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									                                                                     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
                                                                    Rank of average                                                             score out of
                                                                   score out of 354 (1                                                            354 (1 is
                                 LA NAME         Average Score         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
                                                                    Rank of average                                                              score out of
                                                                     score out of 354                                                             354 local
                                                                   local authorities (1                                                         authorities (1
                        LA Name                  Average Score          is worse)                  LA Name                   Average Score        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

                       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 to                       Why will the action be carried out?
                  outcome this will lead to.              action be                 demonstrate success?
                                                         carried out?
     1  Community health development work      Start Nov 08              A baseline of current activities in the        A gap has been identified for operational staff to facilitate health
       in targeted areas on wider determinants and ongoing               most 5 deprived areas and targets                improvement activities on the ground. This has become more
       of health, i.e. health improvement                                set for improvement.                             apparent with the demise of Neighbourhood Renewal. This is a
       initiatives important to the local                                 Numbers of community                           proven way of working to increase capacity within Neighbourhoods
       community.                                                        organisations supported to deliver               which should lead to a cultural shift in the way that residents respond
        Key activities will be supported to                             health improvement interventions,                to lifestyle issues in the longer term. (
       engage and empower residents to make                              numbers seen; service improvements               There are also a wealth of documents on the impact of certain
       changes. This may include Art and                                 demonstrated; feedback from                      interventions. For example- Dr Rosalia Staricoff‟s review of the
       Health activities, community clean ups,                           individuals; feedback from community             medical literature for the Arts Council (2004) cites nearly 400 papers
       transport schemes, walking groups and                             groups and organisations; evidence               showing the beneficial impact of the arts on a wide range of health
       cookery. It includes support to the                               of improved access.                              outcomes.
       health task groups in the former                                                                                   (
       neighbourhood renewal areas and
       support to projects that were previously
       funded by neighbourhood renewal.

     2  Health Trainers working in all areas of         Ongoing with     Numbers of clients seen and                    The health trainer programme is a new public health workforce led
       high health need, providing one to one            expansion in    actions taken recorded.                          by the DH. Bristol was an early implementer of this service but
       practical support and signposting to               09/10 and       Target 1080 per year the Health                because of past financial constraints is very limited in scope. The
       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
                                                                                                                           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 to
      Southville.                                                 and repeated annually.                   increase quality of life and life expectancy. The two pilot areas are
                                                                   Work with older people is being        for an initial two years and if evaluation proves they are successful
                                                                  undertaken on what indicators they       then the programme will be rolled out to the rest of the City.
                                                                  consider most appropriate: e.g.
                                                                  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
    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, LAA      Capitalising on neighbourhood and community infrastructures to
      Action Group and Wellspring Healthy                         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 and                   Feedback from individuals.    education, and in some studies with poor housing and low income.
      suicide.                                                     Feedback from community groupsEvidence 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 of
      to improve services for survivors of    ongoing, but Violence and Abuse (DVA) strategy. death for women under age 45. Recent research found that 40% of
      domestic abuse. Active members of the developments  Attitude towards DVA questions in      women attending primary care have a lifetime experience of
      Bristol Domestic Abuse (DVA) Strategy    phased in   Quality of Life questionnaire.         domestic abuse with 17% having experienced DVA in the past year.
      Group, leading on the prevention         over 09/10  Baseline will be set this year.       Abused women and their children suffer many serious and chronic
      strand of the strategy.                  and 10/11    LAA target NI 32 reduction in repeat health problems.
       Co-ordination of Freedom               with some incidents of domestic abuse of cases
      Programme.                                  work     seen by Multi Agency Risk
       IRIS research project in primary care undertaken Assessment Conference (MARAC).
      (12 intervention and 12 control         before this.
       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 underestimated.
       environment through working with the         ongoing      Authority with responsibility for       It determines whether walking and cycling are possible, or whether
       City Council spatial planning team.                       carrying out health impact              people have to use the car to access services, for example. Mental
        Health impact assessments of                            assessments.                            and physical health is inextricably linked with the environment in
       developments, including core strategy.                     New developments have a positive      which people live.
                                                                 impact on health as measured in the
                                                                 health impact assessments on all
                                                                 major developments.
     9  Consolidation and expansion of health     01/09/2009     Numbers of clients seen who have      See above.
       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 up
      and communities with high health needs                     and new health improvement
      and development of community and                           activities initiated.
      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
                                                                  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.                                             Attitude towards DVA questions in
       Mainstreaming of Freedom                                 Quality of Life questionnaire.
      Programme.                                                  Baseline will be set this year.
       Roll out of IRIS project in primary                       LAA target NI 32 reduction in repeat
      care.                                                      incidents of domestic abuse of cases
       Dissemination of DVA toolkit in                          seen by Multi Agency Risk
      childrens centres and schools.                             Assessment Conference (MARAC).
       Provision of childrens support worker.
       Training for risk assessments and
      DVA generally.
       Support for MARAC and improved
      data collection in Acute Trusts.

   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 determinants                   neighbourhood, able to influence
      of health will be employed in each                         decisions in neighbourhood.
      neighbourhood of high health need.

   13  Further development of the Health          September      Numbers of clients seen who have See above.
      trainer Programme directed at particular      2010 and     made a positive behaviour change.
      communities, e.g. Older People,                ongoing      Target further 120 clients per health
      Travellers and Gypsies.                                    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 who        ongoing     health improvement activities initiated
      are the most marginalised, for example,                    for the most marginalised groups.
      Disabled people, particular Black and
      other minority ethnic groups, Young
   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
   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:

 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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                       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?
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
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
Satisfaction with neighbourhood          NI 5                        Environment       BCC           Bristol Partnership, neighbourhood working, urban                  31
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
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
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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