EALING HEALTH AND WELLBEING STRATEGY

EALING HEALTH AND WELLBEING STRATEGY 2016-21 1

Cntents Frewrd... 3 Executive summary... 4 1. Intrductin... 6 1.1 What is a Health and Wellbeing Strategy?... 6 1.2 Scpe and cntext... 6 2. Prevalence and needs analysis... 8 2.1 Health in Ealing and prgress since the last Health and Wellbeing Strategy... 8 2.2 Stakehlder views... 10 3. Pririties and bjectives... 12 4. Gvernance arrangements... 36 5. Measuring the impact f the strategy... 36 Appendix 1: Legal cntext... 38 Appendix 2: Lcal, reginal and natinal cntext... 39 Appendix 3... 44 Appendix 4: Prgress update frm the previus Health and Wellbeing Strategy (2012-16)... 49 Appendix 5: Current prgrammes f wrk... 51 2

Frewrd Tgether we are delighted t launch ur new Jint Health and Wellbeing Strategy 2016 t 2021 fr Ealing, which draws tgether the wrk f the many key rganisatins in Ealing, wrking in partnership, aiming t imprve the health and wellbeing f lcal residents. It highlights and sets challenging targets that reflect the need t imprve the health f ur residents and t reduce the lng term cst f ill-health n ur health and scial care services. We have a jb t d t imprve the health and wellbeing f ur ppulatin and the strategy sets ut the key verarching features f what needs t happen. Achieving a Healthier Ealing will require leadership frm the bard and active engagement frm the range f partners including cmmissiners and prviders f services, cmmunity and vluntary sectr grups, and the wide range f rganisatins that cme int cntact with citizens n a daily basis including emplyers and schls. It als gives Ealing residents and lcal wrkfrce the pprtunity t cnsider hw they can wrk with rganisatins t imprve their wn health. We wuld like t thank all thse wh have cntributed t the develpment f this strategy and, mst imprtantly, all thse wrking t cntinue t imprve the health and wellbeing f lcal residents. Cuncillr Julian Bell, Chair f the Health and Wellbeing Bard Dr Mhini Parmar, Chair f the Ealing Clinical Cmmissining Grup Cuncillr Hitesh Tailr Cabinet Member fr Health and Adults Services 3

Executive summary Thrugh this Health and Wellbeing Strategy, lcal partners are seeking t achieve the fllwing lngterm ambitins: Create and sustain gd mental and physical health fr children and adults at every stage f life Reduce health inequalities by imprving utcmes fr neighburhds and cmmunities experiencing pr health Enable peple f wrking age t participate as fully as pssible in wrking life, t imprve the health and ecnmic utcmes fr them and their families Enable everyne t be healthy and independent fr as lng as pssible, helping t prevent r delay the need fr scial and acute care At the heart f this Strategy is a desire t prmte wellness, in its bradest sense, thrughut Ealing s ppulatin. Fr t lng, the fcus has been n the health and care needs f individuals, and n treating specific diseases, cnditins r prblems. There has been less emphasis n preventing ill health, and n identifying and using the vast array f assets that individuals, families, and cmmunities can cntribute t sustaining gd health and wellbeing. Organising services and treatment arund specific illnesses, rather than taking a hlistic, persn-centred apprach, has ften meant that care is fragmented and uncrdinated, and the underlying causes f pr physical health and mental ill health are nt addressed. We can n lnger affrd t take this apprach. It is simply nt viable t cntinue trying t respnd t increasing demand fr services, particularly at the expense f preventative actin. We need t find ways t achieve better utcmes fr individuals and their families, in a way that is financially sustainable and makes best use f the cllective resurces that all parties can cntribute. This includes all Health and Wellbeing Bard partners, lcal emplyers, schls/clleges, and residents and cmmunities. Given the current financial climate, this needs t be far brader than mnetary resurces, taking advantage f all the ther assets at ur dispsal. This draft Strategy sets ut hw we prpse t d this, based arund fur pririty areas. These pririty areas have been develped in a way that recgnises and seeks t utilise the intercnnected nature f peple s lives, and the wide range f factrs that psitively and negatively influence their health, wellbeing, and behaviur. In particular, we have taken n bard the strng argument in the NHS Five Year Frward View that the future health f millins f children, the sustainability f the NHS, and the ecnmic prsperity f Britain all nw depend n a radical upgrade in preventin and public health. 1 Whilst this draft Strategy sets ut ur pririties it des nt set ut in detail hw we plan t achieve them. This wrk will fllw and be led by Ealing s Health and Wellbeing Bard. The pririties and bjectives als reflect ambitins in the Lndn Health Cmmissin reprt Better Health fr Lndn, as well as Sir Michael Marmt s reprt Fair Sciety Healthy Lives. 2 Our fur pririty areas fr this draft Strategy are as fllws. 1 NHS: Five Year Frward View (2014) Link 2 Marmt: http://www.institutefhealthequity.rg/prjects/fair-sciety-healthy-lives-the-marmt-review 4

Firstly, develp a systems leadership apprach t Health and Wellbeing. There are many situatins where a cncerted effrt, taken cllectively by partners, is required. Every partner rganisatin, and every team and service area within thse rganisatins, has a rle t play in health and wellbeing. Mre wrk is required t ensure this happens. Secndly, we want t make mre extensive use f educatinal settings and wrkplaces as healthprmting envirnments. A lt f time is spent in these settings, and they can be hugely influential n behaviur. This makes them ideal places t implement a range f health-related measures. There is als cnsiderable ptential t use the Cuncil, healthcare prviders, ther public services, and wider wrkfrce t deliver basic public health messages and t engage residents in health change cnversatins. Thirdly, we want t address the brader scial, ecnmic, and envirnmental factrs that can supprt peple's ability t be healthy and make changes t imprve their health. This includes healthy urban planning, and creating physical envirnments that make it easier fr everyne t eat healthy fd and take mre exercise, and fr lder peple t be independent. Finally, supprt residents and cmmunities t manage their health, prevent ill health and recver quickly frm ill health. This apprach recgnises that behaviural patterns cntribute arund 40 per cent t preventing premature death, and these patterns can be mdified by changes in behaviur and lifestyle. Infrmatin and supprt t make these changes can cme frm a wide range f surces, including families and cmmunities. Activities that prmte wellbeing s peple feel gd and functin well are an essential part f building healthy, resilient individuals and cmmunities, and reducing inequalities. 5

1. Intrductin 1.1 What is a Health and Wellbeing Strategy? A health and wellbeing strategy is a lng-term strategy fr meeting the needs f the lcal ppulatin, as identified in the Jint Strategic Needs Assessment (JSNA). It is a statutry requirement, which is t be develped and delivered jintly by partners in Ealing s Health and Wellbeing Bard. These partners include Ealing Cuncil, Ealing Clinical Cmmissining Grup (CCG), Ealing Cmmunity and Vluntary Service (ECVS), and HealthWatch Ealing. Statutry guidance n health and wellbeing strategies highlights the imprtance f setting ut a small number f key strategic pririties fr actin that will make a real impact n peple s lives. Strategies shuld translate JSNA findings int clear utcmes the bard wants t achieve, which will infrm lcal cmmissining leading t lcally-led initiatives that meet thse utcmes and address the needs. 3 Services and cmmissining plans fr CCGs and lcal authrities are required t take accunt f the pririties set ut in their lcal strategy. The pririties prpsed in this draft Strategy have been develped by Health and Wellbeing Bard members, based n an understanding f issues in the JSNA and wider factrs, and the utcmes that they want t achieve fr the brugh. Engagement with service cmmissiners, prviders and users has helped t infrm these pririties. The Strategy will infrm decisins abut the services cmmissined and delivered by partner rganisatins. This means members f the public and services users will see a difference ver the next few years. 1.2 Scpe and cntext This is a strategic dcument, which sets ut the high-level bjectives and pssible actins in relatin t fur, brad pririty areas. It des nt prvide detailed infrmatin abut hw the pririties will be delivered; these details will be cntained in supprting strategies, and evidence-based implementatin plans, service plans, and/r cmmissining plans. Fr Ealing Cuncil, the Health and Wellbeing Strategy is ne f fur key strategies, alng with grwth, emplyment and skills; husing quality, affrdability and supply; and place and public realm. This means the prvisins in this new Strategy (nce finalised) will direct all ther related strategies and plans, and they will need t include crss-references. There is als an expectatin that Cuncil and CCG plans fr cmmissining services will be infrmed by this Strategy. 4 This includes strategies, plans, and services that are directly health-related, and 3 Department f Health: Statutry Guidance n Jint Strategic Needs Assessments and Jint Health and Wellbeing Strategies (2012) 4 The Lcal Gvernment and Public Invlvement in Health Act 2007, sectin 116B (as inserted by the Health and Scial Care Act 2012, sectin 193) requires lcal authrities and CCGs, in exercising any functins and the NHS Cmmissining Bard, in exercising its cmmissining functins in relatin t the lcal area, t have regard t any JSNA and Health and Wellbeing Strategy that is relevant t the exercise f thse functins. 6

thse with an indirect cnnectin, such as husing, emplyment and skills, children s and adult services, and the Lcal Plan. It is imprtant t nte that health and wellbeing strategies are nt required t cver every health issue facing a lcal area. Statutry guidance emphasises that this is nt abut taking actin n everything at nce, but abut setting a small number f key strategic pririties fr actin. Therefre, nt all f the needs that are highlighted in the JSNA will be addressed in this Strategy. In additin, this Strategy has limited scpe t directly influence matters where Ealing is part f a wider sub-reginal netwrk. Fr example, the main prvider f mental health care in Ealing is the West Lndn Mental Health NHS Trust. Fr sme tpics that benefit frm cllective actin, Ealing CCG is part f the CWHHE Cllabrative, a wrking partnership with Central Lndn, West Lndn, Hammersmith and Fulham, and Hunslw CCGs. This draft Strategy has been develped within a lcal, reginal, and natinal cntext, and an verarching legal framewrk. It has been infrmed by, and seeks t align with, the brader strategic pririties f Ealing Cuncil and Ealing CCG, as well the NHS, Lndn Health Cmmissin, and Public Health England. Further details are prvided in Appendix 1 and 2 n the wider legal and strategic cntext fr this draft strategy. 7

2. Prevalence and needs analysis 2.1 Health in Ealing and prgress since the last Health and Wellbeing Strategy Ealing is the third largest Lndn brugh with a resident ppulatin in 2014 f 342,000 (based n the ONS mid-year ppulatin estimates). There are mre peple aged 0-9 and 25-44 but fewer aged 50 r mre cmpared t England. Over the next 20 years in Ealing, the number f children and yung peple is prjected t grw by 16% and the number f residents aged 65 and ver will increase mre by 53%. These increases, particularly in the lder ppulatin will increase the needs fr bth health and scial services. Ealing is currently the third mst densely ppulated Outer Lndn brugh, with 63 persns per hectare, and this adds t the challenge t maintain envirnment, cmmunity space, schls and public services. Ealing is an increasingly diverse brugh, with a steady rise prjected fr BAME grups at 53% (184,500 ut f a ttal ppulatin f350, 900) and the white ethnic grup at 47% (166400) 5. Sme health cnditins are mre prevalent in the BAME cmmunities highlighted. These include higher levels f mental health issues but lwer levels f advice sught and higher levels f diabetes. Suth Asians are at increased risk f crnary heart disease (CHD) and strke and are particularly prne t the metablic syndrme. African-Caribbean peple have less risk f CHD but greater risk f hypertensin and strke, lwer awareness f cancer and lw uptake f cancer screening. Whilst Ealing is a prsperus brugh with abve average life expectancy, it includes wards with areas and estates amngst the 10% mst health deprived in England, and levels f hmelessness abve the England average. Sme f the health challenges facing Ealing are highlighted belw 6 : Excess weight prevalence rates amng Ealing children aged 10-11 years (37.5%) is higher than the natinal average (33.2%), but n par with Lndn levels (37.2%)(2014-15); The percentage f peple using utdr space fr exercise/health reasns (11.4%) is significantly lwer than the natinal average (17.1%) but similar t Lndn (11.8%); The incidence f tuberculsis in Ealing (65.3 per 100,000) is higher than Lndn (35.4 per 100,000) and the natinal average (13.5 per 100,000); In 2015, the breast cancer screening rate in Ealing was (68.2%) cmpared t Lndn (68.3%) and England (75.4%); The figures fr cervical cancer screening shw that in 2015 the rate in Ealing was (64.6%) cmpared t Lndn (68.4%) and England (73.5%); Emergency hspital admissin rates due t falls amng lder peple in Ealing are wrse than the natinal average. Based n analysis f the JSNA, stakehlder engagement, and cnsideratin f the brader cntext, we have identified the fllwing key issues and pprtunities t be addressed by this Strategy. 5 GLA Trend-based ethnic grup ppulatin prjectins (Lng term migratin scenari); Octber 2015 6 Public Health Outcmes Framewrk, 2015 8

These issues and pprtunities represent a cmbinatin f the things we think need t change and the things that partners can influence directly and cllectively. There is an verarching challenge that faces health and scial care services. Ealing, like the rest f England, is facing an increasing mismatch between needs and resurces. Demgraphic factrs are leading t rising demand fr services at a time where resurces t prvide services are diminishing as the gvernment seeks t reduce the natinal deficit. As the chart belw indicates, this is estimated t be arund 30 billin in the NHS alne by 2021/22, based n current demand patterns and likely available funding. The demand and funding prfile is very similar fr adult scial care services. Clearly, this situatin is nt sustainable. Figure 1: Funding pressures n NHS services Internatinal studies suggest that behaviural patterns cntribute arund 40 per cent t preventing premature death, whereas healthcare cntributes arund 10 per cent - see diagram belw. This means imprving hw peple live their lives ffers cnsiderable pprtunities fr imprving their health. Primary and secndary preventin, early interventin, and supprting self-care and behaviur change, thrughut the life curse, are key factrs. The key issues that this draft strategy seeks t address and the ratinale fr chsing them are set ut belw. 9

Figure 2: Prprtinal cntributin t premature death In 2012, five pririty areas were agreed by the then Ealing Shadw Health and Wellbeing Bard t imprve health and reduce inequalities in Ealing. There have been imprvements in all five pririty areas, in particular imprvements in schl readiness, reductins in alchl related hspital admissins, reductin in childhd besity at receptin age. Hwever, challenges still remain, particular arund besity levels fr lder children and adults which are reflected in the key issues sectin f this new draft strategy. Appendix 3 prvides further detail n imprvements and achievements. 2.2 Stakehlder views T develp this draft Strategy, we have sught views frm a range f stakehlders n the pririties fr actin at the engagement and cnsultatin stages. Engagement exercises included: A survey f lcal stakehlders (Healthwatch members, ECVS partners, and the Ealing Residents Panel), which received 263 respnses. Interviews with ver 20 lead executives and decisin makers frm acrss the Cuncil, CCG and vluntary sectr. Discussins at partnership frums and with managers and frnt line staff. A fcus grup f service users. The survey included a list f sme f the key health issues in Ealing, and asked which nes were cnsidered t be pririty areas. 7 All f the issues n the list received a rating average f six r abve (n a scale frm ne t 10). The highest rated issues were: Imprving the quality f life f lder peple. Imprving the supprt, treatment and/r physical health f adults with mental ill health. 7 In this questin, peple were asked t rate a list f issues in rder f imprtance, n a scale frm 1 t 10. Each respnse was given a rating average ut f 10. There were 240 respnses, 164 frm the residents panel and 76 frm lcal stakehlders. 10

Preventing diabetes. Imprving children s mental health and wellbeing. Reducing besity in children. The survey asked what wuld mst help Ealing residents t imprve r cntrl their wn health. 8 The three mst ppular respnses were: Access t specialist supprt/services (e.g. gyms/exercise prgrammes; weight lss classes; smking cessatin supprt). Better availability f cheap, healthy fd. Fewer places selling unhealthy fd. We als asked what wuld help Ealing residents with lng-term health cnditins t live healthily and independently, and t self-manage their cnditins. The three mst ppular respnses were: Jined-up care services. Patient educatin / mtivatinal training prgrammes. Lcal activities t enable healthy lifestyles. The cnsultatin perid sught views n the pririties selected fr future actin, the utcmes intended t be achieved, the prpsed targets by the end f 2021 and hw partners can wrk differently t achieve these. The cnsultatin perid lasted fr a duratin f 8 weeks in the frm f an nline survey, a fcus grup specifically fr GP practice Patient Representative Grups, presentatins at all partnership bards and the schls frum. Hard t reach grups cnsulted at the engagement stage were nce again cnsulted fr this phase. There were 181 respnses t the nline survey and feedback frm all cnsultees abve-mentined. Feedback frm the cnsultatin has been use t infrm the HWS delivery and implementatin phases. 8 In this questin and the fllwing questin, peple were asked t pick up t three answers frm a list f ptins. There were 236 respnses t each questin, 160 frm the residents panel and 76 frm lcal stakehlders. 11

3. Pririties and bjectives The pririties and bjectives that fllw prvide a summary f what partners want t achieve in relatin t health and wellbeing, and why. They have been develped fllwing cnsideratin f the evidence base, key issues we are seeking t address in Ealing, and wrk that is already underway acrss Lndn and within the brugh (as utlined in sectins 2 and 3 abve). A fcus n reducing health inequalities frms part f all the pririty areas, and there are pprtunities t target interventins at particular ppulatin grups and parts f the brugh. Taking frward the pririties in this Strategy prvides an pprtunity t think abut hw we might d things differently. This means there is ptential t cmmissin new prgrammes/activities, t mdify existing appraches, and t stp ding certain things. This will be cnsidered further as actin plans are develped. Sme f the actins that might be taken t achieve particular utcmes are als prvided belw. These are suggestins fr hw the Strategy culd be delivered, which shuld help t guide the develpment f the mre detailed actin and implementatin plans that will fllw. In these pririty areas and pssible actins, we have lked fr things that are likely t d ne r mre f the fllwing: utilise cllective effrt/resurce fr greater impact; be feasible in terms f delivery; be affrdable and demnstrate a gd return n investment; address a gap in current prvisin/need; expand already effective prgrammes/services fr greater impact; and/r develp an untapped pprtunity. The pririties, bjectives, and utcmes that fllw are intended t address ne r mre f the abve factrs, using a partnership-based apprach wherever pssible. The fcus is n identifying new actins r expanding n already successful activities, rather than describing existing wrk. Hwever, in sme cases wrk is already underway that shuld cntribute t ne r mre f the pririty areas. Further infrmatin n wrk already planned please see Appendix 5. 12

Pririty 1: Ensure all partner rganisatins wrk better tgether t imprving health and wellbeing acrss the brugh Why is this a pririty? Many f the issues that we face are extremely challenging, particularly thse that require wide scale behaviur change t reduce the impact f lifestyle factrs (such as besity and smking), addressing the wider determinants f health, and reducing inequalities within the brugh. These are cmplex matters, requiring jined-up and integrated slutins. Partnership wrking, and the crdinatin and alignment f activities, have the ptential t deliver better utcmes fr individuals/chrts, t reduce duplicatin acrss rganisatins, and t end wrking in siles. There are many areas where a cncerted effrt, taken cllectively acrss and within all partners, is likely t have the biggest impact. T achieve this, all rganisatins (and teams within them) need t recgnise the rle they can play, and cmmit t taking actin. Discussins during the develpment f this draft Strategy have indicated the need fr whlesale actin and widespread cmmitment when it cmes t tackling particularly difficult issues. It has als been suggested that there shuld be ambitius gals assciated with these issues, t fcus attentin and ensure all partners and service areas priritise this wrk and devte the resurces needed t reverse current trends. The pririty areas thrughut this Strategy culd all cntribute t the achievement f such gals. Thrugh this bjective we want t encurage a wide range f rganisatins t take cllective actin t achieve better utcmes building n the added value ffered by the existence f the new Strategy, and utilising the Health and Wellbeing Bard t full effect. Implementatin in relatin t this bjective culd be apprached in varius ways; fr example: There culd be a particular fcus n: tackling multiple issues that affect vulnerable peple wh are facing inequalities (t narrw the gap between them and the rest f the ppulatin); aligning interventins arund chrts f peple with high needs / high service use (wh have multiple interactins with different services); and/r taking a hlistic apprach t imprve the care and utcmes fr peple with cmmn mental health cnditins. Outcmes-based cmmissining ffers an pprtunity t cnsider and cncentrate n the brader utcmes we want t be achieved fr individuals r chrts, rather than thinking abut the prvisin f specific needs-based services in islatin. This is a persn-centred apprach, which is ften used effectively t supprt peple with cmplex lng-term health cnditins and/r adult scial care needs. It relies n crdinated services and partnership wrking. Many f the peple wh cme int regular cntact with lcal services are ften facing multiple issues (directly and indirectly related t health and wellbeing), which are intrinsically linked. This means there is ptential t apply the principles f an utcmes-based apprach mre widely. 13

Cmmissining fr value culd be used t identify pririty prgrammes that ffer the best pprtunities t imprve healthcare fr lcal ppulatins. This is abut imprving the value that patients receive frm their healthcare and imprving the value that ppulatins receive frm investment in their lcal health system. 9 Partnership wrking culd include private sectr rganisatins, as well as the public and vluntary sectrs. It culd be used t shape the market fr adult scial care, fr example, by invlving care prviders in the c-prductin f sustainable care slutins. There are als pprtunities fr public sectr partners t make mre extensive use f scial value appraches in their prcurement activities, t imprve the ecnmic, envirnmental, and scial wellbeing f lcal cmmunities, and deliver value fr mney. 10 Evidence indicates a range f benefits in embedding scial value in cmmissining, including imprved service delivery, greater ecnmic grwth, greater engagement with the vluntary sectr, imprved wellbeing and quality f life, and an increase in the resilience f cmmunities. In the lnger term, there is ptential t reduce health inequalities, and t reduce demand n health and ther services. 11 Implementing and embedding scial value invlves making prcurement decisins in a new way that ensures wider benefits are cnsidered thrughut the cmmissining cycle. Key factrs fr success include ensuring strng leadership, invlving a range f staff, reflecting and embedding within ther pririties, wrking cllabratively with cmmunities and prviders, and strengthening partnerships acrss siles thrugh integrated wrking. Key actin 1: Wrk tgether t achieve challenging targets in a small number f key areas that will have a significant impact n majr health cnditins The areas prpsed fr jint wrking t achieve challenging targets are: Reducing childhd besity; Reducing smking prevalence; Increasing physical activity; Imprving health-related quality f life fr peple with mental illness; Increasing scial cntact fr lder peple and carers; Reductin in alchl related hspital admissins; The widespread implementatin f the Making Every Cntact Cunt (MECC) prgramme; Increasing the uptake f the Lndn Healthy Wrkplace Charter by businesses. Further detail n prpsed targets is set ut belw in sectin 6. Pssible activities that culd be explred by lead cmmissiners include: 9 Cmmissining fr Value is a cllabratin between NHS England, Public Health England, and NHS Right Care 10 The Public Services (Scial Value) Act 2012 came int frce n 31 January 2013. It requires the public sectr t ensure that the mney it spends n services creates the greatest ecnmic, scial and envirnmental value fr lcal cmmunities. It applies t lcal authrities, CCGs, acute trusts, ther NHS rganisatins, fire and rescue services, educatin and early years services, plice, husing assciatins, and gvernment departments. 11 Public Health England and UCL Institute f Health Equity: Using the Scial Value Act t reduce health inequalities in England thrugh actin n the scial determinants f health (Practice Resurce Summary, September 2015) 14

Cmmit t cmprehensive, cllective actin t achieve ambitius gals and jint targets fr specific key issues. Cmpnents f this apprach culd include that: targets are agreed, wned and mnitred by the Health and Wellbeing Bard; Bard members each take the lead fr particular targets; this Strategy is used as the basis fr unifying activity arund cmmn gals (imprving partnership wrking); the implementatin plan fr this Strategy clarifies what each rganisatin/team is respnsible fr leading and delivering, and hw thers will be invlved (helping t reduce duplicatin); c-cmmissining is cnsidered in relatin t sme target areas. Develp and implement jint appraches t imprve health and resilience, and/r reduce reliance n public services, in particular chrts. This culd invlve: A range f activities that build resilient individuals and cmmunities (as utlined in Pririty 4) Lcal implementatin f the Like Minded mental health strategy fr Nrth West Lndn (nce actins have been identified and develped) A neighburhd-based apprach, such as imprving health and wellbeing n scial husing estates (links with Pririty 3) A chrt-based apprach, fcused n identifying peple with high cnsumptin f public services (such as unplanned hspital admissins), predicting future use, and then aligning a range f preventative interventins arund that chrt A chrt-based apprach, fcused n helping peple affected by welfare refrm Trialling the use f utcmes-based cmmissining in the Cuncil and CCG as a way t meet bligatins under the Care Act, fr example Increasing scial value in Cuncil and CCG prcurement activities, including measures t: embed scial value cnsideratins thrughut the cmmissining cycle (including in the cre requirements, cntract ntices, pre-qualificatin questinnaire, award prcesses, and thrughut delivery and cntract management, as well as thrugh a prminent psitin in the pre-prcurement prcess); and ensure that lcal prcurement decisins benefit lcal ppulatins in additin t the direct benefit f the services being purchased. Key actin 2: Lead cmmissiners and partners understand the pririties in the Health and Wellbeing Strategy and that this infrms planning, cmmissining and decisin making acrss the partnership A cmmn message during develpment f this draft Strategy has been that mre culd be dne t embed health and wellbeing within ur rganisatins. This includes develping a general understanding abut pprtunities t imprve and prmte health, wellbeing, and resilience 15

thrugh ur wrk, and cnsidering health implicatins during all planning and decisin-making prcesses. At a natinal level, Public Health England has initiated a wrk prgramme n Health in All Plicies. This is seeking t harness the ptential f diverse lcal authrity plicies and services t address the wider determinants f health. Health in All Plicies is defined as an apprach t public plicies acrss sectrs that systematically takes int accunt the health implicatins f decisins, seeks synergies, and avids harmful health impacts in rder t imprve ppulatin health and health equity. 12 Furthermre, there are new duties under the Care Act that need t be cmmunicated, recgnised, and embedded mre extensively thrughut ur rganisatins in relatin t wellbeing, and preventing and delaying the need fr care and supprt (the preventin pathway ). This Strategy culd be a useful mechanism fr cmmunicating infrmatin abut partners new duties, and fr getting teams/rganisatins t cmmit t embedding these things in their wrk. There is currently a lt f infrmatin (and misinfrmatin) abut hw t be healthy, but this des nt always prvide cnsistent guidance, and peple may be verwhelmed with the amunt f detail available. Within many service areas, there are staff wh wuld like t cnsider and prmte basic health and wellbeing messages, but they are unclear abut what t say. What is needed is a set f simple, key messages abut health and wellbeing that culd be: used cnsistently by all rganisatins when cmmunicating with the public and ther stakehlders; and referred t internally when develping plicies, cmmissining dcuments, cntracts, etc. Health and Wellbeing Bard members have imprtant rles t play in terms f cmmunicating cmmitment t the implementatin f the Strategy and helping their rganisatins t lead by example in a psitive way. They can assist with securing cmmitment t the use f cmmn health imprvement and preventin-related messages acrss their rganisatins. Pssible activities that culd be explred by lead cmmissiners include: General cmmunicatin t imprve the understanding f health, wellbeing, and resilience acrss rganisatins, s every team, service area, and cuncillr can recgnising the part they can play Targeted cmmunicatin abut cntributins and cmmitments specific teams can make fr example, running a series f wrkshps t: explain Care Act duties arund wellbeing and cnsider hw these apply acrss rganisatins; and/r t cnsider what different teams can d t supprt carers r t implement the scial care preventin pathway Mental health, dementia and carers awareness training fr staff and elected members 12 Public Health England, Lcal Gvernment Assciatin, and Assciatin f Directrs f Public Health: Health Equity in All Plicies, Masterclass Summary Reprt (2015) 16

Public health specialists wrking clsely with teams thrughut the Cuncil and CCG t prvide a public health perspective in plans, cmmissining dcuments, etc. (this culd invlve ht-desking, fr example) Making changes t internal prcesses and reprt templates t embed cnsideratins (and data) abut health and wellbeing int decisin making Using a plicy deplyment tl t enable health and wellbeing bjectives t be cascaded thrughut the Cuncil/CCG and translated int service plans Ensuring a Health in All Plicy apprach is being taken systematically, using the Lcal Gvernment Assciatin s peer review r facilitated self-assessment tls, and ther natinal guidance Develping a set f cmmn messages abut health and wellbeing (including health imprvement and preventin, mental wellbeing and resilience, and Care Act duties), which all partners cmmit t using Health and Wellbeing Bard members ensure these messages are used thrughut their rganisatins. Key actin 3: Cntinue t develp a jint apprach t service integratin and preventin fr peple with cmplex needs. A significant wrk prgramme is already underway lking at the integratin f health and scial care services. This is an imprtant new mdel fr delivering care, which places the individual and their needs at the centre, and makes sure the whle system s resurces are directed at thse needs. Taking a persn-centred apprach mves away frm disease-specific r rganisatin-specific care, and has the ptential t reduce duplicatin and imprve the efficiency and effectiveness f services. There are pprtunities t learn frm existing wrk, and cnsider hw t expand this mdel t ther chrts. The aim wuld be t prvide hlistic, persn-centred care t ther pririty grups, where there is added value in cllabratin acrss services and ptential t achieve better utcmes fr individuals. Pririty grups that are likely t benefit the mst frm an integrated service apprach include: children aged 0 t 5; peple with lng-term cnditins; frail elderly peple; peple with dementia. Key actin 4: Quickly identify peple with cmmn mental illnesses and imprve quality and availability f apprpriate supprt. Mental health has been identified as a key issue in Ealing, and features in many f the pririty areas in this Strategy. It is essential that we deal with preventin as well as supprting peple with existing mental health cnditins. There is a grwing evidence base arund the use f psychlgical 17

treatments and educatin t prevent mental health prblems. Sme peple are at particular risk f develping cmmn mental health cnditins during perids f stress r change, such as fllwing a diagnsis f a lng-term health cnditin, fllwing the birth f a child, r after mving int a residential care hme. Simple, cst-effective interventins have been shwn t reduce the likelihd f develping depressin, and reduce stress and anxiety. 13 Like Minded Wrking tgether fr mental health and wellbeing acrss Nrth West Lndn is a significant prgramme f wrk is underway t imprve mental health services in the sub-regin. 14 The prevalence f mental health issues amngst yung peple is als high in Ealing and amngst the Nrth West Lndn brughs (at 9.5%, June 2015). The NHS England/Department f Health publicatin Future in Mind Prmting, prtecting and imprving ur children and yung peple s mental health and wellbeing sets ut the natinal visin and ambitin fr children s mental health services. Its recmmendatins relate t wrk at natinal and mre lcal levels. Future in Mind is a five year imprvement plan cvering the perid 2015 t 2020. It cvers all aspects f children s mental health and service delivery at universal. Part f the guidance is fr lcal areas t develp Lcal Transfrmatin Plans t supprt imprvements in children and yung peple s mental health and wellbeing. The guidance sets ut the expectatin that Clinical Cmmissining Grups will wrk with Health and Wellbeing Bards and partners frm acrss the NHS (including NHS England Specialised Cmmissining), Public Health, Lcal Authrity, Yuth Justice and Educatin sectrs t develp the Plan. Pssible activities that culd be explred by lead cmmissiners include: Implementing prpsals in the Nrth-West Lndn strategy fr mental health Like Minded; Explring ways t help peple at risk f pr mental health/wellbeing t build their psychlgical cping skills (including peple wh are islated, such as the elderly and new parents, the unemplyed, carers and peple with lng-term physical health cnditins) Case study Helping peple with lng term cnditins Ealing Cmmunity and Vluntary Sectr (ECVS) has been running a prgramme t place peple with lng term health cnditins int new vlunteering. ECVS staff meet with ptential vlunteers t discuss and advise them n what kind f vlunteering might be mst suitable given their individual health cnditins, then place them in an initial 12 week vlunteering rle and keep in clse tuch with them during that time. This prgramme is transfrming lives thrugh vlunteering. Many f the participants had previusly been unemplyed r scially islated fr years. Mrs Q has depressin and was diagnsed with Schizphrenia 8 years ag. She was very unwell fr many years but felt ready t vlunteer. Mrs Q started vlunteering with a charity shp and this was s successful she was ffered a paid rle as a Retail Assistant. Mrs U has arthritis and back pains which prevent her frm being able t wrk as she cannt stand r sit fr lng perids f time. Mrs U has been ut f wrk due t her cnditin fr ver 28 years; she cmpleted her vlunteering rle as a befriended became a valued vlunteer and has nw been ffered a paid rle with the rganisatin. 13 Mental Health Strategic Partnership: Building Resilient Cmmunities (2013) 14 http://www.healthiernrthwestlndn.nhs.uk/mental-health 18

Pririty 2: Take every pprtunity t imprve health and wellbeing thrugh cntacts with residents and in key settings such as schls and the wrkplace Why is this a pririty? Primary and secndary preventin are an integral part f this Strategy. This pririty area utilises educatinal and wrkplace settings t supprt children, yung peple, and wrking-age adults t: imprve their verall health, wellbeing, and resilience; prevent pr health, by develping healthy preferences and making lifestyle changes; (fr adults) remain in emplyment during perids f illness. There is a particular fcus n encuraging behaviur change in relatin t several f ur key issues: imprving diet, nutritin and physical activity, and reducing besity, alchl misuse, and smking. Supprting peple with, r at risk f, cmmn mental health cnditins (such as anxiety r depressin) is als an imprtant element. Many peple spend a lt f their time in educatinal r wrkplace settings, making these ideal places t emply health imprvement measures. Schls are a particularly influential setting fr yung children, which can be used t implement a range f actins t imprve diets and exercise, and t help students t develp resilience and healthy preferences that can endure thrughut their lives. Imprving the health f ur students and wrkfrces als prvides pprtunities t extend the impact t their families and cmmunities. The NHS is a significant emplyer, with ptential t d mre t supprt health imprvements in its wn wrkfrce. This was highlighted in the NHS Five Year Frward View, which stated: While three quarters f NHS trusts say they ffer staff help t quit smking, nly abut a third ffer them supprt in keeping t a healthy weight. Three-quarters f hspitals d nt ffer healthy fd t staff wrking night shifts. It has previusly been estimated the NHS culd reduce its verall sickness rate by a third the equivalent f adding almst 15,000 staff and 3.3 millin wrking days, at a cst saving f 550 millin. 15 That dcument als ntes the intentin t pursue several initiatives t imprve health and wellbeing acrss the NHS, including: Cutting access t unhealthy prducts n NHS premises, implementing fd standards, and prviding healthy ptins fr night staff. Measuring staff health and wellbeing, and intrducing vluntary wrk-based weight watching and health schemes (which internatinal studies have shwn achieve sustainable weight lss in mre than a third f thse wh take part). 15 NHS Five Year Frward View, page 12 19

Supprting active travel schemes fr staff and visitrs. Ensuring NICE guidance n prmting healthy wrkplaces is implemented, particularly fr mental health. These are wrkplace-related initiatives that culd be cnsidered by ther Health and Wellbeing Bard partners as well particularly in relatin t demnstrating full cmmitment t the eths f the Lndn Healthy Wrkplace Charter. There is als cnsiderable ptential t train the Cuncil, CCG, and wider lcal wrkfrce t deliver public health messages acrss ur cmmunities, using the Making Every Cntact Cunt apprach. Key actin 5: Our early years ffer prvides a cmprehensive range f supprt t give children the best start in life and lks fr pprtunities t imprve the health f the whle husehld and that healthy behaviurs are embedded n int schls and further educatin Our early years ffer prvides a cmprehensive range f supprt t give children the best start in life and lks fr pprtunities t imprve the health f the whle husehld and that healthy behaviurs are embedded n int schls and further educatin Giving children the best start in life is a cre cmpnent f recmmended appraches t reducing health inequalities. In relatin t nutritin, this can be achieved in part by helping children t establish healthy eating patterns and fd preferences frm an early age. The prmtin f breastfeeding, and nutritin cunselling fr pregnant wmen, new parents and caregivers, are ptential mechanisms fr affecting early feeding practices. Nutritin cunselling/educatin can als encurage families t change their wn fd preferences, affecting what children will g n t eat and drink as they grw up. Reducing childhd besity and imprving ral health are key issues fr this Strategy. Research int besity has emphasised that schls and early years settings are influential places fr yung children, which can help them t develp healthy behaviurs. Specific actins t imprve diets in these settings include: the prvisin f fruits and vegetables; fd-based and nutrient-based standards fr the meals available in schls; changes t presentatin and financial incentives fr fd chices at pint f purchase; and nutritin educatin fr students, teachers, and catering staff. 16 In September 2015, changes t the cmmn inspectin framewrk used by Ofsted fr all early years settings, schls, and further educatin prviders came int effect. This nw includes judgements n persnal develpment, behaviur and welfare. It invlves lking at the extent t which prviders are successfully supprting students t gain knwledge abut hw t keep themselves healthy, including thrugh healthy eating and exercising. Inspectrs will be lking fr evidence f this eths thrughut their visit, in classrms as well as canteens. They will lk at the fd n ffer, the atmsphere, and the breadth f the curriculum. There is ptential t use changes t Ofsted inspectins as a basis fr encuraging all educatin settings t d everything they can t supprt health and wellbeing. 16 Hawkes, Crinna, et al: Smart fd plicies fr besity preventin (published in The Lancet besity series, Vl 385, June 2015) 20

Pssible activities that culd be explred by lead cmmissiners include: Using changes t Ofsted inspectins as a basis fr ensuring all educatin settings are ding everything they can t supprt health and wellbeing, and t change unhealthy behaviur, including: Prviding healthy fd t children and yung peple Reducing access t, and/r disincentivising cnsumptin f, unhealthy fd and drink Prviding healthy eating educatin fr children, their families, teachers, and catering staff Prmting a culture f exercise Messages t prevent smking and alchl/substance misuse Awareness-raising in relatin t mental health issues Helping children and yung peple t build resilience Using the Cuncil s rle in the develpment and/r financing f educatin facilities t build in health prmtin prvisins Pilting a scheme f mini health champins / peer supprt netwrks within schls t increase healthy eating and drinking, and physical activity Case study Reducing childhd besity In 2007/08 40% f year 6 pupils at Berrymede Junir Schl were either verweight r bese. 17 The schl lked int what was happening and a number f issues were highlighted that cntributed t this issue: 23% exercised everyday 38% ate sweets n at least 2-3 days a week 27% ate 5 prtins f fruit and vegetables a day 11% ate n fruit r vegetables 34% had a filling last time they d visited the dentist T tackle this, the schl fcussed n getting pupils active s a dedicated PE teacher was emplyed wh carried ut tw hurs f high quality PE. New play equipment and facilities supprted pupil activity with cmpetitins t encurage this. Teachers were als trained t bring health and wellbeing elements in their lessns. S far, a number f benefits have been nted included a psitive change in behaviur twards physical activity and healthy eating, imprved cncentratin, md and attainment amngst pupils in class. By 2013/14, the weight f year 6 pupils had reduced by 5% frm the 2007/2008 figure t 35%. Significantly, Berrymede Junirs was the ne f nly tw schls in Ealing t see a reductin in the weight f its pupils ver this perid. 17 (NCMP 2007/08). 21

Key actin 6: A wide range f Ealing emplyers adpt the Lndn Healthy Wrkplace Charter, t imprve wrkplace-based health and wellbeing fr emplyees acrss the brugh Wrk plays a key rle in helping peple t be in gd mental and physical health. Evidence suggests that healthy wrkplace prgrammes can encurage psitive lifestyle changes. We spend 60 per cent f ur waking life at wrk. Of Ealing residents in wrk, 26 per cent f them wrk in Ealing. Therefre, a significant imprvement in the health f Ealing s wrkfrce will benefit the health f the brugh s ppulatin. The aim is t create and sustain healthy wrkplaces acrss Ealing, starting with Health and Wellbeing Bard and LSP partners. The Lndn Healthy Wrkplace Charter is a ptentially useful mechanism fr achieving this bjective. The Cuncil has already been accredited under this scheme. As nted abve, the NHS Five Year Frward View emphasises that the NHS needs t d mre t supprt emplyees t be healthy. Healthy wrkplaces make ecnmic sense. The Charter has estimated a return n investment f 9 fr every 1 invested, as a result f reduced sick leave and staff turnver and increased prductivity. Given that Cuncil and NHS venues are wrkplaces, as well as places that might be visited and used by children and yung peple, NICE quality standard 94 (referred t in Pririty 3 belw) has brader applicability. It culd be used t encurage healthy behaviur in emplyees, as part f appraches t supprting weight management and lifestyle changes. The Health and Wellbeing Bard needs t wrk with the Lcal Strategic Partnership t identify and prgress ways t increase uptake Lndn Healthy Wrkplace Charter in member rganisatins, and mre widely acrss Ealing emplyers. Case study Healthy Wrkplace Charter Wellwrking Ltd is a supplier f furniture and services t the wrkplace and hme. Wellwrking s missin is everything abut wrking well in terms f quality furniture and envirnments. In 2015 Wellwrking cmmitted at Directr level t make the wellbeing prgram a central fcus f the business. Based n this the Healthy Wrkplace Charter is a lgical prgressin fr them, demnstrating the cmmitment t emplyee Health & Wellbeing and making their wn wellbeing prgramme mre effective. It has allwed them t benchmark against ther rganisatins and learn as well as hpefully teach thers. Emplyee health and wellbeing is central t the business and achieving the Charter will be a frmal validatin f this. Wellwrking s belief is that imprved emplyee health and wellbeing leads t imprved business utcmes and mre fundamentally that it is imprtant t encurage emplyee health and wellbeing simply because it is the right thing t d. 22

Key actin 7: Making Every Cntact Cunt is embedded acrss the Cuncil and CCG and is used in a wide range f ther public, private and cmmunity settings The NHS Mandate fr 2015/16 includes an bjective fr NHS England t fcus n preventing illness, with staff using every cntact they have with peple as an pprtunity t help them t stay in gd health by nt smking, eating healthily, drinking less alchl, and exercising mre. 18 This apprach is als being champined by the Lcal Gvernment Assciatin (LGA). 19 Ealing Cuncil is starting t rll ut Making Every Cntact Cunt (MECC), fcusing n healthy eating, physical activity, smking, alchl/drugs, and mental health. MECC is an evidence-based, cst and clinically effective initiative, which is starting t be widely used by health and wellbeing partners acrss England. It invlves training the wider public sectr wrkfrce t deliver basic public health messages and t engage residents in health change cnversatins. 20 Staff thrughut the Cuncil and CCG (and in the services we cmmissin) cme int cntact with a significant number f lcal residents every day, prviding multiple pprtunities t encurage them t make psitive lifestyle changes. The aim is t equip these staff with the skills t start cnversatins and prvide brief advice/interventins. There are a range f shrt and lnger term benefits assciated with implementing MECC, including financial, efficiency, and service user benefits. MECC training is als advantageus t staff: evaluatins have shwn that many f thse trained imprved their wn health behaviurs as a result, and applied their new skills t family and friends. Pssible activities that culd be explred by lead cmmissiners include: Expand and embed the use f Making Every Cntact Cunt acrss and within Health and Wellbeing Bard partners, and external service prviders, by: Securing senir-level buy-in, backed up with targets fr the number f staff trained per year (linked with ambitius targets in pririty 1) Managers cmmitting t ensuring all staff wh want t d basic MECC training can d s, and will use what they have learned t train members f their team Cuncillrs cmmitting t ding basic MECC training, s they are cmfrtable encuraging peple they meet t take actin t imprve their health Creating MECC champins within each rganisatin Including MECC requirements in Cuncil and CCG cmmissining dcuments and cntracts with prviders (with targets fr the percentage f cntracts that will include these requirements) Including requirements t d MECC training in the cntracts f frnt line staff 18 Department f Health: A mandate frm the Gvernment t NHS England: April 2015 t March 2016 (December 2014), p.8 19 Fr example, in the Lcal Gvernment Assciatin reprt, Making every cntact cunt: Taking every pprtunity t imprve health and wellbeing 20 Accrding t case studies cllected by the Lcal Gvernment Assciatin, in sme places between 1,000 and 2,000 staff have been trained in MECC, including peple wrking in the Fire Service, Plice, and libraries 23