1 Health in Camden Camden s shadow health and wellbeing board: joint health and wellbeing strategy 2012 to 2013
2 2 Contents 1. Introduction - Reducing health inequalities - Building on strong partnerships - Prevention - How will the health and wellbeing board make a difference - Partnership working to reduce health inequalities the sphere of influence 2. The task: what do we know about people s health in Camden? - Camden s joint strategic needs assessment (JSNA) - What is the JSNA telling us? What health inequalities are priorities for the board? - Key headlines: issues/people/place 3. Health and wellbeing board priority areas - Healthy weight, healthy lives - Complex families 4. How will the health and wellbeing board Members bring their influence to bear?
3 3 1. Introduction The health and wellbeing board (HWBB) brings together a unique partnership with the aim of improving health and reducing health inequalities for the residents of Camden. For the first time, elected councillors and the Council s directors of adults and children s services will work directly with the GPs who will be leading local NHS commissioning, with patient and community sector representatives and with the director of public health, to bring their combined spheres of influence to bear on these important issues. As part of the HWBB s development stages, we have already begun talking with local people about what being healthy means to them, and what supports them to stay healthy. They have been telling us that they want and appreciate support they get from services, and have ideas about what could be done differently. The HWBB will continue conversations with residents as we work together to improve health and wellbeing in Camden continued engagement is one of the principles agreed by the HWBB. Building on strong partnerships Camden Council and the NHS have worked in partnership for many years from the health authority in the nineties to the PCT since 2004, and many services already work closely together where they can help service users by doing so. The real difference in the new NHS system is that for the first time GPs and other primary care professionals will take a lead role in planning and commissioning NHS services, and will be involved in sustained partnership work with the whole community. This gives all partners on the HWBB a new opportunity to work collaboratively to solve the health challenges which no single organisation can deal with alone. As board members, we all have our individual responsibilities and priorities, but alongside those we are all committed to working in partnership to find new solutions to shared problems another of the principles we all share as board members. Links to strategic plans: CCCG: camden.nhs.uk/gps/commissioning camden.gov.uk/camdenplan Reducing health inequalities Health inequalities are entrenched in deprived communities, where more people have a shorter life and live with a long term health condition which can affect their quality of life. The wider determinants of physical and mental health are all the factors, often referred to as the causes of the causes, that impact upon health. These include education, housing, the built environment, the natural environment and many lifestyle related issues. Many of them are beyond the remit of NHS services; council services have a key role in influencing them. The community sector can reach parts that the statutory sector don t, and the experience of patients and the public are central to understanding what makes a difference. By working together, with a common focus on those with poorer outcomes, we can help strengthen our community as a whole.
4 4 Prevention Prevention is certainly better than cure, so we need people to know how to stay healthy, and for our services and surrounding environments to influence health promotion and to help everyone to look after themselves as well as possible. Preventing ill health where we can, and preventing the disabling effects of unavoidable illness is the board s shared aim, and the fundamental business of GPs, public health and many council services. With the financial challenges facing the NHS and local government, the HWBB will provide strategic leadership to promote joined up prevention work, avoid duplication and barriers between services, to be as efficient and effective as possible none of us can afford to waste resources. The board s choice to sponsor the two programmes of work on complex families and healthy weight was partly driven by the impact they can have on prevention, for example: getting the right support into families at the right time can avoid children from falling behind in school for example, build their resilience for good mental health; working together to create an environment which simply helps people to be more active in their day to day lives, as well as supporting attempts to stay fit and healthy, can prevent heart disease and diabetes, and lead to happier lives for people and their communities. How will the health and wellbeing board make a difference? None of the members wants the board to be just another talking shop. We need to talk, but we need to make things happen differently through those conversations. We ve already started involving residents and they have been telling us what being healthy means to them, and we want to hear from everybody, particularly those most likely to be at risk, and then turn the best ideas into action. The board is made up of influential people, and together our spheres of influence go a long way. We intend to harness our influence across the borough, and beyond, and drive changes which will prevent avoidable ill health and improve the quality of life of all Camden citizens, especially the most deprived. The health and wellbeing board will not run projects or services that s the job of council, NHS staff and clinical colleagues but it will bring its combined influence to bear on the complex problems which are beyond the reach of each agency on its own.
5 Health and Wellbeing Board Partnership working to reduce health inequalities the sphere of influence influences 5 Citizens community Elected Members community Business schools council decision making Council Directors Children, schools families Housing adult social care Public health wider determinants Community Centres N Healthwatch Royal Free Camden and Islington Camden Clinical Commissioning Group/GPs Tavistock and Portman Great Ormond Street University College Central and North West London Patient Voice Community Centre W GP practice localities S
6 6 2. The task what do we know about people s health in Camden? Camden s joint strategic needs assessment - We ve been working on our Joint Strategic Needs Assessment (JSNA) to analyse the health needs of the population to build up an evidence base of the health and social care priorities for adults and children in the borough. We know that the health and wellbeing of Camden residents is shaped by social, economic and environmental determinants and the challenge of persistent health inequalities cannot be addressed by any single agency alone. So a clear picture of people s needs enables us to work together and plan for the future through our joint health and wellbeing strategy, and through each organisation s commissioning plans and work programmes. What is the JSNA telling us? What health inequalities should the board address? The good news is that life expectancy for men and women in Camden has improved at a faster rate than nationally over the past 10 years. Overall mortality from major killers (premature cardiovascular conditions and cancer) has fallen in the past 10 years and continues on a downward trend. Camden has seen a 43% reduction in early CVD deaths compared to 47% in London and 50% in England in the past 10 years. The reduction for early cancer deaths has been faster in Camden, a 27% reduction in deaths over the past 10 years compared to 25% in London and 22% in England. However, health outcomes are unequally distributed across Camden and differences in life expectancy are closely associated with deprivation levels across the borough. There are stark differences in mortality rates for major causes between men and women. Men in poor areas die up to 11.6 years earlier than men in the wealthier areas of this small borough. This gap in life expectancy is the third highest amongst London boroughs, the median for England is 8.9 years. There is a 6.2 years gap in life expectancy between women living in the wealthiest and poorest areas in Camden. This is the 6th highest gap amongst all London boroughs but similar to the England median of 6 years. We know that stopping smoking, exercising regularly, drinking alcohol only in moderation and eating healthily make a huge difference to people s life chances. We also know that in the poorest areas it can be much harder to keep up a healthy way of life. This is not just a matter of people trying harder, health inequality is the outcome of the complex interaction between individuals, their environment and their personal circumstances the more deprivation people experience, the worse are their chances of having poor health and dying younger.
7 7 So although the JSNA shows that improvements are being made to the length and quality of people s lives on average, many people don t get the chance to make the differences that will count this is what the HWB wants to change. We ll continue to update the JSNA throughout the year so that we are continually improving the quality of the information we hold. The JSNA is available on the council website: camden.gov.uk/jsna Key headlines: Smoking 22% High blood pressure 14% High cholesterol 10% Risk factors leading to death in perspective Camden Obesity 8% Low fruit and vegetable intake 6% Physical inactivity 4% Alcohol Other 2% external causes 3% Suicide 1% Infections 2% JSNA priority areas: Biggest killers Cardiovascular disease, cancer and respiratory disease Issues with the highest number Where Camden has worse problems than similar areas Cross cutting conditions Increasing prevalence Wider determinants Depression, diabetes, high blood pressure and asthma Mental illness, alcohol and drug misuse, obese children in Year 6, early deaths from heart disease and stroke, deprivation, child poverty Alcohol, obesity Obesity and associated conditions such as diabetes and cardiovascular disease Housing, employment, education There are particular health issues for different groups in Camden, certain groups often experience poorer outcomes: BME groups people with mental health, learning disabilities people on low incomes men women and young people (employment)
8 8 Some areas in Camden consistently experience poor outcomes, in health, education, employment this general deprivation is a reliable predictor of health inequalities. Wards in Camden that consistently experience poor outcomes include: St Pancras and Somers Town Kilburn Haverstock Kentish Town Regents Park
9 9 3. Priority Areas for the health and wellbeing board As part of their development phase, the HWBB looked with partner agencies at evidence from the Marmot review about the wider determinants of health along with the issues which the JSNA flags as priorities, with the feedback from members of the public, and from other stakeholders about how this new partnership might work differently together to change outcomes. They agreed these as the criteria to decide their initial priority areas. The board wanted to sponsor priority areas which have a big impact on long term health outcomes, and have complicated and difficult causes which no single organisation or person themselves can solve. They also need to complement the shared ambition of all HWBB partners to improve integrated working in services for physical and mental health for adults and children, and to reduce inequalities in health outcomes. The priorities agreed are: complex families - providing better outcomes for those families with multiple needs who use a wide range of council and NHS services, and our most vulnerable children who have some of the worst physical and mental health experiences which can affect their life expectancy and life chances. healthy weight, healthy lives supporting action on weight management and active living, as people who find it hardest to maintain a healthy weight are more likely to suffer from life limiting conditions including diabetes, heart disease and breathing problems and cancers, and they often live in areas where there are fewer opportunities to eat and exercise healthily. Sponsoring these priorities doesn t mean that the board has no part to play in other issues. One of our tasks is to make sure that the services commissioned by the Clinical Commissioning Group are in line with the JSNA findings, and that other strategic investments can play their part in supporting the board s overall aims for example smoking is still one of the biggest killers, and we will expect to see continued efforts to get better quit rates. The board will bring influence to bear on things like this, but with its main focus to be using the commitment of the members of this new partnership to get the systems working differently. Healthy weight healthy lives: Why it matters Healthy weight healthy lives is a whole community issue, for local government, local NHS, schools, parks, councillors, businesses, doctors and community groups to play their part. Although the obesity figures for Camden s adults are below the national average (these are based on estimates rather than actual data so we think the prevalence could be higher), the figures for our children are worrying. 22.5% of children in Camden aged are obese, statistically worse than the England average of 19%. We know that obesity is increasing, so we need to develop an environment which encourages active lives, healthy eating and sensible drinking, and encourages whole families to enjoy life together. Camden s public health team commissions weight management services for people whose health is at risk because of their weight problems. But
10 10 it isn t just about treatment, though that is really important, it is about prevention also. It s also about making it easy to eat healthily - knowing what s in your food and drink, and convenient opportunities to take exercise as part of day to day life. But this will require much more than simply promoting healthy choices. The HWB Board will add to the healthy weight strategy through understanding and publicising the bigger picture, the different causes and the interaction between them and targeting where our powers and influence give us opportunities for new solutions. For example, evidence tells us that even when people know what a healthy option is, cheap and easy access to healthy food is not always easily available. So how can board members use our influence here? Scale of the problem in Camden 62% 75% 11% 27% 13% Obese Overweight Children and young people: 11% of children in reception year and 22% in year 6 are obese. 1 in 3 children are obese or overweight in year 6 rates of obesity in year 6 are significantly worse than the national average Adults: it is estimated that 15.5% of Camden residents are obese, but we are not sure and should have better data can GPs help here? The Foresight Report (2007): The 2007 Foresight Report Tackling Obesities: Future Choices highlighted the importance of tackling the growing obesity trend in a coherent and comprehensive manner. It argued that understanding and preventing obesity is very complex which can be summarised by a number of key contributory factors outlined below. It also highlighted that preventing the obesity epidemic will only happen if there is a joined-up, collaborative approach between local government, the NHS and business, health services and other partners. Reception Year 6 14% Healthy weight Underweight
11 11 What are we doing? The health and wellbeing board is supporting public health to lead a healthy weight healthy lives taskforce, bringing together the key people in Camden whose roles contribute towards tackling obesity and supporting a healthy environment. The taskforce will inform a healthy lives healthy weight action plan which will represent intelligent action targeted to get results for the whole population. This figure shows the complexities of the healthy weight, healthy lives issues and highlights the broader determinants of health such as drivers of food production and components of the physical activity environment. What are our ambitions? The rise in unhealthy weight in children between reception and year 6 is worrying we want to halt this rise, and see more children at all ages with a healthy BMI. People from deprived communities will live longer, not dying so young from preventable illnesses which result from being overweight and inactive. Better understanding of the actual prevalence of adult overweight and obesity in Camden through more accurate measurements, and focusing our action accordingly. The full obesity system map with thematic clusters from the Foresight Tackling Obesities: Future Choices Report. 2nd edition
12 12 Complex families - why they matter Every child matters. The better the life in the early years, the better health and wellbeing as children grow up, becoming adults and parents in their turn. We want to make sure that all families get good information, support and services to be healthy, get a good education and live in a safe home and community. There are children and families whose circumstances make it difficult to achieve these aims, with a small cohort of families whose complicated lives mean that services find them hardest to help effectively people affected by combinations of crime and antisocial behaviour, school attendance and worklessness, substance misuse, mental health problems and domestic violence. Complex families are a high priority for the Council. The Camden plan sets out the Council s strategic priorities for the next five years, and includes responding to the government s three year programme around troubled families about 755 families by their definition. We want to work closely with partners to ensure that families with complex needs who need a lot of interventions from health, care, education and criminal justice agencies receive support and services that are targeted, joined up and effective. The health and wellbeing board intends to sponsor this work, with the commitment of all its members to prioritise it within their own services and in their wider spheres of influence, and focus on approaches that build families capacity and support their resilience. What are we doing? troubled families programme outcomes but also transform the way we support families with complex needs in the long term. So far, we have begun an in depth piece of work to better understand what works well alongside what we need to change in order to add most value and make a real difference to outcomes for families. This will be ongoing in the coming months and by January 2013 we will have a clearer picture as to the next steps. What are our ambitions? Work is focused on the individual needs of the family. A reciprocal relationship with families incentivise and reward progress. Analytical understanding of substantive issues affecting families. A single assessment / planning / review process across all services. Interventions are purposeful and based on building effective. relationships with key family members. Ensure network does not get too big and remains focussed on key areas. Resilience building and clear exit pathways for families. A shared toolkit of interventions that are: evidence based clear about what outcomes will be achieved able to enhance the wellbeing of families. There is an in depth study going on across agencies to understand in detail what works, where we need to improve and how we can work together better to develop a new approach that will help us achieve the
13 Complex families: The scale of interventions. 13
14 14 4. How will the HWB make a difference? The board s priorities are not new. The inequalities in our society which result in these stark differences in the length and quality of people s lives have been with us for a long time. We have not resolved them yet, and need to work differently towards our common goal. In summary we all want to see - more children being supported to reach their full potential, and more people with a healthy weight and healthy life. Camden residents have to be part of the solution. The board has started a healthy conversation and you can see on the our website what s important to people and how they think the Council and others can support their efforts to lead healthy lives. We ve also been talking to young people through our pilot online engagement tool: Camdenville and they ve had a lot to say about fast food shops, among other things. We want to work through some of these concerns and take these questions out for a wider conversation about what powers the council has and how we should use them to make Camden a healthier place to live. We will talk with tenants, patients and community centres about what would most help them to live healthily and how we can change the environment if that s not helping planning, licensing, transport and travel can all play a part. We might start by talking to the Council s tenants about how estates could make it easier for people to become and stay healthy. The new clinical leadership of the NHS wants to get better links between the primary care teams and their local communities, to focus on those hard to reach groups who are most at risk, and develop innovative ways to address the wider determinants of the most local health inequalities. All board members have links to the local health care trusts: the Clinical Commissioning Group as commissioners, HealthWatch with hospital patient groups, the Council in social care, planning and economic development. We will develop our relationships with trusts, and with businesses, employers, colleges, housing providers, and other public bodies to encourage them to work together with us on these priorities. Challenge Through the health and wellbeing board we will continue to challenge each other s ways of working to develop more integrated approaches to problems which all our services are working on, and hold each other to account to make sure we are using our combined resources more effectively together. Engagement with partners and the community will continue These are long term problems and need long term, productive dialogue to solve them properly for the future, and we will continue to involve all partners and the local community in finding solutions for the long term. Our intention is to hold to our basic principles of engagement, collaboration, to guide how we, as a health and wellbeing board, make full use of our powers and influence to prevent ill health and reduce health inequalities.
15 15 Next steps Until April 2013, the health and wellbeing board is in shadow form, and this strategy is also in shadow. Our continued dialogue with residents and with Camden s community groups, health organisations and business partners on the HWWB s priority areas will be key to the board s work over the coming months. Between now and April 2013, the Camden Clinical Commissioning Group will develop in to an authorised body. HealthWatch will become the new voice of patients and service users. Alongside this the Council and partners will be delivering the Camden plan, including completing work on the Equality Taskforce and further developing the Camden partnership for educational excellence. Through the concerted action and influence of the members of the health and wellbeing board - all of these developments will play a part in the evolution of an effective, long lasting health and wellbeing strategy for Camden.
16 More information camden.gov.uk/health camden.gov.uk/jsna