Norfolk’s
Living Well
A public health strategy for Norfolk
2016 - 2020
0344 800 8029 | www.norfolk.gov.uk/norfolkslivingwell
“Help the people of Norfolk live in
healthy places, promote healthy lifestyles, prevent ill-health and reduce
health inequalities”
2
A public health strategy for Norfolk
Contents
Foreword
4
Introduction
5
Public Health vision for Norfolk
5
What is Public Health?
8
Guiding principles
9
Levels of public health action
9
Health in Norfolk
10
What influences our health and wellbeing?
13
Value for money – a strong business case for public health 13
Promote
14
Protect
16
Provide
18
Work in Partnership
20
Delivering the strategy
21
Ways of working
21
Measuring our outcomes and performance
22
References
23
www.norfolk.gov.uk/norfolkslivingwell
3
Foreword
At the moment, where somebody is
born, where they live, whether they
have work or not, will impact on their
quality of life, the length of their
life and the enjoyment they can get
out of their lives. We are committed
to changing this, so that no matter
where you are born in this county, you
will have equal chances for a good,
long and happy life.
Public Health opens many doors for Norfolk
County Council and enables us to look after
our residents in a new way, bringing together
the expertise of public health specialists with
the council’s knowledge and relationships
with the community to help us drive forward
a new approach to the populations’ health.
For the first time in a generation we have
direct responsibility for coordinating action
to prevent illness and to improve the health
of our communities and drive forward our
commitment to excellence in education, real
jobs, improved infrastructure and supporting
vulnerable people.
As lead member for Norfolk Public Health,
I am extremely pleased to see how public
health is having an impact across the council
and with local partners. This has ranged from
working with elected members to increase
their knowledge of local health outcomes,
to the tangible benefits of working with
employers. I am sure that this impact will
result in positive changes in health outcomes
for our local residents. This strategy builds
upon this and will ensure that our residents
have the opportunity to live the healthiest
lives possible and to live safely in their
communities.
4
A public health strategy for Norfolk
Cllr Margaret Dewsbury
Chairman of the Communities
Committee
Norfolk County Council
Public Health
vision for
Norfolk
Public Health vision for Norfolk
“Help the people of
Norfolk live in healthy
places, promote healthy
lifestyles, prevent
ill-health and reduce
health inequalities”
We are prioritising public health actions
which will:
• Promote healthy living and healthy places.
• Protect communities and individuals from
harm.
• Provide services that meet community
needs.
• Work in partnership to transform the way
we deliver services.
Dr Louise Smith
Director of Public Health
Norfolk County Council
Implementing this strategy will bring
significant benefits to Norfolk people in terms
of increased quality of life and better health.
This will also support the council’s priorities,
achieving the best outcomes for children and
young people, protecting and supporting
vulnerable people and helping Norfolk to be
economically prosperous.
www.norfolk.gov.uk/norfolkslivingwell
5
“
Public Health Strat
Help the people of Norfolk live in healthy places; promote health
We will
Promote
healthy living and
healthy places
Protect
communities and
individuals from harm
Provide
services that meet
community needs
Work in
Partnership to
transform the way
we deliver services
We will do this by…
}W
orking with district councils to
address the wider issues that affect
health (e.g. housing) and to deliver
joint programmes that make a
positive impact on health.
}R
edesigning drug
and alcohol services
to focus on recovery
and delivery in the
community.
}R
olling o
to reduc
improve
} F ocusing tobacco
control and stop
smoking services on
reducing smoking
rates in key vulnerab
groups.
}C
ommissioning a high quality
health visitor and school nursing
service that is linked with key
services and promotes health
improvement to address obesity.
}C
o-ordinating the work
of Health and Wellbeing
Board (HWB) to address
the goals of integration,
prevention and reduced
inequalities and priorities
of mental health, dementia,
early years and obesity.
} E nsuring
is check
looked a
have the
and me
}D
elivering a new
Health and Well
Strategy, Joint S
Needs Assessme
and Joint Pharm
Needs Assessme
tegic Framework
hy lifestyles; prevent ill-health; and reduce health inequalities
2016-2020
out a workplace health offer
ce sickness absence and
e productivity.
ble
”
} Taking a multi-agency
approach on issues
such as mental health,
domestic abuse and
substance misuse.
g that a child’s development
ked at 2½ years and that all
after children under five
eir health needs assessed
et.
w Joint
lbeing
Strategic
ent
maceutical
ent.
}D
elivering health improvement
and prevention services,
including addressing obesity and
encouraging more people from
deprived areas to have an NHS
Health Check.
}A
ssuring local
strategies for
emergency planning,
protection and
resilience.
}H
alving the number of
people unknowingly
infected with HIV.
}C
ommissioning comprehensive
sexual health and prevention
services and reducing teenage
pregnancy rates in key areas.
} S trengthening alignment
between evidence and
strategy and using
intelligence to support
a sustainable health and
social care system.
}C
ontinuing to reduce the number
of people killed or seriously injured
on Norfolk’s roads.
}U
ndertaking analysis
to monitor service
performance and
population health
outcomes.
}R
educing the
transmission of
infections in
care homes.
}P
roviding strategic support for NHS
commissioning with a focus on
health and social care integration
and prevention.
}D
eveloping a single, fit
for purpose approach to
information and analysis
across teams at Norfolk
County Council.
What is
Public Health?
Public Health is…
• Helping people to stay healthy and make
healthier choices.
• An emphasis on prevention of ill health
rather than providing treatment.
• Protecting people from threats to their
health.
• Understanding factors that influence
people’s health & wellbeing.
• Concerned with the health of the whole
population as well as specific individuals
and groups.
“Public health
is everybody’s
business”
This strategy is designed to contribute to
the Council’s four priorities of excellence in
education, real jobs, good infrastructure and
supporting vulnerable people. By continuing
to work with all our council services we will
make positive changes in health outcomes for
our local residents
The Council also has mandatory public health
functions to:
• Commission sexual health services, the
NHS Health Check programme, and health
visitor reviews for children aged 0-5.
• Protect the health of the population.
• Provide NHS commissioners with
public health advice to support their
commissioning.
• Fulfil the requirements of the National
Child Measurement Programme.
Norfolk Public Health uses evidence and
information to commission other services
that are needed in Norfolk such as services
to address drug and alcohol misuse, stopping
smoking, physical activity and weight
management.
8
A public health strategy for Norfolk
Guiding principles
We have a statutory duty to enable the At the same time we will:
people of Norfolk to live healthy lives.
• Not force people to lead healthy lives.
We will aim to:
• Reduce the risks of ill health that people
might impose on others.
• Ensure that people have appropriate
access to services and information that
they need to improve their health.
• Pay special attention to the health of
children and young people and other
vulnerable people.
• To help people overcome addictions and
other unhealthy behaviours.
• To reduce the causes of ill health.
• Support people to make healthier choices
and support employers to promote healthy
workplaces.
• Minimise measures that are introduced
without consulting people.
• Minimise activity that is perceived as
unduly intrusive or in conflict with
important personal values.
Levels of public health action
Public health activity can take place at
different levels, depending on the importance
of the challenge and the impact on health.
A coordinated public health approach often
requires a combination of actions at different
levels. The table below demonstrates ways in
which Public Health influence these.
Social
Behavioural
Changing social norms about health, e.g.
acceptability of binge drinking, peer level
acceptability of smoking or cyberbullying
Helping individuals to stop smoking,
be more active, lose weight, drink less
alcohol, support parents with children
and increase resilience in young people
Biological
Legislative
Treatments including immunisation,
nicotine replacement therapy, antibiotics
for sexually transmitted infections,
contraceptives, treatment for addictions
The smoking ban, legislation on alcohol
sales, enforcement of legislation on sales
and underage smoking
Environmental
Structural
Increasing active travel, making streets
safer, improving air quality, smoke free
playgrounds, reducing availability of illicit
tobacco, enforcement of stop smoking
legislation
Policy changes e.g. in workplaces
and schools
www.norfolk.gov.uk/norfolkslivingwell
9
Health in Norfolk
There are a number of areas where the health of Norfolk residents compares well to
people in other areas of the country but there are also a number of areas where we
should improve.
Bad and
getting
worse
Killed and injured on roads, violent crime, re-offending, children’s injuries,
admissions, drug treatment success, alcohol admissions, HIV late diagnosis
Good but
getting
worse
Domestic abuse reports, deaths from liver disease,
inequalities in life expectancy
Improving
faster than
England
Number of smokers, school readiness, breastfeeding initiation,
social isolation, childhood immunisation
There are health inequalities associated with deprivation and poverty. For example
there is a 6.2 years life expectancy gap between males living in the most and least
deprived areas in Norfolk.
85
6.2 years
Norfolk
80
Years
80.2
Life expectancy
gap between the
most and least
deprived areas of
Norfolk.
England
Male life
expectancy
75
16 years
70
Male healthy life
expectancy
65
60
8
3.2 years
06
20
83.8
10
A public health strategy for Norfolk
9
-0
07
20
0
-0
08
20
2
1
-1
09
20
-1
10
20
3
-1
11
20
4
-1
12
20
-1
In Norfolk, smoking, alcohol and obesity are estimated to contribute to 23,000
hospital admissions per year. People who drink moderately, exercise and quit
smoking live on average 14 years longer than people who do not. Modest and
achievable lifestyle changes can add years to life as well as life to years.
It is estimated that by 2015 the additional burden of obesity has contributed to
about:
5,900
people with heart disease
82,500
people with high blood pressure
1,600
strokes
42,000
people with diabetes
2 in 3
adults in Norfolk are
overweight or obese
Smoking is still the biggest driver of aviodable poor health. Norwich currently
has the highest smoking prevalence in Norfolk. In terms of demand on the health
sector it is estimated that in 2014/15:
Smoking led to more
than 10,900 admissions
Norfolk
(16.7%)
2014 smoking
prevalence % adults
Norwich
Great Yarmouth
Alcohol led to about
6,100 admissions
Breckland
King’s Lynn
North Norfolk
Obesity led to about
6,100 admissions
Broadland
England
(18.0%)
South Norfolk
0
5
10
15 20
25
www.norfolk.gov.uk/norfolkslivingwell
11
We also face the challenges of an ageing population as there will be more elderly people in Norfolk
in the future. If levels of ill health remain the same in the population, this will increase demand on
health and social care services.
Population of Norfolk 2014 compared to 2025
Population x1,000
80
70
2014
60
2025
50
40
30
20
10
Age band
More information on the health of Norfolk is available at the Norfolk Joint Strategic Needs
Assessment (JSNA)
www.norfolkinsight.org.uk/jsna
12
A public health strategy for Norfolk
90+
85-90
80-85
75-80
70-75
65-70
60-65
55-60
50-45
45-50
40-45
35-40
30-35
25-30
20-25
15-20
10-15
5-10
0-5
0
What influences our health
and wellbeing?
Our health and wellbeing is affected by a range of
different factors.
Some things we cannot change (such as our age,
and our inherited genes) but many others we
can - such as the way we live our lives and the
environment we live in.
Some aspects play a greater contribution to our
health and wellbeing than others. Socio-economic
factors (such as the local environment, housing,
transport, employment and social interactions)
and people’s health behaviours (smoking, alcohol,
physical activity, and a healthy diet) play a bigger
role than the health care services we receive.
The Relative Contribution of Multiple Determinants to
Health Outcomes.
• General socio-economic, cultural and
environmental conditions - real jobs ,
good wages, acceptable taxation and the
infrastructure, services and social benefits, the
price of fuel, transport, food and clothing can all
affect health and social care policy.
Value for money – a strong
business case for public health
Investment in public health is good value for
money and can make savings to the health and
social care system.
The National Institute for Health and Care
Excellence (NICE) has concluded that:
Public health activities can save money
• For example, preventing premature death and
preventable disease can increase productivity
in the workplace, reduce the costs of crime
and antisocial behaviour and reduce costs of
benefits.
• Lifestyle related issues (relating to smoking,
alcohol, obesity, physical activity etc) are
estimated to cost the UK over £45 billion per
year.
Public health actions can have an impact
on many of these factors:
• Individual lifestyles - such as smoking, alcohol
and other drug misuse, poor diet or lack of
physical activity.
• Social and community networks - family,
friends and the wider social circles around us are
good for our health.
• Living and working conditions - education,
employment, health and welfare services,
housing, public transport and ‘essentials’ such
as sanitation, food, clothing and fuel.
Spending now can lead to future savings
• One example is spending now to halt the
increasing trend of obesity, which is likely to
have a significant impact on costs to society in
the future.
• Investments in public mental health could
see benefits to the economy, workplace
productivity and NHS costs.
Public health activities are good value for money
• Most activities aimed at improving the public’s
health have been assessed as providing good
value for money – they generally offer more
health benefits than the alternatives, even
though they may not be realised in the short
term. Many interventions save more money
than they cost to deliver.
www.norfolk.gov.uk/norfolkslivingwell
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Promote
Healthy living and healthy places
Why is it The physical environment in which we live, play, work and socialise influences
our health and wellbeing. It is known that the ‘wider determinants of health’
important? - factors such as housing, planning, employment, income and access to open
spaces, have the greatest impact on our physical and mental health.
Health behaviours (such as smoking, drinking alcohol, physical activity, and
a healthy diet) are also very important to our physical and mental health
– particularly in preventing us from becoming overweight or obese, and
helping us to avoid a range of health conditions, such as cancers, diabetes,
cardiovascular disease, depression, dementia and arthritis.
A future where healthy lifestyle choices are made by individuals, and supported
by the wider public and private sector, will be essential for an affordable NHS
and social care system in Norfolk.
Being in work contributes to our health. A healthy workforce also helps
productivity and reduces sickness absence and ensures businesses in Norfolk
flourish.
What we
will do
1. Work with Norfolk’s district, borough and City councils to deliver
joint programmes and policies that will make a positive impact
on health. This will include:
•
•
•
•
•
•
•
•
14
Considering health in planning decisions and associated policies.
Developing a Healthy Homes strategy and action plan.
Addressing fuel poverty and excess winter deaths.
Increasing physical activity and the use of local leisure facilities and other
assets.
Promoting open spaces, active travel and collaborative approaches to
improve air quality.
Working with local employers and business groups to promote workplace
health, and employment for people with long term health conditions.
Ensuring our health data is analysed at a local level wherever possible.
Building community resilience (where communities and individuals use local
resources and expertise to keep themselves healthy and safe) and reducing
social isolation through partnership working.
A public health strategy for Norfolk
What we
will do
2. Develop and commission a ‘workplace health offer’ to reduce
sickness absence and improve productivity in Norfolk by:
• Raising awareness of the benefits of a healthy workplace and supporting
local employers to take action to improve the health and wellbeing of their
workforce.
• Targeting occupations and areas most in need (for example, target people
working as carers and routine manual workers).
• Supporting Norfolk County Council to lead by example by implementing a
workplace health programme.
3. Deliver health improvement and prevention services and
campaigns as part of a healthy living pathway, including:
• The NHS Health Checks programme, targeting areas at highest risk.
• Supporting the Norfolk Health and Wellbeing Board priorities of prevention,
integration & addressing health inequalities.
• Supporting council members to understand the health of their electoral
division and work with them to create community-led action plans.
• Rolling out the principles of the Making Every Contact Count (MECC)
project to support the wider workforce.
4. Public health campaigns for Norfolk
• Support localized campaigns based on national campaigns such as
‘Change 4 Life’, ‘One You’ and ‘Stay Well this Winter’.
5. Road Safety
• Support the Road Safety partnership and lead the work to reduce the
numbers killed and seriously injured on Norfolk’s roads.
www.norfolk.gov.uk/norfolkslivingwell
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Protect
Communities and individuals from harm
Why is it Our communities should be safe places that promote our health and wellbeing.
important? Improving mental health and building resilience in neighbourhoods and within
communities has a wide range of social and economic benefits to individuals,
families and communities, as well as helping to reduce crime, anti-social
behaviour and health inequalities.
Helping people to recover from drug and alcohol misuse supports some of
the most vulnerable groups in our society and addresses some of the greatest
health inequalities. Tackling these issues helps to remove the barriers to
accessing education, employment, health services and social care.
Tobacco control (measures aimed at controlling the use of tobacco) and
stopping smoking are important public health interventions. Smoking is one
of the biggest causes of premature death and inequalities in life expectancy
in Norfolk. Smoking during pregnancy puts the baby at higher risk of
complications at birth and also later in life. Young children exposed to second
hand smoke are more likely to develop bronchitis and pneumonia, and are at
higher risk of admission to hospital.
Children living in families affected by the ‘toxic trio’ of substance misuse,
enduring mental ill health and domestic abuse are at higher risk of neglect and
abuse.
Health protection assurance is a statutory function of the Director of Public
Health, ensuring that health screening programmes are in place, the spread of
infectious diseases is controlled, vaccination programmes are in place and that
we have appropriate plans and systems in place in the event of an emergency
in Norfolk.
What we
will do
1. Work with partners (e.g. the Norfolk Community Safety
Partnership, Safeguarding Boards etc.)
• Develop safe, supportive and resilient communities.
• Reduce crime, accidents, alcohol and substance misuse, domestic abuse
and mental ill health.
2. Drugs and alcohol services
• Redesign drug and alcohol services to focus on recovery, with the aim of
supporting people to get back into education and employment.
• Further investigate and strengthen the links with criminal justice services,
including the recovery pathway element.
• Support coordinated approaches and initiatives to tackle the harm from
novel psychoactive drugs, legal highs and steroid abuse.
• Consider initiatives to raise awareness of foetal alcohol syndrome.
• Develop an evidence-based alcohol licencing policy and use this to respond
to licensing applications.
16
A public health strategy for Norfolk
What we
will do
3.Mental health
• Provide support to the Norfolk Health and Wellbeing Board’s campaign to
increase awareness of mental health issues, and reduce stigma.
• Work with Children’s Services to support the development of children’s
mental health services.
• Address all three elements of the ‘toxic trio’ (mental health, drug and alcohol
misuse and domestic abuse).
• Support the delivery of the Norfolk Health and Wellbeing Board Dementia
strategy.
• Audit suicides in Norfolk and support a multi-agency county suicide
reduction strategy and plan, developing approaches with the vulnerable
adults safeguarding hub to review and seek to reduce drug related deaths.
4.Tobacco control and stop smoking
• Lead the Tobacco Control Alliance supporting them to implement a tobacco
control strategy and action plan focused on:
o Addressing tobacco control issues.
o ‘Turn off the tap’ of young people from starting smoking.
o Assisting every smoker to quit smoking.
o Protecting families and communities, especially children, from tobacco related harm.
• Commission specialist stop smoking services, targeting women who smoke
during pregnancy, people living in deprived areas, or working in routine and
manual jobs.
5.Emergency planning, protection and resilience
• Lead the Local Health Resilience Partnership jointly with NHS England and
support the Norfolk Resilience Forum.
• Plan, prepare for and respond to countywide incidents, including being the
lead county council responder for health and communicable disease and
outbreaks; e.g. a flu pandemic.
• Work with Public Health England and CCGs to ensure a coordinated
approach across services in tackling threats from communicable diseases.
6.Domestic abuse, sexual abuse and safeguarding
• Support Norfolk’s Domestic Abuse and Sexual Violence Board Delivery Plan
2016-2020.
• Support social marketing campaigns to increase awareness of domestic
abuse and reduce stigma for survivors of abuse.
• Work with partners to develop a reliable evidence base on the prevalence
and characteristics of child sexual exploitation.
• Chair the Child Death Overview Panel for Norfolk and establish new systems
to support the reporting of themes and shared learning, with the aim of
preventing future deaths.
www.norfolk.gov.uk/norfolkslivingwell
17
Provide
services that meet community needs
Why is it Norfolk County Council is required to provide a range of public health services
important? relating to children and young people (including Health Visitors and School
Nurses), sexual health, NHS Health Checks and drug and alcohol misuse.
The health and wellbeing of children and young people is a national and local
priority. There is strong evidence to show how important it is to prioritise
the health of children as this affects the whole of a child’s life, is vital to brain
development, and is crucial to reducing health inequalities across the life
course. Early life experience determines emotional wellbeing, healthy lifestyles
and healthy weight, preventing problems such as mental health, obesity, and
diabetes, and helping to reduce ill health later in life.
Access to good quality sexual health services improves the health and
wellbeing of both individuals and populations. Nationally and in Norfolk, rates
of sexually transmitted infections (STIs) are increasing. Early diagnosis and
treatment of sexually transmissible infection can prevent others from also
becoming unwell, and prevent long term complications such as infertility.
Norwich is an area with high rates of HIV but 55% of people with HIV are
diagnosed late in Norfolk.
This has a poor impact on long term outcomes and the cost of their care.
Unplanned pregnancy has a major impact on individuals, families and wider
society, and the impact of early motherhood can have an adverse effect on
the education and life chances of young women.
The public health team have a leadership role to play within the wider health
and social care system, where there are big challenges to be met, with
increasing demands and limited resources, and a need to increase prevention
and self-care. By delivering the right services in a unified way across health
and social care, we can encourage better ways of working, use our resources
more effectively and improve the quality of life of the people using these
services.
18
A public health strategy for Norfolk
What we
will do
1. Children and Young People services
• Continue to commission the integrated Norfolk 0-19 Healthy Child
Programme - including health visitor and school nursing services, targeting
services for those most vulnerable (including Looked after Children, care
leavers, young mothers and mothers with post-natal depression).
• Promote the social and emotional wellbeing of pre-school children,
supporting the delivery of this priority of the Norfolk Health and Wellbeing
Board.
• Work to integrate health and early years educational setting development
checks, to provide a holistic joined up approach to assessing a child’s
development at 2-2½ years old.
• Support joint working with school nurses and schools as a means of
reducing school absence due to ill health.
• Further explore the integration of health visiting and Children’s Centres,
including a shared estate resources and encouraging shared training and
performance and governance arrangements.
• Work with the Healthy Child programme provider to further develop the
skill mix of the Healthy Child programme team, making the best use of the
skilled professionals.
2.Sexual Health services
• Continue to commission an integrated sexual health service in Norfolk,
including prevention and outreach work focusing on the most vulnerable
and ‘at risk’ groups.
• Halve the number of people unknowingly infected with HIV by increasing
HIV testing, focusing on vulnerable groups particularly in Norwich, where
the HIV prevalence is the highest.
• Develop a countywide, all age sexual health improvement strategy that
considers the wider system of influences on sexual health so that everyone
from the young to our older population are well informed and able to make
responsible choices and decisions.
• Support the delivery of a teenage pregnancy strategy for Norfolk to reduce
the rates of under-18 conceptions.
3.Health and Social Care services
• Contribute to the delivery of the Norfolk Sustainability and Transformation
Plan (STP) for health and social care, and in particular, lead a programme of
work focusing on prevention and wellbeing.
• Contribute our data skills and knowledge of evidence to help shape efficient
and effective services that protect the vulnerable and make prevention a
priority.
• Provide public health support to the delivery of the National Diabetes
Prevention Programme.
www.norfolk.gov.uk/norfolkslivingwell
19
Work in Partnership
Healthy living and healthy places
Why is it “Public Health is everyone’s responsibility”. Improving Public Health requires
important? a range of stakeholders to work together in partnership in a coordinated way,
with a collective responsibility.
To achieve meaningful and sustainable change, we need to work with local
councils, the NHS, the voluntary, community and social enterprise sector,
housing providers, universities and other organisations, as well as citizens and
communities.
Strong system leadership from the Health and Wellbeing Board is essential to
achieving this, supported by high quality information to assist decision making
and monitoring of progress.
Professionals need to be skilled and knowledgeable in public health to equip
them to deliver the vision and required health outcomes.
What we
will do
1.Norfolk Health and Wellbeing Board and Strategy
• Lead the development of the Wellbeing Board and Strategy for 2017
onwards.
• Lead the delivery of the current strategic priorities relating to the social
and emotional wellbeing of young children, healthy weight and dementia,
improving mental health and reducing health inequalities.
2.Joint Strategic Needs Assessment and Pharmaceutical Needs
Assessment
• Continue to develop the Joint Strategic Needs Assessment with partners
aiming for it to be the primary source of data and information on population
health and care needs to support commissioners and other decision makers.
• Review the Pharmaceutical Needs Assessment.
3.NHS Commissioning
• Review and agree a new offer to support NHS commissioning with a stronger
emphasis on health and social care integration.
4.District public health offer
• Develop a district public health offer and support the development of a
district Public Health Directors Group to provide a coordinated public health
advice to the Health and Wellbeing Board.
5.Development of Public Health skills and knowledge
• Support the development of public health skills and knowledge for council
members & officer and other partners including regional specialist public
health training and the Public Health Register.
6.Supporting our partners
• Work with wider partners, particularly the third sector and voluntary, and
support cross sector partnership working.
20
A public health strategy for Norfolk
Delivering the strategy
Ways of working
To deliver this strategy we will:
• Work within a democratic system, with council members setting policy.
• Promote integration of services - public health as everyone’s business.
• Formulate our priorities and base our actions on evidence and information and value for money.
• Work with partners and stakeholders to find local solutions.
• Reduce unfair inequalities by scaling the amount of support given to reflect the level of need.
• Commission high quality services based on local needs.
• Explore the use of technology and innovation to ensure our work reaches more people.
How will we do this?
To deliver this strategy we have a range of resources, powers and partners, including the statutory
responsibilities of the Director of Public Health.
The public health funding received by Norfolk County Council from the Department of Health will be
used to work with partners within the county council, across the NHS, district councils and the voluntary
sector to deliver public health outcomes.
Priorities and implementation plans will be developed to ensure the delivery of each of the priorities in
this strategy.
The first steps to achieve this will be to make sure we have the right resources, we will:
• Review and restructure our current public health team skills and organisation.
• Review the public health information and intelligence offer to better meet county council objectives
and explore integration with the business intelligence and performance service.
• Use some of the public health grant to support public health work in other directorates in the
county council.
• Ensure good governance – seeking continual improvement in clinical and corporate governance,
patient safety, and customer experience. Maximise the quality and effectiveness of our
commissioned services through a dedicated contract management team.
www.norfolk.gov.uk/norfolkslivingwell
21
Delivering the strategy
Measuring our outcomes and performance
We will measure our outcomes and performance by:
1. Reporting against agreed key measures within the county council’s overall performance
management framework.
2. Measuring and benchmarking our public health outcomes in Norfolk against the national Public
Health Outcomes.
3. Monitoring our commissioned services against agreed performance frameworks.
We will further develop specific outcome measures related to the delivery of this strategy and contribute
to the delivery of other key strategies relating to health and wellbeing in Norfolk.
Future influences on Public Health Strategy:
Over the course of this strategy our approach will need to be flexible to adapt to the challenge
of a changing world and evolving system priorities - such as the work of the Sustainability and
Transformation plans, devolution and economic development (e.g. Brexit and Business Rates move).
The health and social care system in Norfolk and Waveney will be transformed over the next five years,
as we implement our new shared vision as part of the Sustainability and Transformation plan. This will
include a focus on Prevention and Wellbeing, alongside other work streams including new models of care
across the system. Public Health will continue to work alongside partners to embed prevention across
the system, reduce health inequalities and implement new models and ways of working.
The impact of leaving the EU on health and social care services, including Public Health, is impossible
to forecast. We will remain responsive to any change and work to minimise any adverse impact and
maximise potential benefits. Working with colleagues at Public Health England will be paramount in
ensuring we are locally responsive to any changes this may bring.
During the lifespan of this strategy, we will also see a change in how Public Health in Norfolk is funded.
The public health grant will be ring-fenced for 2017-18 but from 2018 further consideration will be
needed on how to promote stability and improvements in public health from new funding arrangements
at a local level. It is anticipated that by the end of the current Parliament, local governments will retain
100% of taxes raised locally (this includes 100% retention of business rates) and the Public Health Grant
will be drawn from these local funds in the future.
The strategy will be formally reviewed at the midway point of its implementation programme.
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A public health strategy for Norfolk
References
1. Marmot, M (2010) Fair Society, Healthy Lives. Report on the review of health inequalities in
England. London: Institute of Health Equity
2. Barton, H. and Grant, M., (2006) A health map for the local human habitat, Journal of the Royal
Society for the Promotion of Public Health
3. The Kings Fund (2013), Improving the public’s health, A resource for local authorities.
4. National Institution of Clinical Excellence (2013), Judging whether public health interventions offer
value for money.
5. Local Government Association (2013), Money well spent? Assessing the cost effectiveness and
return on investment of public health interventions
6. Nuffield Council on bioethics (2014-16), an ethical framework – Stewardship Model.
www.norfolk.gov.uk/norfolkslivingwell
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