Agenda Item No. 17 Part 1 X Part 2 NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 28 th October 2014 Title of Report Purpose of the Report Trafford Council Public Health and NHS Trafford CCG Work Plan 2014/15 Update The purpose of this report is to provide an update on the agreed joint Trafford Council Public Health and NHS Trafford CCG work plan 2014/15. Actions Requested Decision Discussion Information Strategic Objectives Supported by the Report Recommendations 1. Consistently achieving local and national quality standards. 2. Delivering an increasing proportion of services from primary care and community services from primary care and community services in an integrated way. 3. Reduce the gap in health outcomes between the most and least deprived communities in Trafford. 4. To be a financial sustainable economy. The CCG Governing Body is asked to note the progress update of the Trafford Council Public Health and NHS Trafford CCG work plan 2014/15. Discussion history prior to the Governing Body NHS Trafford CCG Governing Body 26 th August 2014. NHS Trafford CCG Management Team 19 th August 2014. Trafford Council Children, Families and Well Being SLT - 14 th August 2014. Financial Implications Public Health grant allocation 2014/15. Risk Implications BAF reduce health inequalities and narrow the gap in life expectancy between different parts of the Borough. Equality Impact Assessment Impact assessments have been carried out for Public Health services that have been re-commissioned.
Communications Issues Public Engagement Summary A range of Public Health campaigns will be delivered to residents of Trafford based on a national Public Health England marketing framework, community pharmacy Public Health campaigns and local assisted campaigns on key Public Health priorities (e.g. cervical screening). Not applicable. Prepared by Responsible Director Mr Abdul Razzaq, Director of Public Health Mr Abdul Razzaq, Director of Public Health
TRAFFORD COUNCIL PUBLIC HEALTH AND NHS TRAFFORD CCG WORK PLAN: 2014/15 1.0 INTRODUCTION AND BACKGROUND 1.1 The purpose of the Trafford Council Public Health and NHS Trafford CCG work plan 2014/15 is to highlight a joint programme of activity and synergies between the Local Authority and the CCG on meeting the strategic high level priorities for improving the health and population of Trafford. In addition the document provides a framework for the CCG to meet its internal audit and external NHS England assurance requirements on Public Health. The aim of this document is to set the direction of Public Health in Trafford for the next five years, with particular focus on the actions and outcomes to be delivered in 2014/15. 2.0 PROGRESS UPDATE 2.1 A progress update of the agreed joint Trafford Council Public Health and NHS Trafford CCG work plan 2014/15 is attached at Annexe 1. 3.0 RECOMMENDATION 3.1 The CCG Governing Body is asked to note the progress update of the Trafford Council Public Health and NHS Trafford CCG work plan 2014/15.
Annexe 1: Joint Trafford Council and NHS Trafford CCG Public Health Plan: 2014/15 Progress Update October 2014: Early Years: Early Years Jill Colbert In development with public health input School readiness of 4-5 year olds Agree the processes and services to be implemented for 15/16 roll out for 0-5 years This is on-going work during Q3 and Q4 2014/15. Continue to lead the Trafford project team. This is on-going during Q3 and Q4 2014/15. Evaluate the progress of the early adoption pilot area of the AGMA 8 stage model. This is on-going during Q3 and Q4 2014/15. Early Years: Health Visiting (HV) Commissioning Jill Colbert Effectively transfer HV commissioning to TMBC with public health input. NHS England and Local Authority to agree. Work with NHS England to ensure the smooth transition and appropriate specification, and targets This work has started and will be on-going until October 2015 (scheduled transition date to local Authority). Early Years: Maternal Health Rebecca Fletcher Ensure public health outcomes for included within CCG contracts for expectant mothers and babies Meet the national maternal and child health services requirements. Ensure that maternity services are linked into the appropriate local community services. This work has commenced. Clarify pathways for Family Nurse Partnership (FNP). FNP is being implemented locally and the pathways will be clarified once staff are in place. Implement the new Perinatal and Infant Mental Health Pathway. Final revisions are being done to the pathway.
Early Years: Breastfeeding Early Years: Healthy Child Programme (HCP) for CYP Rebecca Fletcher Rebecca Fletcher Promote the benefits of breastfeeding and provide support for families who wish to breastfeed Implement the School Nursing Model locally in line with additional investment to provide an increased emphasis on public health and supporting the delivery of the full HCP Increase in numbers of women initiating breastfeeding and breastfeeding at 6/8 weeks Increase i numbers of women breastfeeding from priority localities and groups Increased identification of needs and the provision of low tier support for a wide variety of health issues Increased education sessions and drop in within schools and externally Refresh the local strategy and action plan to take breastfeeding promotion and support forward Include Healthy Start in this work to ensure healthy breast milk and reduce vitamin D deficiency Implement the new specification and monitor the service to ensure outcomes locally focusing on delivering a universal public health service for 5-19 This has been completed and work is on-going. This has been completed and work is on-going. This has been completed and work is on-going. Healthy Weight: National Child Measurement Programme, (NCMP) * Rebecca Fletcher National measurement programme for reception and year 6 children. The parent/carer receives written feedback, healthy weight support is provided where necessary. Reduction in % school children in Year 6 (age 10-11) who are measured as obese Weigh all reception and year 6 children annually Provide written results to all parents/ carers This is being undertaken this year and is regularly monitored. This is being undertaken this year and is regularly monitored. Follow-up all overweight and obese children with a weight loss programme This will be undertaken if the appropriate funding is identified. * Mandatory Public Health Commissioned Service Page 5
Healthy Weight: Childhood Obesity Rebecca Fletcher To halt the rise in children and young people who are overweight or obese through an integrated and coordinated partnership response. Old Trafford and Stretford Locality Partnership are working closely with School Governors to promote healthy eating in schools Reduction in % school children in Year 6 (age 10-11) who are measured as obese To implement the healthy weight pathway locally To work as a partnership to develop an approach to reducing obesity and promoting a healthy weight Work is being undertaken to identify appropriate funding. A strategy group has been set up with a plan of work. Healthy Weight: Adults obesity, malnutrition and dietetics Rebecca Fletcher Ensuring that the Community Nutrition and Dietetic (CN&D) Service and Specialist Weight Management Service (SWMS) effectively meet the needs of overweight and obese adults Reduction in the BME of adults receiving treatment Reduction in the negative maternity outcomes associated with obesity Prioritise the treatment of obese BME adults, and pregnant women to reduce diabetes and negative maternity outcomes respectively This is being built into the CN&D specification. Ageing Well: NHS Health Checks * Paula Whittaker The vast majority of NHS Health Checks delivered by general practice. A pilot programme offering NHS Health Checks in pharmacy has been put into place for 2014/15. 10% of eligible population to have received a NHS Health Check annually Invitation of 20% of eligible population annually Appropriate follow-up of patients identified as high risk of CVD 5% invited in Q1. Q2 figures expected to improve. Extended provision in community pharmacy agreed. Audit to be completed of NHS Health Check outcomes by end Oct 2014. * Mandatory Public Health Commissioned Service Page 6
Ageing Well: Falls reduction and bone health Helen Gollins The development and implementation of a strategy to improve bone health and reduce the number of falls across Trafford. A pathway will be a key output. Reduction in rate of admission for fragility fracture per 1000 population aged over 65 Reduction in rate of admission of older people into long term nursing care due to falls Implement the local Trafford Falls and Bone Health strategy and action plan. Single point of access for falls assessment Community based falls team reducing future risk of falls Strategy currently out for comments and presentation at key meetings for sign off. Falls Service being redesign and business case being developed. Falls Service being redesign and business case being developed. Smoking and Tobacco Control Marie Price (Graham Snell) Locally commissioned service from GP and pharmacy. Monitoring of specialist NHS Stop Smoking Service * provided by Pennine Care NHS Foundation Trust. Campaigns and awareness raising. Smoking status at time of delivery to be lower than England average Decrease in proportion of adults who smoke PH Campaigns to link in with national campaigns and NHS services Stoptober campaign: Community Sale West resident case study. Press release issued by Pennine. LCCC support campaign - promotion on LCCC website and twitter by Trafford comms. Resources distributed to GPs and Pharmacies borough wide. Posters and electronic leaflets to partners including GMP who also put on Twitter. * Mandatory Public Health Commissioned Service Page 7
Workplace Promotion via intranet 6 boxes and resources at TTH, Sale Waterside and TGH. 2 SSS staff manned the stall at Waterside on 1st Oct. Alcohol * Paula Whittaker Commission and monitor a full range of services from increasing awareness, locally commissioned services from GPs to inpatient rehab. Reduction in alcoholrelated hospital admission Reduction in binge drinking rates Awareness raising with public and frontline staff Targeting high risk drinkers for intervention Campaign being developed for Alcohol Awareness Week. Developing of a Test on Arrest proposal has commenced. Work closely with specialist community providers Phoenix Futures and Greater Manchester West. This includes expanding family support, and employment and training support. Reduction in % of drinkers that are higher risk drinking Reduction in % of drinkers that are increasing risk drinking Target women for prevention messages Diversion of alcohol-related admissions Target group for Alcohol Awareness Week Communications campaign. RAID service is in place. All license applications are reviewed by public health. Close working with police on public safety issues due to binge drinking and identification and referral from custody suite. * Mandatory Public Health Commissioned Service Page 8
Drug Misuse * Kylie Thornton Commission and monitor a full range of services from increasing awareness to inpatient rehab. Work with police on identification and referral of vulnerable people. Expand use of peer mentors and volunteers in substance misuse services Increase use of recovery coaching to empower individuals to make positive lifestyle choices Increase proportion of drug users that complete treatment successfully Increase proportion of IV drug users screened for HIV Increase proportion of IV drug users vaccinated for Hep B Increase in number of peer mentors and/or volunteers in services Number of recovery coaches increases Those returning to Trafford from prison are supported to access appropriate community services Individuals within BME communities in Trafford are aware of Trafford Increase number of drug users discharged from treatment within 6 months Increase awareness of hepatitis screening and prevention Peer mentors are an integral part of all Trafford drug services. Recovery Champions in post in Phoenix Futures. Recovery and Family coaching will be delivered in the coming months (pending outcome of bid to PHE) explicitly linked to Through the Gate work. Alchemy Arts held a successful workshop to promote what is available in Trafford. Those accepting Hep B vaccination in Trafford continues to lag well behind national averages though every effort is made to encourage drug users to uptake the vaccination. * Mandatory Public Health Commissioned Service Page 9
support services and how to access them Increase Hep C screening uptake among intravenous drug users Hep C figures have improved though still lag behind national averages. Physical Activity Helen Darlington Increase levels of physical activity across Trafford and reduce inequalities by 2021 by increasing awareness and increasing participation. Increase in the percentage of the adult population participating in sport, at moderate intensity, for at least 30 minutes on at least four days out of the last four weeks (equivalent to 30 minutes on one or more day a week). Increase proportion of children who exercise for 1 hour daily Increase proportion of BME women who are physically active Maximising opportunities for use of the physical infrastructure Audit of current provision to be completed, partnership approach to the promotion of opportunities. Outline audit work undertaken as desktop exercise. Initial findings of phase 2 detailed audit work to be completed by end of November 2014. This will be undertaken in partnership with Trafford Partnership, Family Information Service and TCLT Active Living Managers. Sportivate: The Sporting Foundations for Life project is being delivered in key areas of identified need. A Partnership proposal will be submitted at CSAF round Page 10
4 for the 14-25 years age group. Encouraging workplace activity Increase volunteering opportunities in sport and physical activity Support links between school sport and sport in the community Greater Sport: This is regional work being progressed by Greater Sport. Current gaps in provision identified and funding stream located to kick-start activity. Direct mailing is to be sent to schools. Key action to ensure that those eligible for Active Trafford receive the information. Trafford Sports Partnership to ensure that information is circulated with the schools bulletin. Trafford Sports Partnership to link with communication teams to ensure that information is circulated on the intranets. Page 11
Ensure that strategic planning processes contribute to creating a local environment, including facilities for outdoor recreation, physical activity and play that supports an active lifestyle Ongoing work across the Local Authority and with partner organisations. Develop and extend/promote the Active Trafford and Junior Active Trafford Scheme to communities in most need Review of current offer and develop links through partner organisations. Oral Public Health Rebecca Fletcher Contract review of promotion initiatives Strong links with nutrition promotion activities Review the provision and guidance on oral health promotion for children Levels of tooth decay in children Work as a partnership to strategically review the provision and contributions to oral health To implement the new commissioning guidance Not commenced - planned Q4 2014 Not commenced planned Q4 2014 Mental Health and Wellbeing: Adults Helen Darlington A number of 3rdsector agencies are commissioned to deliver projects across Trafford which address Mental Health and Wellbeing: BlueSCI Suicide rate Number of people with mental illnesses who feel well supported Reduce the occurrence of common mental health problems amongst adults Books on prescription has developed into E-books on prescription: Highlights: Change to service users downloading recommended books and currently trailing the Northumberland, Tyne and Wear NHS App, looking to develop the Trafford version when funding secured from Trafford CCG. Page 12
Re-Think Trafford Age UK Trafford CIL LMCP Care Link United Response 42nd Street Alzheimer's Society Trafford Autistic Society New Way Forward This will ensure the self-help guides and service Directory is localised and personal to Trafford and more accessible. Old Trafford BME Mental health counselling through Skype. Old Trafford Asian community are more comfortable using Skype technology to keep in touch with international relatives. This is an appropriate tool with this group to use expand the Skype Counselling pilot and develop it further. This can be used within a portfolio approach of support. Trafford participated in the Greater Manchester sectorled improvement process for Suicide Prevention: See action plan for progress detail. Support people with enduring mental health needs, including dementia to live healthier lives Bespoke training sessions agreed around personal resilience/mental health and wellbeing within the work community, contract agreed, MIND recruiting 100 attendees over 10 sessions, ideally from SME s within Trafford that do not have Page 13
access to such resource normally. Complete by Dec 2014. Provide regular training and updates in risk recognition, assessment and management for front line including GMP staff working with vulnerable groups. Work with GMP developing the Home Office Innovation Fund programme regarding mental health services and GMP working practices and progress the GMP mental health Training programme: NHS Trafford CCG. South Trafford Locality Partnership has successfully bid for funding from Our Place to develop a project to reduce social isolation in older people. Our Place project is ongoing. Mental Health and Wellbeing: Children and Young People Jill Cobert Public Health Investment in CAMHS Provision LA ADP outcomes. Implement CAMHS plan. A review of the CAMHS service is in the planning stages Sexual Health Services * Sian Davies Commission and monitor the mandatory requirement Equitable access to sexual health services for all ages Bridgewater Community NHS FT offer open access to all * Mandatory Public Health Commissioned Service Page 14
of open access community based services are provided by Bridgewater across the borough. LGF are undertaking work identifying and offering MSM screening, including the roll of Point of Care testing for HIV from National Testing Week in November. Talkshop offers specific holistic services for young people. New Greater Manchester Service Specification for the RUClear service is being written, Trafford are directly participating in this process. The service will be tendered in December. Efficient contact tracing of sexually transmitted infections Full range of contraceptive choices, including long-acting reversible methods, to be offered to all women at all clinics and practices Increase in the number of HIV screens performed on MSM and Black African people plus dedicated young person clinic. This is offered via post/ text. This service is provide at the Bridgewater Community NHS FT young persons clinic and via GP locally commissioned service. Campaign to be led by LGF during HIV Awareness Week in November 2014. Domestic Abuse and Violence Kylie Thornton Implement a multiagency, integrated approach to halting and reducing the prevalence of domestic abuse and violence across Trafford outlined in the domestic abuse strategy Increased number of reported cases of DA&V Identification of collaborative funding stream to support the commissioning process beyond 2015 Funding has been identified for specialist services. The following services will undergo a procurement exercise staring October- Specialist Community Based Services, IRIS programme and refuge / floating support. Funding still required for VPP and sexual assault services. (On-going discussion with Page 15
GMP / CCG and Housing Providers) Implementation of recs from GrMCR Public Health Network Service Led Improvement review. BME, Young People, Male and Repeat Victims are priority groups due to under reporting Public Health resources identified to fund the above programmes in partnership with Adult Services. The specialist community services will be required to provide a specialist BME IDVA and support to males. Young Peoples services are currently being provided on a yearly basis to allow for effective evaluation. Establishment of IRIS programme to establish training for primary and secondary care alongside bespoke referral route Funding identified for IRIS programme, this will undergo a tender exercise commencing in October 2014. Links still needs to be established with CCG in regards to providing clinical governance arrangement and buy in from LMC /GPs. Page 16
Outbreak control and incident management * Abdul Razzaq Mandatory function to provide assurance of; emergency planning, resilience and response, (EPRR), infection control and health care acquired infections. Emergency plans in place Incidents responded to and controlled appropriately Number of health care acquired infections Oversight and assurance of mandated health protection Public Health function through Health Protection Forum and HERG. The Trafford Health Protection Forum is chaired by the Director of Public Health and continues to meet bi-monthly to oversee and provide assurance on infection control and healthcare associated infections, screening, immunisation and EPRR (emergency planning resilience and response). Commissioning of Community Infection Control Team The community infection control staff provide a detailed written and verbal update at the Trafford Health Protection Forum on healthcare associated infections (MRSA, C.Diff, MSSA, E.Coli), audit and inspection in healthcare, care home settings, infection control training, clean your hands campaign and updates on any outbreaks. Emergent healthcare issues are CPE, antimicrobial resistance (AMR) and sepsis. * Mandatory Public Health Commissioned Service Page 17
Influenza Paula Whittaker Assurance of delivery of National immunisation campaign. Uptake rates of flu immunisation Advice on reaching low uptake groups such as under 65s at risk and pregnant women A joint NHS Trafford and Trafford Council Integrated action plan is in place. Joint communications to the public A joint NHS Trafford and Trafford Council Integrated action plan is in place. Cancer Prevention and Screening Helen Gollins Improve early diagnosis of cancer through improved uptake of National cancer screening programmes. Achievement of the CCG Quality Premium- 80% uptake of cervical screening indicator. Cervical screening uptake rates in BME women Improve uptake of cervical screening. One Minute campaign launched as part of wider communications plan as part of the cervical screening joint work. Reduce inequalities in screening rates across primary care practices and amongst inequality groups by implementing the integrated cervical screening action plan. This has a population approach to improving uptake but also focuses on more vulnerable groups. A practice incentive scheme is planned. Community engagement plan is being implemented. Childhood Immunisation Programmes Paula Whittaker Ensure that local children are effectively immunised in line with the national immunisation policy Childhood immunisation programme coverage rates Work with NHS England and local services to ensure that this occurs effectively A NHS Trafford and Trafford Council seasonal influenza plan is in place for the 2014/15 season. Page 18
including childhood vaccinations and HPV Support the implementation of the national roll out of the flu vaccine to all 2,3 and 4 year olds Work with local services to deliver immunisations including school nursing To provide advice on quality assurance of childhood immunisation programmes in partnership with CCG, PHE and NHS England A NHS Trafford and Trafford Council seasonal influenza plan is in place for the 2014/15 season. A NHS Trafford and Trafford Council seasonal influenza plan is in place for the 2014/15 season. Performance and benchmarking data has been analysed and areas of improvement have been identified within the local plans. CCG core offer Paula Whittaker Public Health support to CCG in priority setting and commissioning of equitable, evidence based services in line with the memorandum of understanding which outlines the core offer of public health to the CCG from the Trafford public health team Support the CCG in workforce planning including undertaking needs assessments of localities and vulnerable populations as required Service redesign based on robust evidence base of health outcomes, quality of care and return on investment Reduction in inequalities in delivery of care and health outcomes Membership of the individual funding requests panel Support the CCG in reviewing existing and developing new evidence based card re pathways, service specifications and quality indicators Design monitoring and evaluation frameworks, and interpret results for specific projects and/or services as per mutual agreement. An agreed Local Authority core offer MoU to NHS Trafford CCG has been agreed for 2014/15 and is in place. Public Health membership of transformation steering group, PCCC. Work is ongoing on falls, diabetes, AF Page 19
Support the CCG to embed public health interventions into the frontline clinical services of their constituent practices especially in relation to prevention programmes; primary and secondary prevention; behaviour change; and patient and community empowerment Input into CCG Health Inequalities document Collaborative work with CCG on identifying and implementing interventions proven to reduce heath inequalities Completed. On-going Public Health advice and information. Support the CCG to develop new/refreshed strategies around critical areas such as mental health, smoking, alcohol consumption and obesity, and the reduction of health inequalities; and advise on appropriate metrics for progress and outcomes to be monitored. On-going Public Health advice and information. Joint Strategic Needs Assessment Rebecca Fletcher/ Lisa Davies Coordination of annual updates to JSNA pages published on Info Trafford JSNA updated annually Production of template for staff at CCG and council to complete annually To be worked on after move of intelligence team to new premises. Childhood Accident Prevention Jill Colbert Undertake accident needs assessment using GM framework Develop Trafford accident Childhood accidents and deaths. Implement the actions from the Trafford sector led improvement (SLI) review. A childhood accident needs assessment is being undertaken to formulate a local strategy. Page 20
prevention strategy Teenage Pregnancy: Under 18yrs conceptions Sian Davies Mandatory requirement of open access community based services are provided by Bridgewater across the borough and this includes specific provision for young people Further reductions in conceptions and terminations for the under 18 cohort Full range of contraceptive choices, including long-acting reversible methods, to be offered to young women Complete. Bridgewater Community NHS FT young persons clinic provides this service. Talkshop offers specific holistic services for young people Employment and skills Paula Whittaker Public health input to the Health for Work Programme Reduction in number of people in long term unemployment Assurance of programme delivery in Trafford via Work Programme Leavers Steering Group Public Health attend steering group and provide health input an advice into the programme. Support to Locality Partnerships Advice and information is provided on a request and needs basis. Page 21