health and long term health conditions High quality primary care medical services to ensure appropriate clinical treatment Include planning for an ageing population in new spatial plans and developments 05/07/2013

Outcome indicators -

Delivery partners Partnership implementation plan in place and All agreed by all stakeholders Implementation plan incorporated into partner commissioning plans

Effectiveness of early diagnosis, intervention and re-ablement avoiding hospital admissions Falls in over 65s Hip fractures in over 65s Permanent admissions to residential and nursing care homes

All

People with mental illness or disability in settled accommodation People with mental illness or disability in paid employment Proportion of service users and carers who find it easy to get information Proportion of adults in contact with social services in paid employment Reduction in emergency hospital admissions for ‘ambulatory care sensitive conditions’

SMBC SWBCCG Public Health

High quality, safe services where people have control over the services they receive

Recognise and support the contribution of carers

Enable people to retain and regain independence

Ensure people at the end of their life and their carers receive the care and support they need

Sandwell JHWS 2013-15

Implementation of personal budgets Commissioning of services to meet the needs of people needing support Ensuring safe and secure services

Supporting carers by improving access to information, advice and support Enabling young and adult carers to fulfill their education and employment potential Personalised support for carers and those they support, enabling family and community life Supporting carers to stay mentally and physically well Commissioning of comprehensive intermediate care services Commissioning of comprehensive re-ablement / rehabilitation programmes Integrated care and rehabilitation pathways across all partners Provision of Healthy Homes Advocates service Ensure people with support needs have a suitable home environment to enable them to stay at home Provision of a handy person service to support people to remain in their own homes Improve the experience of care of people at the end of their lives Commissioning of comprehensive support services for people at the end of their life and their carers Ensure that people are supported to die in their place of choice.

05/07/2013

Proportion of people eligible for services receiving a personal budget Proportion of people who say that services made them feel safe and secure

SMBC SWBCCG

Proportion of carers receiving needs assessment, review and service or advice & information Proportion of carers who report being included or consulted Carer reported quality of life

SMBC SWBCCG Public Health

Percentage of vulnerable people achieving independent living Number of people accessing intermediate care and re-ablement services Proportion of older people still at home 91 days after discharge into rehabilitation Proportion of people recovering previous mobility following a hip fracture Delayed transfers of care from hospital and those attributable to adult social care

SMBC SWBCCG NHSE Public Health

Survey of bereaved carers

All

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