Agenda item

Terri Roche, Director of Public Health, RMBC, to present

 

Councillor Roche, Cabinet Member for Adult Social Care and Health and Terri Roche, Director of Public Health delivered a detailed presentation on the Rotherham Health and Wellbeing Strategy 2018-25 and the Integrated Health and Social Care Place Plan (IHSCP).  Ian Atkinson and Lydia George from Rotherham Clinical Commissioning Group were also in attendance to provide additional information regarding the IHSCP.

 

The IHSCP was Rotherham’s local plan within the wider South Yorkshire and Bassetlaw (SY&B) Sustainability and Transformation Plan, now known as the Accountable Care Partnership (ACP). 

 

Rotherham Health and Wellbeing Strategy 2018-25

 

Purpose of session

·           Provide an overview of the current strategy and why a refresh is needed

·           To outline key data and intelligence

·           Present a framework for the refreshed strategy for scrutiny to consider

·           Provide an overview of how the Integrated Health and Social Care Place Plan aligns to the new strategy 

·           Present a timeline and next steps

 

Health and Wellbeing Board (HWBB)

·           Statutory board since 2011 – sub-committee of the council

·           Includes statutory members, plus providers on the Rotherham board

·           Duty to prepare Joint Strategic Needs Assessment (JSNA) and local Health and Wellbeing Strategy (HWBS)

·           Duty to encourage integrated working between health and social care commissioners

·           Provides a high-level assurance role; holding partners to account for delivery

 

Membership of Health and Wellbeing Boards (HWBB) varied across the country and Rotherham HWBB was deliberately quite large in order to develop the partnerships with all local key providers.  The Council had previously been criticised for its lack of partnership with health partners, which had been addressed with excellent relationships now with the Clinical Commissioning Group (CCG) and Rotherham Hospital. 

 

The JSNA summarised key features about Rotherham and informed the local HWBS. 

 

Integrated working was going exceedingly well, with joint posts and joint commissioning developing, for example in midwifery.

 

The role of the HWBB was now primarily a strategic one, although it did provide high level assurance.  The board focused on what was best for Rotherham rather than coming from individual organisational perspectives. 

 

Health and Wellbeing Strategy

·           Sets strategic priorities of the HWBB

·           Not intended to include everything that all partners do

·           Based on intelligence from the JSNA and other local knowledge

·           Enables commissioners to plan and commission integrated services

·           Service providers, commissioners and local voluntary and community organisations all have an important role to play in identifying and acting upon local priorities

 

Health and Wellbeing Strategy 2015-18 Principles

·           Shared vision and priorities

·           Enables planning of more integrated services

·           Reduces health inequalities

·           Translates intelligence into action - JSNA and information from partners.  One example last year was partners sharing concerns about care homes and this area was now working better, for example with a nominated GP attached to each care home. 

From when Commissioner Manzie had been in post there had rightly been a strong stress on children, and children would still be a key part, but other elements and health inequalities needed to be worked on and included. 

 

Need for a refresh …

·           Existing strategy runs until end of 2018 – but number of national and local strategic drivers now influencing the HWBB

·           An early refresh ensures the strategy remains fit for purpose, strengthening the board’s role in

o    high level assurance

o    holding partners to account

o    influencing commissioning across the health and social care system, as well as wider determinants of health

o    Reducing health inequalities

o    Promoting a greater focus on prevention

·           LGA support to the HWBB:

o    Self-assessment July 2016

o    Stepping Up To The Place workshop September 2016

o    Positive feedback given about board’s foundation and good partnership working

·           The current strategy was published quickly after the board was refreshed (September 2015)

·           Now in stronger position to set the right strategic vision and priorities for Rotherham

 

The refresh would help to move at a faster pace with greater emphasis on prevention and early intervention, which was the key to what the HWBB were trying to do.  For example, weight management at Tiers 3 and 4 was high cost but if this was tackled earlier it was both more effective and cheaper and achieved more long-term benefit.

 

The Place Board was one of the key drivers for the change and as partners in Rotherham worked well together it was decided to bring things together under the HWBB rather than the Place Plan being a separate entity.

 

Joint Strategic Needs Assessment

·           Ageing population – rising demand for health and social care services

·           More people aged 75+ living alone, vulnerable to isolation

·           High rates of disability, long term sickness (more mental health conditions) and long term health conditions e.g. dementia

·           Need for care rising faster than unpaid carer capacity

·           High rates of smoking and alcohol abuse, low physical activity & low breastfeeding

·           Rising need for children’s social care, esp. related to safeguarding

·           Relatively high levels of learning disability

·           Growing ethnic diversity, esp. in younger population, with new migrant communities

·           Growing inequalities, long term social polarisation

·           High levels of poverty including food and fuel poverty, debt & financial exclusion

 

Inequalities in Life Expectancy

Graphs showing Life Expectancy at Birth and Healthy Life Expectancy for Rotherham and England – males and females.

 

Proposed refreshed strategy

·           Sets strategic vision for the HWBB – not everything all partners do, but what partners can do better together

·           Includes 4 strategic ‘aims’ – shared by all HWBB partners

·           Each aim includes small set of high-level, shared priorities

·           Which the Integrated Health and Social Care Place Plan ‘system’ priorities will align to

 

Strategic aims

Aim 1. All children get the best start in life and go on to achieve their potential and have a healthy adolescence and early adulthood

 

Aim 2. All Rotherham people enjoy the best possible mental health and wellbeing and have a good quality of life

 

Aim 3. All Rotherham people live well and live longer

 

Aim 4. All Rotherham people live in healthy, safe and resilient communities

 

Consultation and engagement

·           HWBB received proposal for refresh September 2017 and framework November 2017

·           IHSC Place Board received an update September 2017

·           New framework shared with HWBB sponsors and theme leads for comments

·           Health Select Commission December 2017

·           All partners to consider taking through their own governance structures Nov – March 2018

·           VAR audience with to take place January 2018

·           Consider what other stakeholder engagement may be needed…

 

The final version of the strategy was due in late February 2018, and would go to Cabinet for endorsement before the final approval from the HWBB on 14th March.  It would be a living document but not undergoing a full refresh for three years.

 

Integrated Health and Social Care Place Plan

 

Integrated Health and Social Care Place Plan (IHSCP)

Current Place Plan agreed November 2016

Work taking place to re-align with the refreshed HWBS

 

How the Rotherham Health and Wellbeing Strategy and Integrated Health and Social Care Plan will align

·           Structure for overall strategy and delivery

·           Structure charts for strategic HWBS aims 1,2 and 3 and the HWBS priorities under each aim and how these then linked to the Place Plan Transformation Groups and their respective priorities to help deliver.  Prevention and early intervention were key elements in everything.  Aim 1 merged the previous two aims for children in one.

·           Structure chart for strategic HWBS aim 4 and the HWBS priorities under each aim and how these link in with other workstreams/strategies as they are not directly aligned with the Place Plan.

 

The Rotherham Care Record (RCR) shared between partners would be a key step forward in integration.  The governance arrangements were key in ensuring integration and communication between partners and working effectively together.  As part of the delivery of the IHSCP, which was a true partnership approach, there were three transformational groups chaired by very senior managers to ensure this work happened.  It was an  integrated approach and integrated effort to deliver effectively together. 

 

HWBS Aim 1 – All children get the best start in life and go on to achieve their potential and have a healthy adolescence and early adulthood

 

HWB Priority 1 Ensure every child gets the best start in life (preconception to age 3) – includes pre-conception, healthy pre-pregnancy and pregnancy – lifestyle including smoking and alcohol consumption, health, diet and seeing a midwife early (cross reference to Marmot).

 

HWB Priority 2 Improve health outcomes for children and young people through integrated commissioning and service delivery – linked back to previous HSC work when the under 5s and school nursing services were brought together in the integrated 0-19 service, delivered through effective health visiting and school nursing, bringing in other services as appropriate.

 

HWB Priority 3 Reduce the number of children who experience neglect – lot done on safeguarding and looked after children and now the focus would be on neglect as this can lead to children and young people becoming looked after, with support offered at an early stage.

 

HWB Priority 4 All children and young people are ready for the world of work - universal proportionalism and the need to be brave in terms of what level of resource goes to different groups of people. Everyone gets some resource but some groups might get more to help them to achieve at school and feel confident and enabled to get into good employment.

 

The transformation group, chaired by Ian Thomas, would oversee delivery of the 0-19 contract (but not undertake contract management), ensuring real added value. 

 

Children’s acute and community integration – 14-16 year olds having a choice of admission to an adult or children’s ward and ensuring that either was able to meet their clinical needs as Rotherham hospital is too small to have an adolescent ward. 

 

HSC already had a good knowledge and overview of implementation of the local CAMHS transformation plan which needed to continue. 

 

Embedding children’s voice - reality not tokenism.  Linked in with Children and Young People’s (C&YP) Partnership Board.

 

HWBS Aim 2 ? All Rotherham people enjoy the best possible mental health and wellbeing and have a good quality of life

 

HWB Priority 1 Improve mental health and wellbeing of all Rotherham people

HWB Priority 2 Reduce the occurrence of common mental health problems

HWB Priority 3 Improve support for enduring mental health needs including dementia

 

It was important to note this was mental health not mental illness as good mental health was an enabler and helped to promote good quality of life.  Levers included the Better Mental Health for All Strategy and the Suicide Prevention Action Plan and also good work at a local level.  Dementia still needed to be included.  It involved early identification and treatment of common mental health problems and support for people with enduring conditions.  The key was getting more people behind it to commit to delivery.

 

The Suicide Prevention Action Plan needed to include communities so people were confident to ask questions, knew where to refer people and could talk about mental health in a much more open way.  HSC were already familiar with the Rotherham Doncaster and South Humber (RDaSH) transformation plan and changes at Woodlands. It was about a good balance across prevention, early intervention and treatment at the right level.

 

HWBS Aim 3 ? All Rotherham people live well and live longer

 

HWB Priority 1 Prevent and reduce early deaths from the key health issues for Rotherham people such as cardiovascular disease, cancer and respiratory disease - reflected lifestyle related issues and the industrial legacy.  It included working with primary care to ensure people attended screening and to catch people earlier, both to prevent ill health and to ensure treatment was more effective.

 

HWB Priority 2 Promote independence and enable self-management and increase independence of care for all people – social care offer to enable people to remain more independent but being confident about self-care knowing they had access to support/advice when needed.

 

HWB Priority 3 Improve health outcomes for adults and older people through integrated commissioning and service delivery ensuring the right care at the right time – through working with the CCG there were already seven joint commissioning posts.  Partners were looking to commission things more effectively together, so no silos and no residents slipping through the gaps.  Levers included Making Every Contact Count (MECC) with all front line staff being confident to have some of these conversations about lifestyles and knowing where to signpost people.  The Wellness Service would be a one stop shop for that as well.

 

Priorities that sit under the transformation group, with prevention and early intervention key to all were:

·           Improving the reablement and intermediate care offer so that people had their physio and were back in their own environment

·           Integrated locality model roll out – HSC would be scrutinising the evaluation in January - what had worked well, what needed to be done differently and how we could make that happen

·           Single point of contact for care needs – hub

·           Autism – further deep dives into needs analysis needed

·           Transforming Care – not easy but partners were trying to overcome barriers around who pays for what and different targets, including by seeking advice from elsewhere and lobbying central government to reduce some of the restrictions

·           Expand Integrated Rapid Response - so people had a timely, quick response when needed

·           Integrated Discharge Teams - Home First Home Safe

·           Co-ordinated approach to care home support

 

HWBS Aim 4 ? All Rotherham people live in healthy, safe and resilient communities

 

HWB Priority 1 Increase opportunities for healthy sustainable employment HWB Priority 2 Ensure planning decisions consider the impact on health and wellbeing

HWB Priority 3 Ensure everyone lives in healthy and safe environments – influencing the housing strategy and making sure people are in warm, sustainable and safe homes.  Domestic abuse was a priority for the Safer Rotherham Partnership and it was important that front line staff were aware of the signs and how to access support.

HWB Priority 4 Increase opportunities for all people to use green spaces – new Cultural Strategy included sport, leisure and green spaces.

 

No prevention was possible without working on the environment as a whole, as the wider determinants of health were a key reason behind the inequalities in life expectancy, so aim 4 was important, as was having housing fully on board.

 

Priority 1 was about getting people into employment but also ensuring that employment was as sustainable and health promoting as it could be.  Funding had been obtained through Sheffield City Region for employment support workers working in a holistic way with people facing barriers to work to try and help them into work.  They would also be working with people at risk of losing employment through musculo-skeletal or mental health conditions to try and keep them in work.  Terri Roche chaired the local implementation board and it was a good opportunity to work with people in a different way.  Work can have a massive role in improving people’s health but with the changes in benefits it was important to ensure people were getting a reasonable wage and in sustainable employment.   

 

What next …

·           Full draft of strategy and IHSC Place Plan to be presented to HWBB 10 January 2018

·           Continue to gather comments and feedback from stakeholders up to March 2018

·           CCG Governing Body, IHSC Place Board and Cabinet to endorse strategy and IHSC Place Plan February/March 2018

·           IHSC Place Board to sign off IHSC Place Plan March 2018

·           HWBB to sign off strategy by April 2018

 

Questions for scrutiny

·           Are the strategic aims and priorities clear about what they mean?

·           Is there anything missing or needs more emphasis?

·           Reducing loneliness and isolation is an emerging issue in the JSNA – how do we ensure this is addressed through the strategy?

·           How can elected members, partners and residents work together to help deliver the strategy aims within neighbourhoods?

 

“Prevention Matters”

·           The Local Government Association (LGA) will be running a workshop looking at how elected members can improve the health of their communities

·           Taking place over two half days: 15^th and 16^th February 2018 - ideally people would attend both sessions as the first would be the LGA talking about prevention and public health and the second would focus on the local ward profiles. 

 

Discussion ensued on the presentation with the following questions and issues raised:-

 

Whilst agreeing with the principles, my concern is the achievability of the aims, which are deep and demanding, including concerns around the finance available and the level of achievability.  On a rating of one to ten what was the likelihood of achievability?

 

-        There had been financial cutbacks but the key funding for the HWBB priorities was from the CCG not the Local Authority.  There were also Better Care Fund and Improved Better Care Fund (IBCF) monies of around £20m.  As the SY&B ACP was a pathfinder extra money was also available to drive that forward.  The belief was that the aims were deliverable but the pace could alter depending on funding availability.  For example, whether locality working would move to seven health villages across the borough all at once or on a staggered basis.  Other health partners were eligible to bid for funding that the Council could not, for example for mental health.  Undeniably there was a lot to do but it was a good team and a good partnership.  8.5 out of 10.

 

-        Aims should be ambitious and the important point here is that if we were talking about outcomes based accountability it was what were we going to do to turn the curve?  The strategy would run until 2025 and some of the issues, such as the difference in life expectancy, would take much longer, even generations, to turn around.  On delivery it was finding the key things that could be done that would make the most difference and committing with partners to address those, things that would be amenable to change over time.  For example, breastfeeding also included longer term health benefits and we were working with the midwives and the hospital trust to see how breast feeding could be improved and then we would need to work with our communities to see how people could be helped to sustain breastfeeding.  We would not be able to achieve absolutely everything but it was important to agree on some key things to take us on that journey.  It was a case of whether the committee felt we should have ambitious aims with clear plans underneath of how we would work towards them.

 

-        IBCF money did come to the Council but the key metric was reducing Delayed Transfer of Care (DTOC), and although the main driver was the hospital, if the targets were not met money was taken away.  Targets had easily been met this year and confirmed by NHS England.

 

-        Within the system everyone was under financial pressure but the step change that we were witnessing in the borough, with the strength of our HWBB and also our place-based approach, was that increasingly we were seeing “how could we best use the Rotherham pound?”, whether the money was flowing down from the local authority or the CCG, in terms of how we deliver our strategy.  So we were not pulling away from each other on strategy but aligning that and trying to make the resource follow.  That did not provide an answer on deliverability but provided assurance on working increasingly together on both the commissioning side and the provider side in trying to achieve our plan.

 

It was really pleasing to see the aspiration and the depth in these aims and it was good to aim high.  Aspiration should be built into everything we do in Rotherham and it was a positive sign that the work of the HWBB in putting this together reflects that.  HSC would be giving this due consideration and scrutiny and the Chair requested that the committee see the final draft, which would probably be in February. 

 

You mentioned life expectancy in Hellaby ward, would the forthcoming boundary changes skew the health data at ward level as the changes mean losing part of Wickersley which is a more affluent area?

 

-        Yes, the formulae would have to be recalculated again following the boundary changes as data was at ward level.  Measuring life expectancy was a statistical calculation and when the populations changed recalculations would be made as soon as possible, as the changes will bring together some very affluent and some very deprived areas.  Similarly the gender profile would need to be recalculated.

 

-        Recognising that pockets of real deprivation existed in wards not classed as deprived overall, it was important to try and capture data below ward level.

 

How do we manage or challenge fast food outlets and schools to ensure greater influence or governance regarding what we want to achieve on obesity?

-        Other Local Authorities have implemented planning rules which say no fast food outlets within a certain distance from schools.  It was suggested here but challenged successfully on appeal by a fast food company.  It had been raised again with Planning and the Strategic Director was looking at other ways to tackle this.  Some evidence did suggest there was a limit as to how far people would be prepared to walk to get fast food so if fast food outlets were located beyond that they would be less likely to go.  Creating a healthy environment overall to help people make healthier choices was covered in the strategy in aim 4 but it would be a challenge going forward as some of the big fast food outlets had very robust legal support.

 

Would the Autism Strategy be coming back to HSC?

-        It was under development with a working group established that included Healthwatch.  It was still early days but there was no reason why it could not come to HSC if the committee wished to see it.

 

From the previous HWBS, to what degree are we reinventing the wheel and is there a need to look at what we were doing previously and what we are doing now to try and pull them both together to have a strategy that is achievable?

-        The draft proposals did take account of the existing strategy and what was still relevant and needed to be taken forward or needed further work, so it was not a case of reinventing the wheel.  Many of the aims would have happened anyway, for example we needed to influence the SEND and CAMHS plans and although there were a number of other strategies the intention was to bring them together through an integrated approach with all services working together.  The C&YP partnership plan would have existed without the HWBB but now it was part of it this allowed that integrated approach.

 

-        This was a refresh of the strategy so people familiar with the current one would see aims that needed to continue because some of the things we still needed to do and were not going to change.  It was hard but needed to be there.  It was a refresh building on what we had before and learning from that rather than starting again.  The key was consistent effort on some key priorities over a longer period of time

 

With regard to older people’s aspects and reducing loneliness and isolation, what approach would be taken to contacting people who we think this might apply to without causing offence?  And how do older people also fit in with green spaces and age friendly Rotherham?

-        Loneliness was becoming increasingly important as seen in the Jo Cox report and the impact on health approximated to smoking 15 cigarettes per day.  It was felt important to talk to partners first to check what was already happening and Members were recently given a leaflet from Rotherham Older People’s Forum about their activities.  Befriending services, social prescribing and luncheon clubs were happening but not everyone knew what was available.  Information collation would take place followed by a meeting early in 2018 to consider what was in place and the gaps, then what to do.  Funding from the IBCF from April onwards would help take this forward.

 

-        Reviewing the evidence showed trigger points such as key life events such as retirement or bereavement could make people more lonely,  and more awareness raising was needed about this with people needing to be confident and better at talking about, it in the same way as for mental health.  In addition to the mapping work there was also ward work such as that in Wingfield where loneliness had been prioritised.  An asset based approach with communities and the powerful impact of word of mouth about activities taking place was important and this was also perhaps a challenge back to Elected Members in their ward role.  Loneliness was intergenerational, not only affecting older people, and carers also experienced isolation.

-        In terms of age friendly borough, activities within the child friendly borough workstream were complementary for older people and would be revisited.  Actions on loneliness, having the conversations and community cohesion would play a part.

 

-        Some places had introduced a badge system saying “you can talk to me”. Befriending was an important step but not a long-term answer, hence the need to change a person’s long-term involvement in things and the community approach.

 

How did the carers’ strategy dovetail with the HWBS and how did you see the two joining together?

-        It was probably not as explicit as it ought to be and consideration was needed about how it was embedded in the assurance process, for example how the HWBB and HSC worked together, but it could be stronger within it.

 

-        Cllr Roche also agreed it could be strengthened but stated that it needed to go back to the HWBB.

 

Referencing the work done by HSC last year, it would be nice to see more detail around the housing strategy and specialist housing, including what percentage would be specialist housing.

-        This came under aim 4 and it was still early days but the HWBB had received a presentation from Housing and discussed how this fitted in, including decent homes and housing design fit for purpose for the life course, such as wheelchair access.  The right design helped to save on adaptations later and contributed to the key aims of increasing independence and choice.

 

-        Improving Places Select Commission led on scrutiny of the implementation of the Housing Strategy and any key issues would be fed back to HSC.

 

Has there been an opportunity yet to consider the impact of universal credit as this keeps cropping up in housing, health and on Improving Lives?

-        It was early days but with the pilots prior to roll out officers were trying to calculate the numbers of people potentially affected and how the Council might be able to mitigate for that when it was a national programme coming in.

 

-        Members had been briefed on the key aspects and it was a concern.  As were possible changes to funding for housing to support people experiencing domestic abuse which were going through parliament.

 

Looking at gathering data on reducing loneliness and isolation, how many partners were you looking at?  Could parishes be involved as they did a lot of good work and had a number of groups?

-        More people who could suggest things so this could grow as a movement was good.  After the small sharing event by starting working in communities hopefully more people would become involved in like a ripple effect.  We could also work with others such as hairdressers and publicans in the long term so they feel confident about this.  Parishes would be a good group to consider.

 

Loneliness is a big issue for retired people and people who are out of work.  Volunteering can be a good opportunity to improve mental health and people in our community have a lot of skills that are often under-used.

-        Agreed and we had seen elsewhere and in the past examples of older people going into schools and passing on their skills and experience.  Another example being considered from the Netherlands was where university students had a room free of charge in a care home in return for some time spent each week talking with and befriending the residents, so everyone benefitted.

 

Education and awareness raising with residents on the health and care system.

 

Councillor Roche and the officers were thanked for their presentation and contributions.

 

Resolved:-

 

(1) That the final draft Health and Wellbeing Strategy be circulated to the Commission in February 2018.

 

(2) That Aim 4 should strengthen and embed becoming an age-friendly borough.

 

(3) That the links and governance for delivery of the Carers’ Strategy be strengthened and made more explicit within the Health and Wellbeing Strategy.

 

(4) That partners consider working with Parish Councils on tackling loneliness and isolation.

 

(5) That information on the implementation of the Housing Strategy with regard to specialist housing be reported back to the Commission from Improving Places.

 

(6) That the Autism Strategy is considered at a future Health Select Commission meeting.