ayrshire and arran nhs board · for children, the jumpstart evening programme and the jumpstart...
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Paper 6
Ayrshire and Arran NHS Board Monday 30 March 2015 Health Improvement Strategies and Action Plans Author: Claire Gray, National Management Trainee
Sponsoring Director: Dr Carol Davidson, Director of Public Health
Date: 9 March 2015
Recommendation The Board is asked to consider the content of the paper provided and review the progress being made with Health Improvement Strategies and Action Plans.
Summary This overarching Health Improvement Strategies paper brings together and provides an update on all NHS Ayrshire & Arran’s current Health Improvement Strategies/Action plans. There are multiple strategies and action plans working together to protect and improve the health and wellbeing of the population and reduce inequalities through advocacy, prevention and anticipatory care (Corporate Objective 2) illustrated via recent achievements and future work. Key Messages:
There are many strategies and action plans addressing Population Health
Improvement.
The strategies are outcome focused and inequalities are addressed throughout
each of the strategies.
These strategies support achievement of the national 2020 vision and NHS Ayrshire
& Arran’s own strategic direction as laid out in Our Health 2020.
The strategies are, as far as possible, developed in partnership with communities
and partner organisations through wide engagement and consultation.
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Glossary of Terms
AHP WATOM ABCD A&E A&A ADP AHEAD AHP BBV BMI CEL CHS CHW FGM FVA GBV GP HEDG HIV HPHS HPPG HWS HWL ISD KPI NDIP NHS A&A NRT SIMD SPS WRAP
Allied Health Professional - Work, Alcohol, Tobacco, Obesity, Mental Health Asset Based Community Development Accident and Emergency Ayrshire and Arran Alcohol and Drugs Partnerships AyrsHirE Asset Development Allied Health Professional Blood Borne Virus Body Mass Index Chief Executive Letter Child Health Strategy Child Healthy Weight Female genital mutilation Fluoride varnish applications Gender Based Violence General Practitioner Health and Employability Delivery Group Human immunodeficiency virus Health Promoting Health Service Health Promoting Prison Group Healthy Weight Strategy Healthy Working Lives Information Services Division Key Performance Indicators National Dental Inspection Programme NHS Ayrshire & Arran Nicotine replacement therapy Scottish Index of Multiple Deprivation Scottish Prison Service Wellness Recovery Action Planning
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Introduction Improving the health of the population is a challenging process, especially in an economic environment that mitigates against the determinants of good health. Of fundamental importance is the recognition that health and health inequalities are the result of a complex and wide-ranging network of factors. People who experience material disadvantage such as poor housing, insecure employment, low income, lower educational attainment, poor access to services or are living in fear are among those more likely to suffer poorer health outcomes and an earlier death compared with the rest of the population. The complex nature of health and health inequalities requires a range of different approaches. Addressing the underlying determinants of health inequalities, such as unemployment, low income and poor housing is essential if we are to sustain an improvement in health status and a reduction in health inequalities in the longer term. Partners in the three Community Planning Partnerships are engaged in a range of initiatives that will support the wider inequalities agenda and address some of these issues. Other important approaches are lobbying and advocacy to make changes at policy and governmental level. The developments in tobacco policy in Scotland, moves around alcohol access and pricing, as well as arrangements with the food industry (thus far) are all a result of years of lobbying and challenging policies at national level. Similar initiatives are reflected at local level in employing organisations, local alcohol provision etc. Within the context of the above, supporting people to choose a healthy lifestyle can have an impact on their health and wellbeing. For example, stopping smoking remains the single most preventable cause of ill health and addressing alcohol issues is important for individuals, families, communities, local services and society in general. However, it is easier for some sections of society to make healthy lifestyle choices than it is for others. Environmental factors such as poor transport links, lack of access to amenities, pressures of daily life, stress and lack of time can create barriers to people making healthier choices. These environmental factors can also be exacerbated by the challenges some people face in accessing appropriate information and advice in order to make informed choices about a healthy lifestyle. It is important that the health inequalities gap is not widened by health improvement activity; accordingly, each strategy and action plan aims to adopt an inequalities sensitive approach, and strives to ensure that there is a proportionate response to need within each community affected by the strategy. All the strategies and action plans outlined below are led by the staff in the Department of Public Health. Some of the strategies have one or more action plans associated with them. There are some additional action plans which do not have overarching strategies, but are required to be done for a variety of reasons. However, almost all of them are multi-agency in nature and many of them have been adopted by (previous) Community Health Partnerships and/or Community Planning Partnerships. Some have HEAT targets, some are required by the Scottish Government, and some are developed as a response to local need.
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All of them are focused on the whole population of Ayrshire and Arran with the aim of improving and maintaining its health & wellbeing. Appendix 1 provides information on the life span of each strategy/action plan referred to in the body of the paper. Further information can be found on the Public Health AthenA website. The process of moving the information to the public NHS Ayrshire and Arran (NHS A&A) website is underway.
Health Improvement Strategies in Ayrshire & Arran, 2015
Tobacco Control
Healthy Weight
(Obesity)
Mental Health & Wellbeing
Child Health
Oral Health
Sexual Health
Range of Action plans
BBV Framework
Physical Activity Action
Plan
Maternal & Infant
Nutrition
Alcohol and
Drug Partnership Strategies
Gender Based
Violence
inequalities inequalities inequalities; inequalities
Population Health
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1. Strategies 1.1 Alcohol The three local ADPs lead the alcohol and drug strategies and action plans in their respective localities. Many organisations, including NHS A&A, are partners in this work and various departments and staff within NHS A&A contribute to the implementation of the strategies.
1.2 Tobacco Strategy including Fresh Air-shire The vision for NHS A&A in relation to Tobacco Control is 'Working towards a Smoke Free Ayrshire and Arran'. This is a 10 year strategy (2012-2021) which will have a series of three year action plans (the first being 2012-2015). The 2014/2015 HEAT target related to successful quits at one month, and was targeted at deprived areas. This target was met. The 2015/2016 HEAT target has changed and relates to successful quits at three months, again, targeted at deprived areas. Progress towards this target has been slow due to a parallel change to the community Pharmacy recording system. We are however, working hard to meet the end of year target. From 30 March 2015, the grounds of NHS A&A will be smoke free. In preparation there has been extensive engagement with the staff and public on the new policy and numerous communication methods are being utilised to ensure everyone is aware of the impending policy change. For any other information on local work or the Tobacco Strategy please contact Elaine Young, Assistant Director of Public Health [email protected] or Brenda Knox, Health Promotion Manager, [email protected]. 1.3 Healthy Weight Strategy The HWS is a 10 year strategy (2014 – 2024) with a three year action plan (2014-2017) which aims to achieve the Healthiest weight possible for everyone in NHS A&A, and to halt the rise in the levels of overweight and obesity among children and adults by 2024, and ultimately reduce them. The 2011/2014 HEAT child healthy weight target was met and exceeded. This target was to achieve1,057 completed child healthy weight interventions over the three years ending March 2014 with at least 40% of the children from the Scottish Index of Multiple Deprivation (SIMD) Quintiles 1 or 2. 1.3.1 Jumpstart Action Plan: For children, the JumpStart evening programme and the JumpStart Choices schools programme continues to be delivered across Ayrshire. Jumpstart is a specifically designed 10 week programme for children and young people aged five to 15 who are overweight or obese. For further information on Jumpstart contact: Alan Brown, Health Promotion Officer [email protected].
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For adults, ring fenced funds have been provided to deliver an adult weight management programme in partnership with the three local authorities. 1.3.2 Breastfeeding Action Plan: Since April 2013 an action plan has been developed to improve maternal and infant nutrition and now forms a key strand of the Ayrshire HWS. This action plan is monitored via Covalent and local breastfeeding data is provided by ISD Scotland. NHS A&A breastfeeding rates at the six to eight week review have been consistently below the Scottish average since 2002. However, following a period of intensive activity particularly over the last five years, the breastfeeding rates have begun to show improvements. The most recent data shows that in 2013/14, 19.3% of babies in Ayrshire were exclusively breastfed at six to eight weeks, compared to 16.9% in the previous year. During the same year, the breastfeeding rates in each locality were as follows:
East Ayrshire: 17.9% (compared to 15.1% in 2012/13)
North Ayrshire: 17.6% (compared to 14.9% in 2012/13)
South Ayrshire: 23.8% (compared to 22% in 2012/13). 1.3 3 Physical Activity Action Plan: As part of the overall approach of the HWS, NHS A&A is committed to encouraging our local population to becoming more active. Work is currently being conducted on five key outcomes which are detailed within the “Public Health Physical Activity Work plan 2014-15” and performance is monitored though Covalent. For any further information or to see a copy of the current work plan, please contact Kevin Lyle, Health Promotion Officer [email protected] or Joanne Inglis, Health Promotion Officer [email protected]. For more information on the Healthy Weight strategy, or any of the associated plans, please contact Ruth Campbell, Consultant Dietician in Public Health Nutrition ruthcampbell@ nhs.net. 1.4 Mental Health and Wellbeing Strategy There is a new 12 year strategy (2015-2027) aimed at achieving the best mental health and wellbeing possible for everyone in Ayrshire and Arran by addressing three main areas.
Sustaining inner resources
Increasing social connectedness and trust in families and communities
Creating mentally healthy environments for working and learning.
There are a number of initiatives underway to support these. A few examples are: work to promote the use of the Positive Mental Attitude Curriculum pack in schools, addressing stigma through drama at Ayrshire College and Wellness Recovery Action Planning (WRAP) Workshops are being delivered by trained facilitators to promote wellness. For more information, please contact Anne Clarke, [email protected] and Nicola Tomkinson, Advanced level WRAP facilitator for WRAP [email protected].
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1.4.1 Gender Based Violence Action plan NHS Boards across Scotland have been tasked with implementing Routine Enquiry of domestic abuse in six priority settings within healthcare delivery: maternity, community nursing, sexual health services, mental health services, addiction services and A&E. Work is well underway but much remains to be done and additional areas, such as Occupational Health and Learning Disabilities have indicated an interest in implementing this too. There is also an NHS A&A policy for staff in relation to GBV. Action on GBV includes work on commercial sexual exploitation, stalking and harassment, human trafficking, forced marriage and female genital mutilation (FGM). NHS A&A works in partnership with the three Violence against Women partnerships in each Local Authority area to address these issues. There is a new three year action plan which has been developed together. It is monitored via Covalent. For more information, please contact Anne Clarke, [email protected] or Maureen Kater, Health Promotion Officer [email protected]. 1.5 Child Health Strategy The current nine year strategy (2008-2017) aims to improve the health and wellbeing of local children and young people up to 19 years of age. The Child Health Strategy currently forms the “health” section of the local Integrated Children’s Services Plans. Following health and social care integration, it has been agreed to develop a shared health and wellbeing policy framework across NHS A&A. This framework will inform the new Integrated Children’s Services Plans which will be prepared from 2016. There are many changes in the policy context for improving child health, not least of these the implementation of the new Children and Young People (Scotland) Act 2014. It is intended to present a paper to the NHS Board in June 2015 bringing forward a Child Health & Wellbeing policy framework. A rapid joint strategic needs assessment was recently conducted to help focus interventions and it set out key areas where action can be taken to reduce serious adverse events in childhood such as hospital admissions, injury, premature death, neglect and maltreatment. The Department of Public Health supports the Early Years Collaborative on a variety of work streams and also works closely with local schools, ensuring that the health & wellbeing strand of Curriculum for Excellence is supported. For more information please contact Dr John O’Dowd, Deputy Director of Public Health john.o’[email protected] 1.6 Oral Health Strategy The vision for this 10 year strategy (2013-2023) is “The Best Oral Health possible for the People of NHS A&A” and it also has a three year action plan (2013-2016). The national oral health improvement programme for children, Child Smile, has been fully implemented in NHS A&A. As a result, the proportion of children with no obvious decay is increasing. The NDIP in 2014 found that 66% of Primary 1 children in A&A had no obvious signs of decay, while the 2013 results for Primary 7 showed that 80.2% of 11/12
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year old children show no obvious dental decay in any of their permanent teeth. In addition, the inequality gap in children’s oral health has been reduced. The percentage of adults and children registered with an NHS dentist in NHS A&A has also continued to increase.
Work is also underway in care homes for older people, care settings for adults with additional needs, homeless support units and the local prison, resulting in many staff being trained in oral care. For ongoing work or further information please contact Dr Maura Edwards, Consultant in Dental Public Health [email protected]. 1.7 Sexual Health Strategy 2011-16 The national Sexual Health and Blood Borne Virus Framework sets out the Scottish Government’s agenda in relation to sexual health, HIV, hepatitis C and hepatitis B. For the first time, these four policy areas have been brought together into a single integrated strategy. The Framework reflects an ambitious vision for sexual health and BBV in Scotland. It adopts an outcomes based approach anchored by effective shared ownership and joint working with a strong focus on challenging inequalities. To support the achievement of the sexual health outcomes within the framework, a five year strategy (2011-2016) was developed which built on previous achievements within the sexual health agenda. The key priorities include increasing awareness and knowledge of the factors which affect sexual health and well being, reduce the levels of unplanned teenage pregnancies, increase the uptake of screening opportunities and increase the uptake of testing for Sexually Transmitted Infections. The BBV Managed Care Network oversees the implementation of the specific BBV outcomes of the framework. For more information please contact Lynda Hamilton, Public Health Specialist [email protected] or Sharon Hardie Health Promotion Manager [email protected] 2. Action Plans 2.1 Health Promoting Health Service Action Plan 2012-1015 The HPHS Steering group are in the process of drafting the final Annual report for this Chief Executive Letter which will be submitted to the Scottish Government by 30 April 2015 and which details progress made in relation to the performance measures highlighted in CEL 01 (2012-2015). For example:
Routine physical activity promotion has been embedded into clinical settings e.g. pet therapy to encourage walking, use of hospital gym, use of walking path at Ayr and Ailsa Hospitals
Patient documentation has been revised to record physical activity status
Staff within the learning disability service have been trained to carry out health checks within the Assessment and Treatment Unit
Allied Health professionals routinely signpost to services to improve lifestyles e.g. smoking cessation, physical activity etc
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Increased awareness of how libraries can support health and wellbeing. This initiative won best poster in Person Centred Health category at NHS Scotland event 2014.
For any other information on HPHS please contact Elaine Young, Assistant Director of Public Health [email protected] or Sarah Bush, Health Promotion Manager [email protected]. 2.2 Greening the NHS Estate This is a joint initiative between NHS A&A and the Green Exercise Partnership (Forestry Commission Scotland, NHS Health Scotland and Scottish Natural Heritage). In 2011 a strategic review of the whole NHS A&A estate was carried out. Seven sites were identified as providing the greatest potential to improve health and wellbeing for staff, patients and visitors and enhance the natural environment in order to promote biodiversity. The University Hospital Ayr and Ailsa site was designated the Board’s National Demonstration site. In 2013, one woodland walk was upgraded and another path was developed on the Ayr /Ailsa Campus. Phase two is now underway. Extensive woodland management works have taken place and over 2,500 trees have been planted. Funding has been secured to create a third woodland walk and improve access around the site for walkers and cyclists as well as creating outdoor teaching spaces and installing seating, signposting and information boards. Work is also underway at the North Ayrshire acute mental health and community hospital facility to build in walking and cycling routes as part of the development of the site. For more information please contact Elaine Caldow, Lead Public Health Practitioner [email protected] or Karen Dow, Health Promotion Officer [email protected]. 2.3 Assets Based Approach Action Plan A number of initiatives using asset based methodology are being taken forward in Ayrshire. The biggest of these is the AHEAD project. This is a three year demonstration programme (2013-2016) which seeks to identify community interests and use the assets in those communities to grow engagement around these shared interests. The theory is that this helps to build confidence and capacity in communities, allowing communities to take more control of their area and the services within them. More information is available on AthenA or alternatively contact: Anne Clarke, Assistant Director of Public Health, [email protected] or Sharon Hardie Health Promotion Manager [email protected] or Clare Black, Health Promotion Manager [email protected]. Both Greening the NHS Estate and the AHEAD assets based approach are funded by NHS Endowments and delivery is supported by NHS staff. 2.4 Inequalities and Welfare reform Action Plan Actions have been implemented in partnership to mitigate the impact of the Welfare Reform which is predicted to have a disproportionately negative effect on vulnerable population groups. Work is underway to develop/adapt an E-Learning Module on Welfare
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Reform for staff with vulnerable client groups to raise their awareness of the likely impacts on their patients. Regular briefings are distributed to all NHS A&A staff on Athena when available. Over 18,000 Scottish Welfare Fund leaflets were distributed via health in partnerships with East, North and South Ayrshire Councils. For more information please contact Marlene McMillan, Lead Public Health Practitioner [email protected]. 2.5 Work, health and wellbeing The national Health and Employability Delivery Group was established in 2009 to support NHS Boards to maximise their role in supporting the employability agenda. Progress in A&A includes: the development and delivery of a health and employability training programme; the creation of single points of contact to assist staff to signpost patients to employability services; and the implementation of the Work, Alcohol, Tobacco, Obesity, Mental Health initiative by Allied Health Professionals. NHS A&A also hosts Working Health Services which supports employees from Small and Medium sized Enterprises who are absent from work due to ill health to return to work, and will also host the new Fit for Work service which is currently being rolled out nationally. The organisation also actively supports training, work experience and employability placements including: Get Ready for Work; Pathways to Skills and Project Search. For more information please contact: Maggie Vooght, Case Manager- Working Health Services [email protected], Sandra Murphy, Employability Advisor [email protected] Development or Elaine Caldow, Lead Public Health Practitioner [email protected] 2.6 Detect Cancer Early Action Plan This action plan aims to improve the five year survival rate for people in Scotland diagnosed with cancer and encourage people to present to their GP earlier. Work is being delivered in communities across Ayrshire and Arran to raise awareness of the importance of early detection, screening and the common signs. By the end of December 2015, the HEAT target is to achieve a 25% increase over the baseline proportion of those diagnosed and treated in the first stage of cancer (for the three types combined: breast, colorectal and lung). To date, there has been a 4.7% increase to 24.3% in the percentage of people diagnosed at stage 1. For further information please contact: Kay Cooper, Senior Health Promotion Officer [email protected] or Gillian Jennings, Health Promotion Officer [email protected]. 2.7 Healthy Working Lives Action Plan HWL helps employers better protect and promote the health, safety and wellbeing of their employees through a mixture of support and services. The local workplace team work to a range of key performance indicators which are regularly reported to the national HWL Directorate. These KPIs include reporting on the number of employers accessing services and attending training and awareness sessions. We have had thirteen award winning companies in Ayrshire since April 2014 and it is a fantastic achievement to have seven Gold winning companies in Ayrshire this year. In addition, the HWL team was delighted to
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have had all three finalists of the Scottish Health Award – Health in the Workplace from Ayrshire based companies, with the major award going to John Miller from EDF Energy Nuclear Generation Ltd – Hunterston B Power Station. For further information or to view the national logic models please contact Lesley Reid Health Promotion Manager [email protected] or the Workplace team on 01292885855 or by email at [email protected] 2.8 Health Promoting Prison Action Plan This Action Plan focuses on promoting health among the prisoner population of HMP Kilmarnock and builds on the health promotion activities which have taken place over many years. These activities include; oral health needs assessment, sexual health training, smoking cessation services and a comprehensive health needs assessment. It utilises the Scottish Prison Service framework for improving health in Scotland’s prisons “Better Health, Better Lives for prisoners” which is fundamentally guided by “Equally Well” (Scottish Government, 2008) and other key policies that drive improved health and wellbeing in Scotland. HMP Kilmarnock has had, for a number of years, a proactive multi disciplinary Health Promoting Prison Group who have supported and contributed to the implementation of the key health promotion activities within the prison. The action plan was previously developed for years 2011 -2014; it has now been extended until 2015 and includes additional actions, programmes and initiatives. It is anticipated that a new action plan will be developed in 2015 based on developments from the Scottish Prison Service National Health Improvement Group, Prison Healthcare Network and Health & Justice Collaboration. For further information on Health Improvement & Justice please contact Sharon Hardie, Health Promotion Manager [email protected] or Kevin Lyle, Health Promotion Officer [email protected] 3. Other NHS strategies Department of Public Health staff contribute to strategies and action plans led by other colleagues, such as the Maternity Strategy, the Learning Disabilities Strategy, the Health Safety & Wellbeing Strategy and many others.
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Monitoring Form
Policy/Strategy Implications
Each strategy has its own implications which have been separately addressed
Workforce Implications
Some of the strategies and action plans have implications for capacity building of NHS staff
Financial Implications
Addressed within each strategy/action plan
Consultation (including Professional Committees)
Completed for each strategy/action plan as required
Risk Assessment
Completed for each strategy/action plan as required
Best Value - Vision and leadership - Effective partnerships - Governance and
accountability - Use of resources - Performance management
Addressed within each strategy/action plan, as required
Each strategy/action plan is lead by the Public Health team, fulfilling our role as leaders for population health in Ayrshire
Almost all the strategies and action plans are supported by a multi-agency partnership group; where plans belong only to the NHS (e.g. the health promoting health service), it is multi-disciplinary and involves members of patient groups and community representatives
There are robust internal governance routes within the public health department and all strategies and action plans are subject to these. Some plans are also subject to wider governance scrutiny, such as Healthcare Governance or other LA scrutiny groups
Some strategies and action plans have ring fenced funding associated with them, which require to be accounted for to both the Scottish Government and local finance systems. Audits are also completed on packages of funding, such as the “prevention bundle”
Almost all the strategies and action plans are monitored on the Covalent performance management system.
Compliance with Corporate Objectives
Corporate objective 2 is where the majority of the strategies and action plans are located, but some also impact on corporate objectives 1, 3, 6 and 8
Single Outcome Agreement (SOA)
Many of the strategies and action plans are implemented via the three SOAs
Impact Assessment
Impact assessments are undertaken for each strategy and action plan individually
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Appendix 1 Health Improvement Strategies “At a Glance”
‘08 09 10 11 12 13
14 – 15 NOW 16 17 18 19 20 21 22 23 24 25 26
27
Mental Health and Well Being Strategy
New mental Health and Well Being Strategy:12 year strategy with 3 year action plans
Gender Based Violence Policy (NHS A&A) (PIN policy: HR led*)
Oral Health Strategy
The Oral Health Strategy - 10 year strategy with a 3 year action plan. This is linked to a HEAT target
Child Health Strategy (CHS)
Child Health strategy is a 9 year strategy
Tobacco Strategy including Fresh Ayrshire
The Tobacco Strategy - 10 year strategy with a 3 year action plan. This is linked to a HEAT target
No Smoking Policy (NHS A&A)* - working towards implementation of smoke free grounds
Healthy Weight Strategy (HWS)
The Healthy Weight Strategy - 10 year strategy with a 3 year action plan
Implementation of the Jumpstart programme. This is linked to a HEAT target
Physical Activity Action Plan (NHS A&A)
Breastfeeding Action plan
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‘08 09 10 11 12 13
14 – 15 NOW 16 17 18 19 20 21 22 23 24 25 26
27
Sexual Health and Blood Borne Viruses Strategy
Sexual Health and Blood Borne Viruses Strategy - 5 year strategy
Health Promoting Health Service (HPHS) Action Plan
This is linked to the CEL 01 (2012-2015)
Greening the NHS Estate Action plan supports aspirations of HPHS
Assets Based Approach Action Plan
This is a 3 year programme which supports the Co-Production action plan
Inequalities and Welfare reform Action Plan
No exact dates have been set yet
Employability Action Plan*
Established in 2009 and ongoing
Detect Cancer Early Action Plan
Established in 2012 and ongoing. This is linked to the HEAT target which ends Dec 2015
The Alcohol and Drugs Strategy
This Alcohol and Drugs Strategy is being reviewed and implementation of the 3 year action plans are predominantly lead by the Alcohol and Drug Partnerships
Substance Misuse Policy (NHS A&A)*
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‘08 09 10 11 12 13
14 – 15 NOW 16 17 18 19 20 21 22 23 24 25 26
27
Healthy Working Lives (HWL) Action Plan
This is an ongoing programme of work
* Not led by Public Health