Health Inequalities
Outcome: Health Inequalities Leads: Viv Harrison & John Twigger & Deborah Lee
A Executive Summary
In terms of deprivation Bristol ranks 64th most deprived local authority in 2007 out of 354 local authorities in England (see B12).
Within Bristol there are wide variations between the most affluent and most deprived areas. 65,000 Bristol residents (15%) live in the most
deprived 10% of small areas in the country. There are 20116 (29%) of children aged 0-15 years living in income deprived households. Health
inequalities across the city are closely linked with deprivation. Filwood is the most educationally deprived ward in the country.
Actions on the wider determinants of health, together with public health and health care interventions, aim to tackle health inequalities. These
inequalities in health are monitored through a number of indicators, including differences in life expectancy between the most deprived fifth and
Bristol overall and differentials in mortality for the diseases contributing most e.g. CVD, cancer and respiratory disease. A separate life expectancy
outcome briefing documents the evidence and the interventions that we need to tackle these conditions through NHS public heath and health care
interventions. This briefing is focussed on partnership activities and work addressing wider determinants of health and
inequalities (see B5).
The more important determinants of health and inequality lie outside direct control but within the area of influence of the NHS e.g. income,
education, mental and social well-being, social networks and support, housing, occupational role, and scope for leisure and recreation. The Local
Area Agreement (LAA) is the overarching delivery mechanism for addressing wider determinants of health through partnership working.
Work on health inequalities is embedded throughout the work of the PCT and its partners. Key strategies which will address health
inequalities include smoking quitters, under 18 conception, cancer mortality, CHD mortality, alcohol misuse, mental wellbeing and childhood
obesity. Actions through the PCTs Equality Schemes address inequality experienced through ethnicity, gender or disability.
Key PCT work includes community development work in neighbourhoods of high health need and work with specific communities. An example
of this is increasing capacity of key voluntary sector organisations providing important activities at the local levels e.g. cooking classes, food co-
ops and reducing domestic violence. The health trainers provide one to one practical support and signposting for individuals who want to make a
lifestyle change (see delivery plan C), while the community development workers from race equality in mental health work with Black and minority
ethnic groups to identify key needs and address barriers to services.
Total new investment 2009/10-2012/13 = £5,195,000 (see delivery plan D).
Partnerships - Key partners are Bristol City Council, Neighbourhood Partnerships, voluntary and community sector agencies working in areas of
high health need.
B Background
B1 Brief description of health outcome:
Average IMD (index of multiple deprivation) score.
B2 Please state the rationale for choosing this health outcome:
National health outcome for all PCTs.
B3 Brief description of indicator:
Average IMD (index of multiple deprivation) score.
B4 Definition of Indices of Multiple Deprivation (IMDs) and Lower Super Output Areas (LSOAs):
The Index of Multiple Deprivation is a measure of multiple deprivation at the small area level. It combines measures of different types of deprivation
into one overall score using seven domains: income; employment; health and disability; education, skills and training; barriers to housing and
services; crime; living environment.
The domain scores are developed at Lower Super Output Area (LSOA) level then combined to give an overall IMD score. Each LSOA can be
ranked on this score against all other LSOAs in England. LSOAs are consistent in size across the country – each with an average population of
1,500 residents. There are 252 LSOAs in Bristol, nationally there are over 32,000. LSOAs are much smaller than electoral wards and therefore
allow pockets of deprivation to be identified.
B5 Causation Analysis and Evidence Base
The main focus of the PCT will be improving health and tackling health inequalities through public health and health care interventions. The more
important determinants of health and inequality lie outside direct control but within the area of influence of the NHS. They include income,
education, social well-being and contacts, housing, occupational role, and scope for leisure and recreation. We must therefore support other
agencies that can improve these health determinants through undertaking partnership activities with them. We must also do our best at undertaking
public health interventions and commissioning evidence-based health services and interventions that tackle health inequalities. The biggest
contributors to the life expectancy gap in Bristol between the most deprived and the city overall are circulatory disease, cancers and respiratory
disease. The life expectancy outcome strategy documents the evidence and the interventions that we need to tackle these conditions through NHS
public health and health care interventions. This briefing is focussing on partnership activities and work addressing wider determinants of health
and inequalities.
B6 Summary of Strategy:
Our strategy is two pronged. One is working with other agencies that can have a direct effect on health and inequalities and the other is working
through the NHS to do the same. The PCT aims to address the wider determinants of health through its work with the Bristol Partnership, its
Sustainable Community Strategy (SCS) and the Local Area Agreement (LAA). The LAA includes 77 indicators, of which 30 are new designated
targets. The indicators are structured around four themes or ‘blocks’, taken from the Sustainable Community Strategy :
• A Learning City
• A Prosperous and Ambitious City
• A Safe and Healthy City
• A City of Thriving Neighbourhoods
Most of the targets in the LAA are directed at narrowing the gap between the most and least deprived areas in Bristol. For those indicators that the
PCT lead on e.g. breastfeeding and childhood obesity, the work is directed at the most deprived areas in order to achieve the citywide targets. The
response of the PCT and the wider NHS as a corporate citizen, in terms of its role as an employer, a place of safety and a purchaser of goods and
services can play a vital role in addressing key determinants of health.
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Health Inequalities
B7 Demonstrate the links to the Joint Strategic Needs Assessment (JSNA):
The JSNA highlights links between deprivation, poor housing, environments, education and skills, community safety and health and wellbeing.
Tackling these wider determinants of health and prioritising healthy lifestyle promotion in deprived wards would have major impact on overall
improvement in health and wellbeing. Lifestyle risk factors e.g. smoking, lack of physical activity, contribute to poorer health outcomes especially
among deprived groups where availability to make healthier choices may be limited by factors relating to socioeconomic circumstances.
B8 Data from national data set (available to assessment panel):
B9 Data source:
Department for Communities & Local Government (DCLG), Indices of Multiple Deprivation 2007 (IMD 2007)
B10 Is the national data robust? How have we come to this conclusion?
Yes, IMD 2007 was released in Spring 2007. Previous deprivation indices have been produced in 2000 and 2004. It is not known when the next
deprivation index will be produced, but it is possible that DCLG will wait until 2011 census data is available before refreshing the deprivation index.
B11 Please state current performance against target outcome:
B12 Do we know the current rate of improvement? If so, please provide details:
Not applicable, as the indicators are not directly comparable between 2004 and 2007. However, our rank has fallen from the 67th most deprived
Local Authority in England in 2004 to the 64th most deprived in 2007 (with 1st being the most deprived). This change in rank only indicates that
there has been a change in relative deprivation (i.e. relative to all other local authorities in England). Actual levels of deprivation may have
improved, deteriorated or stayed the same.
B13 Include benchmarking data where available:
Benchmarking against Core City Local Authorities within England, using Index of Multiple Deprivation (IMD).
The tables below show the ranks of the core cities within England, in terms of IMD. Bristol is the second least deprived of these
core cities and has retained this position between 2004 and 2007.
2007 2004
Rank of
average
Rank of average score out of
score out of 354 354 (1 is
LA NAME Average Score (1 is worse) LA NAME Average Score worse)
Liverpool 46.97 1 Liverpool 49.78 1
Manchester 44.50 4 Manchester 48.91 2
Birmingham 38.67 10 Birmingham 41.75 7
Nottingham 37.46 13 Nottingham 37.57 15
Newcastle 31.36 37 Newcastle 34.53 20
Sheffield 27.84 63 Sheffield 28.42 60
Bristol 27.76 64 Bristol 27.72 67
Leeds 25.07 85 Leeds 27.68 68
Source : DCLG, IMD 2007 Source : DCLG, IMD 2004
Benchmarking against the Office for National Statistics (ONS) cluster group of "Regional Centres" using IMD.
ONS have calculated that this group share a large number of census characteristics in common. Bristol is the 7th most deprived of these regional
centres and has retained this position between 2004 and 2007.
2007 2004
Rank of
average
Rank of average score out of
score out of 354 354 local
local authorities authorities
LA Name Average Score (1 is worse) LA Name Average Score (1 is worse)
Liverpool 46.97 1 Liverpool 49.78 1
Salford 36.51 15 Salford 38.19 12
Hastings 32.21 31 Newcastle 34.53 20
Newcastle 31.36 37 Hastings 31.73 38
Norwich 27.84 62 Sheffield 28.42 60
Sheffield 27.84 63 Norwich 28.33 61
Bristol 27.76 64 Bristol 27.72 67
Lincoln 26.56 70 Leeds 27.68 68
Plymouth 26.11 76 Lincoln 27.23 72
Brighton and Hove 25.56 79 Plymouth 26.16 76
Leeds 25.07 85 Brighton and Hove 25.68 83
Southampton 24.31 91 Portsmouth 24.88 88
Portsmouth 24.21 93 Bournemouth 23.74 95
Eastbourne 23.36 104 Southampton 23.72 96
Bournemouth 22.99 108 Lancaster 22.25 107
Southend-on-Sea 22.47 111 Southend-on-Sea 21.66 114
Lancaster 21.94 117 Exeter 21.58 115
Exeter 20.27 145 Eastbourne 21.46 117
Worthing 17.48 172 Worthing 15.74 198
Source: DCLG, IMD 2007 Source: DCLG, IMD 2004
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Health Inequalities
Benchmarking against Core Cities, using Percentage of Lower Super Output Areas within the 20% most deprived areas in England.
The table below shows the proportion of lower super output areas (LSOAs) within a local authority that fall within the most deprived 20% in
England. Bristol has the smallest proportion of LSOAs in the most deprived 20% in England compared with other Core Cities in 2004 and the
second smallest in 2007.
LA Name 2007 LA Name 2004
England 20% England 20%
Leeds 28% Bristol 27%
Bristol 28% Leeds 32%
Sheffield 36% Sheffield 37%
Newcastle 40% Newcastle 46%
Birmingham 56% Birmingham 55%
Nottingham 60% Nottingham 65%
Manchester 67% Manchester 72%
Liverpool 68% Liverpool 72%
Source: DCLG, IMD 2007 Source: DCLG, IMD 2004
Benchmarking against Regional Centres, using percentage of LSOAs within the 20% most deprived areas in England.
In 2007 Bristol ranked 12th of the regional centres for the proportion of LSOAs within the 20% most deprived in England. In 2004 Bristol was
ranked 10th.
LA Name 2007 LA Name 2004
Worthing 8% Worthing 5%
Eastbourne 14% Eastbourne 10%
Exeter 15% Exeter 14%
Bournemouth 16% Southend 17%
Southend-on-Sea 18% Bournemouth 18%
Lancaster 19% Southampton 20%
Portsmouth 20% ENGLAND 20%
ENGLAND 20% Brighton 21%
Brighton and Hove 21% Lancaster 21%
Southampton 24% Portsmouth 22%
Lincoln 26% Bristol 27%
Leeds 28% Plymouth 28%
Bristol 28% Lincoln 30%
Plymouth 29% Leeds 32%
Norwich 35% Sheffield 37%
Sheffield 36% Norwich 37%
Hastings 40% Hastings 38%
Newcastle 40% Newcastle 46%
Salford 47% Salford 51%
Liverpool 68% Liverpool 72%
Source: DCLG, IMD 2007 Source: DCLG, IMD 2004
B14 Is there an LAA or SHA stretch target? If so, please provide details:
Links to Tier 2 Vital Sign - VSB01 - All-age all-cause mortality rate per 100,000 population. National Indicator Set indicator NI120. Also, numerous
LAA targets relevant to addressing the wider determinants of health.
B15 Are there any links to other WCC health outcomes? If so, please provide details:
Life expectancy, smoking quitters, under 18 conception, cancer mortality, CVD mortality, alcohol misuse, suicide rates and childhood obesity.
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Delivery Plan
C Delivery Plan Actions & Indicators
Existing work supporting vulnerable groups:
Contracts with third sector providers
We have 39 contracts with the third sector which provide services for vulnerable and groups that we have traditionally failed to reach, these include contracts with
community based groups such as Knowle West Health Association and Hartcliffe Health and Environment Action Group to improve access to health services and better
access to healthy food. We have contracts with voluntary sector organisations to support people who abuse alcohol and drugs and we have three contracts to provide
benefits advice workers. We also have contracts with the voluntary sector to support people with mental health problems, people with terminal illnesses, carers, and
people who are homeless. These contracts are worth over £3.7 million pounds.
Contract with Bristol Community Health Services
Within Bristol Community Health we provide the following services for vulnerable and hard to reach groups:
DART for young disabled adults
Looked after children's nurses
The Homeless service
TB Specialist Nurses
Prison healthcare
The Community Learning Difficulties team
Health Links providing translating and interpreting services
Multicultural health and girls clinic
The Haven for asylum seekers
Sickle Cell and Thalassaemia service
Specialist Health Visitors for Gypsy Travellers
Somali health workers
Policy and Programme leadership
The Public Health Directorate provides city wide policy, partnership and programme leadership around Race Equality, Asylum Seekers and Refugees, Hate Crime, Sexual
Orientation and Health, Gypsy Traveller Health, Preventing Homelessness, Prison Health and Domestic Violence. The Public Health Directorate manages participation in
two national equality programmes on behalf of the PCT; Race for Health and the Pacesetter Programme. These programmes require commitment to quality standards
and key performance indicators across the organisation. Bristol PCT has an integrated approach to its equality schemes and duties covering all 6 themes (race,
disability, gender, sexual orientation, religion and age). This is performance managed by a strategic group, chaired by a non executive director, reporting to the Board.
Please state the main actions to be undertaken in order to improve health outcomes:
See also attached table of work within the LAA addressing wider determinants of health which are the responsibility of the Bristol Partnership and in which
the PCT play a role.
No Actions Delivery Date Indicators/Data Collection Evidence Base
Specify the units of activity and exactly what When will the What data/indicators will be collected/used Why will the action be carried out?
outcome this will lead to. action be to demonstrate success?
carried out?
2008/09
1 Community health development work Start Nov 08 A baseline of current activities in A gap has been identified for operational staff to facilitate health
in targeted areas on wider and ongoing the most 5 deprived areas and improvement activities on the ground. This has become more
determinants of health, i.e. health targets set for improvement. apparent with the demise of Neighbourhood Renewal. This is a
improvement initiatives important to the Numbers of community proven way of working to increase capacity within Neighbourhoods
local community. organisations supported to deliver which should lead to a cultural shift in the way that residents
Key activities will be supported to health improvement interventions, respond to lifestyle issues in the longer term.
engage and empower residents to numbers seen; service (www.nice.org.uk/PH009). There are also a wealth of documents
make changes. This may include Art improvements demonstrated; on the impact of certain interventions. For example- Dr Rosalia
and Health activities, community clean feedback from individuals; feedback Staricoff’s review of the medical literature for the Arts Council
ups, transport schemes, walking from community groups and (2004) cites nearly 400 papers showing the beneficial impact of the
groups and cookery. It includes organisations; evidence of improved arts on a wide range of health outcomes.
support to the health task groups in the access. (www.artscouncil.org.uk/documents/publications/php7FMawE.doc)
former neighbourhood renewal areas
and support to projects that were
previously funded by neighbourhood
renewal.
2 Health Trainers working in all areas Ongoing with Numbers of clients seen and The health trainer programme is a new public health workforce led
of high health need, providing one to expansion in actions taken recorded. by the DH. Bristol was an early implementer of this service but
one practical support and signposting 09/10 and Target 1080 per year the Health because of past financial constraints is very limited in scope. The
to assist lifestyle change. 10/11 trainers will be using the National programme needs to be expanded in order to be effective. The
This includes the health trainers Health Trainer database from 2009 programme has been gathering momentum on a national level and
working exclusively with people with which will give details of all clients the following documents evidence its effectiveness in improving
learning difficulties. seen and behaviours changed. health in disadvantaged communities:
The project is being consolidated in Department of Health White Paper: Choosing Health: Making
08/09 with the employment of a healthy choices easier, 16/11/2004
manager and health trainers with Department of Health White Paper: Our Health, Our Care, Our
learning difficulties, and developed Say: A new direction for community services 30/01/2006
further by an incremental expansion of Department of Health - National Health Trainer Outcome and
the programme in subsequent years so Evaluation Synopsis (Feb 2008) Research Team Dr Dawn
that all areas of high health need are Wilkinson, Ms Priya Jain, Ms Lynda Hyland, Prof. Susan Michie-
covered by 10/11. Centre for Outcomes Research and Effectiveness University
College London
Department of Health - Summary of the findings from the National
Health Trainer Activity Report and Outcome and Evaluation
Synopsis (Feb 2008) Dawn Wilkinson – CORE, UCL
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Delivery Plan
3 Linkage Pilots to improve services Pilots to Evaluation Framework developed Linkage is one of the Five Big Ideas to deliver key outcomes in the
and facilities for older people in Easton continue until focussing on key outcomes. Older People's Strategy Document for Bristol. It is about putting
and Lawrence Hill and Bedminster and March 10 Baseline survey to be undertaken older people in the driving seat and responding to identified needs
Southville. and repeated annually. to increase quality of life and life expectancy. The two pilot areas
Work with older people is being are for an initial two years and if evaluation proves they are
undertaken on what indicators they successful then the programme will be rolled out to the rest of the
consider most appropriate: e.g. City.
Health and wellbeing, increased
social circle, undertaking exercise,
improved mental health, reduced
social isolation, provision of
information, companionship and
friendship, increased confidence,
greater understanding of the
availability of resources and services
etc.
4 Increase capacity of key voluntary Ongoing Numbers of clients seen and The VCS provide a vital resource in providing health promoting
sector organisations that work in areas actions taken recorded. activities tailored to, and led by, the communities they serve. They
of high health need. Thriving voluntary and community are also able to add value to these activities by accessing funds and
This includes projects that deliver sector NI 7. resources from a wide range of sources. Consequently, a relatively
health improvement activities such as Influencing decisions in small investment from the PCT can have a considerable impact. “
Hartcliffe Health and Environment neighbourhoods Local Indicator, Capitalising on neighbourhood and community infrastructures to
Action Group and Wellspring Healthy LAA reward target. engage individuals, families and communities, particularly those
Living Centre. For example, cooking Incapacity claimants Local ‘seldom seen, seldom heard’ in services, using them to ensure
skills, access to healthy food via food indicator, reward target. services are responsive to needs and to motivate and support
co-ops and box schemes, singing appropriate health seeking behaviour”. Ref:
groups, dance and physical activity,
walking groups, support to survivors of Health White Paper: Choosing Health: Making healthy choices
domestic abuse, mental health support easier, 16/11/2004
groups. This list is not exhaustive and
will be dependent on the identified
needs in areas.
The development of work and
identification of needs should result in
additional services being delivered by
the VCS. One example already
identified is Men's health. Additional
funding has been included in the
investment table to reflect this.
5 Develop programme of mental Sep-08 Numbers seen. Mental health and mental illnesses are determined by multiple and
wellbeing interventions, to include Service improvements interacting social, psychological and biological factors. The risk of
targeted work with vulnerable groups demonstrated. mental illness is associated with indicators of poverty, low levels of
and those at risk of mental ill health Feedback from individuals. education, and in some studies with poor housing and low income.
and suicide. Feedback from community groups Evidence indicates that mental ill-health is more common among
and organisations. people with relative social disadvantage. The greater vulnerability of
Evidence of improved access. disadvantaged people to mental illnesses has been linked to factors
such as the experience of insecurity and hopelessness, rapid social
change, and the risks of violence and physical ill-health. There is
growing evidence to suggest interplay between mental and physical
health and well-being and outcomes such as educational
achievement, productivity at work, development of positive personal
relationships, reduction in crime rates and decreasing harms
associated with use of alcohol and drugs. Building positive mental
health will be achieved through policies and programmes in
government and business sectors including education, labour,
justice, transport, environment, housing and
welfare, as well as specific activities in the health field relating to
the prevention and treatment of ill-health. The new UK framework
for public mental health, builds on the national health promotion
strategy, and outlines the importance of investing in proactive
mental health measures in order to promote resilience and reduce
risk, particularly among vulnerable groups.
6 Action to prevent domestic abuse and Sep 08 Actions met in Bristol Domestic Domestic abuse affects one in four women. It is the largest cause
to improve services for survivors of ongoing, but Violence and Abuse (DVA) strategy. of death for women under age 45. Recent research found that 40%
domestic abuse. Active members of the developments of women attending primary care have a lifetime experience of
Bristol Domestic Abuse (DVA) Strategy phased in Attitude towards DVA questions in domestic abuse with 17% having experienced DVA in the past year.
Group, leading on the prevention over 09/10 Quality of Life questionnaire. Abused women and their children suffer many serious and chronic
strand of the strategy. and 10/11 Baseline will be set this year. health problems.
Co-ordination of Freedom with some LAA target NI 32 reduction in
Programme. work repeat incidents of domestic abuse
IRIS research project in primary care undertaken of cases seen by Multi Agency Risk
(12 intervention and 12 control before this. Assessment Conference (MARAC).
practices).
Dissemination of DVA toolkit in
childrens centres and schools.
Training for risk assessments and
DVA generally.
Support for MARAC and improved
data collection in primary care.
7 Partnership work to deliver the Local April 08 to National and local indicators as The LAA is the delivery vehicle for sustainable community strategy
Area Agreement (LAA) targets which March 2011 listed on the attached table. which aims to tackle inequalities and deprivation in the City.
tackle the wider determinants of health.
This includes work on particular
indicators as well as being part of the
Challenge Group that oversees the
whole of the LAA. These are listed
separately in the attached table which
links them to IMD domains.
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Delivery Plan
8 Action to influence the urban Nov 08 Appointment of planner in Local The importance of the urban environment cannot be
environment through working with the ongoing Authority with responsibility for underestimated. It determines whether walking and cycling are
City Council spatial planning team. carrying out health impact possible, or whether people have to use the car to access services,
Health impact assessments of assessments. for example. Mental and physical health is inextricably linked with
developments, including core strategy. New developments have a positive the environment in which people live.
impact on health as measured in the
health impact assessments on all
major developments.
2009/10
9 Consolidation and expansion of 01/09/2009 Numbers of clients seen who have See above.
health trainer programme to cover all ongoing made a positive behaviour change.
communities and neighbourhoods of Target further 1080 clients.
high health need, new local training
programme commissioned.
10 Expansion of community health 01/07/2009 Numbers of community See above.
development work in neighbourhoods ongoing organisations supported and or set
and communities with high health up and new health improvement
needs and development of community activities initiated.
and voluntary sector projects to deliver Numbers of community
health improvement interventions in the organisations supported to deliver
community. health improvement interventions.
Numbers seen.
Service improvements
demonstrated.
Feedback from individuals
Feedback from community groups
and organisations.
Evidence of improved access.
11 Action to prevent domestic abuse and July 09 and Actions met in Bristol Domestic See above.
to improve services for survivors of ongoing Violence and Abuse (DVA) strategy.
domestic abuse.
Mainstreaming of Freedom Attitude towards DVA questions in
Programme. Quality of Life questionnaire.
Roll out of IRIS project in primary Baseline will be set this year.
care. LAA target NI 32 reduction in
Dissemination of DVA toolkit in repeat incidents of domestic abuse
childrens centres and schools. of cases seen by Multi Agency Risk
Provision of childrens support worker. Assessment Conference (MARAC).
Training for risk assessments and
DVA generally.
Support for MARAC and improved
data collection in Acute Trusts.
2010/11
12 By 10/11 it is anticipated that a health September Numbers of people reporting to the See above.
promotion specialist with responsibility 2010 and Quality of Life Survey, feeling safe,
for developing health improvement ongoing healthy, satisfaction with
activities around the wider neighbourhood, able to influence
determinants of health will be decisions in neighbourhood.
employed in each neighbourhood of
high health need.
13 Further development of the Health September Numbers of clients seen who have See above.
trainer Programme directed at 2010 and made a positive behaviour change.
particular communities, e.g. Older ongoing Target further 120 clients per
People, Travellers and Gypsies. health trainer.
14 Further development of community September Numbers of community See above.
health development work targeting 2010 and organisations supported and new
people with the highest health need ongoing health improvement activities
who are the most marginalised, for initiated for the most marginalised
example, Disabled people, particular groups.
Black and other minority ethnic groups,
Young People.
15 Roll out of the LinkAge projects if the September Number of new LinkAge Centres Evaluation of the pilot projects.
evaluation is deemed to make a 2010 and developed.
difference in achieving positive health ongoing Service improvements
outcomes for Older People in line with demonstrated.
the evaluation framework. Feedback from individuals.
Feedback from community groups
and organisations.
Evidence of improved access to
services.
16 Further development of the Ongoing Numbers of clients seen and See above.
Community and Voluntary Sector actions taken recorded.
delivering health improvement projects. Thriving voluntary and community
sector NI 7.
Influencing decisions in
neighbourhoods Local Indicator, LAA
reward target.
Incapacity claimants Local
indicator, reward target.
D Total Investment
D1 Please provide details of the total new investment between 2009/10-2012/13:
£5,195,000
D2 Please include comments if funding is subject to Operational Planning Process (OPP) approval:
Future investment for 2009 onwards is subject to OPP process.
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Triangle
Well
Being
Immunisation and screening. Smoking Healthy eating and Get Cooking projects.
cessation groups. Exercise Prevention of
prescriptions Illness
Healthy behaviours and
lifestyle Preventative medicine
Campaigning for local health, social and Community led Health Needs assessment.
Health and Social Care Improving access to responsive services.
Responsive and appropriate health
and welfare services
Advice and information Community-based Education in school and community. Lay
Health Awareness health workers.
Knowledge and understanding health
Developing local economic solutions
such as credit unions. Campaigning for Counselling, self-help and support.
Mental Survival Assertiveness training and confidence
employment, improved benefits and
uptake. Community and self-esteem building
Physical Survival Housing and environment action.
Participation in local democracy
Improving access to food via food
and decision making. Food, shelter, warmth and safety
coops and retail outlets.
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LAA Links to IMD Domains
Priority Area LAA Indicators Links to IMD Lead Partner PCT Involvement/Contribution to Partnership LAA number or Any Investment
Domain Arrangements Delivery Plan Issues?
Name
Thriving Voluntary and Community NI 7 Environment BCC Community health development work at 1 Additional investment
sector neighbourhood level. Linkage pilots by PCT required
Serious crime, assault, antisocial NI 19 Crime Youth Offending Early intervention project 3
behaviour Team
Re-offending young people NI 16, 20, 21 Crime Police Through Safer Bristol and strategy groups 2, 4, 5
Support re sexual abuse NI 26 Crime Police Safer Bristol, Sexual Abuse Referal Centre 6
Domestic abuse re-offending NI 32 Crime Police Safer Bristol, Domestic Abuse Strategy Groups, 7 Additional investment
MARACS by PCT required
Unemployment NI 152, 153 Employment Job Centre Plus Bristol Partnership, neighbourhood working 18, 19
Extra homes, affordable homes NI 154, 155, 159 Housing BCC Local Development Framework Steering Group, 20, 21, 22
support to planning
Adult qualifications NI 163 Skills and LSC Bristol Partnership, neighbourhood working 23
training
Congestion, walking, cycling, public NI 167, 175, 177, 186 Environment BCC Active Bristol, HWDG, Green Capital 24, 25, 26, 27 Additional investment
transport, CO2 emissions by PCT required
Recycling, street cleanliness, litter, NI 192, 193, 195 Environment BCC Neighbourhood working, Bristol Partnership, 28, 29, 30
graffiti
Satisfaction with neighbourhood NI 5 Environment BCC Bristol Partnership, neighbourhood working, urban 31
planning
Educational achievement absence NI 72 -75, 83, 87, 92, 93 -101, Education BCC Healthy Schools, Children Looked after nurses, 33-55
rates, exclusions plus local indicators CAHMS, neighbourhood working.
Incapacity claimants Local indicator, reward target Employment Job Centre Plus Neighbourhood working, Bristol Partnership, health 56 Additional investment
trainers, expert patient programme, mental health by PCT required
work
Prolific offenders Local indicator, reward targets Crime Police Safer Bristol 57-59
Drug and alcohol misuse treatment Local indicator, reward targets Crime Police Safer Bristol, drug and alcohol work 60-63
Influencing decisions in neighbourhood Local indicator, reward target Environment Change Up Bristol Partnership, neighbourhood working, health 73 Additional investment
Consortium trainers by PCT required
School governors Local indicators, reward targets Education BCC Healthy Schools, neighbourhood working 74, 75
Improved parks in NR areas Local indicators, reward targets Environment BCC Bristol Partnership, Active Bristol, neighbourhood 76, 77
working
NB: A number of these areas have received additional PCT investment in the last LDP round.
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Deprivation Map
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