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Health and Well-being Luton's Partnership Strategic Plan 2009-2011

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					Health and Well-being
Luton’s Partnership Strategic Plan
2009-2011

1.      INTRODUCTION
This strategic plan sets out the Health and Well-being Board’s vision for
improving the health and well-being of adults in Luton to 2026. It identifies our
key aims and objectives for improving health and well-being and the outcomes
that we want to achieve. The strategy will be reviewed every three years in
line with the Local Area Agreement (LAA) refresh process. This will allow us
to agree new improvement targets every three years and include other health
and well-being priorities as they emerge.

The Health and Well-being strategic plan supports the delivery of the health
and well-being priorities identified within the Sustainable Community Strategy
(SCS). It also supports the delivery of NHS Luton’s five year strategic plan.
This strategic plan reinforces the health priorities in the SCS but also identifies
some additional key priorities for Luton which are not included within the SCS.

The SCS describes Luton Forum’s vision for how Luton will be in 2026.
Health and well-being is one of four key themes identified within this strategy
which will contribute to delivering the vision. The SCS is underpinned by
shorter term (three year) plans and will support the achievement of the three
year improvement targets which have been agreed to support the national
indicators relating to health and well-being identified in the LAA.

NHS Luton’s five year Strategic Plan is based on evidence of what is causing
the life expectancy gap in Luton and sets out three strategic priorities for
reducing that gap: the improvement of public health; transformation of primary
care and our overarching commitment to improving the quality of healthcare
services we commission. Through the development of public health it shows
how NHS Luton will work with all of their partners and local communities to
increase capacity and capability in order to ensure that people are
empowered to improve their own health and well being, including the
prevention of ill health and self care. Through the transformation of primary
care it shows how NHS Luton will move services from secondary into local
primary care settings, ensure there are sufficient GP’s for our local population,
increase the quality of primary care, and maximise early intervention for long
term condition prevention and management in primary care. Through
improving the quality of the services we will ensure that the best services are
provided, in line with the patients needs, and in a manner that optimises
efficiency, value for money and productivity.
The Health and Well-being strategic plan brings together and builds on a
number of existing strategies related to improving health and reducing health




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inequalities in Luton. (See appendix 1 for list of supporting strategies). This
bringing together of existing strategies will help to ensure a shared
understanding of the key health and well-being priorities in Luton and provide
a strategic framework for addressing these priorities.

The strategic plan has also been informed by the Joint Strategic Needs
Assessment (JSNA) 2008 and the Annual Public Health Report (APHR) both
of which provide a rich source of data and information on health in Luton. The
key issues in the JSNA have been taken into account in preparing the SCS
and the Health and Well-being strategy.


2.      SCOPE
It is widely recognised that issues such as education, employment and
transport all have a significant impact on health and well-being. Detailed
strategies and plans already exist to address these key areas in Luton which
are monitored by the other theme groups of the Luton Forum. This strategic
plan does not seek to reproduce these strategies and plans but to
acknowledge and reference them as appropriate.

This strategic plan does not directly address issues relating to the health and
well–being of children and young people. Issues affecting the health and well-
being of children and young people are addressed in the Children and Young
People’s plan which is monitored by the Children and Young People’s Trust
Board. However it is envisaged that through implementing this strategic plan
there will be some indirect benefits for children and young people in Luton.


3.    NATIONAL POLICY CONTEXT
National guidance on health and social care has been plentiful in recent
years. The most important and significant being the two White Papers: Our
Health, Our Care1, Our Say and Choosing Health2 and the Green Paper
Independence, Well-being and Choice3.

In January 2006, the Health and Social Care White Paper ‘Our Health, Our
Care, Our Say: a new direction for community services’ was published. It set
out a vision for better health and social care services by locating more
services in the community and care closer to where people live. Four
 outcomes were highlighted in the paper:

        •    better prevention services with earlier intervention
        •    giving people more choice and control
1
    Our Health, Our Care, Our Say: a new direction for community services. DH, 2006
2
    Choosing Health: making healthier choices easier. DH, 2004
3                                        :
    
Independence, Well-being and Choice Our Vision for the Future of Social Care for Adults in England. DH, 2005




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      •   tackling inequalities and improving access to community services
      •   more support to people with long term conditions

The ‘Choosing Health’ (2004) White Paper sets out the key principles for
supporting the public to make healthier and more informed choices in regards
to their health. It highlights the Government’s intentions to provide information
and practical support to get people motivated and improve emotional
wellbeing and access to services so that healthy choices are easier to make.
It highlights 6 priority areas:

      •   tackling Heath Inequalities
      •   reducing the numbers of people who smoke
      •   tackling obesity
      •   improving sexual health
      •   improving mental health and well-being
      •   reducing harm and encouraging sensible drinking

These priority areas are underpinned by 3 principles – informed choice,
personalised support and partnership working.

Independence, Well-being and Choice set out the Governement’s vision for
the future of adult social care in England, addressing the challenges of an
ageing population with higher expectations and a desire to remain as
independent as possible for as long as possible. These aspirations are now
reflected within the outcomes of Our Health, Our Care, Our Say.

The following principles which have been drawn from the national policy
context will underpin the way in which we work in Luton

      •   self-care - increasing individuals’ ability to improve their own health
          and well being.
      •   Increasing choice for local people
      •   making it easier for people to receive services in a place and at a time
          which is convenient to them.
      •   working in partnership with other agencies and providers across all
          sectors to achieve our aspirations.
      •   engaging the local community in shaping the services that we
          currently commission and plan to commission, and how those services
          operate
      •   prevention and early intervention - we will shift resources in this
          direction whenever possible

4.        LOCAL CONTEXT
4.1       The Population of Luton




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The population of Luton was estimated to be 188,800 in 2007 (ONS).
However there has been considerable inward migration into the town in recent
years and research undertaken by the council suggests a population of
203,800 is more realistic.

Luton’s population is younger than the average for the East of England region
and England as a whole with 21% of Luton’s current population aged 15 years
or under compared with 19% in the East of England and 18% in England as a
whole. The 5-15 year old age group is projected to rise by 11.5% from 2011
to 2016 with a similar rise expected in the over 65 age group.

The general fertility rate in Luton (i.e. the number of births per year per 1,000
total population) has increased, similar to the national trend. However, Luton
has the second highest general fertility rate of all unitary authorities in
England, 83.7 live births per 1,000 women aged between 15-44 years
compared with 62.1 in England.




Figure 1: Proportion of Luton’s population by gender and age group (2007 ONS
estimates)



4.2      Ethnicity
Luton is ethnically diverse with approximately 35% of the total population and
50% of school children being from Black and Minority Ethnic (BME)
communities. We have significant Pakistani, Bangladeshi, Indian and African
Caribbean communities living in Luton and compared to the rest of the East of
England, there are proportionally high proportions in the mixed category and a
high proportion of White Irish residents in Luton. There are also increasing
levels of migration from other EU countries such as Poland. In 2001 the white
population accounted for 71.9% of Luton’s population (132,550 people) and
this is forecast to drop to 68.0% (122,100 people) by 2021. The changing
ethnic mix will impact on future healthcare needs:

   •   national data shows that women from black and minority communities
       have higher infant mortality rates when compared to women in the
       general population.




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      •   Cardio-vascular disease (CVD) and diabetes have high prevalence in
          the BME population.




Figure 2: ONS estimates of ethnic groups (excluding white British) composition in
Luton, East of England and Peterborough

4.3    Life Expectancy
In Luton, life expectancy at birth has shown a steady increase since 1999.
However for men and women in Luton, life expectancy remains below the
national average by over a year for each gender - males 76.5 years compared
to 77.3 nationally and females 80.3 compared to 81.54. Luton is ranked 315
out of 352 local authorities for female life expectancy and 282 for male life
expectancy out of 352 local authorities.

Comparing life expectancy in Luton to life expectancy with our ‘near
neighbours’ (Table 1) we note that Luton is not significantly different from the
cluster group average of 76.2 years for males and 80.6 years for females.

                   Males                          Females
Local Authority    Life           Significant     Life             Significant
                   Expectancy     Difference to   Expectancy       Difference to
                                  Luton                            Luton
Luton              76.5                           80.3
Blackburn with     74.2           Lower           79.2             No sig.
Darwen                                                             difference
Bolton             75.1           Lower           79.2             No sig.
                                                                   Difference
Bradford           75.9           No sig.         79.8             No sig.
                                  difference                       Difference


4
    ERPHO, 2008a




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Coventry            76.2          No sig.          80.9          No sig.
                                  difference                     Difference
Derby               77.0          No sig.          81.9          Higher
                                  Difference
Medway              76.6          No sig.          81.0          No sig.
                                  Difference                     Difference
Milton Keynes       78.0          Higher           81.5          Higher

Oldham              75.3          Lower            79.2          Lower

Peterborough        76.4          No sig.          80.5          No sig.
                                  Difference                     Difference
Rochdale            75.1          Lower            79.6          No sig.
                                                                 Difference
Slough              77.9          Higher           82.3          Higher

Telford and         76.9          No sig.          81.4          Higher
Wrekin                            difference
Walsall             75.7          No sig.          81.3          Higher
                                  difference
Leicester           75.3          Lower            79.9          No sig.
                                                                 Difference
Thurrock            77.9          Higher           81.6          Higher

Table 1: Life Expectancy for Luton and Comparators, 2005-07

4.4    Life Expectancy and Health Inequalities
Although life expectancy has been rising in Luton, this masks the inequalities
that exist between some areas. There is 8.4 years difference between the
Middle Super Output Area (MSOA) with the highest life expectancy and the
MSOA with the lowest life expectancy5. The MSOAs with the poorest health
outcomes broadly map to the following wards: Dallow, Biscot, High Town,
Challney and Farley.




5
    PHAST Report, 2008




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                                                                  i
Figure 3: Life Expectancy by Middle Super Output Area (MSOA) for all persons in
Luton (2005-07)

A key aim of this strategy is to target our MSOAs with the poorest outcomes.
This will be critical to increasing life expectancy as there is a clear correlation
between levels of deprivation and life expectancy.

4.5    Deprivation & Life Expectancy
The indices of deprivation (IMD, 2007) rank Luton as the 87th most deprived
area out of 354 local authorities in England. This ranking has worsened since
the last data was published in 2004.

Nineteen per cent of people in Luton have no qualifications, compared to 14%
nationally. In addition those attaining grades A* to C at GSCE are 7
percentage points lower than the national average. Gross disposable income
per head in Luton is £11,4326, almost £2,000 less than the national average
of £13,302 and £3,000 lower than the East of England average.
Unemployment is high in Luton compared to the East of England and the
national average and there is significant variation in unemployment within
Luton.

There are 19 wards in Luton and figure 4 shows there are areas both of
affluence and of deprivation within Luton. The most deprived areas are
concentrated in the south west and north west areas of Luton.




66
     ONS, Provisional 2005 Gross Disposable Household Income at current prices




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Figure 4: Index of Multiple Deprivations in Luton



5.      CONSULTATION PROCESS
This strategic plan has built on a number of previous consultation and
workshop exercises. The health and well-being priorities within the SCS were
identified from the Joint Strategic Needs Assessment report and also by a
panel of people representing a cross section of Luton residents and through
input from each of the thematic partnerships. In addition to this, a workshop
was held for key stakeholders whose work streams contribute or impact on
the health and wellbeing of local people to ensure that the identified priorities
are consistent with the priorities identified in this strategy.


6.     VISION and PRINCIPLES
6.1    Vision
The vision for improved health and well-being in Luton complements and
builds on the vision in the SCS

      ‘We will have improved physical, mental and social well-being by
      pursuing policies which empower people to live healthy and creative
      lives, reduce health inequalities and support people to live independently


6.2    Principles
The following principles which underpin the SCS strategy also underpin this
strategy.




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All adults in Luton should:
    • enjoy fair access to goods, services, employment and justice - equality
    • are able to participate in and feel a part of that community - inclusion
    • feel respected and able to live in with dignity and in harmony with
       others and our environment - cohesion


7.        AIMS AND OBJECTIVES
7.1       Aim

Our aim is to improve the health and well-being of Luton residents and reduce
the health inequalities which exist within the borough.

By 2011 we will have increased life expectancy at birth to 77.4 years for men
and 81.2 years for women and narrowed the gap in life expectancy at birth
between the least deprived quintile and the most deprived quintile to 4.85
years for men and 2.72 years for women7



7.2   Objectives
We will achieve our aim by focussing on the following objectives which have
been identified as priorities in the SCS.

We recognise that priorities 2 and 8 are slightly different from the other six in
that they relate more to a way of working than to a specific service area or
health issue. This does not diminish their status as priorities.

      1. promoting healthy living and tackling the key risk factors which affect
         health
      2. focusing on prevention and early intervention
      3. supporting people to live independently
      4. improving housing conditions for existing and new housing
      5. improving mental health services
      6. improving services for carers
      7. improving leisure and cultural opportunities for all and improving
         access
      8. understanding that different service delivery will be necessary to
         ensure fair health and wellbeing outcomes for all




7
    NHS Luton’s Strategic plan 2009/10-2014/15




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7.2.1:Objective 1: Promoting Healthy Living and Tackling the Key Risk
Factors which Affect Health

This priority covers 5 specific risk factor areas :
A. reducing the number of people who smoke
B. tackling obesity
C. reducing harm and encouraging sensible drinking
D. improving sexual health
E. increasing the number of years that people live in good health

A.    Reducing the Number of People who Smoke
Local Context
Reducing the prevalence of smoking in Luton is a key priority for NHS Luton.
Smoking is the single greatest cause of illness and premature death in
England today and the cause of debilitating illnesses including cancer, heart
disease, bronchitis and emphysema. It kills approximately 86,500 people in
England and approximately 268 people in Luton each year.

In Luton, the estimated smoking prevalence is 27.3%8 compared to a national
prevalence of 24.1% and a regional prevalence of 23.0%. Recent data from
ERPHO estimates the prevalence in Luton to be 26.18%9. There has been
very little difference in the rate in Luton between 2000-02 and 2003-05
compared to the downward trend seen in England as a whole. Estimated
smoking prevalence by ward shows significant variation highlighting a
difference of 23.1 percentage points between the MSOAs with the highest and
lowest prevalence in Luton.

The 2008 East of England lifestyle survey10 was conducted to obtain more
accurate figures of lifestyle behaviours for PCTs in the East of England. The
results show Luton to have a smoking prevalence much lower than our
estimated prevalence for 2005. Overall in Luton 21% of the population are
thought to smoke compared to 23% in the most deprived areas. This
compares to a prevalence of 18.4% in the East of England as whole. Of these
current smokers 69% of those asked expressed an interest to quit.

In Luton 15% of women are smoking when they leave hospital after having
their baby. Nationally, 45% of pregnant women under the age of 20 are
recorded as smoking during pregnancy.

The 2008 Health Inequalities Profile suggests smoking attributable mortality in
males has gone down in the least deprived fifth and Luton overall. However it
8
 ERPHO, Luton Health Profile 2008
9
 Eastern Region Public Health Observatory (ERPHO). Experimental Local Authority Level Smoking Prevalence
Estimates for the East of England 2005
10
 Ipsos MORI (2008). 2008 East of England Lifestyle survey. Eastern Region Public Health
Observatory (ERPHO)




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has increased for the most deprived areas, widening the health inequalities for
men. For females the inequality gap is smaller than males and despite
narrowing in 2004-06 (mainly due to an increase in mortality in the least
deprived group) it has now widened (2005-07). The least deprived groups
and area average mortality rates have started to decrease in recent years, but
unfortunately the most deprived continued to increase and therefore widening
the gap between the two. The areas with the highest smoking attributable
mortality are comparable with areas of low life expectancy and high
deprivation in the south west of Luton (Dallow, Biscot and High Town).

In addition to the morbidity and mortality caused by smoking there is also high
economic price to pay. Smoking costs the NHS around £1.5 billion per year
and causes an estimated 1,000 hospital admissions a day. Around 35 million
working days are lost each year through smoking related sickness.

Key Areas of Focus
Our strategy to reduce the number of smokers in Luton will focus on
  • reducing the uptake of smoking
  • promoting smoking cessation
  • reducing inequalities caused by smoking
  • strengthening community action for tobacco control including effective
       enforcement of smoke-free legislation; dealing with emerging trends
       such as Shisha bars, electronic cigarettes and other forms of tobacco
       traditionally used by minority ethnic communities, and under-age sales
       of tobacco products.

Action to reduce the number of people who smoke will focus on key groups
including the Bangladeshi men, routine and manual workers, pregnant
women, young people and those requiring hospitalisation.

Action to reduce health inequalities will be focused on increasing provision of
workplace stop smoking clinics for those who employ high numbers of routine
and manual workers and on the five MSOAs in Luton with the lowest life
expectancy. These are Biscot, Dallow, Farley, Challney and High Town.

Implementing Action
Implementation will be through the following action plans

   •   NHS Luton’s Operating Plan
   •   LAA Smoking Action Plan
   •   Stop Smoking Service Action Plan

Measures of Success
Success will be measured using the following Indicators. Table 1 provides
baseline data and the target to be achieved by 2010/11




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Indicator                                                    2007/8         2010/11
                                                            baseline
VSB05: number of 4 week quitters attending stop               1364            1480
smoking services)
NI123: 16+ smoking prevalence                                27.3%            21%
*
Proportion of women who smoke during pregnancy (at            15%             12%
discharge)



B.     Tackling Obesity
Local Context
In Luton, the challenge to halt the rise in obesity is a key priority. According to
the 2006/07 and 2007/08 National Child Measurement Programme (NCMP)
data (Table 2), the prevalence of obesity is as follows:
Figure 5: Year R and Year 6 obesity data from the NCMP




This is significantly higher than both the East of England and England.

Amongst adults the prevalence is estimated to be 26.7% in Luton compared
to 23.6%11 in England.

Obesity has significant health, social and economic consequences for
individuals and populations. The prevalence of obesity has trebled in the UK
since the 1980s and it is estimated that the cost of the obesity epidemic in
terms of health care provision and lost work hours could be in the region of
£45 billion a year by 2050 if the current trend continues.

         Table 2: The cost of overweight and obesity in Luton

           Estimated annual costs to NHS of          Estimated annual costs to
           diseases related to overweight and        NHS of diseases related to
11
     ERPHO:obesity
           Luton Health Profile 2008                 obesity
                           £ million                          £ million
                      2007           2010 2015       2007        2010    2015
           Luton      50.7           52.6 56.2       26.3        28.5    32.7


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       Source: Healthy Weight, Healthy Lives Toolkit, October 2008

Obesity reduces life expectancy on average by nine years and is responsible
for 9,000 premature deaths a year in the UK. Being overweight and obese
increases the risk of a wide range of chronic diseases and illnesses including
heart disease, type 2 diabetes, some cancers and arthritis.

Effective action to tackle obesity requires a comprehensive and coordinated
series of interventions delivered by the NHS and partners to inform and
support adults and children, and to create supportive environments for
behaviour change.

Key Areas of Focus
Our local strategy will focus on the prevention and treatment of overweight
and obesity in adults:

Prevention:
   • increasing support for adults to make healthy lifestyle choices including
      the provision of personalised advice and support

Weight Management:
  • developing a range of options to support overweight and obese adults
      to manage their weight.

Implementing Action
Implementation will be through the following action plans

   •   NHS Luton’s Operating Plan and Weight Management Plan
   •   LAA Adult Obesity Plan (multi-agency)
   •   Healthy Weight Management Plan (multi-agency)
   •   Transport Plan
   •   Sports Development Plan


Measuring Success
Success will be measured using the following Indicators. Table 3 provides
baseline data and the targets to be achieved by 2010/11

Indicator                                                     2007/8    2010/11
                                                             baseline
NI055 / VSB09: % of Yr R children who are obese               12.5%     12.0%




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NI056 / VSB09: % of Yr 6 children who are obese          20.4%      22%

Proportion of adults who are obese – recorded by GP      26.7%      27.4%
practices (Quality and Outcomes Famework)
NI053: Prevalence of breastfeeding at 6 – 8 weeks from    tbc       95%
birth



C.     Reducing Harm and Encouraging Sensible Drinking
Local Context
Public health information shows high use of alcohol in the deprived urban
area of Luton and local research identified these areas of concern:

   •   25,000 people in Luton are drinking over 14 units (women) and 21 units
       (men)
   •   6000 people drinking over 35 units (women) and 50 units (men)
   •   750 people or more have moderate or severe symptoms of alcohol
       dependency
   •   1 in 7 people admitted to hospital have a problem with alcohol and
   •   60% are likely to be male between 35-74 years.

Providing evidence based services for problematic alcohol users will increase
life expectancy and reduce health inequalities. Evidence based practice
shows that young people and adults reduce their alcohol use quickly with brief
interventions and support at times of crisis. For every £1 invested in alcohol
services £5 is saved in health and social care costs

Key Areas of Focus
The Luton Alcohol Harm Reduction strategy will focus on
   • Providing targeted harm prevention information to high risk groups
   • Providing brief interventions in GP surgeries
   • Providing brief interventions on hospital wards
   • Providing alcohol advice to young people in A&E Fri and Sat night
   • Increasing community and in patient detox

Implementing Action
Implementation will be through the following action plans

   •   NHS Luton’s Operating Plan
   •   LAA Plan – Reducing Alcohol Related Hospital Admissions

Measures of Success
Success will be measured using the following Indicators. Table 4 provides
baseline data and the target to be achieved by 2010/11

Indicator                                                2007/8    2010/11




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                                                      baseline
NI039 / VSC 26: Rates of alcohol related hospital      1556            2373
admissions /100,000



D.     Improving Sexual Health
Local Context
The sexual health status of the population of Luton is poor with rates of
sexually transmitted infections higher than the national average and the
number of cases of HIV infection has increased substantially since 1998 and
this poses a significant threat to public health.

The under 18 (U18) conception rate for Luton is on a downward trend. 2006
saw a dramatic drop in the rate from the previous year - 41.7/1000 to
34.7/1000. In 2007 teenage pregnancy rates in England rose by 1.1% and
this was reflected in Luton with an increase of 0.9% and a rate of 35.6/1000.
Rates in Luton are still below the England rate. The current rate represents a
-17.4% from the baseline in 1998 and achieving the national target of a 45%
reduction from baseline by 2010 will be a significant challenge. To meet the
challenge there is an evidence based multi agency strategy in place with
strong commitment from a full range of stakeholders and support from the
Children and Young People’s Board.

The number of young people being screened for chlamydia is low. In 2007,
2.9% were screened against a national target of 15%. Chlamydia can often
go undetected and can lead to health complications including infertility if not
treated early.

Improving the sexual health of Luton’s population is a key priority with a
particular focus on three main areas:
   • teenage pregnancy
   • chlamydia screening,
   • HIV and AIDS

Key Areas of focus
  • increasing access to integrated sexual health services
  • improving access to and uptake of chlamydia screening
  • improving access to HIV testing
  • increasing access to contraception
  • targeted work with high risk groups

Implementing Action
Implementation will be through the following action plans

    •   NHS Luton’s Operating Plan
    •   Teenage Pregnancy Plan (multi-agency)




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   •   Chlamydia Screening Plan
   •   HIV Plan (multi-agency)

Measures of Success
Success will be measured using the following Indicators. Table 5 provides
baseline data and the targets to be achieved by 2010/11

Indicator                                               2007/8        2010/11
                                                       baseline
VSB13: % of 16-24 year olds screened or tested for       2.9%           35%
chlamydia
NI112 U18 conception rate                            34.4/1000       23.7/1000
                                                         (2006)



F.    Increasing the number of years that people live in good health
Local Context
The two main causes of death in Luton are circulatory diseases and cancer.
Over the past decade, deaths from all causes and early deaths from heart
disease and stroke in Luton have been higher than the England average.
This gap has widened for early deaths in heart disease and stroke. Cancer
mortality is similar to the England average but within Luton it has risen in the
most deprived fifth of the population while falling in the least deprived.

There are 8,558 Luton patients recorded as having diabetes on local GP
registers (March, 2008). This accounts for 4.2% of patients registered with a
GP in Luton. Projected figures estimate an increase in diabetes prevalence
from 4.65% of the population to 5.35% in 2010

There are an estimated 41,401 people in Luton with hypertension (20.3% of the
registered population) compared to England where it is estimated that 23.8% of
the registered population have hypertension.

Evidence nationally and regionally suggests that levels of dental activity are
lower than they should be, and that Luton residents are not accessing
dentistry when they should. Work with our local population indicates this is as
a result of a combination of factors, including: that they are not aware of how
they can go about accessing services, that culturally some groups do not tend
to routinely use dentistry and fears about cost implications. In 2006 it was
recorded that 59% of children and 49% of adults had not seen a dentist within
the last 2 years.

There are an estimated 1,914 problematic heroin and/or crack users in Luton and
at any one time some 600 Class A drug users are receiving structured treatment.

The annual uptake of flu vaccinations for the over 65 age group has been
below the national target (75%) for the last three years. In 2006-07 the local




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uptake was 72.7%, in 2007-08 uptake was 71.7% and in 2008-09 uptake was
71.4% in 2007.

Luton has approximately 3000 businesses where health and safety standards
are enforced by the Environmental Health Service. Within those,
approximately 400 accident and serious injury notifications are received each
year.

Key Areas of Focus
In addition to the areas of focus outlined in A-D above and the other four
priority areas action will also focus on:
    • increasing access to and uptake of national screening programmes
    • providing personalised support from individuals in areas of low life
        expectancy through the health trainer programme
    • increasing uptake of affordable warmth benefits
    • Improving the quality of primary care services, and in particular access
        to these services in the five MSOAs (including outside core GP hours)
    • improving primary prevention of CVD by introducing multi risk factor
        assessment and risk management, delivering 100% coverage
    • establishing vascular checks
    • continue to work with partners to target specific businesses in order to
        raise workplace health and safety standards and reduce ill health at
        work.

Implementing Action
Implementation will be through the following action plans

    •   NHS Luton’s Operating Plan
    •   LAA Healthy Life Expectancy Plan

Measures of success
Success will be measured using the following Indicators. Table 6 provides
baseline data and the targets to be achieved by 2010/11

Indicator                                                    2007/8       2010/11
                                                            baseline
NI137 Healthy Life Expectancy at 65                        14.1 (DWP        14.8
                                                             2008)
NI 122 Mortality from all cancers at ages under 75       117.6/100,000   108/100,000
                                                          (pooled data
                                                            2005-07)
NI 121 Mortality rate from all circulatory diseases at    89.7/100,000   80/100,000
ages under 75 DH
DSO                                      (pooled data
                                                            2005-07)
VSB18 Number of patients receiving NHS primary
dental services located within NHS Luton area within a
24 month period                                             91,570        100,000




morag.stewart                               Page 17                         24/09/2009
Percentage Uptake of flu vaccinations in Over 65 years   71.7%          75%



7.2.2: Objective 2 - Focusing on prevention and early intervention
Local Context
In the context of our population and their specific health needs, we recognise
that preventing the onset of ill-health, and early interventions are key to
increasing both the quality of life, and life expectancy. In order to improve
public health, we need to shift focus from treatment to the prevention or
delayed onset of ill health.

Our Health, Our Care, Our Say’ gave a new focus in promoting health
improvement and health equality. The focus is on prevention and greater
partnership working between health and social care with earlier prevention
and intervention services being developed. ‘Putting People First’, the
transformation of adult social care, sets the directions of travel for 10 years or
more. One key theme is to develop the support available to assist people who
need a little more help, at an early stage to stay as independent for as long as
possible. This will include support to recover from the effect of illness and help
to manage a long-term condition.

There are a range of vulnerable people in Luton such as people with mental
health problems and an increasing number of people with learning disabilities
requiring focused attention. The increasing number of older people requires
consideration in terms of long term conditions and support to remain
independent including support to carers.

We are committed to improving the health of Luton’s people. We want people
in Luton to enjoy the same health as those elsewhere in England, to stay
healthier for longer and be able to access services easily and fairly regardless
of age, gender, disability, race or belief. Partners will work together with local
communities to tackle the key risk factors and increase capacity and capability
to ensure that people are empowered to improve their own health and well
being, including the prevention of ill health and self care.

Key areas of focus will include:
  • Universal, joined up information and advice available for all individuals,
      (including those who self assess and fund), available in a range of
      neighbourhood outlets and targeting low activity groups.
  • Working with partners to develop, promote and provide a wide range of
      activities
  • Develop a ‘one front-line’ approach to helping communities
  • Modernise day opportunities to ensure an effective and attractive range
      of services are delivered that allow people to develop their full potential
  • Empowering staff, equipped with the right skills and information




morag.stewart                            Page 18                        24/09/2009
    •   Empowering local people to take more control of their own health
    •   Develop learning opportunities to help people live healthy lives

Implementing Action
Implementation will be through the following action plans
   • NHS Luton’s Operating Plan
   • Transformation adult social care plan
   • Delivery plans for adult social care commissioning strategies
   • Workforce Strategy
   • Annual Delivery Plans for Luton Cultural Services Trust and Active
      Luton

Measures of Success
Success will be measured using the following Indicators. Table 6 provides
baseline data and the targets to be achieved by 2010/11

Indicator                                                   2007/8     2010/11
                                                           baseline
NI 008 Increase adult participation in activities           18.5%      27.5%

NI011 Increase the engagement in the Arts                   37.9%      49.9%

NI 126 Early access for women to maternity services (by       tbc       87%
12 weeks)
NI 119 Self reported measure of overall health and well-      tbc        tbc
being
NI138 Satisfaction over 65’s with locality

NI 137 Increase Healthy Life Expectancy at 65              14.1 (DWP    14.8
                                                             2008)
Increased take up in Telecare




7.2.3: Objective 3: Supporting People to Live Independently
(Drafting comment – this section is incomplete)
Local Context
With an increasing older population the demand for social care is expected to
increase over the next 20 years. This will have implications for future health
and social care requirements and planning must start to take into account
these long term demands.

Services provided under the supporting people programme are housing-
related support activities that are designed to develop or sustain an
individual’s ability to live independently. The support is provided to vulnerable
people, including people from the BME community, single people, homeless
families, teenage parents, couples without children, people with alcohol and/or
drug problems, people with HIV and physical ill health, ex-offenders, people




morag.stewart                                Page 19                    24/09/2009
with mental health needs and disabilities. The aim is to enable vulnerable
people to live as independently as possible in their own homes, for as long as
it is safe to do so, leading valued and fulfilled lives. The focus will be on
enabling vulnerable adults to be treated as equal citizens and incrementally
move away from segregated services to a more integrated provision, whereby
adults are enabled as far as possible to access mainstream community
services. Much of the outcome identified above is a lifestyle choice
determined by individuals in the community. However we have a crucial role in
informing the lifestyle choices available to people within the community.

There is a range of vulnerable people in Luton, such as people with mental
health problems and an increasing number of people with learning disabilities,
and these require focused attention.

National estimates suggests that in Luton there are up to 7,000 people with at
least one long term condition such as diabetes or heart disease, over 900
older people with dementia and over 500 older people with a mental health
problem.
25% of older people in Luton care homes have dementia and this rate
increases to 30% in nursing homes. There are currently 560 people on GP
registers with dementia which is lower than the estimated 900.
There are 530 (known to LBC) people with learning disabilities which is just
over 70% of the number predicted by standard prevalence rates. However,
the number of people on GP registers is lower at 375.

Key Areas of Focus
  • enable vulnerable people to live as independently as possible in their
     own homes, for as long as it is safe to do so by improving signposting,
     advice and advocacy
  • focus on enabling vulnerable adults to be treated as equal citizens and
     incrementally move away from segregated services to a more
     integrated provision by increasing direct payments and telecare
  • enable vulnerable adults – as far as possible - to access mainstream
     community facilities.
  • develop services to help older people remain outside the formal care
     systems by developing a prevention strategy

Implementing Action
Implementation will be through the following action plans
   • Intermediate Care plan
   •

Measures of Success
Success will be measured using the following Indicators. Table 7 provides
baseline data and the target to be achieved by 2010/11




morag.stewart                      Page 20                           24/09/2009
Indicator                                                    2007/8    2010/11
                                                            baseline
NI 125 Achieving independence for Older people
through rehabilitation and intermediate care
NI130 Social care clients receiving self directed support

NI 141 Number of people achieving independent living

NI 142 Number of vulnerable people supported to
maintain independence
SAS 2.1OP 307 Total planned expenditure on telecare           24
equipment and service
SAS 2.20OP029 Number of additional extra-care                  9
housing places to be provided
Number of people accessing supported housing

Number of Adaptations carried out to enable vulnerable
people to remain living independently in their own
homes
Number of people receiving floating support services

Percentage of new tenants receiving support sustaining
their tenancies for six months



7.2.4: Objective 4: Improving Housing Conditions for Existing and New
Housing
(Drafting comment – this section is incomplete)

Local Context
In Luton, 22.4% of private sector housing does not meet the decent homes
standard the main reason for this is poor thermal comfort mainly seen in
single pensioners and vulnerable households. Of the private sector housing
stock, 7.6% are considered to be overcrowded and 7.7% (4768 households)
live in a house that has a category 1 hazard. Approximately 83% of the private
sector housing stock is owner occupied and 17% is private rented. There are
approx 8907 council tenant households in Luton.
[Drafting comment the latest update of the House Condition Survey arrives
12.03.09 –this section to be updated.

Key Areas of Focus
In order to meet the housing challenge, action will focus on three key areas:
    • supporting people to live independently
    • improving housing conditions
    • delivering more housing

Implementing Action
Implementation will be through the following action plans
   •




morag.stewart                              Page 21                      24/09/2009
Measures of Success
Success will be measured using the following Indicators. Table 8 provides
baseline data and the target to be achieved by 2010/11

Indicator                                                 2007/8      2010/11
                                                         baseline
NI 124 – People with long term conditions supported to
be independent and in control of their condition
NI 125 – Achieving independence for older people
through rehabilitation/intermediate care
NI 142 - % of vulnerable people who are supported to
maintain independent living
NI 155 – Number of affordable homes delivered (gross)

NI 156 – Number of households living in temporary
accommodation
NI 187 – Tackling fuel poverty – people receiving
income based benefits living in homes with low energy
rating 3.



7.2.5: Objective 5: Improving Mental Health Services
(Drafting comment – this section is incomplete)
Local Context
It is estimated nationally that 1 in 4 people will develop a mental health
problem and between 1 in 8 and 1 in 5 will have depression or sever
depression. There are currently 1500 on GP registers in Luton with severe
mental health problems including schizophrenia, bi-polar disorder and other
psychoses.

One of the main disabilities later in life is dementia where there is predicted to
be a steady and dramatic rise over the next 15 years. The need for social care
is rising due to the increasing age of the population, particularly the year on
year rise of people over 85 who are major users of the services. People in this
age group are more likely to have dementia and a high level of need for care
services. Currently 25% of older people in Luton care homes have dementia,
the rate increasing to 30% in nursing homes. There are currently 560 people
on GP registers with dementia, although this is lower than the statistical
expectation of 900 with dementia.

Key Areas of Focus
  • strengthening local joint commissioning of mental health services
     between the Council and NHS Luton
  • bringing forward the IAPT (Improved Access to Psychological
     Therapies) programme for Luton to June 2009
  • significantly increasing NHS investment in local mental health services




morag.stewart                            Page 22                        24/09/2009
    •    focusing the work of the new Community Development Workers within
        the NHS partnership Trust on developing community mental health
        initiatives and creative solutions for hard to reach sections of the
        community
    •   creating new “Gateway Workers” to improve the interface with Primary
        Care
    •   develop in partnership, housing solutions particularly for those with
        dementia needs
    •   develop personalised budgets to allow more people to be ‘in-control’
        and therefore live independently
    •   addressing the issue of problem gambling

Implementing Action
Implementation will be through the following action plans
   •

Measures of Success
Success will be measured using the following Indicators. Table 9 provides
baseline data and the target to be achieved by 2010/11

Indicator                                                 2007/8    2010/11
                                                         baseline

NI 124 : People with long term conditions supported to
be independent and in control of their condition
NI 130 : Social care clients receiving self directed
support per 100,000 of the population
NI 142 : % of vulnerable people who are supported to
maintain independent living
NI 152 : Working age people on out of work benefits




7.2.6: Objective 6: Improving Services for Carers
Local Context
Locally there is a lack of clear data around carers in Luton both in terms of
who they are and what they need. The 2001 census indicates that there are
16,000 carers in the town, however only about 10% of these are known to
statutory services. The census also reveals that around 3,300 carers provide
more than 50 hours of unpaid care a week and of these around 1600 are
older people themselves. These older people are twice as likely to be in poor
health themselves and need to be supported in their own right and in their role
as carer. We need to develop appropriate support services (including low level
support) which assist people to live independently and help prevent the
breakdown of care arrangements. The JSNA highlights these needs

Key Areas of Focus




morag.stewart                             Page 23                    24/09/2009
    •   raising awareness of carers issues and needs
    •   improving access to information and advice
    •   improving access to services (including third sector)
    •   Improve access to statutory services to give carers a break
    •   targeting work with hard to reach groups
    •   establish a carers centre

Implementing Action
Implementation will be through the following action plans
   • Carers strategy

Measures of Success
Success will be measured using the following Indicators. Table 10 provides
baseline data and the target to be achieved by 2010/11

Indicator                                                 2007/8          2010/11
                                                         baseline
Number of carers identified in Luton                       1600             6000
Number of new carers accessing statutory and third     Baseline to be       1200
sector (voluntary) services                             established
NI135 carers receiving needs assessment/review of           591             1200
specific carers service/info/advice


Number of carers with emergency plan                         0              500
Number of carers in receipt of a carers break               338             500



7.2.7: Objective 7: Improving leisure and cultural opportunities for all
and improving access
Local Context
The Active People Survey commissioned by Sport England to measure
participation in sport and active recreation at a local level highlighted high
levels of inactivity in Luton (55.1%) compared to the East of England (50%)
and the national figure (50.6%). Luton also has a low level of people
participating in moderate intensity activity on at least 3 occasions of 30
minutes per week – 18.5% compared to the East of England (20.5%) and
nationally (21%).
                        Luton                 East of England        National
 All                    18.5%                 20.5%                  21%
 Male                   20.7%                 22.5%                  23.7%
 Female                 14.9%                 18.7%                  18.5%
Table 11: The % participating in moderate intensity activity (sport & recreation
activity)on at least 3 occasions of 30minutes per week over the previous 28 days




morag.stewart                             Page 24                           24/09/2009
Other Key Findings
   • zero participation was higher in the lower socio-economic groups (5-8)
      when compared to the higher socioeconomic groups (1-4)
   • 55.1% of the respondents reported zero activity. This figure was
      slightly lower for males but increased to two thirds for females
   • overall participation rates were low in Luton with only one in six
      reporting sport or recreational activity on 3 occasions a week. Female
      participation was even lower dropping to one in seven
   • participation is higher for the 16-34 age group and Luton had one of the
      highest rates when compared to its geographical neighbours and its
      IMD and Office of National Statistics (ONS) areas
   • participation reduced for the older age groups and only one in fourteen
      people over 55 reported activity on 3 occasions a week
   • two out of five people aged 16-34 reported no activity and this
      increased to three out of four in the over 55s
   • the sample size of the respondents with limiting longstanding disability
      was quite small. However the percentage was higher for 3 occasions a
      week than the East and England figure.
   • participation amongst the higher socio-economic groups (1-4) on 3
      occasions a week was much higher than the lower socio-economic
      groups (5-8).


Key Areas of Focus
   • increase the levels of physical activity within the Borough with a
      specific focus on groups where activity is significantly lower than
      comparators
   • Increase take up of Go4Less Card
   • improve access to quality park sports and open space, culture, leisure
      and play facilities and develop opportunities for vulnerable groups to
      access ‘mainstream’ facilities and activities
  • increase access to lifelong learning through a range of formal and
     informal learning, performance and workshop opportunities via
     libraries, arts, museums and Adult Learning
  • support elderly people and those with mental health difficulties by
     providing targeted opportunities to take part in cultural and recreational
     activities,
  • support people in care homes, sheltered housing etc to visit parks and
     cultural venues in the town and take advantage of their public events
     and activity programmes and in particular opportunities for passive
     recreation that are free at the point of use.

Implementing Action
Implementation will be through the following action plans
   • Active Luton Delivery Plan (Local)
   • Luton Cultural Services Trust Delivery Plan (Local)
   • Team Beds & Luton Delivery Plan (local)




morag.stewart                       Page 25                           24/09/2009
    •   Luton Rights of Way Improvement Plan (local)

Measures of Success
Success will be measured using the following Indicators. Table 12 provides
baseline data and the target to be achieved by 2010/11

Indicator                                           2007/08          2010/11
NI 008 – Increase Adult Participation               18.5%            27.5%

NI 009 – Use of public libraries                    49.4%            55.4%

NI 010 – Increase Adult Participation in Museums    47.6%            53.6%

NI 011 – Increase the engagement in the Arts        37.9%            49.9%
NI 119 - Self-reported measure of peoples overall   tbc              tbc
health and wellbeing
Increase in number of Green Flag Awards             2                5

% take up of allotment plots                        90% take up of
                                                    existing sites



7.2.8: Objective 8 - Understanding that different service delivery will be
necessary to ensure fair health and wellbeing outcomes for all
(Drafting comment – this section is incomplete)
Local Context
The Government’s White Paper “Our Health, Our Care, Our Say” clearly sets
out the Government’s intended direction of travel for adult social care services
describing a personalised approach to Adult Social Care services. In future
people should have choice and control over the shape of his or her support in
the most appropriate setting. There is an emphasis on enablement and early
intervention to promote independence.
Alongside this requirement authorities are required to provide universal
information and advice to all individuals, including those who pay for their own
care. This new approach will require radical changes in the way Adult Social
Care services are organised and delivered including building capacity and
working with other services including health, private, voluntary and
independent sectors as well as internal services. This transformation will
address:
    • improving access to universal services such as transport, leisure and
      education as well as information, advice and advocacy – planning for
      these to consider the implications for disable and older people.
    • improving prevention and early intervention – helping people early
      enough or in the right way, so that they say healthy and recover quickly
      from illness.
    • improving choice and control – people who need support can design it
      themselves, understanding quickly how much money is available for




morag.stewart                             Page 26                            24/09/2009
        this, and having a choice about how they receive support and who
        manages this.
    •   improving social capital – making sure that everybody has the
        opportunity to be part of a community and experience the friendships
        and care that can come from families, friends and neighbours.

Mortality rates are a key indicator of the overall health status of a population
and illustrate where inequalities in health between different groups within the
community may exist, with poorer areas invariably having higher mortality
rates than the more affluent areas. Poor health outcomes are concentrated in
pockets and not spread evenly across the Borough. Life expectancy is lower
in parts of Biscot, Dallow, Farley, High Town and Challney.

Whilst there is a high degree of overlap between the wards which are most
deprived and the MSOAs with the lowest life expectancy there is not a
complete match. Our strategy is focussing on the five wards that contain the
MSOAs with the lowest life expectancy, as we believe this will make the
biggest difference to narrowing the gap in life expectancy between those parts
of our population who are best and worst off.


Key Areas of Focus
  • Dedicate an implementation team to deliver the transformation of adult
     social care project
  • Develop a resource allocation system (RAS)
  • Develop brokerage and commissioning, working with the market to
     allow then to adapt to change
  • Review, improve and promote direct payments
  • Develop quality assurance
  • Involve users and stakeholders in the change
  • Review safeguarding, so that people are given choice and control, with
     proportionate checks to ensure people are as safe as possible.

Implementing Action
Implementation will be through the following action plans
   • Personalisation project plan
   • Day opportunities plan
   • Workforce strategy implementation plan
   • Safeguarding strategy implementation plan

Measures of Success
Success will be measured using the following Indicators. Table 12 provides
baseline data and the target to be achieved by 2010/11

Indicator                                           2007/08     2010/11
NI007 Environment for a thriving 3rd sector




morag.stewart                             Page 27                     24/09/2009
NI127 Self reported experience of social care

NI 128 User reported measure of respect and dignity

NI 129 End of Life access to palliative care

NI130 Social Care clients receiving self directed care




8.      GOVERNANCE
8.1     The Health and Well Being Board

The Health and Well-being Board will oversee the implementation of this
strategy. This Board is one of four theme groups, which make up the Local
Strategic Partnership and is accountable to the Local Public Service Board
and the Luton Forum. The Board is made up of representatives from Luton
Borough Council, NHS Luton and Luton Assembly and is responsible for
overseeing the health and well-being of those who live and work in Luton.


8.2    The Health and Well-Being Management Group
The Health and Well being management group is a sub group of the Health
and Well-being Board and will ensure that delivery plans are in place to
implement the strategy and for monitoring progress towards targets. This
group will make regular progress reports to the Board. Terms of Reference
for both groups are attached in appendix 2.

9.     REVIEW
This strategy will be reviewed every three years in line with the LAA refresh.
The first review will take place in March 2011.




morag.stewart                                  Page 28                24/09/2009
APPENDIX 1

Supporting Strategies

Priority 1: Promoting Healthy Living and Tackling the Key Risk Factors
which Affect Health
Smoking:
   • NHS Luton’s Strategic Plan 2009/10 – 2014/15
   • Choosing Health (DH)
   • Luton Smoke Free strategy
Obesity:
   • NHS Luton’s Strategic Plan 2009/10 – 2014/15
   • Choosing Health (DH)
   • Luton Prevention and Management of Obesity in Adults and Children’s
       Strategy
   • Cycling Strategy
   • Play Strategy
Reducing Harm and Encouraging Sensible Drinking
   • NHS Luton’s Strategic Plan 2009/10 – 2014/15
   • Choosing Health (DH)
   • Luton Alcohol Harm Reduction strategy
Improving Sexual Health
   • NHS Luton’s Strategic Plan 2009/10 – 2014/15
   • Choosing Health (DH)
   • Luton Teenage Pregnancy Strategy
   • Luton HIV and Sexual Health Strategy
   • Every Child Matters
Increasing the number of years that people live in good health
   • NHS Luton’s Strategic Plan 2009/10 – 2014/15

Priority 2: Focusing on prevention and early intervention
   • Transformation adult social care plan
   • Commissioning Strategies for older People, people with learning
       disability, people with sensory impairment, people with physical
       disability and people with mental health problems Workforce Strategy
   • Funding and management agreements for culture and leisure
   • NHS Luton’s Strategic Plan 2009/10 – 2014/15

Priority 3: Supporting People to Live Independently
   • Supporting people strategy
   • Homeless strategy
   • Commissioning Strategies for older People, people with learning
       disability, people with sensory impairment, people with physical
       disability and people with mental health problems.
   • Carers strategy
   • Domestic violence policy




morag.stewart                      Page 29                          24/09/2009
   •   Anti poverty strategy
   •   Affordable Warmth strategy
   •   Transition protocol

Priority 4: Improving Housing Conditions for Existing and New Housing
   • Housing Strategy 2007 – 2011
   • Homelessness Strategy 2008
   • Supporting People Strategy
   • Housing Strategy for an Aging Population –(to be completed mid 2009)
   • Bedfordshire Sub-regional Housing Strategy 2005-2010
   • BME Housing Strategy - to be finalised early 2009
   • Private Sector Renewal Strategy - to be finalised early 2009

Priority 5: Improving Mental Health Services
   • Luton Joint Mental Health Strategy (LBC and NHS Luton)
   • NHS Luton’s Strategic Plan 2009/10 – 2014/15

Priority 6: Improving Services for Carers
   • LBC Carers Strategy (draft)- local
   • Care Programme Approach- national
   • Joint Strategic Needs Assessment - local
   • Carers at the Heart of 21st Century Families and Communities -
       national

Priority 7: Improving leisure and cultural opportunities for all and
improving access
   • Luton Sports Network (Local)
   • Luton Play Strategy (local)
   • Luton and South Bedfordshire Green Space Strategy (local)
   • Extended Services through schools
   • Sport England Strategy 2008-2011 (National)

Priority 8: Understanding that different service delivery will be
necessary to ensure fair health and wellbeing outcomes for all
   • Personalisation project plan
   • Day opportunities plan
   • Workforce strategy
   • Safeguarding strategy
   • Putting people First (national)




morag.stewart                       Page 30                         24/09/2009
                                                                   Attachment 1



                             HEALTH & WELL BEING BOARD
                                         Terms of Operation


ACCOUNTABLE TO:            Luton Strategic Partnership, Luton Borough Council Cabinet and Luton tPCT
                           Board

MEMBERSHIP: Three Assembly members
            LBC Portfolio Holder: Housing and Community Living
            Corporate Director of Housing and Community Living
            Associate Director Public Health (Health Improvement)
            Chief Executive Luton tPCT
            Chair of POVA
            Performance Review Manager (Pam Garraway)

TIMING:                    The Board will meet approximately every 3 months.


PURPOSE:                   The Health & Well Being Board acts as the high level strategic partnership
                           for the commissioning of health improvement and well being in Luton. The
                           purpose of the Board is to hold the statutory agencies to account for ensuring
                           changes to the provision of health and social care services, which deliver the
                           agreed outcomes in health and wellbeing.       It will be guided by the Joint
                           Strategic Needs Assessment.


Terms of Reference

1. The H&WBB for Luton is established to oversee the health improvement of
     those who live and work in Luton.


2.   The H&WBB will achieve this by negotiating and establishing outcomes and monitoring the
     performance of health and social care agencies and partnerships in delivering them. It will guide
     and support continuous improvement within local service.


3.   The H&WBB will develop an approach to health and wellbeing improvement in Luton, that
     addresses health inequalities and social exclusion by overseeing the development and
     implementation of an inter-agency Inequalities Strategy.


4.   The H&WBB will ensure that health & social care improvement in Luton is developed within the
     context of good practice and clinical governance.


5.   The H&WBB will have oversight of specified Partnership Boards within the Borough, acting as a
     check and balance to strategic planning initiatives proposed. These partnerships are The
     Supporting People Commissioning Body; the Luton SPLD Partnership Group and once established,




morag.stewart                                   Page 31                                     24/09/2009
     the Partnership body for mental health services commissioning. A close connection with the LDAP
     will also be maintained.


6.   The H&WBB will propose LAA health and wellbeing objectives and account to the LSP for
     delivering them.


7.   The H&WBB will develop its own work programme and monitoring and review process. This will
     include the production of an annual report that will be publicly available via the local authority web
     site.


8.   Meetings of the H&WBB are open to the general public and dates of meetings, agendas and notes
     will be posted on the local authority web site at least one week prior to meetings taking place.




morag.stewart                                    Page 32                                        24/09/2009
APPENDIX 2

            HEALTH AND WELL-BEING MANAGEMENT GROUP
                        Terms of Reference

ACCOUNTABLE TO:           Health and Well-Being Board

PURPOSE: To identify priorities for action and ensure plans are in place to
improve the health and well being of adults in Luton. The Partnership
Management Group will provide a bridge between the Health and Wellbeing
Board and all other strategic, policy and planning groups relating to adult
health and well-being in Luton.

KEY TASKS:
  • To ensure a shared understanding of Luton’s position in relation to the
     key health and social care targets
  • To identify the health and well-being needs in Luton and make
     recommendations for action to the Health and Well-Being Board.
  • To make recommendations to the Health and Well-Being Board on the
     allocation and management of specific resources related to health and
     well-being
  • To ensure joint action plans are in place to meet key targets in the
     Local Area Agreement and Health and Well-Being Strategy
  • To ensure that the work of planning groups that contribute to the key
     targets is coordinated and that a whole-systems approach is adopted
     across Luton
  • To monitor the implementation of the action plans, and provide regular
     reports to the Health and Well-Being Board
  • To promote the consideration of health and social care issues in the
     policymaking of local organisations through, for example, health impact
     assessment
  • To provide a forum for discussion of issues relating to health and well-
     being across agencies and with voluntary and independent sector
     providers.
  • To ensure the wider involvement of local people and organisations in
     work programmes established by the group


MEMBERSHIP:         Senior Managers (or their representative) from:
                    NHS Luton (Public Health and Community Services)
                    Bedfordshire and Luton Partnership Trust
                    Luton and Dunstable Hospital
                    Luton Borough Council (Adult Social Care, Housing,
                    Social Inclusion, Leisure and Culture, Environmental
                    Health
                    Beds and Luton Fire and Rescue Service




morag.stewart                      Page 33                          24/09/2009
                          Drug and Alcohol Partnership
                          Active Luton
                          Luton Cultural Services Trust
                          Representatives from:
                          Luton Assembly
                          Voluntary Action Luton
                          Community Development Trust/s

                          Other members will be co-opted as appropriate


CHAIR OF GROUP:                   Joint Director of Public Health

QUORUM:                           Half of the total membership plus one, to include a
                                  representative from at least four organisations.

TIMING:                           The group will meet 6 times a year


DECISION MAKING:                  Decisions made by the Group will be recorded in
                                  minutes of the meeting


PAPERS:                           Agenda items must be submitted two weeks prior
                                  to meetings. Agenda and supporting papers will
                                  be circulated by email/post one week prior to
                                  meetings. Additional items may be submitted for
                                  AOB 48 hours prior to meetings.


MINUTES OF MEETINGS: Minutes will be taken by the secretary, agreed by
                     The Chair and circulated within two weeks of
                     meetings. They will be re-circulated with the
                     agenda one week prior to the next meeting. They
                     will be ratified at the beginning of each meeting.



i
    More about ONS geographical boundaries is available at:
http://www.statistics.gov.uk/geography/ons_geog.asp




morag.stewart                               Page 34                        24/09/2009

				
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