Workshop 1 Report Current Strategic Priority Needs Health and Wellbeing Thematic Group June 2015
1.0 Introduction 1.1 The purpose of this report is to help facilitate discussion at the first workshop of the Health and Wellbeing Thematic Working Group. It sets out a strategic overview of existing strategies and plans under health and wellbeing highlighting strategic priority needs and outcomes. 1.2 At the preliminary meeting of the Health and Wellbeing Thematic Group there was discussion on the strategic issues which had been previously identified through the codesigned process and the Task and Finishing Group for the Community Plan. During feedback from our discussion session there was strong endorsement for the inclusion of Mental Health and Emotional Wellbeing as a separate strategic issue as well as the convergence of sports and leisure into Physical Activity. Following this meeting, the notes were collated and reviewed. A consistent idea emerged throughout these notes in that the strategic issues of the Community Plan for Health and Wellbeing should be reflective of the themes of the Making Life Better 2013-2020 (Strategic Framework for Public Health). 1.3 It was further suggested that the strategic issues should not be viewed narrowly but should be inclusive of key local health challenges. For example Community Safety is more than the physical safety in communities but also includes issues such as domestic violence, road safety, internet safety and so forth. 2.0 Existing Strategies and Plans 2.1 A draft list of strategies and policies was circulated at the preliminary meeting of the Health and Wellbeing Thematic Working Group and participants were requested to review the list and to forward any additional strategies for inclusion on the list. The purpose of compiling the list is to provide a broad overview of the current strategic priority needs and outcomes. 2.2 Attached in Appendix 1 is the most up to date version of the full list of strategies and policies relating to Health and Wellbeing and attached in Appendix 2 is a high level synopsis of key regional and local strategies. 3.0 Current Strategic Priority Needs and Outcomes 3.1 The primary regional strategy for health and wellbeing is Making Life Better A whole strategic framework for public health 2013-2023. This is a ten year public health strategy and builds on the work of the Investing for Health Strategy (2002/12). It recognises that in addition to factors such as health behaviours and the provision of health and social care services, population health is to a large extent affected by
economic, social and environmental factors. The framework is structured around six themes: Giving Every Child the Best Start Equipped Throughout Life Empowering Healthy Living Creating the Conditions Empowering Communities Developing Collaboration. For each of the six themes long term outcomes have been set with strategic supporting actions and commitments over the current budgetary period that works towards these. Delivery is not purely focussed on the Department and its Agents but across all sectors and promotes collaboration and better communication for improved service delivery. It states while in general the health of people in Northern Ireland has been improving over time, health inequalities remain. The table below details the key long term outcomes for the six strategic themes: Strategic Theme Key Long Term Outcome Giving Every Child the Best Good quality parenting and family support Start Healthy and confident children and young people Children and young people skilled for life Equipped Throughout Life Ready for adult life Employment, life-long learning and participation Healthy active ageing Empowering Healthy Living Improved health and reduction in harm Improved mental health and wellbeing and reduction in self harm and suicide People are better informed about health matters Prevention embedded in services Creating the Conditions A decent standard of living Making the most of the physical environment Safe and healthy homes Empowering Communities Thriving communities Safe communities Safe and healthy workplaces Developing Collaboration A single strategic approach to Public Health Strengthen collaboration for health and wellbeing
3.2 Another key regional strategy is Transforming Our Care December 2011. This strategy sets out an overarching road map for change in the provision of health and social care services in Northern Ireland. It focuses on reshaping how services are to be structured and delivered in order to make best use of all resources available to us, and in so doing, ensure that our services are safe, resilient and sustainable into the future. (DHSSPS) The report recommends planned change over a five year period and contains 99 proposals for change across the range of health and social care services. It also identified 12 major principles for change which would underpin the future model of health and social care in Northern Ireland. These include: 1. Placing the individual at the centre of the model by promoting a better outcome for the service user, carer, and their family 2. Using outcomes and quality evidence to shape services 3. Providing the right care in the right place at the right time 4. Population-based planning of services 5. A focus on prevention and tackling inequalities 6. Integrated care working together 7. Promoting independence and personalisation of care 8. Safeguarding the most vulnerable 9. Ensuring sustainability of service provision 10. Realising value for money 11. Maximising the use of technology 12. Incentivising innovation at a local level After the review was published, the Health and Social Care Board and the five Health and Social Care Trusts developed local population plans and a Strategic Implementation Plan which set out the changes which need to be made to support Transforming Your Care. The key strategic changes identified in the Western Local Commissioning Group Locality Population Plan are: Formation of Integrated Care Partnerships (ICPs) Acute Services Reform Transformation of Unscheduled Care Supporting Independent Living Long term condition management Palliative Care Prevention & Early Intervention Developing Cross Boundary and Cross Border Services Patient and Public Involvement (PPI) Family & Childcare
3.3 At a local level two strategic planning processes were undertaken across the former Derry City Council area and the Strabane Council area, known as the One Plan and Strabane Future Search respectively. Strabane Future Search Community Regeneration Plan In January 2010 Strabane District Council teamed up with ILEX, Derry s urban regeneration company to run a Future Search process. A wide range of stakeholders were involved across the statutory, voluntary and community sectors and the local community. This culminated in the development of a vision and four strategic aims to facilitate community regeneration greater life choices, growing prosperity for the whole community, caring for our environment, and enhancing our supporting infrastructure. During the process misuse of alcohol emerged as a area of concern requiring attention and the final report identified strong support for early years intervention and increasing physical activity. One City, One Plan, One Voice One City, One Plan, One Voice the Regeneration Plan for Derry-Londonderry 2020 was guided and lead by Ilex to provide an overall regeneration framework for Derry City and which integrated wider community development and well being issues within a plan for economic, physical and social renewal. Five transformational themes and 11 catalyst programmes were identified as game changers for the city and region. Under Transformational Theme 4, Health for All, 5 priorities were identified: 1. Transform the culture of alcohol in the city 2. Promote positive more sustainable communities 3. Establish Derry-Londonderry as an active city to stop the rise in obesity 4. Promote and improve mental and emotional health and wellbeing of all age groups 5. Promote active ageing A number of key outcomes were also identified, which included a focus on early intervention. 3.4 Highlight health indicators for Derry City and Strabane District area are: 3.4.1 Demographics Projections up to 2037 show an ageing population which peaks at 150,525, with an additional 12,000 over 70s and 5,400 fewer under 19s. 3.4.2 Life Expectancy The area exhibits life expectancy levels on a par with NI but on closer inspection the urban deprived Super Output Areas have levels way below
those in the affluent or rural areas. Health outcomes were worse in the more deprived areas than in Derry and Strabane LGD as a whole across all 26 indicators. 3.4.3 Deprivation Within the new DCSDC area using Super Output area data 21% of the population (30,925) live in areas defined as deprived with an additional 24% at the 20% level equating to 45.6% of the overall population resident within the 10% and 20% SOAs. Note while deprivation measures are appropriate for urban deprivation estimation they are less reliable for rural areas. Using Output Area rather than Super Output area data it is estimated there are an additional forty Output Areas (almost half within rural areas) that contain deep pockets of multiple deprivation. Fuel poverty levels in 2011 were estimated at 47-51% of households within DCC and 52-56% in Strabane DC. 3.4.4 Health & Wellbeing Within DCSDC area all the indicators were worse than the NI average with the exception of the standardised admission rate for circulatory disease. Cancer rates, prescriptions for anti-depressants, admissions to A&E for residents from the more deprived areas are all multiples of the rates for NI and non-deprived areas. Rural dwellers, compared to urban dwellers, are likely to be healthy, a house owner, self-employed (male) and culturally deprived (Cultural Deprivation Index). Further information on baseline statistics is available at http://www.derrycityandstrabanedistrict.com/getmedia/d68e0229-39bd- 4619-b9ba-b078090f3482/DCSDC_StatsDoc_FINALv2.pdf 4.0 Informing the Derry City and Strabane District Community Plan 4.1 Having completed the review of existing strategies and plans along with the baseline information the next step is to begin to identify possible Council wide strategic priority needs and outcomes. The long term outcomes presented below are for discussion purposes with the intention of exploring these and others during the course of our first workshop.
4.2 The analysis of existing strategies and plans identifies that health inequalities remain in the council area and is a strategic priority for the Department and its Agents. We might therefore consider for the DCSDC area an outcome such as Citizens in Derry City and Strabane District Council area will have improved physical health and mental well-being and will experience fewer health inequalities. 4.3 Other priority areas which have emerged in the strategic review are: Active Ageing Mental health and wellbeing Obesity Suicide Early Intervention across all life stages Participation in physical activity. 5.0 Conclusions and Next Steps 5.1 Workshop 2 will revisit the long-term outcomes and will consider indicators and quantifiable measures of progress and impact.