Agenda item

A report was circulated as part of the agenda pack. Dr Jeanelle de Gruchy, Director of Public Health, gave a presentation to the Board on the draft Health and Wellbeing Strategy, which incorporated revisions made following the public consultation that concluded in March. Following the presentation, the Board discussed the presentation and agreed a number of performance measures for the strategy.

The Board noted that the purpose of the strategy was to enable:

• All partners to be clear about our agreed priorities for the next three years.
• Priorities to be embedded by all members of HWB within their own organisations and ensure that these were reflected in their commissioning and delivery plans.
• Joined-up commissioning and delivery plans to be developed by key agencies to address these priorities.
• Member organisations held to account by the HWB for their actions towards achieving the priorities within the strategy.
• Members of the HWB to work with and influence partner organisations outside the HWB to contribute to the priorities and the approaches for working agreed within this strategy; this included residents engaged in co-producing solutions.

The Board noted that strategy focused on three key priority areas:

• Reducing obesity.
• Increasing healthy life expectancy.
• Improving mental health and wellbeing.

Dr. de Gruchy proposed that the Strategy had nine ambitions to be delivered within the three key areas. The nine ambitions were:

• Fewer children and young people will be overweight or obese
• More adults will be physically active
• Every resident enjoys long lasting good health
• Haringey is a healthy place to live
• People can access the right care at the right time
• More people will do more to look after themselves
• More adults will have good mental health and wellbeing
• More children and young people will have good mental health and wellbeing
• People with severe mental health needs live well in the community

The Board was asked to agree the performance measures and the level of the ambitions for the Health and Wellbeing Strategy.

The Board agreed to work towards a 35% target for childhood obesity at Year 6 by 2018, in line with the England average. A 35% target equated to a 2% year on year decrease. Gill Hawken, HAVCO Interim Joint CEO / Management Consultant commented that targeting parents, possibly through a programme of evidence based parenting activities, was required. Dr. de Gruchy responded that a number of intervention programmes were in place, starting with breastfeeding, but the challenge was how to affect change at scale.

Ms. Etheridge commented that the Board may wish to set an ambition that reflected the aim of reducing childhood obesity without specifically saying by how much to prevent setting a level of specifity and targeting that may not be achieved.  Ms. Herman advocated a less specific measure such as, agreeing to match the England average, as this was more likely to be relevant to local residents. Sarah Price, Chief Operating Officer of Haringey CCG, commented that obesity figures would be very different across different parts of the borough and suggested that the Board should ensure that the ambition didn’t incentivise a greater disparity between those with higher levels and obesity and those with lower levels. The Board agreed that the target would include an equalities check, to monitor discrepancies around deprivation levels (by ward) and ethnicity factors.

The Board agreed to set a target of 25% for the proportion of adults participating in less than 30 minutes of physical activity per week. Dr. de Gruchy advised that reducing inactivity levels would produce the largest health improvement gain (as opposed to increasing activity levels in those who were already active). 

The Board agreed to set a target of being in the London top quartile by 2018, for proportion of people who travel by walking and bicycle in London where trip origin is in Haringey. Dr. de Gruchy commented that the current percentage of people to travel to work via cycling was 3% and walking was 37%.

The Board agreed a 25% reduction in the current (2011-13) mortality rate (22.5 per 100,000) to 16.9 deaths per 100,000 (2016-2018), for the rate of early death from stroke. The Board noted that this target was in line with what was in the Corporate Plan. Dr. de Gruchy advised that this was an ambitious but doable target that required all of the determining health factors, such as smoking and high levels of alcohol consumption, being tackled as part of a wider approach. The management of underlying conditions such as hypertension and diabetes will also play a significant role in improving performance around this indicator.

Regarding, the proportion of patients able to get a GP appointment to see or speak to someone, Cllr Morton advocated setting an ambitious target as a statement of intent. Ms. Grant requested the inclusion of equalities targets to offset the likely unequal distribution across different equalities groups. Ms. Price agreed that a collaborative level target should feasible, with the aim of reducing the gap between different collaboratives.

The Board agreed to set an 83% target, in line with the projected England average, for the proportion of patients able to get a GP appointment to see or speak to someone. The Board also agreed in principle to also have a collaborative level target. Chief Operating Officer, Haringey CCG & Director of Public Health agreed to look into the possibility of having an individual target in each ward area not just as an overall target, to safeguard against the persistence of an underlying level of equality.

The Board agreed to set a target of 59%, in line with Better Care Fund target, for the percentage of people with a long-term condition who reported that in the last 6 months, they have had enough support from local services/organisations to help manage their long-term conditions.

The Board noted that a residents’ survey using the Warwick-Edinburgh wellbeing scale would be used to measure the number of adults who have good mental health and wellbeing. Whilst a school’s survey using questions drawn from a set of well developed and tested questions created by the Schools Health Education Unit (SHEU), would be used to measure the  number children and young people who have good mental health and wellbeing. The Board agreed to defer the setting of a target for these two ambitions until the results of a local survey commissioned to establish a baseline was available. The Director of Public Health agreed to bring the baseline information back to a subsequent meeting of the Board to agree targets for 2018.

Ms. Price advised that mental health issues in children can emerge at quite a young age and proposed using some of the existing work that was potentially being done in schools around wellbeing as a proxy to the SHEU survey. Dr. de Gruchy commented that Sir Paul Ennals had made a similar point and he had suggested using early years foundation status (EYFS). The Board noted that the issue with this proposal was that EYFS was being discontinued as a statutory measure and that going forward, the measure would be optional for schools.

The Board agreed that the ninth ambition would be people with severe mental health needs live well in the community. The Board agreed the measure of:  The number of people receiving co-ordinated care for their mental health condition who were in employment or settled accommodation. The board opted for this indicator instead of the number of people sectioned under Mental Health Act section 136 as the numbers of people sectioned would be very low. Ms. Price commented that an indicator that monitored serious mental health conditions, such as the number of psychotic episodes, may also be required going forward.

Ms. Grant reiterated Sir Paul Ennals’ comments from the previous meeting of the Board around the need to have a single central strategy that bound all of the other Health and Wellbeing strategies together and drove improvement. Ms. Grant agreed that the Health and Wellbeing Strategy was that central strategy. Ms. Grant proposed that there should be a Health and Wellbeing comment on every report that the Council and CCG produced as standard, to ensure the proposals and any implications were aligned to the Health and Wellbeing Board. The Board agreed to review the possibility further and bring an item back to a subsequent agenda for further discussion.

Stephen Lawrence-Orumwense, Assistant Head of Legal Services, proposed a minor agreement to the Health and Wellbeing Strategy. The Board agreed to remove the sentence “It has a general duty to promote the individual wellbeing of all local residents (Care Act 2014)” from draft strategy, at page 180 of the agenda pack, as this was a duty of the Council as a whole.

The Board agreed the Health and Wellbeing Strategy and also formally agreed the establishment of the Haringey Obesity Alliance. The Director of Public Health agreed to circulate an updated report, along with a summary version and big print version to the Board in due course.

It was:

RESOLVED:

I). That the responses to the consultation on the draft Joint Health and Wellbeing Strategy were considered;

II). That the final version of the Health and Wellbeing Strategy was agreed, as per Appendix 1 of the agenda pack;

III). The Board formally established the Haringey Obesity Alliance;

IV). The Board agreed targets for the nine Health and Wellbeing Strategy ambitions (where possible).