Health and Wellbeing Strategy for Bristol
Draft 2 (10/7/12)
U. Freudenstein (Chair of the Health and Wellbeing Strategy Group and Chair of the NW Bristol NHS
locality)
Introduction
As part of the Health and Social Care Bill councils and the health care sector need to produce a
“health and well-being strategy”. It needs to have aims and details of how to achieve them. This
strategy needs the widest possible support in an uncertain climate.
The strategy group has agreed on a number of basic principles. Suggestions made to the strategy
group on what to include should follow the principles outlined.
Basic Principles
In order to making it easier to arrive at such a strategy between the city council and the health
service a number of ingredients are necessary.
1) Cross party and senior management leadership of the city as well as the leadership of the
Clinical Commissioning Group need to agree on the principles and the details of the strategy.
2) Actions to be taken under the strategy need to be affordable in the widest sense (i.e. service
changes, mergers or service reductions elsewhere may need to take place to free up
resources for investment).
3) Targets for investment should make sense to the public, public health, elected members and
health service leaders.
4) Part of the strategy should be the identification of work-streams where closer co-operation
between council services and health care will benefit the public.
5) We should use the strategy to influence others bodies (e.g. schools, criminal justice system,
voluntary sector) to co-ordinate their actions with ours to achieve our aims.
6) Policies or actions that either have good evidence against them (previous experience,
research) or that have no evidence in their favour (i.e. it might make sense but nobody has
tried it before) should not become part of the strategy.
7) We should, however, consider innovative proposals that (by definition) do not yet have any
evidence for or against them.
8) The strategic aims should take account of need identified through the Joint Strategic Needs
Assessment (JSNA).
9) This strategy should as a rule NOT repeat other existing strategy documents unless there are
specific aspects that should be included by common consent.
10) Actions under the strategy should help people to help themselves and use people as a
resource whenever possible.
11) The final arbiter of what will appear in the strategy is the health and well being board.
Public Health Principles to select aims for the Health and Wellbeing
Strategy
To inform this part of the strategy we could do worse than going back to the latest of many reviews
into the question how to improve the public health. I therefore quote the Key Messages of “Fair
Society, Healthy Lives” (also known as the Marmot Review):
Reducing health inequalities is a matter of
fairness and social justice. In England, the many
people who are currently dying prematurely
each year as a result of health inequalities would
otherwise have enjoyed, in total, between 1.3
and 2.5 million extra years of life.
To look at this another way, within Bristol wards
the average life expectancy at birth ranges from
75.7 to 85 years; an inequalities gap of over 9
years within the city.
There is a social gradient in health – the lower a
person’s social position, the worse his or her
health. Action should focus on reducing the
gradient in health.
Health inequalities result from social
inequalities. Action on health inequalities
requires action across all the social determinants
of health.
Action taken to reduce health inequalities will
benefit society in many ways. It will have
economic benefits in reducing losses from illness
associated with health inequalities. These
currently account for productivity losses,
reduced tax revenue, higher welfare payments
and increased treatment costs.
Economic growth is not the only important
measure of our country’s success. The fair
distribution of health, well-being and
sustainability are important social goals. Tackling
social inequalities in health and tackling climate
change must go together.
Reducing health inequalities will require
action on six policy objectives:
— Give every child the best start in life
— Enable all children young people and adults to
maximise their capabilities
and have control over their lives
— Create fair employment and good work for all
— Ensure healthy standard of living for all
— Create and develop healthy and sustainable
places and communities
— Strengthen the role and impact of ill
health prevention
Focusing solely on the most disadvantaged will
not reduce health inequalities sufficiently.
To reduce the steepness of the social gradient in
health, actions must be universal, but with a
scale and intensity that is proportionate to the
level of disadvantage. We call this proportionate
universalism.
Delivering these policy objectives will require
action by central and local government, the NHS,
the third and private sectors and community
groups. National policies will not work without
effective local delivery systems focused on
health equity in all policies.
Effective local delivery requires effective
participatory decision-making at local level. This
can only happen by empowering individuals and
local communities.
One of the problems with the conclusions of national reviews of public health relevant policy is that
often action is recommended at a national level that is not open to local councils or health care
planners. However, there are often some actions that can be taken.
How will we arrive at the final strategy
1) Gathering suggestions from a wide range of contributors (July)
2) Agreeing an initial short list (August/September)
3) Consulting with others on the shortlist (further new suggestions) and developing existing
aims
4) Final draft strategy (November) – work to detail how these aims will be implemented across
Bristol
5) April 2013 – Final version with agreed actions to support the stated aims
Possible Actions to be taken under the strategy
The strategy group made some first suggestions on possible aims of the strategy. At this point they
would merely act as an example of the kinds of issues that may be suitable.
1) Improving the mental and physical health of Bristol’s children
a) Co-ordinate nutrition, exercise and mental health strategy across all schools in Bristol
b) Take account of the geographical spread of high birth rate and school intake pressures
2) Making it easier for young people from areas of high unemployment to reach parts of Bristol
with jobs
3) Reducing the impact of alcohol and drug misuse on families, communities and users
Membership of Health and Wellbeing Strategy Group of the Health and
Wellbeing Board
Dr Ulrich Freudenstein (Chair)
General Practitioner, Chair of NW Bristol NHS Locality
Kathy Eastwood (Co-ordinator)
Service Manager: Health Strategy, Bristol City Council
Dr Pat Diskett
Deputy Director for Public Health
Netta Meadows
Service Director: Strategic Planning and Commissioning,
Health and Social Care, BCC
Claudia McConnell
Service Director: Strategic Commissioning, Children and
Young People’s Services, BCC
Peter Walker or Rachel Robinson
On behalf of VCS (shared role)
Richard Lyle
Associate Director, Community, Partnerships and PPI, NHS
Bristol – BNSSG Cluster.
Nick Hooper
Service Director: Strategic Housing, BCC (Links with Wider
Determinants of Health work)
Suzanne Ogborne (Support)
Project Administrator: Health Strategy.
[email protected] or 0117 922 2080