PUBLIC
Agenda item 4
DERBYSHIRE HEALTH AND WELLBEING BOARD
10 September 2015
Report of the Strategic Director Health and Communities
DRAFT HEALTH AND WELLBEING STRATEGY
1. Purpose of the report
To consult the Health and Wellbeing Board (HWB) on the draft Health and
Wellbeing Strategy.
2. Information and analysis
The Board has previously been consulted on the development of the key
priorities for the refreshed strategy. In addition, all members were invited to
attend two workshops at which actions and performance measures for
each priority within the strategy were developed. Following this activity the
strategy has been drafted and further developed around the four agreed
priorities of:
•
•
•
•
Keep people healthy and independent in their own home;
Build social capital;
Create healthy communities; and
Support the emotional health and wellbeing of children and young
people.
In line with recommendations from the LGA Peer Review conducted in
autumn 2014, the strategy does not provide a comprehensive long list of
the work that the board collectively, or as individual partner organisations,
are undertaking and consider ‘business as usual’. It is intended that the
Health and Wellbeing Board will focus activity on the delivery of these four
priorities over the next two years.
By focusing on the priority areas, actions have been developed in
conjunction with the champions for each priority where the Board can addvalue by working collectively to address key issues. This approach will help
ensure that outcomes are realised within the two year time frame and we
make the best use of our limited financial and staffing resources.
This draft strategy builds from the previous strategy which ran from 201215. Much of the evidence, engagement and policy development work
1
PUBLIC
undertaken for this initial strategy is still relevant and where appropriate
this have been bought up to date using the latest JSNA data and other
national and local policy documents to reflect the latest thinking and
strategic position.
Therefore it is proposed that the draft strategy is tabled for consultation
amongst Health and Wellbeing Board members who are invited to provide
feedback on the document to [email protected] by 25
September 2015. Comments and feedback received from Board members
will be considered before a final version of the strategy is presented to the
Health and Wellbeing Board for implementation in November.
3. RECOMMENDATIONS
1. That the Board considers the draft Health and Wellbeing Strategy
2015-17 and provides any feedback on the document by the agreed
consultation deadline.
2. Notes that the final version of the strategy will be presented to the
meeting of the Health and Wellbeing Board on 19 November for
implementation.
David Lowe
Strategic Director, Health and Communities
Derbyshire County Council
2
HEALTHY
DERBYSHIRE
Derbyshire Health and Wellbeing Strategy
2015-17
1
Contents
Foreword from the Chair of the Health and Wellbeing Board...................................................... 3
Context ......................................................................................................................................... 4
Why are we refreshing the health and wellbeing strategy? .......................................................... 5
Our priority areas for health and wellbeing .................................................................................. 6
The health of Derbyshire .............................................................................................................. 7
Keep people healthy and independent in their own home .......................................................... 8
Build social capital ...................................................................................................................... 11
Create healthy communities ....................................................................................................... 13
Support the emotional health and wellbeing of children and young people ............................... 16
How will we deliver this strategy? .............................................................................................. 19
Working together for a healthy Derbyshire ................................................................................. 20
Health and Wellbeing Board Members ...................................................................................... 21
A Derby and Derbyshire approach to all health and care service organisations working as one
................................................................................................................................................... 22
Derbyshire Health and Wellbeing Board - role and function ...................................................... 23
Version
Document Classification
Update notes
Date
0.7
PUBLIC
DRAFT- for HWB 10 September 2015
27/08/2015
2
Fore
eworrd fro
om th
he Chair of th
he
Healt
H th an
nd We
ellbe
eing Boar
B rd
The Health an
nd Wellbeiing Board has been
n establish
hed for thrree
s and in th
hat time we
w have co
ome a lon
ng way and stronge
er
years
relationships b
between partner
p
org
ganisation
ns have developed..
ow right fo
or us to loo
ok at whatt we do an
nd how we
e
The time is no
ur
do it,, to make sure that we make the mostt effective use of ou
ever shrinking
g financial resources
s across tthe health and socia
al
care system.
ars public services iin Derbyshire have
Overr the past three yea
faced
d continua
al rounds of budgett cuts, the
e County Council
C
alo
one
has to
t cut £15
57 million by 2017/18 and the
e NHS has
s an
estimated de
eficit of £150m overr the next five years
s. This has
s meant a
all health and
a
artners havve had to take som
me tough decisions
d
to
t reduce services whilst
w
trying
welllbeing pa
to find
f
differe
ent ways to
t supportt the healtth and wellbeing of our reside
ents, particularly those
who
o are mosst vulnerab
ble.
As Chair of the Health
h and Wellbeing Bo ard, I am determine
ed to ensu
ure that we
w work
do the besst we can for
f the co mmunities
s of Derby
yshire by making th
he most
together to d
ective use
e of our lim
mited budg
get. Utilising our strrengths an
nd speciallities, such as the ro
ole
effe
of district
d
cou
uncils in re
elation to housing a
and voluntary secto
or in termss of comm
munity
sup
pport, we need to th
hink differe
ently, worrk innovatively and collaboratting acros
ss
org
ganisationa
al bounda
aries. By doing
d
this,, we will be able to meet the challenge
es related to
an increasing
gly ageing
g populatio
on, suppo
orting families and individualss with com
mplex nee
eds,
alities and ensuring the best start
s
in life
e for childrren and yo
oung people.
tackling health inequa
er the passt year, we
e have tak
ken time tto review the
t arrang
gements i n place fo
or the Hea
alth
Ove
and
d Wellbein
ng Board to
t make sure
s
it rem
mains fit fo
or purpose
e and can tackle the
e challeng
ges
ahe
ead. In the
e next two
o years we
e must co ntinue to deliver ag
gainst our identified priorities
outtlined in th
his strateg
gy, to help deliver ou
h is aboutt more tha
an
ur vision. But health
org
ganisationss working and deliv
vering toge
ether – it involves every
e
sing
gle Derbys
shire
resident. We
e all have a respons
sibility to lo
ook after our own health
h
and
d we need
d everyone
e to
bit to maintain a hea
althy lifesty
tyle. I wan
nt to make
e
pledge wayss in which they can do their b
e Health an
nd Wellbe
eing Board
d is greate
er than the
e sum of iits parts and
a I believe
surre that the
the Board ca
an make an
a importa
ant contrib
bution to im
mprove ou
ur populattion health
h over the
e
xt two yea
ars.
nex
Councillor D
Dave Alle
en
air of the Health an
nd Wellbeing Board
Cha
and
d Cabinet Member for
f Health
h and Com
mmunities, Derbysh
hire Countty Council
3
Conte
C
ext
Botth locally a
and nation
nally there
e is a clea
ar drive to change th
he empha
asis of the
e health
sys
stem from one whicch treats ill-health to
o one whic
ch prevents people from bec
coming ill in
the first place
e. Health and wellb
being partn
ners in De
erbyshire are comm
mitted to an approacch
o remain healthy
h
an
nd independent for as long aas possible
e so that they
t
whiich allowss people to
hav
ve a better quality of
o life, with
h better ou
utcomes.
Hea
alth and w
wellbeing partners
p
in Derbysh
hire are co
ommitted to joining up health
h and sociial
carre so that w
we focus on the ne
eeds of an
n individua
al and we always wo
work in a ‘p
personcen
ntred’ wayy. Finding the right solution
s
w
will be challenging, but
b we are
e determin
ned to ma
ake
this
s a reality..
Ways of
o working
g which ce
entre on th
he whole
needs of the person are iin place with
w the
uction of virtual
v
warrds, teleca
are,
introdu
integra
ated teams, and the
e voluntary sector
single point of access (vS
SPA).
The Be
etter Care
e Fund hass also bro
ought a sh
harp
focus to
t what ca
an be achiieved toge
ether through
aligned
d working and we w
want to build on thiss
with ou
ur joined up
u care prrogramme
es. The
County
y Council’s
s role in re
educing health
h
inequalitie
es and improving th
he health of the
pop
pulation provides op
pportunitie
es to co-o
ordinate work.
w
Nattionally, th
he NHS Five Year Forward
F
V
View outlin
nes a clea
ar vision fo
or how health servicces
nee
ed to chan
nge so tha
at new rela
ationshipss are forge
ed with pa
atients, ca
arers and citizens
thro
ough the d
development of new
w models of care. In
n Derbysh
hire, Erew
wash is developing the
t
Multi-speciality Comm
munity Prov
vider (MC
CP) model, which will bring th
he commu
unity and
alth servicces closer together. All health
h partners
s in Derbyshire will ffollow the
ese
hea
dev
velopmentts closely so that le
earning an
nd innovattion can be shared. We need
d to contin
nue
to work
w
togetther to ma
ake sure that some of this go
ood practic
ce becom
mes more embedded
e
d
acrross the w
whole syste
em.
Ove
er the nexxt two yea
ars the Boa
ard will ne
eed to balance the immediate
e requirem
ment to
inte
egrate serrvices and
d commiss
sioning witth the longer term ambition
a
tto promote
e health and
a
welllbeing in order to im
mprove th
he generall health off the popu
ulation and
d reduce the
t
incrreasing de
emand on
n acute se
ervices.
4
Why are we refreshing the health and
wellbeing strategy?
The Health and Wellbeing Strategy 2015-17 outlines four priority areas, which the Health
and Wellbeing Board will focus activity on over the next two years. This strategy does not
provide a comprehensive long list of the work that the board collectively, or as individual
partner organisations, are undertaking or consider ‘business as usual’.
But, this is not to say these priorities are all that the Board will work on. The Health and
Wellbeing Board, informed by the latest Joint Strategic Needs Assessment (JSNA), will
continue to provide strategic direction and commission services to meet the health and
wellbeing needs of the population of Derbyshire.
This refreshed strategy builds from the previous strategy 2012-2015, much of the
evidence, engagement and policy development work undertaken is still relevant and where
appropriate we have bought this up to date by using the latest JSNA data and other
documents to help further inform our thinking. To this end our vision remains unchanged:
“To reduce health inequalities and improve health and
wellbeing across all stages of life by working in partnership
with our communities.”
Our priorities, outlined on the next page will allow us to consider where by working
together, joining things up and delivering through strong collective leadership, a greater –
more positive – impact can be made to prevent avoidable ill health and reduce health
inequalities.
This more focused approach is drawn from a recommendation of the LGA Peer Review
Team, which spent time in Derbyshire in the autumn of 2014. The review team endorsed
the approach taken in this refreshed strategy to narrow the scope of work and deliver
agreed actions in a small number of priority areas. We have subsequently held a number
of workshops to develop our priorities and issues identified in these sessions form the
basis of this strategy. This approach will help ensure that outcomes are realised within the
two year time frame and we make the best use of our precious financial resources.
Each of the priority areas has identified leads, accountable to the Health and Wellbeing
Board, for the delivery of agreed actions. These leads will be required to provide regular
updates on progress to the Health and Wellbeing Board and additional workshops will take
place to allow us to focus on solving problems and generating new solutions to maintain
delivery at pace and scale. In addition, task and finish groups will be created to take
specific pieces of work forward, delivering practical solutions to the strategic priorities.
5
Our priority areas for health and wellbeing
Our priorities
Keep people healthy and independent in their own home
Build social capital
Create healthy communities
Support the emotional health and wellbeing of children and
young people
Addressing these priorities will help us work to achieve two overarching outcomes
for Derbyshire:
•
•
Increased healthy life expectancy.
Reduced differences in life expectancy and healthy life expectancy between
communities.
We will address these priorities using the following principles and values:
•
•
•
•
•
•
•
•
All services will be person centred and delivered in an integrated manner.
Approaches to care will be provided flexibly taking into account all the circumstances
around a person.
People experiencing mental ill health will have both their physical and mental health
needs met in a co-ordinated way.
Individuals will benefit from community facing services.
Services will be planned and delivered in partnership.
Health lifestyles will be promoted.
Core community services will be available seven days a week.
Children and young people will be helped to reach their full potential.
6
The
e hea
alth of
o De
erbys
shire
e
Derb
byshire ha
as an estim
mated
p
population
n of 779,8
800

Derbysh
hire’s popu
ulation is set to
increase
e by 11.7%
% from 201
12 to
2037
65+
6
Two
o out of te
en people in the
cou
unty are currently aged
a
65 an
nd
ove
er, by 2037
7, this ratio will
incrrease to three out of
o ten
peo
ople
90
0+
T
The population aged 90 and o
over
w
will more than
t
doub
ble by 203
37
Over th
he last 10 years the
e
rates o
of death frrom all
causes
s and the rates of
death ffrom canc
cer, heart
disease and stro
oke have
all improved and
d are
close tto average
e for
Englan
nd

20.4
2 %
20.4% of res
sidents ha
ave limited
d
day to day a
activities, compared
d
to 17.6% forr England
pital admis
ssions cau
used by
Hosp
uninttentional a
and delibe
erate
injuries in youn
ng people
e is
er than in
highe
otherr areas
7
This infographicc provides a snap shot of the
latest relevant st
statistics reg
garding the health
being of Derrbyshire res
sidents. The
e Joint
and wellb
Strateg
gic Needs A
Assessmentt, a live document
which
h is updatedd with the latest datasets and
in-depth annalysis and resources can
c be
accessed on thhe Derbyshire Observatory .
Female
F
liffe expecta
ancy is 83.2
and
a for ma
ales it is 79.4
7
years
s
The diffe
erence bettween the
e
healthiesst and unh
healthiestt
areas of the countty leads to
o
differenc
ces in life expectancy of
7.9 yearss for male
es and 5.8
years forr females
12.1
1%
12.1%
1
of rresidents provide
unpaid
u
ca
are, compa
ared to
10.2%
1
for England
6..2%
%
Th
here were
e 3,903
de
eaths attributable
to
o smoking between
20
011 and 2013
6.2% off residentts are
in bad health
compared to 5.5
5% for
England
Ke
eep pe
eople health
hy and
d inde
epende
ent
in their own home
h
Derbyshire
e Care Wedg
ge
Derb
byshire ha
as an ageeing population. By
2037
7 it is anticipated th
hat the population
aged
d 65 and over will h
have incre
eased by
68%
% and the very elderrly, those aged 90+
+,
will have more than do ubled in number
n
fro
om
2. We nee
ed to take
e a longer--term view
w to
2012
cons
sider how we will ad
ddress the
e challeng
ges
of an increasingly agein
ng popula
ation by
ntative ste
eps in plac
ce now – if
putting preven
d
we will
w face sp
piralling demand an
nd
we don’t
costts.
There is a lot of work a
already un
nderway to
o
join
n up health
h and soccial care services ass part of th
he Better Care Fun
nd, which will
w help
red
duce dema
and on sp
pecialist an
nd acute ccare, shifting provis
sion using the Derbyshire Ca
are
We
edge to the
e commun
nity and self-help w
wherever possible
p
and reduciing deman
nd on
spe
ecialist care and care homes. In additio
on, this offten mean
ns those in
ndividuals
s with
phy
ysical or le
earning disabilities can live m
more indep
pendently
y at home with apprropriate ca
are
and
d support arrangem
ments in place.
The
e Derbysh
hire Health
h and Wellbeing Bo
oard has an
a agreed a vision ffor integra
ated health
and
d social ca
are, which
h is aligned to the B
Better Care
e Fund, th
he transfo
ormation programme
p
es
in the north, through 21c
2 Joined
d Up Care
e, and sou
uth, throug
gh Joined Up Care for the So
outh
D
e, alongside Tames
side and G
Glossop’s Care Tog
gether pro
ogramme. A full cop
py
of Derbyshire
of this
t
vision documen
nt is includ
ded at the
e back of this strateg
gy.
The
e Health a
and Wellbeing Boarrd has ide
entified tha
at its work
k over the next two years
y
nee
eds
to focus
f
on the cross cutting
c
enabling ele
ements of the transfformation programm
mes, to
ens
sure there
e is consisstency acrross the co
ounty foottprint, so that
t
best p
practice can be sha
ared
and
d impact a
across the
e whole he
ealth and social carre system is maxim ised. Wo
ork will
therefore foccus on delivering the aspiratio
ons for a joint
j
workforce, con
nsidering how we
o estate
e, what sh
hared perfformance arrangem
ments need
d to be in
make the best use of our
ow the Health and Wellbeing
W
Board ca
an provide
e oversigh t and evolve to besst
place and ho
pport more
e integrate
ed working.
sup
8
What do we want to achieve by 2017?
 Partners will be delivering the joint vision for health and social care for Derbyshire,
which supports definition of integration produced by National Voices: “I can plan my
care with people who work together to understand me and my carers allowing me
control and bringing together services to achieve the outcomes important to me”.
 We will work in partnership with the people needing care and their families and
carers to provide care as close to the person’s home or, where practical, within the
home. Where appropriate we will support them to access the right care in a
specialist setting, such as an acute hospital or residential care home.
 Care co-ordination will seek to create person centred solutions. These will be
developed alongside the person using their strengths and aspirations supported by
multi agency teams as appropriate.
 We will have a joined up workforce equipped to work in multi-disciplinary teams,
ensuring organisation boundaries do not get in the way of a seamless services for
local people.
How will the Health and Wellbeing Board add value to achieve these aims?
 Support primary care transformation across the county in line with the respective
Joined Up Care programmes.
 Develop a joint quality and financial governance framework to ensure that quality
flows throughout the system and is reflected throughout the commissioning process.
 Work together to share best practice and unblock key issues so that health and
social care integration progresses at pace and scale.
 Strengthen links with neighbouring Health and Wellbeing Boards, especially Derby
City, so we have a broader understanding of system change and good practice.
 Develop a talent management system to ensure we retain staff who can be effective
integrated system leaders, facilitating job swaps across all parts of the health and
social care sector so we develop the leaders of tomorrow.
 Implement an integrated training and development programme so there is one style,
one approach and one set of values shared across organisations to allow our
workforce to operate in a truly integrated manner.
 Gain a shared understanding our joint asset base, through the development of a live
database where all assets are logged and is utilised and updated regularly.
 Open up our estate and facilities for greater community use and where appropriate
share these assets between partners to maximise their potential.
 Share proposals for new build projects at Health and Wellbeing Board meetings so
that opportunities are maximised for developing mixed-use, multi-function buildings.
9
 Develop a strategy regarding the release of our current estate, maximising the
potential from this land and help us shape the market through, for example, requiring
the development of housing built to lifetime homes standards.
 Develop an information governance, intelligence and performance framework, so
that data is accurate and can be easily shared to ensure all partners have visibility of
key datasets.
Key indicators to track:









Emergency admissions for hip fractures in people aged 65 and over.
Adult social care users have as much social contact as they would like.
People aged 65 and over injured due to falls.
People who are re-admitted to hospital due to an emergency within 30 days of
discharge.
Hospital episodes where individuals are admitted for non-elective procedures.
Population aged 65 and over who are permanently admitted to residential and
nursing care homes.
Population aged 65 and over who are still at home 91 days after discharge from
hospital following the use of re-ablement or rehabilitation services.
Delayed transfers of care from hospital.
Patients who took part in a GP Patient Survey who stated in the last six months, they
had received enough support from local services/organisations to help manage their
long-term condition.
10
Build
B
socia
al cap
pital
Social capital is
s about the
e relations
ships,
networks and trust whichh help people to
ort each otther, buildd confidence and
suppo
create
e the oppo
ortunities tto bring ab
bout chan
nge
in their lives and
d commun
nities.
s the
There is strong evidence that links
nce of soc
cial capitaal in comm
munities with
presen
improv
ved health
h outcome
es, especiially the
possib
bility that social
s
cappital influen
nces the
rela
ationship b
between socio-eco
s
nomic dissadvantage and hea
alth inequa
ality.
Buiilding com
mmunity ne
etworks and suppo rt that sus
stains hea
alth is an i mportant element of
o
the self-care agenda. The creattion of soccial capita
al is a key part of ad
dult care reforms an
nd
nical Com
mmissionin
ng Groups
s five yearr planning strategies
s. Utilised
d correctly
y it can actt as
Clin
‘the
e renewab
ble energyy’ which ca
an help re
educe relia
ance on more
m
expe
ensive hea
alth
inte
erventionss, building strengths
s within co
ommunitie
es. We wa
ant to ado
opt a long-term
app
proach to build sociial capital within com
mmunities
s to aide wellbeing.
w
.
Soc
cial capita
al is aboutt everyone
e and can exist at different
d
le
evels – witth an indiv
vidual, the
e
com
mmunity o
or with socciety as a whole. Bu
uilding trust betwee
en differen
nt types off people and
a
bettween peo
ople and public
p
serv
vices is an
n importan
nt element of sociall capital. Therefore
T
,
individuals, ccommunityy groups, the volun
ntary secto
or and pub
blic sectorr all have an equally
portant contribution to make in building
g social ca
apital. Doiing so, willl alongsid
de human,
imp
phy
ysical and economic capital help
h
support resilien
nt commu
unities acrross Derby
yshire.
ady takes place in both
b
the pu
ublic and voluntary sector, w
which build
ds social
Acttivity alrea
cap
pital. For e
example lu
uncheon clubs,
c
loca
al area co
o-ordinatio
on, projectts which promote
p
rela
ationship b
building, the
t voluntary sectorr single po
oint of acc
cess (vSP
PA) and initiatives
whiich involve
es membe
ers of the communiity in co-design and
d co-produ
uction of services.
s
The
e Health a
and Wellbeing Boarrd recogniises the im
mportance
e of sociall capital and social
nettworks in h
helping individuals remain in dependen
nt and in their own h
cial capita
al
home, soc
form
ms a key part of the
e Better Care
C
Fund implemen
ntation. Through
T
th
his priority
y the Boarrd
wan
nts to gain
n a better understanding of w
what best supports people an
nd commu
unities in
Derrbyshire to
o better achieve he
ealth outco
omes and agree a collective
c
approach
h, which
maximises im
mpact in ta
aking this work forw
ward.
11
What do we want to achieve by 2017?
 Gain a better understanding of existing activity, investment, effectiveness and value
which is currently being deployed to build social capital across all sectors.
 Agree the best way of investing to further develop social capital in terms of the
Derbyshire care wedge to build self-care, prevention and appropriate interventions.
 Commit to a strengths based approach which recognises the assets rather than
deficits of communities and individuals.
 People are enabled to support themselves and this reduces the need to access
services.
How will the Health and Wellbeing Board add value to achieve these aims?
 Publish a report in the autumn of 2015 which will make a range of recommendations
to be taken forward by all health and wellbeing partners and we will update this
strategy to reflect these.
 Relationships matter to people at all levels and the Health and Wellbeing Board
needs to consider this throughout all its work.
 Ensure that social capital forms a key-part of the joined up care programmes to
encourage people to seek early help, promote self-care and prevent ill health.
 Implement a set of principles which will inform the commissioning of community
based services to support the ongoing development of social capital.
 Develop a series of tools and enablers which all partners can use to support the
further development of social capital in our communities.
 Pilot new service models which will develop and strengthen social capital, sharing
learning and best practice across organisations so that these can be upscaled.
 Implement a way of measuring social capital that is meaningful to local residents and
communities.
Key indicators to track:
 Residents trust people who live on their street to a large extent.
 Residents trust people living in the local area to a large extent.
 Residents state that trust in their neighbourhood has improved in the last 12
months.
 Residents state that trust in their neighbourhood has got worse in the last 12
months.
 Residents have been involved in decisions affecting their community in the last 12
months.
 Individuals who have provided unpaid help to a group, club or organisation at least
once a month in the past year.
12
Creat
C
te hea
althy communiities
Tackling health
h inequalitties and im
mproving the
t
h and wellbeing of l ocal resid
dents acro
oss
health
the life
e course is
i crucial tto what we
w want to
achiev
ve. To do this we nneed to lea
ad a place
e
based
d approach to workiing with our
comm
munities to
o improve both the health
h
and
d
wellbe
eing of ind
dividuals, but also addressing
a
g
the wiider determinants o
of health.
cross the ccounty is generally
Whilst health ac
mpared to other partts of the UK,
U there are
good com
sign
nificant differences in life exp
pectancy b
between the
t health
hiest and u
unhealthie
est areas of
o
the county att 7.9 yearrs for male
es and 5.8
8 years for females.. We need
d to focus our work in
mmunitiess with the greatest health
h
ineq
qualities and
a work with
w indiviiduals to tackle
t
issu
ues
com
suc
ch as obessity, smokking, diabe
etes and liver disea
ase. By do
oing this w
we will reduce the
differences sseen in life
e expectancy and im
mprove th
he quality of life for local resid
dents,
red
ducing the numberss of people
e who havve preventtable illnesses.
Enc
couraging
g residentss to regula
arly exerccise, lead a healthy lifestyle a
and eat a balanced
b
diet
is key.
k
Promoting the benefits of
o an activve lifestyle
e will help us tackle obesity and preven
nt
peo
ople becoming diab
betic. We understan
u
nd the imp
portance of
o place in
n improving health and
a
welllbeing; therefore, utilising
u
De
erbyshire’’s natural landscape
e and enccouraging individuals
to take
t
part in sports such
s
as ru
unning, wa
alking and
d cycling which
w
can enable in
ndividuals to
rem
main fit at relatively low cost is importa
ant.
County Co
ouncil has recently jjoined the
e UK Healthy Cities Network and throu
ugh
Derrbyshire C
this
s we want to use go
ood practic
ce from otther areas
s to promo
ote health
h and wellbeing. We
e
also
o know that improvving health
h is linked to a rang
ge of wider determin
nants, suc
ch as
ens
suring peo
ople have a job, can
n manage
e their own
n finances
s and live in a warm
m home.
The
ese preve
entative measures can
c help re
educe cos
sts to the health sysstem, but also allow
wa
perrson to pla
ay an activve role in society.
Hea
alth inequ
ualities are
e a key iss
sue and p
preventativ
ve measures are im
mportant in
n reducing
g
dem
mand on a
acute servvices and preventin
ng individu
uals from developin
d
g avoidab
ble long te
erm
con
nditions. P
Prevention
n is an imp
portant pa
art of both the transformation programm
mes and
Bettter Care F
Fund so th
he Health and Welllbeing Boa
ard needs
s to champ
pion this approach
a
and
d ensure tthat work is strategiically align
ned to hellp supportt the integ
gration age
enda.
13
What do we want to achieve by 2017?
•
•
•
Increased numbers of residents who lead happier, healthier and more active
lifestyles.
Empower our workforce, partner organisations and elected members to act as
enablers, alongside individuals and community members, to develop healthy
communities.
Embed health in the planning process so we can ‘design in’ health benefits and
design out ‘health inequality’.
How will the Health and Wellbeing Board add value to achieve these aims?
•
•
•
•
•
•
•
•
•
Understand the infrastructure within our communities to see how public, voluntary
and community assets can come together to collectively promote health and
wellbeing and promote active lifestyles.
Create walkable neighbourhoods using devices such as mile markers, increase the
number of people who regularly cycle and promote an active lifestyle.
Use the Healthy Communities programme to address health inequalities, especially
where Derbyshire performs poorly compared to other areas, such as alcohol related
admissions to hospital, obesity in adults and recorded diabetes.
Encourage boroughs, other organisations and communities themselves to become
affiliate members of the Healthy Cities Network.
Work with district councils, other partners and communities to further develop and
enhance our commitment to healthy communities, healthy housing, tobacco control,
and tackling unhealthy behaviours.
Enable our workforce to be advocates of good health and make sure every contact
counts with individuals and families who use our services. We will adopt a policy of
there is ‘no wrong front door’ to help address health inequalities.
Work with Elected Members so they understand how they can provide key links
between organisations to promote health and wellbeing in their area.
Develop a shared statement for planning and health, which the Health and
Wellbeing Board and planning authorities can sign up to. Undertake health impact
assessments to understand more about the health implications of large-scale
developments in the county.
Share information with developers about how they can ensure they build healthy
homes to meet the changing needs of our population.
14
Key indicators to track:








15
Adults aged 18 or over smoke.
Adults classified as obese or overweight.
Patients on GP registers have diabetes.
Deaths from causes considered to be preventable.
Deaths in people aged under 75 from cardiovascular diseases.
Deaths in people aged under 75 from cancer.
Population who eat the recommended ‘fruit and veg 5 a day’.
Adults are physically active.
Su
upportt the emotio
e
onal he
ealth and
a we
ellbein
ng of childre
c
en
an
nd young people
We wa
ant children in Derbyyshire to have
h
the
best sta
art in life, ensuring that children have
good access
a
to support
s
an
nd advice
e if they
experie
ence mental health issues.
i increasing eviden
nce both nationally
n
There is
and loc
cally that emotional
e
health an
nd wellbeing
is an im
mportant is
ssue to ge
et right in early years.
The lattest nation
nal statisti cs sugges
st that 75%
%
of adult mental health
h
pro
oblems, ex
xcluding
dem
mentia, de
evelop by the age of
o 18. How
wever, a trreatment gap
g existss where only 25%-3
30%
of those
t
with
h a diagno
osable mental health
h conditio
on accesse
ed the sup
pport they
y needed.
Earrly interve
ention and preventio
on in child
dhood can
n avoid expensive a
and longerr term
inte
erventionss in adulth
hood. Therre is a cle
ear cost be
enefit to so
ociety of ttackling mental
m
hea
alth
issu
ues early on in life. The mental health of childre
en and you
ung peoplle is a larg
ge policy
are
ea so for th
he next tw
wo years the Health
h and Welllbeing Boa
ard has de
ecided to focus its
worrk on self--harm and
d suicide prevention
p
n amongst children and youn
ng people.
d suicides
e latest na
ational sta
atistics sug
ggest thatt numbers
s relating to
t reported
s are low, but
The
there is intellligence to
o suggest that
t
self-h
harm is a growing
g
is
ssue. Selff-harm is increasing
gly
en as a co
oping strattegy by yo
oung peop
ple who fe
eel overwh
helmed byy problems they can
n
see
neitther resolve nor live
e with. Ma
any young
g people fiind it very
y difficult to
o express
s these
con
ncerns and
d seek he
elp and so
ome feel th
hey are no
ot listened
d to.
Suiicide may often be the result of a comb
bination of
o other fac
ctors, succh as abus
se, neglecct,
fam
mily proble
ems or me
ental healtth issues. In many cases
c
children and young pe
eople who
o
take their ow
wn lives feel that the
ere is no w
way out off their prob
blems and
d the rightt help is not
ng we want to prev ent.
there. This iss somethin
er the passt year, the Children
n’s Trust h
has developed an agreed
a
ap
pproach to
o help
Ove
individuals w
who self-ha
arm, which is due to
o be signe
ed off this autumn, and has supported
s
da
ot working with youn
ng people
e in schoo ls to cons
sider how an approp
priate earlly help offfer
pilo
can
n be developed with
h schools.. In respon
nse to the
e Future in
n Mind rep
port, the Children’s
C
Tru
ust, workin
ng with CC
CG, partne
ers and yo
oung peop
ple is developing a Transform
mation Pla
an
for implemen
ntation.
e Health a
and Wellbeing Boarrd does no
ot want to duplicate
e the workk undertak
ken by the
e
The
Chiildren’s Trrust Board
d. But, by taking a ssystem wide view we
w can stre
rengthen early
e
inte
ervention a
across the
e county and
a reducce the dem
mand for costly
c
servvices and provide
add
ditional su
upport for young people identtified at ris
sk of self-harming o
or committing suicid
de.
16
What do we want to achieve by 2017?
 Adopt approaches which actively promote early intervention and prevention to
support young people with a mental health issue who are at risk of self-harming.
 Increased resilience amongst young people so they have improved coping and
problem solving skills.
 Reduced demand on high cost child and adolescent mental health services
(CAMHS) and transitions to adult services.
 A whole system approach to strengthening preventative approaches, building
resilience in children and young people and improving outcomes which better meet
the identified needs of individuals.
How will the Health and Wellbeing Board add value to achieve these aims?
 Commit to develop and utilise approaches which allow for early intervention and
prevention to support the emotional health and wellbeing of children.
 Explore opportunities for devolution of specialised commissioning from NHS
England.
 Work with children and young people to raise their self-esteem and allow them to
develop coping mechanisms to difficulties they encounter by involving them in
determining what works best then developing a programme of work to respond.
 Develop a range of lower level support options, such as online self-help, peer
support and informal counselling for young people so that they can seek help at an
early stage.
 Utilise the transfer of commissioning 0-5 year old public health services to local
government in October 2015 as an opportunity to create a stronger focus on mental
health in the early years and beyond.
 Sign off and implement the ‘Future in Mind’ Transformation Plan, which will help
build capacity within evidence based outcome focused CAMHS by 2020.
 Implement a training strategy across all agencies that support our workforce to deal
with young people who self-harm confidently and reduce unnecessary referrals to
more costly services.
 Hold a workshop with representatives from the north and south Derbyshire CAMHS
teams and partners to simplify processes, explore data requirements, agree good
practice and allows for greater equity in provision, which can then be shared and
taken forward by the Health and Wellbeing Board for implementation.
17
Key indicators to track:
 Number of children in Derbyshire who self-harm and attend hospital due to these
injuries.
 Children achieving a good level of development at the end of reception.
 GCSE attainment.
 Population aged 18 or under are admitted to hospital for alcohol specific issues.
 Suicide rate.
 Children aged 0-14 who are admitted to hospital due to unintentional and deliberate
injuries.
 Children’s perceptions of care and support
18
How will we deliver this strategy?
There is enormous capacity and potential available across the partnership, which can be
harnessed to achieve the actions and outcomes outlined in this strategy. To aide this, a
member of the Health and Wellbeing Board has been identified to champion to take
forward our priorities.
Identified leads will report back to the Health and Wellbeing Board on progress made
against the actions and outcomes outlined in this strategy every six months. Health and
Wellbeing Board meetings will provide opportunities for mutual challenge so that we are
constantly driving forward better, more integrated, working based around the needs of the
person and delivered to the best possible standards. All Board members will hold each
other to account to make sure we make the most effective use of our combined resources
and limited budgets.
Poor performance against agreed delivery targets and timescales will be reported by
exception to the Health and Wellbeing Board Core Group on a bi-monthly basis. This will
allow for early awareness of potential issues to allow this group to consider if additional
support can be put in place; whether the matter needs to be referred to the full board for
consideration, a task and finish group established or a specific workshop organised to
agree solutions.
We will track the high level indicators detailed for each priority over the life of the strategy
so we can demonstrate that we have begun to ‘bend the curve’ and address key health
and wellbeing challenges. In some instances, it will take a concerted effort over more than
this two-year timeframe to reduce the variances in life expectancy currently seen across
the county, but we want to demonstrate by 2017 that we have made a start. In addition to
these indicators we will benchmark our performance against other Health and Wellbeing
Boards from comparable areas to assess the effectiveness of the Board and the work it
commissions.
19
Worrking
g togethe
er forr a he
ealth
hy
D
Derby
yshirre
As muc
ch as the Health an
nd Wellbeing Board
d
has to be accountable forr actions, we
w also need
shire resid
dents to be
e part of the solutio
on.
Derbys
We wa
ant to esta
ablish an o
ongoing dialogue with
w
our loc
cal commu
unities abo
out the mo
ost effective
way to respond to
t local he
ealth challenges, bu
ut
r
stand theirr
also alllow local residents
to unders
own responsibilitties when
n it comes to their
a wellbbeing.
personal health and
atch also provides us with intelligence
e
Healthwa
and
d insight o
of the view
ws and opinions of a range off social ca
are and he
ealth services. The
Hea
alth and W
Wellbeing Board rec
ceives reg
gularly
upd
dates from
m Healthw
watch and through a range off
dee
ep-dive re
eports we gain a dettailed und
derstandin
ng of
currrent issue
es and con
nsider where there are
opp
portunitiess to improvve.
By the end o
of 2015, we
w will have develop
ped and begun to im
mplement a Health and
ellbeing Bo
oard Enga
agement and
a Comm
munication
ns Plan. This
T
docum
ment will set
s out ho
ow
We
we intend to have con
nversations with serrvice users, local co
ommunitie
es and ind
dividual
enable uss to unders
stand morre about the
t health needs off the population and
d
residents to e
w we can work morre effective
ely to add
dress these needs through th
he co-prod
duction of
how
serrvices.
We
e also wan
nt to engage with co
ommunitie
es and ind
dividuals so
s that the
ey can und
derstand
more about w
what they can do to
ogether to
o live a hea
althy lifesttyle or sup
pport family membe
ers,
neighbourrs who ma
ay be in ill--health.
friends and n
which is already
e don’t want to duplicate the work
w
of otther organ
nisations and
a work w
a
We
taking place in Derbysshire. Therefore we
e will ensure that ou
ur work me
esh with other
o
ategic doccuments and
a we willl continue
e to share
e information and lea
arning witth other
stra
boa
ards and ccommittee
es such as
s the Adullts and Ch
hildren’s Safeguard
S
ding Board
ds, the
tran
nsformatio
on boardss, the Child
dren’s Tru
ust and Ad
dult Care Board.
Thrrough an o
open convversation with partn
ners and communit
c
ies we willl encoura
age
individuals to
o lead hea
althier lifes
styles, sup
pport people in poo
or health a
and ensure we workk
make the best
b
use of
o our colle
ective res
source so we can alll make a difference
e to
together to m
gin to redu
uce the he
ealth inequalities an
nd tackle the
t major health an
nd wellbeing issuess in
beg
Derrbyshire.
20
Health and Wellbeing Board Members
Cabinet Member for Health and Communities, Chair of the Health and Wellbeing
Board, Derbyshire County Council
Leader of Derbyshire County Council
Cabinet Member for Children and Young People, Derbyshire County Council
Cabinet for Adult Social Care, Derbyshire County Council
Director of Public Health, Derbyshire County Council
Strategic Director of Adult Social Care, Derbyshire County Council
Strategic Director for Children and Younger Adults, Derbyshire County Council,
Derbyshire County Council
Strategic Director for Health and Communities, Derbyshire County Council
Shadow Cabinet Member Health and Communities, Derbyshire County Council
Chief Executive, Chesterfield Borough Council
Leader, South Derbyshire District Council
Leader, Bolsover District Council
Chair, Erewash Clinical Commissioning Group
Chief Operating Officer, Erewash Clinical Commissioning Group
Chair, Hardwick Clinical Commissioning Group
Chief Operating Officer, Hardwick Clinical Commissioning Group
GP representative, North Derbyshire Clinical Commissioning Group
Chief Operating Officer, North Derbyshire Clinical Commissioning Group
Chair, Southern Derbyshire Clinical Commissioning Group
Chief Operating Officer, Southern Derbyshire Clinical Commissioning Group
Chair, Tameside and Glossop Clinical Commissioning Group
Chief Operating Officer, Tameside and Glossop Clinical Commissioning Group
Vice- Chair, Healthwatch Derbyshire
Chief Executive, Healthwatch Derbyshire
Police and Crime Commissioner for Derbyshire
Director, NHS England East Midlands
Chair, Chesterfield Royal Hospital NHS Foundation Trust
Chief Executive, Chesterfield Royal Hospital NHS Foundation Trust
Chief Executive, North Derbyshire Voluntary Association
Chief Executive, South Derbyshire CVS
Chair, Derbyshire Community Health Services NHS Foundation Trust
Chief Executive, Derbyshire Community Health Services NHS Foundation Trust
Chair, Derby Teaching Hospitals NHS Trust
Chief Executive, Derby Teaching Hospitals NHS Trust
Chair, Derbyshire Healthcare Foundation Trust
Chief Executive, Derbyshire Healthcare Foundation Trust
Deputy Chief Fire Officer, Derbyshire Fire and Rescue
Chief Executive, East Midlands Ambulance Trust
Correct at July 2015
21
A Derby and Derbyshire approach to all health
and care service organisations working as one
All health and care service organisations in
Derbyshire want to ensure people stay
healthy and independent for as long as
possible. We are committed to preventing illhealth and dependency, through self-help,
community resilience and a range of inclusive
universal services.
When people do want to access our specific
health and care services, the way in which
they wish to do so is changing. People want
to receive support within their own homes for
as long as possible, community services to
be more accessible, staying overnight in
hospital only when absolutely necessary.
This is true across all health conditions and
for all ages.
People want their health and care to be
delivered flexibly and be available during
evenings and the weekend.
We know this because the people of Derby
City and Derbyshire have shared this with us.
Our challenge is to make this happen, to
meet the changing health and care needs
and to provide more opportunities to help
people take more control of their own care.
We have been working together to address
the challenges we all face. We are confident
that the best way to improve and develop
services across Derby City and Derbyshire is
to do it together, in a consistent and joined up
way.
This approach is shared by us all, and
reflects our commitment to work together to
meet the needs and expectations of people
living in Derby City and Derbyshire.
To do this, we are committed to:
 working with patients, carers, young
people and families to enable them to take
more control of their own health and care
needs.
 working as one big team, across
organisations and within communities, to
achieve the best outcomes for the people
of Derby City and Derbyshire. We will
establish a set of shared values, and work
together in a consistent and collaborative
way.
 people telling their story once. Where
possible and appropriate, we will share
information and knowledge between us,
reduce transfers between services,
enhancing people’s experience of our
services.
 providing care at or close to home where
possible. We will work together in an
innovative way to develop new models of
care, that best meet the needs of the
people of Derby City and Derbyshire.
 delivering accessible local services which
are of high quality and are able to
demonstrate they provide taxpayers with
value for money.
This is how we will improve health and care services for people in Derby City and Derbyshire.
We are committed to working together to develop healthy, independent and resilient communities
in which people can flourish.
22
Derbyshire Health and Wellbeing Board - role and
function
The overarching aim of the Derbyshire Health and Wellbeing Board (HWB) is to provide a joined-up health
and care system which is financially sustainable and provides the best care possible. The core strategic
function of the Derbyshire Health and Wellbeing Board is as follows:
1. Provide strategic leadership for the Derbyshire health and care system.
a. Set the vision for improving the health and wellbeing of the people of Derbyshire;
b. Hold organisations and partners to account for progress in delivering this vision;
c. Identify and seek to address the big strategic challenges facing health and care now and in
the future;
d. Explore opportunities for improving the health and care system in Derbyshire, building on the
shared assets of the HWB partners and leveraging additional investment where possible.
2. Oversee and direct the development of whole person centred integrated health and care services in
the county.
a. Provide advice and direction to the transformation programmes in the county;
b. Explore opportunities for aligning and joining budgets and resources across the county; and
c. Support the delivery of the Better Care Fund Plan.
These ambitions will be supported by the following actions:
1. Identify and develop a shared understanding of the needs and priorities of local communities in
Derbyshire through the development of the Derbyshire Joint Strategic Needs Assessment
(JSNA) with the Clinical Commissioning Groups (CCGs). The Board will:
a. Ensure the Derbyshire JSNA is reviewed, refreshed and further developed taking into
account the latest evidence and data so that it is fit for purpose and reflects the views of
local people, users and stakeholders;
b. Ensure the JSNA drives the development of the Joint Derbyshire Health and Wellbeing
Strategy (HWBS) and influences other key plans and strategies across the county;
c. Ensure the County Council, CCGs and other HWB partners demonstrate how the JSNA
has driven commissioning decisions.
2. Prepare, publish and oversee the HWBS for Derbyshire to ensure that the needs identified in the
JSNA are delivered in a planned, coordinated and measured way. The Board will:
a. Take account of the health needs, inequalities and risk factors identified in the
Derbyshire JSNA along with recommendations set out in the Director of Public Health’s
Annual Report;
b. Develop an agreed set of strategic priorities to focus both collective effort and resources
across the county;
c. Ensure that plans are in place to deliver the Board’s strategic priorities and outcomes;
d. Challenge the performance of delivery plans taking action as necessary to support
underperformance through the agreement of recovery and improvement plans;
e. Receive reports from other strategic groups and partners in the county responsible for
delivery;
f. Develop mechanisms to measure, monitor and report improvements in health and
wellbeing outcomes ensuring linkages with performance frameworks for the NHS, public
health and local authorities.
3. Develop effective mechanisms to communicate, engage and involve local people and
stakeholders in Derbyshire to ensure that the work of the Board reflects local needs. The Board
will:
a. Ensure that appropriate structures and arrangements are in place to ensure the effective
engagement and influence of local people and stakeholders;
b. Represent Derbyshire in relation to Health and Wellbeing issues across localities and at
a sub-regional and national level; and
c. Work closely with the Derbyshire HealthWatch ensuring that appropriate engagement
and involvement with existing patient and service user involvement groups takes place.
A full version of the Terms of Reference can be found on the Derbyshire County Council website.
23
For further information about the
Derbyshire Health
and Wellbeing Board
log on to:
derbyshire.gov.uk/healthandwellbeingboard
Version control
Version
Author
Date
Contact
0.1
Research & Information, Chief Executive’s
01/08/2014
Ellen Langton (01629) 538252
[email protected]
Document Classification
Notes
Mid-year estimates of the resident population are available for a range of
geographies by age and sex and these will be loaded on to the Derbyshire
Observatory site as interactive maps once the data has been released by
ONS later in 2014. This includes LSOA, Health Areas and National Parks.
PUBLIC
24