Lewisham Shadow Health and Wellbeing Board by Z8z8nu9H


									Lewisham Shadow Health
  and Wellbeing Board

 Towards a Lewisham Health
    & Wellbeing Strategy
Where have we got to so
  Previously, on ‘The Shadow Health
       and Wellbeing Board’ ….

We identified 9 possible priorities for
    a health and wellbeing strategy
              based on …

• Biggest burden on life expectancy & QoL
• Multi agency approach can make a
• Current delivery plans don’t go far
            but …

Existing JSNA doesn’t completely
        address all 9 areas
          therefore …

   NHS & Council Officers have
 completed ‘mini’ JSNA summaries
for each of the 9 proposed priority
The tasks for the H&WB Board today
1. Review 9 ‘mini’ JSNA summaries
   and agree the priorities for
   Lewisham’s Health & Wellbeing
2. Start a deliberation on what each
   H&WB Board member organisation
   can do to help deliver these
3. From the 9 priorities, select 3 for
   the focus of H&WB Board work
   over the next 12 months

     (on the basis that they present
       either a quick win, a knotty
    problem, or engage all members)
4. Agree a process for addressing the
   3 chosen priorities at each of the
   next 3 H&WB Board meetings
5. Agree a timetable for producing a
   10 year Health & Wellbeing
   Strategy for Lewisham
‘Mini’ JSNA Summaries

 For each of the 9 proposed
  H&WB Strategy priorities
               Tobacco Control: What do we know?

             Facts & Figures                                   Key Inequalities

•The number of smokers in Lewisham is between    • low income twice as likely to smoke as more
45,000 and 50,000                                affluent
•Smoking is the primary cause of premature       •Children with mother/both parents smoke 2-
death and preventable illness                    3 times more likely to smoke themselves
•710 new young smokers a year, mostly 11-15      •More than 40% of total tobacco consumption
                                                 is by those with mental illness
year olds

           What works                                           Local Views

Reducing smoking in young people
                                                • Year 8s question why it’s legal when they
 Peer support
                                                learn about industry’s marketing to young
 comprehensive strategy for preventing take-
                                                people to recruit replacement smokers.
up: mass media; education programmes;
                                                • The Young Mayor’s advisors say young
cessation support services; community
                                                people are influenced by other young people
programmes; reducing the number of parents
                                                and people they look up to e.g. footballers and
who smoke                                       athletes. We have to combat smoking as ‘cool’.
            Tobacco Control: What is this telling us?

            Gaps knowledge/services                              On the horizon

•No information about scale and impact of illegal   • Users of addictive substances likely to
trade in tobacco in Lewisham                        relapse at time of recession
•No strategic approach to prevent uptake of         •Tobacco industry targets vulnerable groups
smoking among young people                          e.g. young people in countries where
•Stop smoking service only reaches 7% of            regulation is tighter

            What should we consider doing next?

•Promote the de-normalisation of smoking
•Prioritise tackling illegal trade in tobacco products to protect children
•Focus on preventing uptake of smoking
•Promote smoke free homes
•Ensure everyone in Lewisham knows how to access help to stop smoking
•Ensure sign up and representation on delivery group from all partners
          Reducing Alcohol Harm: What do we know?

              Facts & Figures                                      Key Inequalities
•Alcohol use has a major impact on health, anti-   • men > twice likely to die from alcohol than
social behaviour, crime                            women, but death rate decreasing for men and
•In Lewisham an estimated: 11365 higher risk,      increasing for women
31,873 increasing risk, 118,194 lower risk         •<18s women twice admission rate as men, >18s
drinkers                                           three times as high for men
•Alcohol-related admissions high in Lewisham       • Whites over represented admissions/treatment
and rising
            What works                                              Local Views

                                                   •Street drinkers continue to be identified as
 Population based public health approaches        problem by some Lewisham residents
 Screening, brief interventions for both          •Different sites for treatment and recovery
young people and adults                            services
 parental supervision and parental drinking        Increase the speed of access to detox.
in front of children                               services and links with rehab. services
 School-based alcohol use prevention              • Make information on services/referral
programmes                                         pathways more readily available to GPs and
                                                   other agencies
         Reducing Alcohol Harm: What is this telling us?

            Gaps knowledge/services                                On the horizon
                                                     •New national alcohol strategy December
•Scored high on NTA self evaluation tool, but        •Potential reductions in current funding
gap in clinical engagement from acute sector         •Public Health and NTA structural changes
•Limited capacity at each tier                       2013

            What should we consider doing next?

•Prevention of uptake by young women through: use of social marketing; involving families;
school programmes
•Promoting use existing licensing powers and good practice; working with alcohol sellers to
ensure compliance with licensing regulations; A&E data sharing to ensure targeted approach to
tackling alcohol related violence.
•Improve referral pathways and expand interventions to support those most at risk through:
identification; early intervention and brief advice by key professionals; interventions through the
criminal justice system; primary care helping people onto treatment pathways; accessible levels
of treatment
     Immunising Children <5yrs: What do we know?

             Facts & Figures                                     Key Inequalities
                                                 • At risk not being immunised: looked after
•Uptake of vaccines below target                 children; children with physical/learning
•Significant numbers of children in Lewisham are difficulties; children of teenage/lone parents;
not protected against potentially serious        children not registered with GP; travellers,
infections                                       asylum seekers, homeless
•Outbreak of measles in Lewisham in 2008 with    •Uptake of vaccines varies greatly by GP practice
a total of 275 confirmed or suspected cases.     in Lewisham
            What works                                            Local Views

                                                 • little effort in recent years to understand the
 London-wide and local plans have been          views of parents locally, nor to identify barriers
based on elements of the approach that the
                                                 to immunisation
city of Birmingham has taken to this issue
and which have been clearly demonstrated to      • Parental resistance, especially to MMR,
                                                 probably does not account for most of the gap
have a major impact on uptake
                                                 between performance and relevant targets
   Immunising Children <5yrs: What is this telling us?

           Gaps knowledge/services                              On the horizon
                                                  •Possibility of inclusion of influenza vaccine in
•Continued failure to meet most targets on        routine immunisation programme for all
immunisation, particularly MMR and PSB.           children
•Continued need to improve information            •Possible availability of a vaccine against
systems and to use information to make things     Group B Meningococcus, the most important
better.                                           cause of meningococcal disease in this
•Variation between GP practices.                  country.

           What should we consider doing next?

•Working with relevant stakeholders to ensure implementation of a preschool booster pathway
(similar to the MMR pathway).
•Engaging with primary schools and early years providers to implement standardised collection
of information on the immunisation status of new entrants, exploring options for offering
vaccinations to under-vaccinated children, and identify opportunities to promote immunisation
(e.g. among childminders).
•Continued work on MMR pathway, improved information systems and with GPs.
•Survey of parents to better understand barriers to immunisation.
•Opportunistic immunisation of children whenever they present within the health service.
       Improving Mental Health: What do we know?

              Facts & Figures                                        Key Inequalities
                                                     • SMI in those from African Caribbean and Black
•Common Mental Illness estimated to afflict          African backgrounds 7 or 8 times higher than
19.8% Lewisham’s population at any one time          white populations
(higher than London and England)                     •Women more frequently affected by CMI than
•Severe Mental Illness estimated to affect 1.1% of   men, southern Asian women higher risk.
Lewisham’s population (England 0.7%)                 •Poor maternal mental health associated 4-5 fold
• Most mental disorder begins before adulthood       increase conduct disorder in children.

            What works                                                Local Views

 Prevention of conduct disorder through
social and emotional learning programmes
result in total returns of £83.73 for each £         • IAPT warmly received by patients with high
invested                                             satisfaction rates.
                                                     •In patient services at the Ladywell issues
 universal and targeted interventions in
                                                     around sub-optimal patient experience
primary schools
 Employment support for those recovering
from mental illness
     Improving Mental Health: What is this telling us?

            Gaps knowledge/services                               On the horizon
                                                    - high rates of unemployment and immigrant
                                                    demographic will increase need for both CMI
•large proportion of people with mental health      and SMI services
problems never seek healthcare                      - £5.6M worth of efficiencies need to be
• no generic mental health voluntary support        found across mental health services by
organisation                                        2013/14, in addition to 4% efficiency saving
                                                    which must be achieved by the provider

            What should we consider doing next?

•Tackling stigma and facilitating work for those with mental health problems is possible through
concerted community action.
•Early intervention services, particularly in childhood are cost effective mechanisms for reducing
the long term impact of conduct disorders, antisocial personality disorders and mental ill health
in adolescents and adulthood and should be investigated further for local implementation.
•As part of the reconfiguration of CMHTs and the care offer available to people with mental
health problems, the development of commissioned voluntary sector support should be
      Improving Cancer Survival: What do we know?

              Facts & Figures                                      Key Inequalities
                                                    • Cancer incidence and mortality generally
•In Lewisham approximately 1000 Lewisham            higher in deprived groups Breast cancer higher
residents are diagnosed with cancer each year       incidence in more affluent groups, but mortality
•The premature mortality rate ( under 75years)      higher in less affluent women
for males in Lewisham is 24% higher than that       •Variance in mortality partly attributed to
of England and 10% higher for females               delayed diagnosis amongst deprived groups and
•Smoking is the single, largest preventable cause
                                                    certain BME groups (for breast cancer)
of cancer
             What works                                             Local Views

  Research suggests major explanation for          • The Healthy Communities Collaborative
 poorer outcomes in England is that cancers         Cancer Project worked with a team of lay
 are diagnosed at a later stage                     volunteers to organise and facilitate cancer
 Raising awareness of signs and symptoms of        awareness workshops, presentations, festival or
 lung cancer in Doncaster resulted in rates of      group meetings, which attract a diverse
 early diagnosis increasing by 70% from 11%         population in terms of age and ethnicity.
 to 17%
    Improving Cancer Survival: What is this telling us?

            Gaps knowledge/services                              On the horizon
                                                   •Improved detection will increase proportion
•Lack of Scale of primary prevention
                                                   of cancers requiring active, curative and
interventions                                      intensive treatment.
•Effective interventions needed to increase        •Increased demand for adjuvant therapy
uptake of screening and awareness of symptoms      •Improved survival rates will lead to increased
and signs of cancer in the population as a whole   workload in monitoring and treatment of
and in specific population groups.                 recurrence
                                                   •Increased demand for emotional support.
            What should we consider doing next?

•Need to increase the scale of primary prevention interventions to reducing smoking prevalence,
promote healthy eating and physical activity, promote sensible drinking and to sustain the skin
•List validation in primary care and checking patient contact details including telephone
numbers key to increase uptake of screening
•Practices to promote screening and to actively follow up patients that have DNAed their
screening appointments.
•Active promotion of cancer screening programmes to eligible communites
      Promoting Healthy Weight: What do we know?

              Facts & Figures                                    Key Inequalities
•Local maternal obesity data show more women     • In adults higher level of obesity found among
overweight (31%) or obese (24%) in Lewisham      more deprived groups. Association stronger for
compared with England as a whole (28% and        women
17%).                                            •Obesity in children increases with increasing
•Over 48,000 adults in Lewisham obese, over      levels of children eligible for Free School Meals.
70,000 adults with raised waist circumference    •In adults obesity higher in women of Black
•Over 40% of Lewisham10-11 year olds and over    Caribbean, Black African and Pakistani groups
                                                 compared to the general population.
25% of 4-5 year olds were overweight or obese
            What works                                            Local Views

 • Joint partnership working to tackle obesity
 promoting environments                          • Public consultation by PCT identified reducing
 •Breastfeeding                                  childhood obesity as key priority area
 •Multi-component interventions for              •Consultations with children and young people
 promoting behaviour change that target          through student councils and the young
 dietary and physical activity behaviours that   mayor’s advisors have highlighted obesity and
 use individual or group based strategies        healthy living to be a concern to children
 •Family based programmes for children
    Promoting Healthy Weight: What is this telling us?

            Gaps knowledge/services                              On the horizon
•Limited local information on: incidence obesity
in children below school age, during pregnancy     •Nationally the prevalence of obesity in
and adults, diet/activity levels children and      children levelled over the past few years but
                                                   too early to know if this is a trend.
                                                   •The recession may influence types of foods
•Capacity for weight management support            purchased which are likely to be energy dense
inadequate for level of need.                      and contribute to excess weight.

            What should we consider doing next?

•Extend and reinforce the healthy weight strategy for Lewisham and include measures to
prevent and reduce obesity together with treatment of individuals already identified as
overweight or obese.
•Expand on workplace health
•Work with fast food outlets to increase range of healthy options available to customers.
•Expand on work with housing and planning to create a healthier built environment.
        Improving Sexual Health: What do we know?

              Facts & Figures                                     Key Inequalities
•In 2009 the teenage conception rate in            • Teenagers from Black ethnic groups are 74%
Lewisham had fallen 31% since 1998 (17th           more likely to get pregnant than those from
highest rate in England and 4th highest in         White ethnic groups
London)                                            •Late HIV diagnosis more common in Black
•1,360 people have HIV infection in Lewisham       Africans, particularly heterosexual men
(8th highest prevalence in UK).                    •sexual health needs of men who have sex with
•10% 15-24 year olds have Chlamydia                men not well met within borough

            What works                                             Local Views

 • Multifaceted approaches work best for           • Young parents valued dedicated youth
 teenage pregnancy (high quality SRE,              workers within ‘virtual team’ (including young
 accessible services, broader work to raise self   persons midwifery services and Sure Start
 esteem and aspiration                             based at Connexions)
 •HIV testing offered in range of non-sexual       •2010 SHEU survey in secondary schools found
 health settings such as primary care and          that 16% of year 10 students could not recall
 community settings reaches people who don’t       any SRE lessons in school
 usually present to sexual health services         contraception responsibility of female,
                                                   condoms perceived to be for preventing STIs,
                                                   linked to promiscuity, erratically used.
      Improving Sexual Health: What is this telling us?

            Gaps knowledge/services                                On the horizon

•Inequity in SRE provision
• currently no abortion service based in            •Increased use of e-technologies and self
                                                    •Implementation of a sexual health tariff from
•local sexual health services not attracting men
                                                    April 2012 (financial implications not yet clear)
who have sex with men

            What should we consider doing next?
•Promote broader range of settings to deliver sexual health including pharmacies, GPs, schools
and web based services.
•Further develop the roll out of peer educators particularly in FE colleges
•Roll out HIV testing in primary care planned for 2012 onwards. Opportunities to increase HIV
testing in other settings such as hospitals and opportunistically in primary care should also be a
•Targeted work with Black African communities to better understand the high rates of repeat
abortion and any barriers to accessing sexual health services.
•Expansion of pan-London c-card scheme into more settings.
   Reduce Emergency Admissions for LTCs: What do we know?

               Facts & Figures                                   Key Inequalities
                                                  • Cardiovascular disease main contributor to life
•Lewisham COPD emergency admission rate           expectancy gap between Lewisham and England
significantly higher than the national average.   •COPD estimated to contribute 11.3% to
•There were 13,406 people on Lewisham GP          Lewisham life expectancy gap for men and 9.1%
Diabetes Registers in 2010/11 aged 17+            for women
•There were 5,581 people on Lewisham GP           •People from BME communities at increased risk
Coronary Heart Disease (CHD) Registers in         of diabetes, hypertension, stroke and renal
2010/11 aged 17+                                  disease
             What works                                           Local Views

 • Tiered, Managed Care Model for diagnosis
 and management of Long Term Conditions in
 primary and secondary care, including clinical   • LTCs Support Group (now a patient‐led
 guidelines, referral protocols, key worker,      group)
 community matron, early supported                •Diabetes UK input into the Lewisham Diabetes
 discharge, specialist nurse led community        tier 1 and 2 service
 clinics                                          •‘Breathe Easy’ Group
Reduce Emergency Admissions for LTCs: What is this telling us?

            Gaps knowledge/services                               On the horizon

                                                    •Telehealth and telecare offer opportunities
•Lack of evidence on effectiveness of
                                                    for delivering care more efficiently. Use of
combinations of interventions to reduce
                                                    both these technologies in a transformed
emergency admissions
                                                    service can lead to significant reductions in
• Gaps in transfer of patient care from one care
                                                    hospital admissions and better patient
setting to another

            What should we consider doing next?

•Integrating health and social care may be effective in reducing admissions. An independent
enquiry into the quality of general practice underlined the importance of better co-ordination
and engagement with social care
• Developing a shared vision and strategy for ‘integration’ across the heath economy in
     Reduce need for long term care and support: What do we
               Facts & Figures                                         Key Inequalities
   •2,862 (11.8% ) Lewisham older adults                  •More women than men receive services –
   aged 65+ receive social care                           more than borough average for population
   •Approx 290 adults aged 65 + receive                   •More White British service users than
   residential and nursing home packages                  borough average for this age group.
   •153 adult safeguarding referrals for                  •There are more female safe guarding alerts
   clients aged 65 and over were received                 in 2010/11 compared to males.

             What works                                                 Local Views

 The Partnerships for Older People Projects (Popp)          •Annual self-assessment, service user
cost-effective compared with usual care (small               questionnaires, monitoring visits
housing repairs, gardening, limited assistive                (announced and unannounced) reports
technology or shopping) with improved quality of life        form advocacy organisations, lay
& wellbeing.                                                 visitor scheme are examples of tools
• Evidence for Care services efficiency delivery (CSED)      used locally to collect local views from
that 36-48% of users who complete reablement                 clients, carers and families.
required no homecare package two years later
       Reduce need for long term care and support: What is this
                              telling us?
             Gaps knowledge/services                                On the horizon
•Poor co-ordination between Adult social care,            •Closer scrutiny of care standards locally
customer services and Lewisham Homes in provision         in the light CQC and Health Service
of sheltered/extra care housing in Lewisham.              Ombudsman reports
•Lack of systematic mapping to predict real impact         Moves from process/output based
of intermediate care services                             performance management to outcome
•Gaps in knowledge about uptake of social care            based framework across adult social care,
services for this age group by ethnicity, religion etc.   NHS and public health.
             What should we consider doing next?

    •Further work required on systematic collection, evaluation and interpretation of data sources
   •Improve strategic co-ordination between Adult social care, customer services and Lewisham
   Homes in provision or re-provision of sheltered/extra care housing provision in Lewisham.
   •Further work to map older adults residential, nursing and domiciliary pathways, to predict
   real impact of intermediate care services (reablement, sheltered accommodation) on reducing
   demand and spend on residential, nursing and domiciliary care packages
Review 9 ‘mini’ JSNA summaries and
  agree the priorities for Lewisham’s
      Health & Wellbeing Strategy
 Start a deliberation on what each
  H&WB Board member organisation
     can do to help deliver these
From the 9 priorities, select 3 for the
   focus of H&WB Board work over
          the next 12 months

    (on the basis that they present
      either a quick win, a knotty
   problem, or engage all members)
Breakout Groups
We Recommend the following three

1. Reducing Smoking
2. Improving Mental Health
3. Reducing Emergency Admissions
   for people with Long Term
Agree a process for addressing the 3
    chosen priorities at each of the
     next 3 H&WB Board meetings
We recommend the following process

At each of the next three H&WB Board meetings we:

1.   Review the more detailed JSNA evidence;

2.   Examine the existing delivery plan;

3.   Assess current performance;

4.   Identify what more we can do collectively and
     individually to accelerate progress
Agree a timetable for producing a 10
   year Health & Wellbeing Strategy
             for Lewisham
We recommend:

1. Senior Officers, with input from
   Voluntary Sector, LHNT, SLAM and
   Clinical Commissioners, bring first
   draft H&WB Strategy to next H&WB
We recommend:

2. Present findings of initial
   consultation at next Board meeting
3. Complete consultation and bring
   final draft for approval at second
   Board Meeting
Lewisham Shadow Health
  and Wellbeing Board

 Towards a Lewisham Health
    & Wellbeing Strategy

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