Contact: Martin Combs ex 7479

e-mail [email protected]

1. Summary and Purpose

1.1 The purpose of this report is to provide members with an up-date on the review programme agreed by the Committee in May 2005.

1.2 The format and focus of the topic presented reflects the previously agreed criteria selected by members, namely:

· Capacity to influence and improve the service under consideration

· Timeliness and relevance to local health services

· Issues not under consideration elsewhere

· Issues not subject to other scrutiny or performance monitoring activities

Of significance are the recent statements by the Secretary of State for Health which say that HOSCs are increasingly conducting reviews that recognise the role of local authorities in improving community well being, instead of only focusing on the NHS. The Secretary of State also says that Scrutiny Committees are very active, not only looking at the planning and delivery of healthcare, but increasingly tackling the public health agenda and promoting what local councils can do to improve health

1.3 Since the Committee selected public health as a key topic for review there have been a number of national and local developments that have significantly raised the profile of this work and the way in which it can be most effectively delivered for local people. Key drivers of change have been:

Choosing Health, the Department of Health white paper on Public Health, 2004, with the following overarching priorities:

· Reducing the numbers of people who smoke

· Reducing obesity and improving diet and nutrition

· Increasing exercise

· Encouraging and supporting sensible drinking

· Improving sexual health

· Improving mental health

Health Improvement Foundations for LAAs (proposed by the SE Public Health Group, GOSE/DH), July 2005, adds the priorities:

· Health inequalities

· Older people

1.4 As a consequence the Committee has been able to work with those currently considering the way in which public health is planned and delivered across Hampshire. The emphasis of this initial report has therefore been on identifying activities already taking place across Hampshire, to inform the identification of any gaps and more importantly, highlight good practice.

1.5 The report represents one element of a number of work strands that are currently being progressed and members will require an up date on the way in which the different elements of this work are integrated across the NHS and Local Government

1.6 Particular thanks need to be expressed to Katie Crabbe and Mary Amos for their contribution to the findings that informed this report.

1.7 The report and recommendations provide members with an opportunity to inform and influence the planning and delivery of public health across Hampshire and therefore support Aim 5 (Improving Services) of the Corporate Strategy.

2. Public Health Outcomes: Reported activities

2.1 This paper is a first attempt to look at health improvement and public health/well-being across Hampshire. It is recognised that further work needs to be done to build an accurate picture. Further work will be required with colleagues in Local Government and the local NHS to achieve this.

2.2 This is a complex area to analyse, reflecting the diverse nature of communities across Hampshire. As such this is only a `snapshot' of information provided to us in October 2005. This work now needs to be tested and evaluated to ensure that the range of work currently being taken forward by local Government and the NHS across Hampshire is understood as a whole system.

2.3 The following tables capture initiatives taken forward by Hampshire County Council, Hampshire District Councils and Primary Care Trusts (PCTs) against the national standards for Public Health/Well-being outcomes. Symbols are used to provide a quick picture of work initiated or planned in different communities.

2.4 The results have to be treated with some caution since they depend upon information either offered to us, or gleaned from available documents. Additional information will be required to build a more accurate picture of public health initiatives across Hampshire. Therefore the charts are primarily indicative of activity or achievement and not absolute guides.

2.5 The tables try to align council areas with PCT areas as far as possible. This is a first draft attempt to consolidate information about progress against the Public Health objectives. In subsequent reports it may be helpful to include, where possible, activity by voluntary sector partners.

2.6 What do the symbols represent? Given the foregoing comments, the responses have been analysed as follows:

Reported Initiatives
Significant variety of initiatives or investment in resource	_
Initiatives under way, commitment of resource	_
No reported initiatives or investment in resource	_

Please note: this report does not see its purpose as judgemental, but rather as an instrument, and in so far as it summarises activity and intent, broad brush. In particular we are very conscious that the difficulty in aligning county, district and health boundaries of influence (administrative responsibility) and activity, in turn this makes it difficult to consolidate information. The tables attempt to relate district with local health boundaries, whilst county activity is taken to be broadly true for all district and health areas. The current consultation `Commissioning a Patient-Led NHS' provides an opportunity to addresses some boundary anomalies between local government and the NHS

2.7 The report is organised to reflect the following health and well-being objectives:

1. Reducing the number of people who smoke

2. Drinking sensibly and harm reduction

3. Reducing Health inequalities

4. Tackling obesity

A. Healthy eating for Adults

B. Increasing physical activity for Adults

5. Helping Children and Young People to lead healthy lives

6. Mental health and well-being

7. Promoting healthy and active life amongst older people

8. Promoting health and well-being

9. Promoting health and well-being for LA staff `investing in the workforce'

2.8 The objectives include the `Health Improvement Foundations for LAAs' developed by the Government Office for the South East in conjunction with the Department of Health. They also capture the `overarching priorities' of the Government/Department of Health white paper, `Choosing Health: making healthy choices easier', 2004.

Please note that Rushmoor was not able, at this time, to provide information to inform this exercise, so no activity has been reported for the district.

Comment:

· Local Strategic Partnership organisations are committed to smoke-free workplaces by March 07 in line with current Government legislation. Some districts are committed to smoke-free council-owned & occupied premises by April 2006 e.g. Eastleigh.

· Some PCT initiatives appear to be planned rather than actual. Future reports will therefore follow up the implementation process.

· Some joint working initiatives, e.g. Winchester City Council and Mid Hampshire PCT are examples of good practice

Comment:

· Partnership working e.g. JIGSAW¹ in Havant with funding from Hampshire DAAT^2.

Comment:

· An emphasis on people's living conditions - a prime area for tackling, in part, the root of some health problems.

· Community strategies reflect the strategic priority to promote & support the well-being of local communities; this is achieved in partnership by addressing gaps in provision via health equity audits with PCTs.

Comment:

· No reported PCT activity in some areas; additional information is therefore required.

Comment:

· Some partnership working, e.g. Havant and East Hampshire PCT (SE Cluster), Eastleigh, Test Valley South & New Forest PCT ( SW Cluster).

·Work taking place in the north of Test Valley needs to be identified.

Comment:

·Local government reports a range of activities and initiatives.

·Initiatives to support the delivery of sub-objective 5.7 (Supporting young people involved in substance misuse) need to be identified.

Comment:

·Initiatives in Test Valley need to be identified.

· Partnership working e.g. JIGSAW¹ in Havant with funding from Hampshire DAAT^2.

Comment:

· In the districts of Hart and East Hampshire initiatives need to be identified.

· Eastleigh has an inter-agency older people strategy- `Live Long & Better'.

Key questions to be tested within this objective could include:

Comment:

· The Healthy Eastleigh Living Network , funded by the Big Lottery, brings together a variety of initiatives designed to improve the health & well being of people living & working in the Borough.

·The contribution of PCTs to delivery of this objective is not clear, and this needs to be addressed in subsequent work. Further work could be done with the following sub-objectives:

Comment:

· Eastleigh Borough Council runs health screening, annual staff health events & supports national awareness days.

·Further information is required with regard to action to promote the health or well-being of staff.

· Hampshire County Council is one of five winners in the Most Improved Employer Category in the Solent Area BBC Healthy Workplace Awards.

4. Summary

4.1 This paper sets out the first steps in identifying plans and programmes to improve the health of people living in Hampshire. It provides a baseline, albeit tentative, of progress reported against national objectives for public health. By drawing together work undertaken by local government and the NHS in Hampshire a dialogue across different communities can be encouraged, raising the profile of public health and supporting any further action required.

4.2 The County Council, local NHS and District Councils are currently undertaking a programme of seminars to support the effective delivery of CPLNHS. Part of this work includes consideration of the local arrangements that need to be in place to improve the health of the population of Hampshire.

4.3 Bearing in mind the provisional nature of the findings reported all stakeholders will be invited to provide additional information for inclusion with a view to the final version being shared with Members at the March meeting.

4.4 LSP Chairmen will be invited to comment on the issues raised in the report

4.5 Further up-dates and amendments will then be driven through lead officers in local government and the NHS. And a report back on progress will be presented to the Committee at the November meeting

5. Recommendations

It is therefore recommended:


a) That this report be shared with the Adult Services Restructuring Board Working Group that is taking forward joint working with the Public Health Network. This will include:

· A more detailed mapping of public health plans and programmes across the county, including opportunities to share best practice and identify gaps in delivery.

· The development of LSPs and LAAs.





· Identification of the health improvements to be delivered by local people.

b) Lead officers from Adult Services and the Public Health Network will report back to the Committee on progress with this work on 28 November 2006 detailing the outcomes of the review.

Glossary

¹JIGSAW is a flexible working partnership of active players and supporters (including Havant BC and East Hampshire PCT) aiming to educate, inform and support young people around health-related issues, including: physical activity, healthy eating, sexual health, alcohol and substance awareness, stress, self-esteem and bullying, and smoking.

²Hampshire DAAT: the Hampshire Drug and Alcohol Action Team is a multi-agency partnership working to implement the National Drug Strategy; it includes a number of statutory and voluntary sector partners. Each year an Annual Plan is produced, which sets out the county drug policy and targets for the year.

Hampshire County Council departments

Acronym	Department
CX	Chief Executive's Department
HR	Human Resources
PBRS	Property, Business and Regulatory Services
R&H	Recreation and Heritage