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Page 1: Joint Health and Wellbeing Strategy Refresh 2017 - 2019€¦ · Kingston’s Joint Health and Wellbeing Strategy 2017 - 2019. The Health and Wellbeing Board brings together elected

Kingston-upon-Thames Health and Wellbeing Board

Empowering communities, families and individuals to be more involved in taking responsibility for their

health and care

Joint Health and Wellbeing Strategy Refresh 2017 - 2019

Page 2: Joint Health and Wellbeing Strategy Refresh 2017 - 2019€¦ · Kingston’s Joint Health and Wellbeing Strategy 2017 - 2019. The Health and Wellbeing Board brings together elected

Introduction We are delighted to introduce Kingston’s Joint Health and Wellbeing Strategy 2017 - 2019.

The Health and Wellbeing Board brings together elected members and senior leaders from the council, the Kingston Clinical Commissioning Group, Healthwatch Kingston, and health and care organisations including the voluntary and community sector. The board’s ‘reason for being’ is to make sure that health and social care outcomes for people in Kingston are the very best they can be. Through this strategy we will focus on the following four priority areas where we believe that by working together we will make the most difference:

1. Children and young people 2. Mental health 3. Older people and people with

long term conditions 4. Addressing the needs of

socially excluded and disadvantaged communities

More detail about these priorities can be found later on in this document.

The context we are working in is changing. People are living longer and so the population of older people in Kingston is growing. This is excellent news and we must celebrate the valuable contribution that older people make to our borough. It is however the case that many people spend their later years in poor health which not only results in a major impact on their lives (and that of their carers) but also results in them requiring high cost health and social care interventions. A key focus of our work is on supporting people to address the lifestyle behaviours that can lead to poor health in later years. At the other end of the

age spectrum we must ensure that services work with families to give children and young people the best start in life. Local authority and NHS funding pressures create significant challenges. We have to use this situation as a lever, however hard that is, to continue to find ways to innovate so that we can maintain high quality essential health and care services in Kingston. Health and care organisations must work together and not separately to make the most of the resources across the system. In addition we must support people to draw on their own strengths, skills and networks to ensure they live independent and healthy lives. This takes us to the theme that runs through this strategy - empowering families, communities and individuals to be more involved in taking responsibility for their health and care. Councillor Julie Pickering Co-Chair Health and Wellbeing Board

Dr Naz Jivani Co-Chair Health and Wellbeing Board

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1. The purpose of the Joint Health and Wellbeing Strategy (JHWS)

The JHWS is the framework that underpins the work of the Health and Wellbeing Board. It is not intended to capture every priority for improving health and care in Kingston.

It focuses on those areas which require a collective health and wellbeing board contribution to achieve the most impact. We will promote this strategy to the wider ‘Kingston family’ of partners and encourage all organisations to work collaboratively towards achieving the shared goal of improving health and wellbeing for people in Kingston, focusing resources on the things that matter the most.

The strategy supports board members to take the step from assessing needs to planning the delivery of integrated local services based on local needs and assets to collectively address the underlying determinants of health and wellbeing. The combined information in the Joint Strategic Needs Assessment and JHWS form the basis for local decisions that drive service change such as investment and disinvestment in services according to local needs and engagement with the local community. Kingston Council, Kingston Clinical Commissioning Group and NHS England need to have regard to the JHWS as they draw up their detailed commissioning plans.

2. Prevention, early intervention and self-care

Empowering communities, families and individuals through preventative, early intervention and self-care approaches will be embedded within all four priority areas in this strategy. In the NHS Five Year Forward View

(published in October 2014) the compelling case is made for ‘getting serious about prevention’. Through health improvement programmes and awareness raising campaigns we will work with local people to address lifestyle issues that are responsible for many of the long term conditions that people suffer from. Kingston CCG has been successful in being part of the first phase of the National Diabetes Prevention Programme (NDPP). This gives us a real opportunity to improve the quality of life of our population by reducing their risk of developing Type 2 Diabetes. More examples are given below of early intervention initiatives that will continue to be prioritised in this strategy such as reducing waiting times for mental health services for children and young people, and improving the identification of people with dementia so they and their carers get the support they need as early as possible. Critical to addressing the challenges we have is managing the future demand on health and social care services. We know that the majority of people in Kingston are getting on with their lives and living independently of statutory services. We will empower and support families, individuals and communities to exercise more control, choice and responsibility for their own health and care.

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The following are examples of actions already in progress to support this ambition:

We are working with GPs, voluntary and community organisations and health and care providers to develop a ‘social prescribing’ model in Kingston. This will put people in touch with the range of community support available to them to augment and/or replace medical or social care interventions where these can be avoided, and help people to live their lives in the way they would wish to.

We will continue to strengthen how we engage with our communities through Kingston Conversations, Healthwatch Kingston, CCG engagement events, Kingston Youth Council and in other ways, giving people from all age groups and all local communities a real say in how we do things.

We are looking at how we can develop a comprehensive and easily accessible information and advice resource in Kingston, including the options for an online directory that people and organisations can access, so that people know about and can choose from the wide range of care and support services available in Kingston.

The CCG and the council have agreed to work on joint self-care campaigns across the borough to increase awareness of the steps people can take to improve their health, or limit the progression of their health or care problem.

We will continue to work with the voluntary and community sector to develop capacity and community led solutions, such as peer support groups, programmes to combat social isolation and volunteering opportunities.

3. About Kingston The Royal Borough of Kingston- upon-Thames is in South West London and shares borders with Wandsworth, Richmond, Sutton, Merton and Surrey. It has the smallest population of any borough in London (apart from the City of London) and is the 7th smallest borough in terms of geographical area.

Since 2001, Kingston’s population is estimated to have grown by over 16% from 149,000 to 173,500. The population registered with Kingston General Practices (GPs) is 201,403 as at April 2016.

The population is predicted to grow by a further 7% to 181,000 by 2025, and by a further 3% to 186,200 by 2035. The number of people aged over 75 in the borough is set to rise 44% by 2035. As Kingston’s population grows, we are evolving to become an ever more diverse borough. In 2014 the Black, Asian and Minority Ethnic (BAME) population comprised 28.8% of the borough. By 2024 it is estimated that this percentage will have risen to 35.1%.

Kingston’s health Kingston’s health profile for 2016 indicates that the health of people in Kingston is generally better than the England average. Out of 27 health indicators in the Kingston health profile, Kingston’s performance is significantly better than the England average in 19 of the 27 areas, and significantly worse in one: new sexually transmitted infections, although performance in this area is better than the London average. Kingston is one of the 20% least deprived districts in England, being ranked as the 49th most affluent using the Index of Multiple Deprivation. However, about 12% (3,500) of children live in low income families.

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There were 972 deaths in Kingston in 2014. 73% of which were due to three disease groups: 29% cancer; 28% circulatory disease and 16% respiratory disease. Many of these deaths have preventable risk factors – smoking, obesity, physical inactivity and excess alcohol consumption. The number of live births to Kingston residents in 2015 was 2,350. This is an increase of 103 (4.6%) from the previous year.

Life expectancy for men and women at 82.0 and 84.6 respectively are both significantly higher than the national average. Healthy life expectancy - the number of years a person can expect to be in good health is 67.5 years for men and 69.3 years for women. So on average men in Kingston will spend 14½ years in poor health whilst for women the figure is just over 15 years. Life expectancy in Kingston varies depending on the level of deprivation. Life expectancy is 4.8 years lower for men and 4.6 years lower for women in the most deprived area of Kingston compared with the most affluent area.

4. Principles running through this strategy

Empowering communities, families

and individuals to be more involved and supported in taking more responsibility for their own health care. This includes empowering people with long term conditions to understand how to manage their conditions effectively – a self-care approach.

Information and advice to support self-care is jargon-free, up-to-date

and easy to find.

Services are joined up, of high quality and accessible to those that require them.

Local organisations will collaborate to maximise the health and wellbeing of the population.

A commitment to work to reduce health inequalities across the life course exemplified by proportionate universalism – universal services are targeted proportionately to those most in need so as to reduce health inequalities.

Prevention is prioritised in all its forms: o Primary prevention activities

which avoid the development of disease.

o Secondary prevention activities which diagnose and treat an existing disease in its early stages before it results in significant morbidity.

o Tertiary prevention which aims to reduce the negative impact of established disease by restoring function and reducing disease-related complications.

o Quaternary prevention which refers to the set of activities that mitigate or avoid the consequences of unnecessary or excessive interventions.

Recognition of the role that carers - including young carers - play in helping those they care for to live well, healthy and independent lives.

Making the best use of all the resources - not just money – that making the best use of all we have available to us to help to create sustainable health and care system.

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Ensuring that we use technology (including social media) to both make the most efficient use of everyone’s time and enable more people to live independently and safely in their communities.

5. Priorities

The four agreed priorities for this Joint Health and Wellbeing Strategy are:

1. Children and young people 2. Mental health 3. Older people and people with

long term conditions. 4. Addressing the needs of

socially excluded and disadvantaged communities

Members of the Kingston Health and Wellbeing Board agree to make sure that these four priorities are reflected within their own organisations strategic plans.

It is recognised that there are numerous connections between the priorities. Some examples are:

Mental health issues affect both children and young people and older people.

People from socially excluded and disadvantaged communities will have a higher risk of both long term conditions and mental health problems.

Long term conditions can affect children and young people.

These priorities were first agreed by the board in 2013. In January 2016 the board reviewed these priorities and, based on the evidence, agreed that these were still the right ones to focus on up to 2019.

Considerable progress has been made in delivering the actions agreed in 2013 in each of the four areas but there is still more to do. (A progress report is available on the Health and Wellbeing Board webpages – www.kingston.gov.uk). As well as the priority actions below, the Health and Wellbeing Board has prioritised the following two actions for the next 12 months:

● Implementation of the Joint Dementia Strategy (including creating ‘Dementia Friendly Kingston’).

● Delivery of the transformation plan for Child and Adolescent Mental Health Services.

6. Why these priorities are important

6.1 Children and young people

Lifelong health inequalities have their roots in pregnancy and the early years, and parents or carers play a pivotal role in influencing their children’s future life chances; economically, socially and with regards to their physical and emotional health.

11.9% of children in Kingston live in low income families.

Giving every child the best start in life to develop physically, psychologically and socially is crucial to reducing health inequalities across society.

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The percentage of children achieving a good level of development at the end of reception is 72.1% which is higher than the London average of 68.1%.

Although Kingston performs better than both London and England averages, by Year 6 (age 10-11 years) 30% of children are overweight or obese, with potentially serious implications for their health as adults.

Teenage pregnancy on average results in worse health outcomes for both mother and child.

Please see the last three bullet points in section 6.2 below for the link with mental health.

Actions we will take in this priority area: 1. Improve access and early

intervention and preventative approaches to mental health services through the single point of access.

2. Provide post diagnosis support for children and young people with Autistic Spectrum Disorder.

3. Improve transition pathways for young people including joining up services to provide a ‘whole life course’ response.

4. Embed learning from serious case reviews and further improve safeguarding for children and young people with physical or learning disabilities.

5. Provide programmes targeted at preventing and reducing obesity in children.

6. Implement the recommendations of the assessment into the needs of children and young people who participate in risky behaviours.

7. Make sure that there is good support for young carers.

6.2 Mental health

Mental illness makes up nearly a quarter of the total burden of ill health.

In any one year, one in four people will have a mental health problem and at any one point in time one in six people will be affected.

10 million people in the UK will experience a mental health problem each year.

Mental health and physical health are closely intertwined with people with mental health problems often having poor physical health, and people with physical health problems being more at risk of developing mental health issues, with this affecting an estimated 12,000 people in Kingston.

The stigma surrounding mental illness can cause great distress, stop people seeking treatment, impede recovery and affect people’s chances of being in work.

Early intervention can decrease psychiatric symptoms, the onset of mental disorders and improve physical health.

Intervening early with children and adolescents could prevent ¼ to ½ of adult mental illness.

Up to half of lifetime mental health problems start by the age of 15 and 75% by age 18.

The children most at risk of mental health problem are those being raised in families where parents have a mental health problem or misuse drugs or alcohol.

Page 8: Joint Health and Wellbeing Strategy Refresh 2017 - 2019€¦ · Kingston’s Joint Health and Wellbeing Strategy 2017 - 2019. The Health and Wellbeing Board brings together elected

Actions we will take in this priority area: 1. Finalise the adult mental health

strategy for Kingston and deliver the action plan.

2. Make sure all elements of mental health crisis care are in place.

3. Improve perinatal mental health services.

4. Improve access to local inpatient beds for people with mental health problems.

5. Improve access to housing for people with mental health problems.

6.3 Older people and people with long term conditions

People can develop long term conditions (defined as a condition that cannot be cured, but can be managed through treatment) at any age, but older people are more likely to have one or more long term conditions (LTCs). LTCs include diabetes, asthma, chronic obstructive pulmonary disease, epilepsy, coronary heart disease and many cancers.

31% of all adults in Kingston have a long term condition (LTC) and two thirds of these are people aged over 65. 70% of all health and social care spend is for people with LTCs.

1 million older people in the UK are socially isolated and this will increase to 2.2 million in the next 15 years if not addressed. A local consultation (2013 PH Annual Report ‘Living Well in Later Life’) highlighted this as a major issue in Kingston.

76% of older people in Kingston are owner occupiers. Housing in poor repair results in increased risks of falls, accidents and cold related ill-health as well as risks to personal safety due to the risk of scams.

There are estimated to be 1,714 residents in Kingston (including people under the age of 65) with dementia. It is predicted that this will rise to around 2,100 residents aged over 65 by 2027.

The annual healthcare costs of dementia in the UK are estimated at £4.3 billion whilst social care costs are £10.3 billion annually (this is both public and private funding).

National research shows that if local dementia friendly communities are established and a range of local peer support networks are provided, we can delay admission to residential care by an average of one year, saving £11,500 per person per year.

The percentage of deaths in hospital (for all ages) in Kingston in 2014 was 49.3%, which was below the London average of 53.9%

Actions we will take in this priority area 1. Maintain a focus on preventative

services that help people to stay well, independent and healthy for longer.

2. Develop services to reduce loneliness and social isolation and recognise the valuable part that older people can play in creating vibrant, resilient and supportive communities.

3. Make sure that people have easy access to information and advice about health care and other services that keep them well and independent.

4. Make sure that there is appropriate housing to meet the needs of older people and people with long term conditions.

Page 9: Joint Health and Wellbeing Strategy Refresh 2017 - 2019€¦ · Kingston’s Joint Health and Wellbeing Strategy 2017 - 2019. The Health and Wellbeing Board brings together elected

6.4 Addressing the needs of socially excluded and disadvantaged communities

Reducing health inequalities is a statutory responsibility of the Health and Wellbeing Board and as such this theme cuts across all priorities in this strategy.

Factors that impact on health needs and outcomes of communities include material disadvantage, poor housing, low educational attainment, low literacy skills, poor environments, insecure employment and homelessness. Collective action is needed to tackle these issues.

People who experience these factors are more likely to suffer poorer health outcomes and an earlier death compared with the rest of the population.

The unemployment rate in Kingston as a whole is 1.7% but the rate in Norbiton ward is 2.8%, in Chessington South it is 2.1% and it

Actions we will take in this priority area 1. Delivering the Action Plan that sets

out what initiatives will be undertaken in our most disadvantaged localities (Norbiton, Malden Manor, Alpha Road and Chessington South).

2. Deliver the Health Improvement Plan for marginalised communities.

3. Run a programme of mental health improvement for disadvantaged communities including improving community resilience and access to information.

7. Action plans and outcomes An action plan for each priority area involving all local partners will be developed setting out in more detail specific actions that we will take, timelines and the outcomes to be achieved.

8. Engagement

Extensive feedback has been gathered over recent months, including during the co-production of the mental health strategy, the development of the dementia strategy and the feedback received during the ‘voice of the customer’ exercise. This sought views from people about their experiences of the current customer journey through the health and care system. We have also invited feedback from all organisations represented on the Health and Wellbeing Board, wider partners and individuals on the four priorities and high level actions set out in this strategy document.

9. Monitoring and review

The Health and Wellbeing Board will keep this strategy under review and will receive assurance through regular reports to the board about progress being made in improving health and wellbeing outcomes in the four priority areas.

10. Strategic context A wide range of delivery plans and strategies which impact on improving health and wellbeing sit alongside this JHWS. Some examples of these are given in Annex A although this is not intended to be an exhaustive list. The Joint Strategic Needs Assessment (data.kingston.gov.uk/Kingston_jsna) gives detailed information on local needs and assets. It also includes community voice sections which detail work undertaken on a range of topic areas with the local population.

Page 10: Joint Health and Wellbeing Strategy Refresh 2017 - 2019€¦ · Kingston’s Joint Health and Wellbeing Strategy 2017 - 2019. The Health and Wellbeing Board brings together elected

Using the Special Educational Needs and Disability (SEND) Code of Practice 2014 we have a duty to put the views of children, young people and their families at the heart of commissioning. The JSNA analysis of children and young people (CYP) aged 0-25 informs the outcomes that local authorities and CCGs agree to achieving, working with CYP, parents and carer forums. The Local Offer published by the local authority sets out what support is available for 0-25 year olds with SEN or disability in Kingston.

11. Examples of where we are working together to make a difference

Active and supportive communities The council and the KCCG combined their funding to commission the voluntary and community sector (VCS) to deliver a range outcomes which were co-produced with the VCS and local people. This includes support for people to manage direct payments and purchase their own support, advocacy support for carers and community support from a network of 14 community organisations to help people keep resilient, independent and reduced loneliness. Through testimonials we are hearing about the positive difference that services such as befriending services are having on people’s lives. We are working with GPs and other partners to develop a ‘social prescribing’ model for Kingston that will put people in touch with the wide range of community, leisure, learning, cultural and active and healthy lifestyle services that are available in Kingston to keep people healthy and well and independent of statutory services.

Kingston Coordinated Care Kingston Coordinated Care is the name of our programme to integrate health and care services. The council and the KCCG are working in partnership with the main health and care providers in Kingston and the voluntary and community sector to develop a new model of care. People have told us that the health and care system is difficult to navigate and understand, and this leads to delays in getting the support they need at the right time in their lives.

We are creating a single care pathway

so that people experience a joint

response from health and care

organisations.

We are developing a simpler and more

proportionate assessment which will

free up time to develop an

understanding of the person and to

plan their support with them.

We will put people in touch much

sooner with community support to meet

their needs and keep them connected

to their communities, and not isolated

in their own homes and dependent on

long term support.

We will provide short term services

that help people regain skills, abilities

and independence.

We will jointly commission organisations

to work to a common set of outcomes.

Providers will work together as ‘one

system’ in multi- agency teams, sharing

information and using all the capabilities

across the workforce to do the right

thing for individuals irrespective of the

organisation they work for.

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Child and Adolescent Mental Health

Services

We received funding from NHS

England to transform mental health

services for children and young

people. The Child Adolescent Mental

Health Services (CAMHS) Local

Transformation Plan (LTP) focuses on

early intervention and developing

community services so that fewer

children and young people are

admitted to hospital.

During 2016 we will continue to focus

on tackling issues for children and

young people at key transition points in

their lives and the growing impact of

Autistic Spectrum Disorder locally. In

addition over 30 schools have signed

up for mental health training to build

resilience and equip staff with the

knowledge to manage emotional

wellbeing and mental health issues.

Extra staff are in place to reduce the

length of time children and young

people have to wait to access Tier 2

services after initial assessment, from

20 weeks to eight weeks.

Increased investment in Psychiatric

Liaison Services to provide seven day

services for the assessment of children

and young people admitted to A&E,

which will reduce avoidable

admissions to hospital.

Dementia Strategy

The Joint Dementia Strategy was

launched in June 2015 following

Consultation with over 200 stakeholders.

Since the launch a lead general

practitioner (GP) has set up a primary

care Dementia Review Service where

people that are diagnosed with

dementia have their needs and

medication reviewed on an ongoing

basis in a primary care setting.

A dementia development worker has

been appointed to establish and

support a local peer support network in

the four Kingston localities.

We have also recruited a dementia

advisor to work with people once they

have been diagnosed, to help co-

ordinate their care and provide them

with information about all the support

and services available to them.

The CCG is working with local practices to

ensure that people who have dementia are

diagnosed. The Dementia Action Alliance

has been refreshed and will bring all partners

together to develop Kingston as a dementia

friendly place.

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Community engagement for health

The accredited Community

Engagement for Health (CEH) course

was co-produced and co-delivered

with residents in 2015 to individuals

who identified themselves as socially

excluded, disadvantaged or

representing those who are.

Fifteen learners completed the course,

receiving accreditation from the Open

College Network.

Eleven participants completed a

wellbeing questionnaire reporting an

increase in their happiness and

confidence on a daily basis.

Nine respondents also stated that they

now had a better understanding of

health and wellbeing as well as the

factors that influence health and

wellbeing.

Eighteen participants from previous

courses have volunteered in various

roles in the community during 2015.

Graduates of the course have set up a

‘Kingston Community Empowerment

Forum’ currently with 45 residents who

have completed the course.

The forum now has a Facebook group

and four meetings have taken place.

https://m.facebook.com/groups/1

563924630491083?ref=bookmarks

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ANNEX A

STRATEGIC CONTEXT

Carers Strategy Active and Supportive Communities Strategy

Housing

Strategy

NHS SWL Sustainability

and Transformation Plan

Healthy Weight and

Physical Activity Strategy

Dementia Strategy

Adult Mental Health Strategy

Prevention of Suicide

Strategy

Mental health

Children

and young people

Children and Young People's Plan

CAMHS Local Transformation Plan

Child Poverty Strategy Local Safeguarding Children’s Board Annual Report Local Offer for children and young people with SEN or disability

Health Improvement Plan for marginalised communities Localities Strategy Refugee and Migrant Strategy

Addressing the needs of

socially excluded and

disadvantaged communities

Older people and people with LTC

Dementia Strategy Active and Supportive Communities

Housing Strategy for Older and Vulnerable People


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