Renfrewshire CHP Development Plan Update (Summary) 2011/12 Renfrewshire Community Health Partnership (CHP) Development Plan 2010/13 is the key directional plan for the CHP. This plan update has been produced to report on progress and impact against the previously identified actions. It then attempts to use this progress as the new baseline to identify changes required in the coming year. This summary has been produced with our Public Partnership Forum (PPF). The full plan is available at http://www.chps.org.uk/content/default.asp?page=s478 The plan covers the following areas: A. Adult Mental Health B. Alcohol and Drugs C. Sexual Health D. Child and Maternal Health E. Long Term Conditions, Older People and Disability F. Primary Care G. Cancer H. Acute Planning I. Unplanned Care J. Unpaid Care K. Health Improvement Framework L. Tackling Inequality M. Quality Policy Framework N. Sustainability O. Employability, Financial Inclusion and Responding to the Recession 1
A. Adult Mental Health No Health without mental health and mental wellbeing Psychological therapies 2010/11 Progress In the last year, we have focused our efforts on consolidating the changes associated with the Modernising Mental Health Services Strategy and delivering on identified Health Improvement, Efficiency, Access and Treatment (HEAT) targets. Continued progress has been made in shifting the balance of care and on the ongoing redesign of our community based mental health services. We have secured capital funding and approval to modernise our in patient areas to ensure high quality accommodation for all clients when the capital project is completed. Significant progress was made in rolling out the Doing Well service, which is now available in all GP practices across Renfrewshire and will assist the further work around anti-depressant prescribing. Excellent progress has been made also in relation to the training of Mental Health staff in both suicide prevention training and in alcohol screening and brief interventions. All areas have now completed an Equality Impact Assessment (EQIA) and have agreed or are in the process of agreeing action plans based on the outcome of this process. 2011/12 Challenges and Priorities During the course of 2011/12, we will work with a range of partners to develop Renfrewshire s response to No Health without Mental Health, working together to promote better mental health and to respond to the challenge of high levels of mental distress and mental ill-health in our communities. We will progress the work to ensure effective and efficient delivery of services in order to best prepare for the introduction of new HEAT targets designed to improve access to psychological therapies. We will do this by using a range of service improvement methodologies, supported by the Mental Health Collaborative. The year ahead will present significant financial challenges that will require review of all services including mental health. We will contribute to the ongoing review of activity, staffing establishments and skill mix in both community and in-patient areas across the mental health partnerships. 2
B. Alcohol and Drugs Reduced waiting times and increased number of Alcohol Brief Interventions Review of strategy Recovery approach 2010/11 Progress The implementation of the Integrated alcohol team has ensured greater flexibility in accessing services with greater opportunity to work with individuals to reduce harm as well as achieve abstinence. The Integrated alcohol team has also had a significant impact on waiting times from referral to assessment with a reduction from 5-8 weeks to 8 days. The drug services have consistently managed to provide assessment to individuals within 14 days of referral and achieve local target of 80% from assessment to treatment within 14 days. Implementation of the Low threshold clinic has provided rapid access to high risk injecting drug users and provides a range of health related interventions. 2011/12 Challenges and Priorities Renfrewshire CHP will ensure services deliver a whole population approach to alcohol and a recovery approach to drugs as set out in the Scottish Governments drug strategy The Road to Recovery and the alcohol policy discussion paper Changing Scotland s relationship with alcohol. There is representation from CHP at the Alcohol and Drug Partnership (ADP) and sub groups with the CHP Director co-chairing the ADP and regular representation from Planning/Health improvement, addictions and mental health. The ADP will develop a new Alcohol and Drugs Strategy and Delivery Plan for 2011-2014. Addiction services in Renfrewshire will also be responding to key elements of the quality framework through robust Equality Impact Assessment (EQIA) processes, developing and reporting on outcome measures and ensuring meaningful service user involvement in planning and evaluating services. Three EQIAs are planned for 2011/12 in areas of service specification and operational policy. We will continue to explore further integration of addiction services to achieve a clear and agreed model for addiction services in Renfrewshire. In the next year Addiction services will work in partnership with mental health services to implement clear care pathways for individuals with a diagnosis of co-morbid mental health issue and individuals with a diagnosis of Alcohol Related Brain Disorder (ARBD). A key challenge in 2011/12 for addiction services will be to achieve HEAT target for waiting times. 3
C. Sexual Health A new location for the Sandyford services Focus on looked after and accommodated young people Early work with homeless population, students and those with learning disabilities 2010/11 Progress Sexual health services are delivered in partnership with Sandyford. Renfrewshire CHP is responsible for linking sexual health services with other local services, focussing on vulnerable groups of people and those at high risk of sexual ill health. The CHP leads on sexual health improvement locally and has embedded sexual health in Community Planning. Renfrewshire Council has identified the Director of Education, as the lead for sexual health and we will work with him in the coming months, particularly to drive forward some of the work in schools e.g. continuing professional development for teachers, protocol for sexually active young people under 16 and a focus on looked after and accommodated young people. 2011/12 Challenges and Priorities The Sandyford hub in Renfrewshire will be moving from the Russell Institute to New Sneddon Street during 2011. A smooth transition, maintaining the current high attendance rates (particularly in target groups) will be a priority for us. The other major service change/redesign in this area is the transfer of general sexual health services from Sandyford to primary care. We will support this by using the GP Forum and the emerging locality groups. Our local work will focus on vulnerable groups in 2011/12. We will continue our progress in supporting staff working with looked after and accommodated young people and will begin some targeted work with homeless people, the student population and those with learning disabilities. 4
D. Child and Maternal Health A focus on improved outcomes for children Parenting support Child protection 2010/11 Progress The Renfrewshire Children s Services Partnership (RCSP) is part of Community Planning arrangements and provides the strategic leadership for planning for children s services. Health visiting and school nursing have taken a key role in the Integrated Assessment Framework (IAF) process. Getting It Right For Every Child (GIRFEC) provides a clear framework to ensure that children s needs are identified early and met appropriately. Next year our Children and Family teams will maximise the links with Speech and Language Therapy (SLT) and embed the role of Primary Mental Health workers. Last year saw the follow-up HMIe Interagency Child Protection Inspection. The report is very favourable and positive progress evidenced in relation to the areas for development identified at the initial inspection in 2008. The Child and Adolescent Mental Health Services (CAMHS) service has received additional resources enabling the service to be enhanced. This has allowed us to begin to address the provision of out of hours service, increasing the age range up to 18 and investment in the nursing resource to assist in meeting the HEAT target for referral to treatment target. 2011/12 Challenges and Priorities Strategy days involving key lead officers from across children s services in Renfrewshire will be held in March 2011 as part of the Achieving Step Change in Children s Outcomes project to agree the vision and priorities for children s services in Renfrewshire. The aim is to identify innovative ways to develop outcome focused children services, using efficient and effective interventions. Consultation with children and families is critical to the approach. Implementing a parenting and family support strategy is a key aim. To support the strategy we are implementing Triple P on a whole population approach. Staff training will commence in February 2011 with a seminar programme, initially targeting parents of Primary 1 children in May 2011. Releasing staff for training, embedding the training in practice and delivering the seminar programme will be a challenge in 2011/12. There will be resource implications in terms of the time of both professional and administrative staff to support the GIRFEC process, which will be a challenge. We are currently piloting the electronic information portal to improve information sharing within health and with key agencies. We recognise that substance misuse and neglect impact on children in Renfrewshire. We will be building on the findings of the Getting Our Priorities Right Impact Analysis and work closely with the Alcohol and Drug Partnership (ADP) and adult services to protect children. 5
E. Long Term Conditions Older People and Disability Supporting people to stay in their own community Implementation of Community Rehabilitation and Enablement Service Implementation of Physical Disability Strategy It is expected that between 2002 and 2013 the number of people aged over 65 years in Renfrewshire will increase by 15% and those over 75 years by 23%. Over 27,000 older adults in Renfrewshire are living in circumstances of relative multiple deprivation, with 36,300 people reporting that they have a long term limiting illness which is 3% above the Scottish average. We know that people experiencing deprivation are at higher risk of avoidable hospital emergency admissions. These demographic changes will lead to an increase in the number of adults with disability and the number of older adults with long term conditions and dementia. At the same time there will be a decrease in the number of unpaid carers and a reduction in the workforce that provides paid care. In Renfrewshire there are almost 1300 people with learning disabilities known to the Renfrewshire Learning Disabilities Service (RLDS) many of who are dependent on carers who themselves are older adults. The challenges are magnified by the current economic recession. In addition, there is a need to maximise and accelerate our work on prevention and self care as well as manage current demand and shift the balance of care from hospital to community settings where possible. Key challenges in the year ahead are: Development and implementation of local partnership plans for use of the Change Fund Improving and maintaining our performance re bed days lost to delayed discharges Increased prevention of avoidable hospital admissions Reduction in length of stay and improved supported discharge Reduction in use of care home places Full implementation of the Community Rehabilitation & Enablement Service Implementation of year 2 of Long Term Conditions Framework Implementation of the Dementia Strategy Agreeing service model and staffing levels for Elderly Mentally Ill (EMI) wards with the aim of achieving financial balance as part of NHSGGC Review of in patient beds Implementation of the Renfrewshire Physical Disability Strategy Implementation of the RLDS Day Service Review Undertake EQIAs in EMI wards and aspects of the Rehabilitation and Enablement Service. The attached template outlines these priorities in some more detail along with the planned outcomes and performance measures. Individual templates for each of the areas (long term conditions, older people and disability) are also available. 6
F. Primary Care Establish locality groups Develop interface and relationship with acute services Prescribing improvements 2010/11 Progress In 2010/11 our main focus has been developing and improving relationships with contractors, particularly GPs and frontline staff working in Primary Care settings. This has mainly progressed through engagement of GPs on our CHP Committee, Professional Executive Group, GP Forum and through individual practice visits, notably QI and prescribing visits with our staff and have continued to build engagement with District Nurses, Heath Visitors and Speech and Language Therapists as we implement service change. 2011/12 Challenges and Priorities In 2011/12 our main focus will be to sustain these key working relationships. One of our key objectives is to move to establish our Locality Groups an agreed action from the Primary Care and Strategic Framework. Our plan is to form two groups and to ensure these groups are effectively supported from the outset to develop ways of working and a work programme that delivers against agreed measures of success. In short, we see these Groups as critical to reinvigorating our interface with Contractors and frontline staff and in doing so contribute to our on-going cultural shift programme. The challenge for us in this will be to establish Groups that work well, are credible and deliver sustained and meaningful input and influence over day to day operational management and decision making. Other goals for the year will be to: Promote high uptake on the 2011/12 GG&C Enhanced Services Programme and to ensure we monitor the patient benefit from these; Support Renfrewshire GP Practices where required in the migration to the new General Medical Service (GMS) practice IM&T system; Ensure procedures are supported to deliver on agreed programme of prescribing improvements; Support practices where we can to maintain high levels of performance regarding access to general medical services, and to encourage and enable improvement where required; Establish clear work programmes to deliver the primary care element of Long Term Conditions (LTCs) pathways e.g. diabetes, Chronic Obstructive Pulmonary Disease (COPD); Continuing to develop interface and relationships with Acute Services. We see our main challenges in delivering these actions being: operating with effective engagement and network, maintaining constructive working relationships, and ensuring that the criticality of Primary Care services remains a visible and real priority for the CHP. 7
G. Cancer Improving screening rates Improving palliative care 2010/11 Progress Renfrewshire has very much benefited in 2010/11 from the appointment of a McMillan Cancer GP Facilitator. The facilitator works with GP practices in promoting the use and audit of the Liverpool Care Pathway and has also started work within the local authority care homes to consider how staff and residents there might best be supported in palliative and end-of-life care. Additionally the facilitator has also been active in promoting Scottish Government s recently introduced Do Not Attempt Cardio-Pulmonary Resuscitation policy among health and social care staff. In terms of prevention of and screening for cancer Renfrewshire enjoyed a high take-up rate of the Human Papillomavirus (HPV) vaccine to prevent cervical cancer and through the work of the clinical governance forum GP practices are being encouraged to optimise cervical screening opportunities for women and audit their unsatisfactory smear rates. 2011/12 Challenges and Priorities Renfrewshire CHP s role in delivering the outcomes in the Cancer Planning Framework is in main areas: - Reducing risk by awareness raising and improving lifestyles. - Promote and increase screening rates. - Deliver palliative care in partnership with acute and voluntary sector colleagues. For the purposes of this update plan, all palliative care (including our response to the palliative and end of life care direction statement) actions are covered in this section. We do, however, recognise the need to consider the palliative care needs of all people with life limiting progressive diseases, including cancer. We will continue the work started in the (Supportive and Palliative Action Register (SPAR) project in the care home sector and develop a palliative care approach in EMI units, nursing homes, extra care housing and those living in the community with a non-malignant disease e.g. organ failure, general frailty, dementia. This work is being led by the Palliative Care Joint Planning, Performance and Implementation Group (JPPIG) which has representation from primary care, acute services, social work, pharmacy nursing homes and patients. 8
H. Acute Planning Interface issues with primary care New discharge letter 2010/11 Progress and 2011/12 Challenges and Priorities Within Renfrewshire the main interface between clinicians in primary care and those in secondary care continues to be the quarterly meetings of the GP Forum where each meeting has a focus on a particular clinical area. Discussions in 2010/11 included cancer referrals, DEXA scanning and breast clinic services while in 2011/12 we will progress discussions around the treatment of hepatitis c, the development of rheumatology services at the Royal Alexandra Hospital (RAH) and specialist dental services in Renfrewshire. Discussions have taken place to agree a new discharge letter template which will be piloted within the acute medical assessment unit at the RAH. The Extended Professional Executive Group (epeg) which includes membership from across acute, primary care and social work steers the CHP s work on the Board s Long Term Conditions strategy and oversees that of the Primary Care strategy locally. Good progress has been made already in respect of the management of diabetes and the development of a Single Point of Access (SPOA) for all diabetes related referrals whether the services are acute or community based. 9
I. Unplanned Care Development of Single Point of Access Establishment of community rehabilitation and enablement service Unplanned Care is the range of health and social care service responses to people who require or perceive the need for emergency and urgent care advice, care, support, treatment or diagnosis. Within the RAH a persistent, unsustainable demand placed on Accident and Emergency Services (A&E). A high proportion of these attendances are inappropriate and it is clear that alternative action and intervention by other services could address these needs in more appropriate cost effective ways. The Renfrewshire Older People s Joint, Planning and Performance Group (OPJPPIG) leads a programme of work to re-design services to improve care pathways with the aim of reducing demand on acute services. This is set in the context of a local health system which is experiencing unprecedented and unsustainable levels of demand for emergency services. The full implementation of the community rehabilitation and enablement service in April 2011 will provide accessible and integrated services for older people, older people with mental illness and people with a physical disability. This service will offer choice, address local need and provide value for money. The service is supported by a Single Point of Access (SPOA) which will improve the pathways in and out of services to provide a co-ordinated approach to supported discharge, preventing avoidable hospital admission or attendance at Accident and Emergency. We plan to integrate the CHP and Social Work SPOA as of April 2011. We plan to use the SPARRA data within the rehabilitation service to target and support these people with the aim of prevention of avoidable hospital admission. Key Challenges in 2011/12 include; Further development of our joint work with Scottish Ambulance Service with a focus on the Out of Hours (OOH) period to where possible reduce or prevent attendance at hospital Integration of NHS and SW SPOA Introduction of self referral to SPOA Increasing referrals to SPOA from A&E in particular during the OOH period Optimising the use of SPARRA data in wider community teams including all ages SPARRA and data for people with mental ill health Establishing the community rehabilitation and enablement service and measuring high impact changes and key performance indicators Establishing effective focus groups and subsequent action plans Undertaking a comprehensive approach to Inequalities Sensitive Practice within community rehabilitation and enablement service Improving our responses to unplanned care as part of our local Change Fund Plan 10
J. Unpaid Care Increase carers assessments Increase carers training 2010/11 Progress In Renfrewshire, the Carers Joint Planning, Performance and Implementation Group (Carers JPPIG) is the key strategic vehicle for planning service improvements for unpaid carers. Membership is drawn from the voluntary sector, CHP, Council and university, and includes four carers. The Carers JPPIG has well established links with the other joint planning groups for older people: mental health; learning disability; physical disability and palliative care. Caring Together: The Carers Strategy for Scotland (July 2010) aims to ensure that carers are supported to manage their caring responsibilities with confidence and in good health, and to have a life of their own outside of caring. The strategy sets out expectations which require RCHP to ensure that carers are identified and appropriate services are provided to meet their health needs, particularly in relation to mental health. There are significant financial challenges for services for carers as we are heavily reliant on fixed term funding. A further significant challenge for the Renfrewshire Partnership is that the demand for respite outweighs capacity. This has been compounded by financial and resource constraints in 2010/11 resulting in a reduction in respite capacity below the concordat target. 2011/12 Challenges and Priorities During 2011/12 we aim to; Increase the numbers of carers self and full assessments completed so that support can be provided to enable the carer to maintain their role effectively whilst also maintaining their own health. Increase the number and range of carers training and support sessions to provide carers with the information and skills to execute their role and to minimise the stress often associated with the caring role. Seek to utilise the opportunity presented by the Change Fund to develop new and more innovative respite models in 2011/2012 which will increase the respite provision for both the cared for and the carer. Further develop our work with the Patient Experience Group to include carers experiences so that these can be used to improve the quality of the service provision to more effectively meet carers needs. 11
K. Health Improvement Framework Targets for smoking cessation, child healthy weight, breastfeeding and alcohol brief interventions Healthier, Wealthier Children to provide financial advice to families 2010/11 Progress In the last year we have focused our health improvement efforts on delivering the HEAT targets, and the explicit health priorities within the Renfrewshire Single Outcome Agreement using inequality sensitive approaches. Excellent progress has been made in smoking cessation, in the nursery tooth brushing programme and in delivering the child healthy weight intervention, Active Children Eating Smart (ACES). Challenges in the year ahead include our ability to continue to support more vulnerable smokers to stop on an individual basis as Fairer Scotland Funding ceases, delivering the tooth brushing programme comprehensively in primary schools and implementing the school based ACES programme in Renfrewshire. 2011/12 Challenges and Priorities There have been some promising results with recent breast feeding rates, largely due to better liaison with maternity services and the introduction of support workers funded by short term funding. However, we are still some way from out target and will continue to prioritise exclusive breastfeeding at 6 weeks during 2011/12. The Healthier Wealthier Children initiative to impact on child poverty started in Renfrewshire in December 2010 and will run until March 2012. During that time, an income maximiser will support parents and carers of children under five to access their benefit entitlement. A key challenge will be to create a legacy from this initiative which makes our mainstream services and those of our partners more able to prioritise and respond quickly to new parents. An EQIA will be undertaken of the local Healthier Wealthier Children Initiative. The challenges we face in the next year, for many of our health improvement programmes, is the reduction in core and additional funding and the uncertainty around the level of funding available in other areas. To date the additional funds have afforded the CHP the opportunity to take new approaches to improve results. The following template describes our planned actions for 2011/12 in more detail. Many health improvement actions can be found in other frameworks: Child and Maternal Health Adult Mental Health Alcohol and Drugs Sexual Health Cancer Long Term Conditions of Older People 12
L. Tackling Inequality Gender based violence awareness Employability and financial advice Equalities sensitive practice The CHP has used inequality sensitive approaches to meet the challenge of addressing inequalities in health. We have begun to adapt service models to suit the needs of equality groups mainly as a result of the Equality Impact Assessments (EQIAs) undertaken. Positive progress has been made with the introduction of sensitive enquiry in the community nursing setting, particularly in the children and families service area. Plans are also well advanced to deliver Gender Based Violence (GBV) training for health and community care staff. There is a strong partnership to support GBV in Renfrewshire through the Community Planning structures. An increased number of services have undertaken EQIAs in the last year. A number of EQIAs have been completed, particularly in areas of service redesign; PPF, Rehabilitation and Enablement and Renfrew Health & Social Work Centre. EQIAs will continue to be programmed into work areas, in particular in specialist children s services. The challenge is to maintain the momentum to undertake EQIAs and staff have an awareness of the recent changes in the legislation. In 2011/12 eight EQIAs are planned: EMI wards Alcohol Problems Clinic Healthier Wealthier Children Initiative Renfrewshire Drug Services Speech and Language Therapy access Integrated Alcohol Team Specification Health and Employability Exit from Rehabilitation and Enablement Service Health improvement activity has been targeted at the areas with lowest breast feeding rates, highest smoking levels, and mental health issues. Community profiles and action plans have been developed to support Local Areas Committees utilise funding on the basis of greatest need. Challenges in the year ahead will be to continue to ensure inequality sensitive approaches are embedded in the way we do business. Renfrewshire CHP s Health and Homelessness Action Plan 2010-13 is contained within the full plan. This describes our planned actions for the next three years against the Health and Homelessness standards, and is monitored through a multi-agency planning group. There have been increased referrals to employability and financial advice services from frontline health staff, as a result of the investment in staff training. A pilot was carried out involving part time work experience placements, of six month duration, for two people with health barriers to employment. A key challenge will be to sustain future contribution to this programme. The challenges we face in the next year will be to ensure that cost savings have been subject to an equality impact assessment and we do not adversely affect vulnerable people and those in equality groups with the financial challenges ahead.. 13
M. Quality Policy Framework Public Involvement and Patient Experience Person Centred Care Safe and effective care The NHS Scotland Healthcare Quality Strategy which was published in May 2010 has been profiled across the CHP, including discussion with the Senior Management Team (SMT), extended SMT and Staff Partnership Forum meetings. The CHP s Development Group has also discussed its role in supporting the development of a person centred and mutual NHS and ways in which quality can be effectively embedded in all our healthcare and other activity and has encouraged discussion at team meetings. Quality is one of the core Knowledge and Skills Framework (KSF) dimensions. Each member of staff has a discussion with their manager at their annual review about the ways in which improving quality has impacted on their work and/or service delivered with the opportunity to agree development activity in this area and/or specific objectives. It will be evident elsewhere in this Development Plan Update that public involvement is the norm within the CHP in terms of planning and redesigning services and this input is expected to increase as we introduce Locality Groups as part of the Primary Care Strategy. There are also good examples of involving patients both directly and through a range of local groups to influence service delivery and ensure healthcare needs are met in a way which assures quality delivery. Our EQIA programme is also strongly evidenced, supported by Health Improvement colleagues, and the work we have taken forward on culture change will be reviewed to effectively meet the ambitions set out in the Quality Strategy. At present our culture web paradigm includes: Providing excellent care to improve the health of our community and address health inequalities Putting patients and people of Renfrewshire at the heart of what we do Working together to identify opportunities for improvements Working with others to deliver what is best for Renfrewshire. 14
N. Sustainability Achievement of Healthy Working Lives Increasing recycling opportunities As recognised in the sustainability policy framework, the CHP does not have the lead role. However, during 2011/12, the CHP will continue to develop ways in which we can ensure our activities contribute to achieving sustainable development. In terms of addressing our responsibilities, the CHP will: - work with and support the Local Authority to achieve its target to reduce waste by extending recycling facilities in our premises; - in it work towards achieving the Healthy Working Lives Gold Award, will involve staff in initiatives which impact on the environment such as reducing energy use, recycling initiatives and the reduction in the CHP s carbon footprint. These actions, together with others contained in the attached framework will be monitored against agreed performance measures. 15
O. Employability, Financial Inclusion and Responding to the Recession Financial advice in primary care REALise initiative to support people in work to stay in work Employability work with Renfrewshire Workforce+ The Community Planning partners in Renfrewshire have established an Anti-Poverty Strategy with three key work streams: - an ongoing commitment to practical advice programmes; - a strategic approach to advice service provision and policy planning; - development of early intervention initiatives and practice. 2009 Scottish Index of Multiple Deprivation (SIMD) data shows that Renfrewshire s income deprivation has worsened since 2004 and 2006, and that our comparative position in Scotland is poor. Renfrewshire s share of 15% datazones has increased and there has been an increase in the absolute number of income deprived individuals. The income deprivation figures are echoed by employment deprivation, where there has been a 2.1% increase. Early work by the Anti-Poverty Group indicates that the workforce reforms will directly affect Renfrewshire residents by 19m to 22m per year. Renfrewshire CHP s contribution as a partner in this work has been recognised. CHP will focus on four main areas to contribute to the anti-poverty agenda. In 2011/12 the i) A small health team works within Renfrewshire Workforce Plus to raise awareness among health staff about employability issues and to assist those people whose health is a barrier to work. An EQIA on the service will be completed in 2011/12. A baseline survey on NHS attitudes to and awareness of employability will be repeated following training sessions. ii) We have developed a small service with Citizen s Advice Bureau and the Council to provide advice in healthcare settings (GP surgeries, clinics and a pharmacy). Early indications are that this is targeting people who would not access mainstream advice services. Further evaluation will be carried out during 2011/12. iii) A third area of work led by the CHP is the Realise initiative which aims to support people in work who are at risk of losing their job due to health reasons. Again, 2011/12 is a year where we will begin to get results from this service to test its effectiveness. iv) The Healthier Wealthier Children posts in Renfrewshire were appointed in November 2010 and the initiative is commencing in Linwood. This year we will progress the two strands of this work (income maximisation for families and creating sustainable pathways) with other CHPs. Importantly, we will continue to work with Community Planning partners to ensure that we contribute to the comprehensive range of anti-poverty actions in Renfrewshire. 16