report to: care together single commissioning ... 6b...healthy, happy and prosperous we aim to...
TRANSCRIPT
Report to: CARE TOGETHER SINGLE COMMISSIONING BOARD
Date: 5 July 2016
Officer of Single Commissioning Board
Angela Hardman – Director of Public Health
Subject: MOBILISING COMMUNITIES AND TRANSFORMING SELF CARE IN TAMESIDE & GLOSSOP: A SYSTEM-WIDE APPROACH
Report Summary: The report describes the system wide Model of Care developed by the Healthy Lives workstream. The current work programme is described, and the proposed transformation approach needed across the Care Together system to promote self-management and self-care across Tameside & Glossop.
Recommendations: The Single Commissioning Board is asked to note and endorse the proposed Model of Care
Financial Implications: (Authorised by the statutory Section 151 Officer & Chief Finance Officer)
This report articulates a significant step in delivering a more sustainable future for our economy. It is recognised that this proposition will go a long way in addressing the improvement in population health required for the future. Initial extra investment to launch some of these initiatives such as social prescribing has been requested via the GM Transformation Funds. Any further investment in the prevention agenda will have to be subsequently approved by using some of the recycled funds generated through other areas of the model of care redesign work but this will all be subject to more detailed business cases as and when required. Overall, this business case should reduce demand management in the most expensive part of our system going forward.
Legal Implications: (Authorised by the Borough Solicitor)
It will be important as we develop these invest to save business models that we have clarity about the current system cost, the investment needed, the revised running cost and the date to be achieved and importantly the better outcomes to be achieved.
How do proposals align with Health & Wellbeing Strategy?
The proposals align with the Health and Wellbeing Strategy aim that all actions by the public, private and voluntary sectors should build on the strengths, support, skills and knowledge already in communities, be responsive to the priorities of local communities, accountable to them and involve them in planning and development.
How do proposals align with Locality Plan?
The proposals align to the vision of the Locality Plan to improve healthy life expectancy, recognising and building on the strong voluntary, community and faith sector presence in our locality and ensuring that we continually hear the voice of our communities. The proposal will strive to empower local residents, build community resilience by developing and delivering place based services and early intervention and prevention to keep people healthy and independent.
How do proposals align with the Commissioning Strategy?
The proposals align to all the strategic aims of the Commissioning Strategy in particular ‘Empowering citizens and communities’.
Recommendations / views of the Professional Reference Group:
The proposal was commended and supported by the Professional Reference Group.
Public and Patient Implications:
PRG acknowledged at its meeting on the 8 June 2016 ‘that this piece of work cuts across all workstreams for Care Together although recognising that there is a challenge to get patients to self-care depending on ways in which they access a particular service and are therefore keen to see the strength to this model built in with the third sector as a strong focus. The high-risk stratification within the case navigator supports this.
The links with planned care is an important one for a patient active measure and a good marker of quality of care and outcome measure.
PRG noted that this is good innovative transformation as an integrated piece of work and support onward presentation to SCB.’
Quality Implications: Improved health outcomes and experience with residents and patients receiving individualised care and support.
How do the proposals help to reduce health inequalities?
The proposal offers a broad focus on promoting health and reducing inequalities across whole populations with particular emphasis on place based interventions which tackle the wider determinants of health.
What are the Equality and Diversity implications?
An Equality Impact Assessment has been drafted and will be reviewed regularly by the Healthy Lives workstream.
What are the safeguarding implications?
There are no safeguarding implications in the proposal.
What are the Information Governance implications? Has a privacy impact assessment been conducted?
No Information governance issues have been identified. There is therefore no privacy impact assessment attached.
Risk Management: A risk register has been developed as part of the project management arrangements for the Care Together programme and reported to the Healthy Lives Workstream.
Access to Information : The background papers relating to this report can be inspected by contacting Debbie Watson, Head of Health and Wellbeing:
Telephone: 07816533828
e-mail: [email protected]
1.0 STRATEGIC CONTEXT
1.1 Our aim is for Tameside to be a place where everyone is both physically and mentally healthy, happy and prosperous We aim to reduce inequalities and deliver high quality health and social care services that protect our most vulnerable and offer people greater choice, independence and control.
1.2 The Care Together programme has the ambition to significantly raise healthy life expectancy
(HLE) in Tameside and Glossop, through the adoption of a place based approach to better prosperity, health and, wellbeing. Supporting information to support the ambition, including key headline health statistics can be seen in Appendix 1. Care Together aims to reduce the legacy of poor health outcomes and avoidable deaths through the radical upgrading of prevention and public health activities and transformation of the whole health care system.
1.3 To achieve this, the following commissioning priorities have been developed:
A focus on the wider determinants of health and wellbeing, in particular giving children the best start in life and helping people to stay in and return to work, thereby improving their own prosperity.
Early intervention and prevention across the life course to encourage healthy lifestyles and promote, improve and sustain population health.
Creating the right care model so that people with long term conditions are better supported and equipped with the right skills to look after themselves and manage their conditions more effectively, reducing dependency on the health and social care system by promoting independence.
Supporting positive mental health in all that we do.
1.4 The Healthy Lives programme will act as a significant enabler to the realisation of this strategic ambition. The model represents a fundamental shift in thinking, blending evidence based public health approaches and interventions, robust workforce development, and place-based community approaches. Fundamentally, the approach recognises that provision needs to be a mosaic of offers, with a myriad of options that can respond flexibly to the needs of different people in different places at different stages of life.
2.0 PLACE-BASED APPROACH WITH A FOCUS ON PREVENTION 2.1 If a new system is to reduce the demands and pressures on services and enable people to
live healthier lives, then it is local people themselves who need to sit in the heart of the model through community leadership. Health and social care cannot sit within silos but rather must form a family of networks with wider partners such as housing, business and voluntary sector. A shift is needed from technocratic systems to one that is led by communities for the community with a focus firmly on supporting wellness, prevention, and reducing inequalities, whist still providing high quality health and social care when required – informed by partnership working with communities to improve planning and decision-making.
2.2 There are three core principles of a place based approach.
People must be empowered to take greater control over their own lives, to influence personalised services and to take greater responsibility for their health outcomes
All resources and assets in places must be used to support wider determinants of health and wellbeing outcomes
A system shift towards prevention and early intervention will require services to organise and professionals to behave in very different ways.
2.3 To achieve this, services need to be incentivised, commissioned and organised in very
different ways to work with people, supporting them to live positive, fulfilling lives and activating existing channels of community or social networks. This will mean staff being
trained differently, organisations linking into primary care, and health staff accessing information on resources in places to inform a different conversation. The Healthy Lives programme aims to drive the system change required to truly provide a place based approach, by ensuring prevention and people are at the heart of the vision formation and development of the integrated care organisation.
2.4 The diagram below demonstrates how there needs to be a shift from a system that focuses
large amounts of energy on urgent care and crisis management, to one that energetically and consistently focuses on preventing illness and supporting wellness socially, physically, and mentally.
2.5 The table below discribes the required shifts in the thinking and actions of health and social
care providers 1– rethinking place based health, and how the Care Together Programme and Healthy Lives work stream will contribute.
Required Shift Descriptor Care Together/ Healthy Lives
SHIFT ONE: FROM INSTITUTIONS TO PEOPLE AND PLACES
Health and care institutions currently hold the power and determine the direction of service delivery
Care Together and Healthy lives will aim to create the conditions where social movements can flourish - Supporting assets, building community engagement, utilising social marketing, and developing community focused new communication approaches. If the system is to shift towards prevention and embed health as a social movement, people’s capacity and local resources need to be leveraged much more effectively and become integral to place-based health.
SHIFT TWO: FROM SERVICE SILOS TO SYSTEM OUTCOMES
Separate services are currently set up to work to their own organisational priorities. Moving from the dominance of vertical silos of 'health' and 'care' to horizontal place-based systems will involve cultural and behavioural change on a completely new scale.
The Care Together, Healthy Lives vision is built on the philosophy of asset based community approaches, providing a mosaic of traditional programmes, innovative new ways of working, and a programme of Asset Based Community Development that aims to influence the whole system. Enablers of this change need to be recognised, developed and supported at every level and across all workstreams, to then lead the creation of a new system from the inside out.
1 New Local Government Network (NLGN), 2016, Get Well Soon - Reimagining Place Based Health
SHIFT THREE: ENABLING CHANGE FROM NATIONAL TO LOCAL
Changes in local practice and behaviour must be supported by the national policy framework. National bodies must focus on creating a long-term environment for prevention, approaching places as whole systems rather than reinforcing silos, and removing blockages for local practitioners.
The Care Together/ Healthy Lives programme is built on a solid research, evidence based commissioning for population health and local and regional policy. Aligned to GM Devolution Taking Charge - creating a transformed health and social care system which helps many more people stay independent and well and takes better care of those who are ill.
3.0 BUILDING THE MODEL - VISION FOR HEALTHY LIVES 3.1 The Healthy Lives Programme aims to provide enhanced system leadership for continuing
strategy and policy development that will shape outcome based commissioning priorities and intentions to enable the delivery of the Care Together ambition with a focus on early intervention and prevention, asset based community development and enabling self-care as an integrated part of the emergent new model of care.
3.2 The ultimate objective of this work stream is to improve health and wellbeing outcomes
(Healthy Life Expectancy) for the people of Tameside and Glossop by working across all models of care in localities, planned, urgent and acute care. A key strategy within the programme is embedding preventive thinking across the models of health and social care elucidating the requirement to build systems that promote good health and wellness rather than just treating ill health.
3.3 In order to increase Healthy Life Expectancy whilst contributing to tackling the considerable
financial challenge that exists within the system, and ensure quality services are maintained and developed, a transformational approach needs to be adopted. Notwithstanding the challenges, Care Together offers a unique opportunity to be transformative, scale up our preventative programmes and support our local communities to improve health outcomes and quality of life.
3.4 The Healthy Lives work stream builds on the partnership approach and work conducted from
2014/15 in the development of the Wellness concept which remains a central component of the Healthy Lives approach. At the heart of the new model is a person and community centred approach, which is flexible and responsive enough to respond to the individuals need throughout the life course. The model is universal but will utilise risk stratification to direct services to those who would gain the most benefit.
3.5 The Healthy lives programme forms one of the 4 work streams supporting the
implementation of the ICO as part of Care Together. Healthy Lives ‘house of care’ demonstrates that in order to deliver our ambition we will need to deliver a new way of thinking and working across our communities, across our work force, and across our commissioning.functions and this will require a fundamentally different approach which, is system wide and elevates prevention to the forthought of all within system and community, we believe ultimatly this will build a strong health happy community.
3.6 The current services aligned and delivered as part of the Healthy Lives Programme can be
seen below under the strategic priorities of our Commissioning for Reform Strategy. There are five key pillars of delivery to the Healthy Lives model delivering the Care Together strategic priorities. There is potential to scale up systematically and further develop these programmes to increase the effects of the interventions. The ‘enablers’ that sit under the programme include Selfcare, an Asset Based Community Development approach, workforce development and the use of knowledge and intelligence to support, build and promote a culture of early intervention and prevention.
3.7 To deliver on the Care Together vision the focus on early intervention will be integrated
across all models of care - the focus will be around shared leadership and accountability for delivering population health and wellbeing across all workstreams to manage demand and embedding preventative pathways across primary, secondary and tertiary care in the heart of communities.
3.8 The programme is aligned to the Greater Manchester Public Service Reform (PSR)
principles to promote:
A new relationship between public services and citizens, communities and businesses that enables shared decision making, democratic accountability and voice, genuine co-production and joint delivery of services. Do with, not to.
An asset based approach that recognises and builds on the strengths of individuals, families and our communities rather than focusing on the deficits.
Behaviour change in our communities that builds independence and supports residents to be in control
A place-based approach that redefines services and places individuals, families, communities at the heart
stronger prioritisation of wellbeing, prevention and early intervention
An evidence led understanding of risk and impact to ensure the right intervention at the right time
THE CURRENT HEALTHY LIVES PROGRAMME MODEL
ENABLERS
4.0 PROPOSED TRANSFORMATION PROGRAMME – SCALING UP OUR AMBITION 4.1 The current programmes delivered as part of the Healthy Lives Programme are based on
improving whole population health. Best practice would suggest using a comprehensive framework based on the work of Chris Bentley (National Support Team for Health Inequalities) around the economics of prevention to form the basis of the approach to population health commissioning. The Framework which can link to our risk stratification models identifies groups interventions by their gestation or notional rate of return in order to recognise that dividends for different interventions are likely to be realised over different time period and proposes that because health, education, work and social status have substantial
interdependence, addressing morbidity and pre-morbidity in specific sub-groups of the population can accelerate the rate of return across all time frames.
Figure 1. A Framework for Interventions 4.2 This categorisation has been used to describe an approach that considers the range of short,
medium and longer term evidence-based interventions. Therefore careful consideration will need to be given to maximise any additional proposal for scale up in 16/17 through transformation funding should we be successful in securing this.
Short Term Benefit Realisation with a long term legacy
4.3 For additional transformation funding over 1 year, we would need to focus on interventions that typically deliver the quickest payback. These are those which focus on residents already in, or close to, the NHS system, and/or limit additional costs to the system due to expensive treatment and support. Supporting this will be a foundation programme with some key enablers that will ensure that the work programme continues to grow organically.
5.0 MOBILISING COMMUNITIES AND TRANSFORMING SELF CARE IN TAMESIDE &
GLOSSOP: A SYSTEM-WIDE APPROACH
Making the case 5.1 The current policy focus on the ageing population and increased prevalence of chronic
diseases is pushing a strong reorientation away from the current emphasis on acute and episodic care and a pull towards prevention and self-care. Through the Locality Plan the health and social care economy across Tameside and Glossop have made a commitment to ensure that people are empowered to shape and manage their own health and make meaningful choices about their care. To meet this commitment, it is proposed that across all work streams of Care Together we develop a strategic system wide approach to Self-Care, to scale-up support for people living in Tameside and Glossop to manage their own health and whilst delivering financial benefit to the wider healthcare system as part of the £69 million efficiency challenge.
5.2 There is evidence to show that resident’s capacity to ‘self-care’ is changeable and effective
interventions can help to increase people’s activation levels and their confidence in managing their health.1 A number of programmes have demonstrated the ability to raise
activation scores in people - these typically focus on the individuals gaining new skills, encouraging a sense of ownership of their health, changes in their social environment with greater community support, asset based approaches such as social prescribing, education and self-management courses. All of these help to empower people to take greater control of their health, leading to better outcomes and improved experience of the health service. 1 If this new model is to reduce the demands and pressures on services and enable people to live healthier lives, then it is local people themselves who need to sit in the heart of the model through community leadership. This will require an innovative and far reaching change in thinking across all areas of health and social care, and have a far greater emphasis on prevention and active support for those with long term conditions.
5.3 A growing body of evidence emphasises the importance of effective self-management of
long-term conditions.2 People who recognise that they have a key role in self-managing their condition (and have the skills and confidence to do so) experience better health outcomes. Yet, the ability of people to successfully self-care and stay well at home can vary considerably from person to person. People with LTCs and their carers need to be better equipped to manage their own condition(s). In recognition of this, the NHS Five Year Forward View set out a central ambition for the NHS to become better at helping people to manage their own health – ‘staying healthy, making informed choices of treatment, managing conditions and avoiding complications’.3
Who will benefit?
5.4 The model is system wide. We will use our strategy around population risk stratification is to deliver our population based current Healthy Lives programme to the whole footprint of Tameside and Glossop with particular focus on the groups identified in Appendix 2 – ‘Health Challenges’ Group. We will also work with the Integrated Neighbourhood Model to support those residents with a risk score of between 30% and 69%. These residents will be proactively managed via a wraparound wellbeing service supported by GPs and community services. Types of interventions for this group could be individualised care plans, support to self-manage, education programmes, referral to social prescribing etc. The preventative services described in this paper will offer a holistic community focused support.
Tameside & Glossop Model of Self Care
5.5 The diagram below proposes a new model of Self Care for Tameside & Glossop. The key driver of the new model is to ensure that people are better supported, and equipped with the right skills, the knowledge and the confidence to manage their health and wellbeing and conditions, reducing dependency on the health and social care system and promoting independence.
5.6 The model describes key system conditions or enablers that will need to be in place to
ensure the model is implemented effectively. This includes strong leadership and commitment for the vision across all workstreams together with a system and public understanding around the imperative to move towards prevention and self-care. The model has a place based neighbourhood focus and therefore the engagement and leadership of a strong, engaged and vibrant Voluntary, Community, Faith Sector is essential. We recognise the need to fundamentally shift the relationship between people and their health and between people and health and care services – a shift in organisational cultures will be needed. We will aim to support this shift through our Organisational Development plan which will focus on building a skilled, flexible and enabling workforce where support towards self care will be the system default.
2 The King’s Fund (2014) Supporting People to Manage their Health: An introduction to Patient Activation
3 NHS England (2014) NHS Five Year Forward View
5.7 We aim to strengthen the model and support the enabling environment by commissioning
evidence based interventions designed to reduce demand in the system by scaling up our programme on community asset based approaches and further developing our approach to social prescribing. We propose to deliver these interventions as outlined below:
ASSET BASED APPROACHES – STRENGTHENING COMMUNITIES PROGRAMME
5.8 Assets require both whole system and whole community working. Instead of services that
target the most disadvantaged and reduce exposure to risk, there is a shift to facilitating and supporting the wellbeing of individuals, families and neighbourhoods. It requires all agencies and communities to collaborate and invest in actions that foster health-giving assets, prevent illness and benefit the whole community by reducing the steepness of the social gradient in health.
5.9 Asset based working is not an alternative to properly funded public services. It challenges
how those services are designed and delivered and requires a recasting of the relationship between commissioners, providers, service users and communities. It puts a positive value on social relationships and networks, on self-confidence and efficacy and the ability to take control of your life circumstances.
5.10 Priorities for this system wide programme are:
Developing social and community capital, for the purpose of strengthening communities
Reconfiguring the commissioning landscape to bring asset-based service providers within the health and social care delivery system, by:
o priming the market of informal peer support networks o committing a financial resource to enable and sustain the voluntary,
community and faith sector to deliver as asset-based providers
5.11 This requires a radical transformation of the commissioning landscape and a priming of the market, to enable local people and communities – as opposed to established organisations - to utilise their latent potential to engage with the health economy as providers of asset-based services. This approach recognises the variance within the voluntary, community and faith sector VCFS and proactively aims to accommodate the different needs within different parts of the sector to engage as equal partners. Under the Healthy Lives workstream focus on Asset Based Community Development4 and building resilient communities to tackle key health priorities, this work would focus on:
Increasing participation and work with local people to facilitate their involvement in shaping services that tackle health inequalities.
Strengthening the self-help support available within community groups and connect and develop new peer support mechanisms – putting a framework in place to support people to be more resilient and growing our approach to self-management peer support and education.
5.12 In partnership with Tameside Action Together we proposed to tap in to and further develop such potential community capital through a volunteering and community grants programme (combining our resources) investing in innovation from groups that currently offer some social support and health and social care in their communities and who can also:
• identify solutions to, often intractable, health or social “problems”; • help people to more appropriately access services within community settings; • develop new ways to support self-management and offer peer support.
SOCIAL PRESCRIBING
5.13 As previously outlined there is a compelling case that community and person centred
approaches have a significant and real impact on the delivery of health within communities (Realising the value 2016). By transforming our thinking and adopting approaches that are asset based considerable gains can be achieved for communities, individuals, and the health and social care economy.
5.14 This approach recognises the strengths that exist within communities and seeks to build on
these in order to:
• Support to non-medical interventions within the community. • Reduce reliance on traditional forms of health provision – freeing up capacity to
focuses this on acute care. • Build health literacy within the community • Build on community strengths and assets • Support individuals to be healthier and more prosperous
5.15 Social prescribing is defined as a “mechanism for linking patients with non-medical sources
of support within the community” (CentreForum 2014:6). The voluntary sector is recognised for contributing to individual and community health (South et al 2008) and with health care resources being under financial strain, it is envisaged that the voluntary and community organisations will be called upon more to supplement health service and support requirements. Over the last several years well-known models of social prescribing have emerged and these include: exercise referral schemes; prescription for art; and healthy living schemes. A recent review of community referral schemes has found benefits of social prescribing to include: increases in self-esteem and confidence; a sense of control and empowerment; improvements in psychological wellbeing; and positive mood (Thomson et al
4 Appendix 3 provides a summary of the recent Public Health funded Valuing Our Communities work in
Tameside on asset based approaches and outlines a scope of how we can develop and embed this into a systematic plan. This information has been presented to the Care Together Models of Care Steering Group and the Healthy Lives Workstream.
2015). A social prescribing pilot project with GP practices and local Age UKs involved GPs referring older people with mild to moderate depression or who were lonely and socially isolated to Age UK services and this was seen as a successful model of partnership working between voluntary sector and general practitioners (Age UK, 2012).
5.16 Using the Rotherham model 5of social prescribing which has been extensively evaluated for
both effectiveness and return on investment, we propose to deliver this programme through our emerging Integrated Neighbourhood Model. At its core will be a team of Community Navigators in each of the five Neighbourhoods, providing a single gateway to voluntary and community support for GPs, other health and social care professionals and residents. They will receive referrals from GPs of eligible patients and carers or will be identified through risk stratification. The Community Navigators will assess support needs before referring on to appropriate VCFS services. Each Neighbourhood will also be allocated and administer a grant funding pot through which a 'menu' of community activities to meet the needs of local residents will be commissioned.
5.17 The Community Navigators will have experience and local knowledge and will be trained to
look behind presenting problems in order to identify the full range of issues/needs to provide personalised responses through ‘supported signposting’ . They will be supported by a network of community volunteers linked to GP practices based on the ‘Altogether Better’ model of health champions.6
5.18 An online directory and referral tool will be developed to enable the health and social care system to identify, assess and tap into the support on offer across the borough. A partnership web portal incorporating the JSNA and the current Partnership Information Portal (PIP) for Tameside and Glossop is planned to bring the statutory JSNA, PNA and JSAA together onto one innovative, easy to access and user friendly website. The website will hold high quality and timely data and intelligence for anyone to access and use in creative and inspiring ways. The intention is for this to:
help commissioners across Tameside and Glossop make evidence and knowledge based decisions.
enable residents understand health and wellbeing where they live, while giving them insight into how to make better decisions about their own health and wellbeing and where they might get help and support.
incorporate links that will signpost residents to the help they may need.
5 http://www4.shu.ac.uk/research/cresr/sites/shu.ac.uk/files/rotherham-social-prescribing-annual-eval-report-
2016_7.pdf 6 http://www.altogetherbetter.org.uk/
SOCIAL PRESCRIBING MODEL DESCRIPTOR
6. FUNDAMENTAL BUILDING BLOCKS 6.1 There are a number of fundamental building blocks to the Self Care model which will be
instrumental to the systematic scaling up and reach of the interventions. Neighbourhood planning and coordination and close alignment and synergy with the Integrated Neighbourhood workstream will be key to ensuring a seamless place based offer for local people.
6.2 The term ‘health literacy’ refers to people having the appropriate skills, knowledge,
understanding and confidence to access, understand, evaluate, use and navigate health and social care information and services. Levels of health literacy are also influenced by the provision of clear and accessible health and social care services and information for all (service responsiveness). The available evidence suggests that strategies to improve health literacy are important empowerment tools which have the potential to reduce health inequalities because the most vulnerable and disadvantaged people in society are at risk of limited health literacy and are known to have the poorest health outcomes.
6.3 The final building block of the model delivered across the whole current Healthy Lives
Programme – Engaging Communities and Changing Behaviour - aims to reduce the avoidable harm caused by lifestyle choices which key to improving healthy life expectancy, reducing avoidable mortality, maximising economic growth and prosperity and avoiding the costs of ‘failure demand’ across the entire system.
6.4 Engaging local citizens and enabling behaviour change forms part of a continuum of ‘self-
care’ proposals which represent a transformational shift at a local level. 6.5 It is proposed that this specific part of the proposition relating to engaging communities and
enabling behaviour change has 3 core elements:
Engaging local people and enabling participation
Implementing evidence based Behaviour Change approaches:
o At a population-level
o In ‘target’ communities
o With individuals
Maximising the impact of Social Marketing
Measuring Patient Activation 6.6 ‘Patient activation’ is a widely recognised concept. It describes the knowledge, skills and
confidence a person has in managing their own health and health care. We view the measurement of patient activation as a key tool in supporting us to deliver and measure change across the system. People who have low levels of activation are less likely to play an active role in staying healthy. They are less good at seeking help when they need it, at following a doctor’s advice and at managing their health when they are no longer being treated. Their lack of confidence and their experience of failing to manage their health often means that they prefer not to think about it.
6.7 The Patient Activation Measure (PAM) is a patient-reported measure that has been validated
in the United Kingdom. It is a powerful and reliable measure of patient activation. Patient activation scores have been robustly demonstrated to predict a number of health behaviours. They are closely linked to clinical outcomes, the costs of health care and patients’ ratings of their experience. Highly activated patients are more likely to adopt healthy behaviour, to have better clinical outcomes and lower rates of hospitalisation, and to report higher levels of satisfaction with services.
6.8 Patients with low activation levels are more likely to attend accident and emergency
departments, to be hospitalised or to be re-admitted to hospital after being discharged. This is likely to lead to higher health care costs. The relationship between patient activation and
health outcomes has been demonstrated across a range of different populations and health conditions. Intervening to increase activation can improve a patient’s engagement and health outcomes and is an important factor in helping patients to manage their health. Improvements in patient activation scores have been seen for up 18 months following intervention.
6.9 We would like to use the PAM in the following ways:
To support risk stratification tool – Our risk stratification methodologies assess people via a) their likely risk and b) the anticipated level of proactive support to be offered through the new model of care. We would aim to use the PAM score as an additional indicator of risk to ensure that we are able to prioritise the right people and support them in the most appropriate way.
As an individual tailoring tool – PAM will enable us to tailor supported self-care activity to most effectively meet the needs of people in Tameside and Glossop. We would want this to be used widely
Embedding the PAM in Primary Care with a risk stratified cohort; For individuals who receive support from newly formed Integrated
Neighbourhood Teams; Through our Community Navigators and Social Prescribing Programme Through our programme of Community Health Checks; Through the embedding of self-care approaches within a selected number of
chronic disease pathways;
As an outcome metric – Evidence highlights, improvements in PAM score can equate to reduction in activity and cost. When the PAM is embedded locally at sufficient scale we aim to include it as part of a newly developed outcomes framework for the Integrated Care Organisation. Patient Activation Measurement would sit alongside other metrics measuring patient experience, health and wellbeing indicators and system performance metrics.
6.10 Evidence shows that as the level of activation is improved, people experience better health,
have better outcomes, report better experience of care, engage in healthier behaviours, and have fewer episodes of emergency care that leads to lower costs for the NHS7. A study found that less activated patients had 8 percent higher costs in the base year and 21 percent higher costs in the following year than more activated patients.8 Evidence has also shown that when patients are fully informed about their options and outcomes, they choose fewer treatments, reducing the gap between what they want and what doctors think they want.
6.11 The Healthy Lives workstream are currently working together to submit a bid to NHSE to
fund 12,000 individual PAM licences covering the next 5 years to realise the ambition of our programme.
7. DEFINING OUTCOMES and INDICATORS OF SUCCESS 7.1 The Healthy Lives workstream continues to work with other Care Together workstream leads
to develop an Outcomes and Performance Framework which will evaluate the success of our approaches.
7.2 Key outcomes for the effectiveness of the model which will form part of our framework
include:
7 The King’s Fund (2014) Supporting People to Manage their Health: An introduction to Patient Activation
8 Hibbard J et al (2013) Patients with lower activation associated with higher costs; delivery systems should
know their patients' 'scores', Health Affairs (Millwood);32(2):216-22
To support the continuous improvement in the safety and effectiveness of community based support resulting in a positive experience for residents
To help people live healthily and independently and improve their quality of life in the community
To use personalised approaches to reduce demand for more formal health and social care services
To reduce unplanned activity through understanding people’s level of knowledge, skills and confidence through tailored self-care support.
To reduce the number of people with long term conditions requiring emergency hospital admission or attendance at A&E.
To ensure whenever possible and desirable people who access secondary care are enabled to recover both a quality of life and achieve independence of health and social care services
7.3 We intend to work closely with an academic partner to evaluate the efficacy of our model as
well as demonstrating delivery against commissioning priority objectives and various National Outcomes Frameworks. The Healthy Lives workstream are looking towards building a bid to the Health Foundation who have shown interest in our system wide approach. The Health Foundation is an independent charity committed to bringing about better health and care for people within the UK. The current call is for research teams who are able to explore ways that health, or health and social care services can address the challenge of increasing efficiency and value for money, with a focus on mental health or out of hospital care. The funding is available for each project to receive between £250,000 and £500,000 for research completed over three to five years.
7.4 Priority areas for this programme:
Allocative efficiency: achieving a more cost-effective mix of services within health and social care services to maximise the health of the UK
Aligning incentives: generating the greatest pull to improve efficiency and value for money
Technology and workforce: optimising the role of technology and the workforce to improve efficiency
Diffusion of best practice: optimising the spread and diffusion of efficient practice in health and social care services
7.5 The Healthy Lives workstream will be developing a research proposal with organisations within Care Together, voluntary sector, and an academic partner which is likely to be Salford University. This bid if successful will support the implementation and testing of our system wide model of self-management within Tameside and Glossop. Furthermore, it will provide a robust evaluation of the impact of both individual projects and the whole system impact of the programme. The research bid will focus a range of evaluations including system, economic and patient centred. While these calls are very competitive, the uniqueness and scale of the approach being adopted within Tameside and Glossop provides an excellent fit with the objectives
.
APPENDIX 1 SUPPORTING INFORMATION
The landscape of health and social care has changed dramatically over the past decades. Ill health no longer centres on the communicable diseases of the past and the number of people with three or more long term conditions is set to rise from 1.9 million in 2008 to 2.9 million in 2018. 70% of total expenditure on health and care in England is associated with the treatment of the 30% of the population with one long term condition or more. Therefore the traditional models of delivery of health and social care are not sustainable or desirable in their current form. There needs to be a fundamental and sustained shift from treat of disease to prevention. This situation is compounded by the current financial challenges within health and social care economies. By 2020 the gap between need and resource nationally will be 25 billion. The table below demonstrates the North West has the highest avoidable mortality rates within the UK. This is one indicator of the health challenges faced by our local health economies
Greater Manchester perspective Tameside and Glossop Care Together partners are part of a wider Greater Manchester health and social care system. In February 2015, the 37 NHS organisations and local authorities in Greater Manchester (GM) signed a landmark agreement with the government to take charge of health and social care spending and decisions in the Greater Manchester area; Tameside and Glossop Clinical Commissioning Group and Tameside Council are two of the 37 organisations. Greater Manchester has the fastest growing economy in the country and yet people here die younger than people in other parts of England. Within Tameside and Glossop people become ill at a younger age and live with their illness longer than in other parts of the country. In addition, the growing numbers of older people living in the area often have many long term health issues to manage. Devolution enables a change to the way we currently spend £6 billion on health and social care in GM; without change, by 2021 more people will be suffering from poor health and we will be facing a £2 billion shortfall in funding for health and social care services.
In December 2015, the Strategic Plan: Taking Charge of Health and Social Care in Greater Manchester (the Plan), was published and approved. The goal of the Plan is to see the greatest and fastest improvement to the health, wealth and wellbeing of the 2.8 million people in the towns and cities of Greater Manchester over the next 5 years. The Plan recognises the need to focus on people and place, not organisations. This means that there will be a responsibility for everyone to work together, from individuals, families and communities to the approximately 100,000 staff working in the NHS and social care, the voluntary sector and other public bodies. The Plan demonstrates the need to take action not just in health and social care, but across the whole range of public services so that people in GM can start well, live well and age well. The GM Plan was built from the ten locality plans created by the local authorities and NHS in each part of Greater Manchester, as well as the hospitals and other providers of NHS services.
Life in Tameside and Glossop The health and wellbeing outcomes for people in Tameside and Glossop are generally worse than the England averages. It is the ambition of the Healthy Lives work stream to change the course of how health and social care is delivered across Tameside and Glossop and support the community to gain control of their health outcomes. 70% of all preventable deaths in Tameside and Glossop are linked to 4 conditions (Liver disease, Heart disease, Respiratory disease, and Cancer),and these conditions have causative links within 4 lifestyle behaviours (Alcohol, Physical activity, Smoking and Diet). Healthy life expectancy is the average equivalent number of years a person can expect to live in full health. Healthy life expectancy within Tameside is currently 57.5 years for males and 56.8 years for females this remains significantly lower than the England national average of 63.2 years for males and 64.2 years for females. However, it is important to note that there are significant differences across Tameside with high correlation between depravation and lower life expectancy. There are over an eight year difference in male life expectancy from 71.6 in St. Peter’s to 79.8 in Denton West. Across Tameside wards there are over a seven year difference between in female life expectancy from 83.8 in Droylsden West to 76.2 in St. Peter’s. The table below indicators of deprivation spread across Tameside.
Tameside Health and Wellbeing at a glance:
Health and well-being of people in Tameside is generally worse than the England average
Deprivation is higher in Tameside with around 10,300 children living in poverty
Life expectancy at birth for both males and females is lower than the England average (75.9 years males, 80.5 years females)
Life expectancy locally is 8.9 years lower for men and 6.9 years lower for women in the most deprived areas of Tameside compared to the least deprived areas.
Healthy life expectancy at birth is currently 57.4 years for males in Tameside and 56.6 years for females in Tameside. This is significantly lower than the England averages.
In year 6, 18.6% of children are classified as obese, under 18 alcohol specific hospital admissions, breast feeding initiation and at 6 to 8 weeks and smoking in pregnancy are all worse than the England average.
In adults the recorded diabetes prevalence, excess weight and drug and alcohol misuse are significantly worse than the England average
Rates of smoking related deaths and hospital admissions for alcohol harm are significantly higher than the England average
For overall premature deaths, Tameside is ranked 138th out of 150 Local Authorities in England (<75 years)
For premature deaths from Cancer, Tameside is ranked 133rd out of 150 Local Authorities in England
For premature deaths from heart disease and stroke, Tameside is ranked 145th out of 150 Local Authorities in England
Within the Care Together programme we have committed to creating a care system that is financially balanced within 5 years. Through the Commissioning for Reform Strategy there is a requirement to save £70 million to develop an sustainable, affordable model of care.
Creating an Integrated Care Organisation In October 2015 a memorandum of understanding was signed by NHS Tameside and Glossop Clinical commissioning, Tameside NHS Foundation Trust, and Tameside metropolitan Council setting a joint commitment to delivering a new model of care through an integrated care organisation (ICO). Overtime it is envisage that this organisation will be responsible for managing the majority of care delivered in the Tameside and Glossop area across all settings. This will require integration of primary, community and secondary physical and mental health care, public health programmes and social care services as well as co-ordinating and commissioning services from other providers e.g. voluntary and faith sectors. It is expected that the ICO, alongside provision of services, will take on many of the responsibilities and functions of the existing commissioners such as contracting and procurement as it becomes the ‘prime provider’ and ‘market manager’.
APPENDIX 2 Risk Stratification : A Happier, Healthier and more prosperous Tameside and Glossop – meeting the ambition The cornerstone of successful delivery of the Healthy Lives model will be its potential to increase healthy life expectancy in the population. Healthy life expectancy at birth is a summary measure of mortality and morbidity in an area. It is defined as the average number of years a person would expect to live in good health based on contemporary mortality rates and the prevalence of self -reported good health. The latter is derived from the general health question in the Annual Population Survey (PHE). Three years of data are combined to improve the robustness of the information.
Unlike the Health Deprivation and Disability Domain of the Index of Multiple Deprivation it provides and absolute measure of health in an area. .In order to reach our ambition of a healthier, happier more prosperous Tameside and Glossop we will need increase healthy life expectancy for our males by 5.4 years and for females 5.3 years, to bring us in line with the rest of England. It is evident that to achieve this we need to improve outcomes across the life course from early years to older years, through tackling not only pure health related outcomes such as cancer and heart disease but by improving the wider determinants of health such as poverty and education. The tables below (Tameside and Glossop are highlighted in green) illustrate the percentage and numerical change Tameside and Glossop need to achieve to reach our accumulative contribution to the Greater Manchester ambition to improve outcomes for local residents.
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NHS Bolton CCG 11.1% 11.1% 11.1% 9.2% 9.2% 9.2% 10.9%
Bolton MBC 11.1% 11.1% 11.1% 9.2% 9.2% 9.2% 10.9%
NHS Bury CCG 4.9% 4.9% 4.9% 4.5% 4.5% 4.5% 5.2%
Bury MBC 4.9% 4.9% 4.9% 4.5% 4.5% 4.5% 5.2%
NHS North Manchester CCG 10.6% 10.6% 10.6% 9.4% 9.4% 9.4% 8.5% Manchester CC 28.2% 28.2% 28.2% 29.1% 29.1% 29.1% 23.7% NHS Central Manchester CCG 10.1% 10.1% 10.1% 11.0% 11.0% 11.0% 7.4% NHS South Manchester CCG 7.5% 7.5% 7.5% 8.7% 8.7% 8.7% 7.8%
NHS Oldham CCG 10.4% 10.4% 10.4% 7.5% 7.5% 7.5% 8.0%
Oldham MBC 10.4% 10.4% 10.4% 7.5% 7.5% 7.5% 8.0% NHS Heywood, Middleton and Rochdale CCG 9.9% 9.9% 9.9% 8.6% 8.6% 8.6% 8.9%
Rochdale MBC 9.9% 9.9% 9.9% 8.6% 8.6% 8.6% 8.9%
NHS Salford CCG 9.3% 9.3% 9.3% 10.8% 10.8% 10.8% 11.1%
Salford CC 9.3% 9.3% 9.3% 10.8% 10.8% 10.8% 11.1%
NHS Stockport CCG 4.7% 4.7% 4.7% 6.6% 6.6% 6.6% 6.0%
Stockport MBC 4.7% 4.7% 4.7% 6.6% 6.6% 6.6% 6.0%
NHS Tameside and Glossop CCG
9.3% 9.3% 9.3% 9.9% 9.9% 9.9% 9.0%
Tameside MBC 8.6% 8.6% 8.6% 9.3% 9.3% 9.3% 8.3%
Glossopdale* 0.7% 0.7% 0.7% 0.6% 0.6% 0.6% 0.8%
NHS Trafford CCG 3.7% 3.7% 3.7% 3.6% 3.6% 3.6% 5.1%
Trafford MBC 3.7% 3.7% 3.7% 3.6% 3.6% 3.6% 5.1%
NHS Wigan Borough CCG 8.5% 8.5% 8.5% 10.2% 10.2% 10.2% 12.0%
Wigan MBC 8.5% 8.5% 8.5% 10.2% 10.2% 10.2% 12.0%
Total 100% 100% 100% 100% 100% 100% 100%
Total 100% 100% 100% 100% 100% 100% 100%
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NHS Bolton CCG 390 30 1,774 55 120 53 299
Bolton MBC 390 30 1,774 55 120 53 299
NHS Bury CCG 173 13 786 27 58 26 143
Bury MBC 173 13 786 27 58 26 143
NHS North Manchester CCG 372 29 1,691 56 122 54 234
Manchester CC 994 76 4,517 174 378 168 653 NHS Central Manchester CCG 357 27 1,622 66 143 64 204
NHS South Manchester CCG 265 20 1,204 52 113 50 215
NHS Oldham CCG 366 28 1,665 45 97 44 220
Oldham MBC 366 28 1,665 45 97 44 220 NHS Heywood, Middleton and Rochdale CCG 350 27 1,590 52 112 50 243
Rochdale MBC 350 27 1,590 52 112 50 243
NHS Salford CCG 327 25 1,485 65 140 63 307
Salford CC 327 25 1,485 65 140 63 307
NHS Stockport CCG 164 13 747 40 86 38 166
Stockport MBC 164 13 747 40 86 38 166
NHS Tameside and Glossop CCG
326 25 1,482 59 129 58 249
Tameside MBC 302 23 1,373 56 121 55 228
Glossopdale* 24 2 109 3 8 3 21
NHS Trafford CCG 130 10 589 22 47 21 140
Trafford MBC 130 10 589 22 47 21 140
NHS Wigan Borough CCG 300 23 1,365 61 133 59 330
Wigan MBC 300 23 1,365 61 133 59 330
Total 3,520 270 16,000 600 1,300 580 2,750
Total 3,520 270 16,000 600 1,300 580 2,750
The table below illustrates Healthy Life Expectancy (HLE) across Greater Manchester. Although Tameside has the lowest HLE in Greater Manchester progress has been made with increases in healthy life expectancy for both males and females (2009 – 2011 to 2011 – 2013). Healthy life expectancy was not calculated before 2009. Tameside has also seen reduction in the gap in healthy life expectancy with England for both males and females (2009 – 2011 to 2011 – 2013).
Healthy Life Expectancy in Greater Manchester
To achieve our local ambition of improving healthy life expectancy and reducing inequalities for our residents the ambition needs to be greater than the Greater Manchester collective if we are to achieve a healthy life expectancy that is similar or equals the England average. This therefore means that we will have to reduce our premature mortality rates considered preventable by 33% and increase our residents’ self-reported health of very good and good and reduce self-reported bad health. Self-reported health The following table illustrates the percentage of people who rated their health under the various categories and the percentage change and numbers of residents needed to self-report their health under the three categories in a more positive way as to impact on healthy life expectancy.
Census Category
Tameside England Difference
% number % number % number
Very good health 44.0 80,072 47.2 n/a 6.8 5,444
good health 33.7 61,328 34.2 n/a 1.5 920
bad health 5.7 10,373 4.2 n/a 26.3 -2,728 Source: PHE, Annual Health Survey 13/14
The table below illustrates the number of residents needed year on year to self-report their health in a more positive way.
Census category
2016 2017 2018 2019 2020
total change total change total change total change total
Very good health 80,072 1,361 81433 1384 82817 1407 84224 1441 85665
good health 61,328 245 61573 246 61819 2472 64291 257 64548
bad health 10,373 -685 9688 -639 9049 -597 8452 -557 7895
Please note that this PHE annual population survey is a random sample and not a whole population survey. Therefore to monitor progress we need to close the percentage gap between Tameside and England year on year by 1.7% increase for self-reported very good health; 0.4% increase for self-reported good health; 6.6% decrease for self-reported bad health. Preventable Premature Mortality To deliver on the Tameside and Glossop contribution to the reduction of premature mortality for Greater Manchester over the next 5 years, Tameside and Glossop will need to reduce its premature mortality rates. This equates to 59 fewer deaths from CVD, 129 fewer deaths from preventable cancer and 58 fewer deaths from respiratory disease. However for Tameside and Glossop to reach its ambition locally to increase healthy life expectancy to the England average we need to improve further on the Greater Manchester contribution. Below is a table that illustrates the mortality rates for Tameside and Glossop against the England average. The table highlights that Tameside and Glossop need to reduce overall premature mortality by 542 deaths over 5 years to meet our local ambition compared to the GM target of 246. The table below also includes preventable mortality from liver disease as liver disease play a major role in our premature mortality rates.
England
Rate number Rate %
Under 75 preventable mortality 272.4 1,643 182.7 33%
Under 75 preventable cancer mortality 171.3 951 141.5 17.4%
Under 75 preventable CVD mortality 83.5 460 49.2 41.1%
Under 75 preventable respiratory disease 42.4 143 32.6 23.1%
Under 75 preventable liver disease 21.8 127 15.7 28%
DifferenceTameside &
GlossopPreventable mortality
The following table illustrates the percentage contribution each condition plays in the overall preventable mortality rate and the number of fewer deaths we need to achieve to reach the England average.
Condition
% Contribution
to preventable
mortality
number of deaths
less to achieve
England average
Under 75 preventable mortality 542
Under 75 preventable cancer mortality 53.8 141
Under 75 preventable CVD mortality 26 230
Under 75 preventable respiratory disease 13 94
Under 75 preventable liver disease 7.2 78
The table below highlights the number of fewer deaths Tameside and Glossop need to achieve over the five years to 2020.
Condition Number of deaths less each year needed
2016 2017 2018 2019 2020
Under 75 preventable mortality 109 108 108 108 109 (9) less deaths each month
Under 75 preventable cancer mortality 28 28 28 28 28
(2) less deaths each month
Under 75 preventable CVD mortality 46 46 46 46 46
(4) less deaths each month
Under 75 preventable respiratory disease 19 19 19 19 19
(2) less deaths each month
Under 75 preventable liver disease 16 16 16 16 16 (1) less deaths each month
The tables above illustrate the scale of the challenge for Tameside and Glossop. Therefore the next section will look at the lifestyle choices and behaviours our residents make that have the greatest impact on premature mortality. Sub Outcome measures for Tameside and Glossop (Health, lifestyles and self-care and wider social determinants) The following categories are the lifestyle and health issues of our residents that impact directly on premature mortality and the number/% change needed to significantly reduce the burden of
disease on mortality across Tameside and Glossop. Improvements in these outcomes will have a major impact on mortality over the next 5 to 10 years. Data below relates to latest data 14/15.
England
% number % % number Direction
Binge drinking 25.6 45,418 20.1 21% 9758
Smoking 22.5 39,918 18 20% 7,984
over weight and obese adults 66.8 118,512 64.6 25% 29,805
Physically active 50.7 89,948 57 11% 11,177
Physically inactive 29.9 53,046 27.7 13% 3,903
uncontrolled hypertension 17.2 6,143 16 13% 799
uncontrolled glucose levels (those with diabetes) 29.1 3,742 30.3 14% 524
uncontrolled cholesterol levels (those with CHD) 38.1 3,155 30.9 19% 599
Falls in people aged 65+ (rate) 2256 822 2125 6% 49
Flu vaccination in people aged 65 years and over 73.4 30,750 69.8 2% 615
Flu vaccination in people under 65 years with a LTC 50.1 16,225 43.6 33% 5,354
Tameside & GlossopLife Style and Health Issue
Change needed
The table below gives an indication of the rate of improvement needed against the same range of health issues over the next 5 years, and the number of residents who will need to be engaged in behaviour change to improve healthy lifestyles.
Lifestyle and Health Issue Number of residents each year Total
Improvement Annual
Improvement Quarterly
Improvement 2016 2017 2018 2019 2020 2021
Binge drinking 45,418 43,466 41,515 39,563 37,611 35,660 9,758 1,952 488
Smoking 39,918 38,321 36,724 35,128 33,531 31,934 7,984 1,597 399
over weight and obese adults 118,512 112,551 106,590 100,629 94,668 88,707 29,805 5,961 1,490
Physically active 89,948 92,184 94,419 96,655 98,890 101,125 11,177 2,235 559
Physically inactive 53,046 52,266 51,485 50,705 49,924 49,143 3,903 781 195
uncontrolled hypertension 6,143 5,983 5,824 5,664 5,504 5,344 799 160 40
uncontrolled glucose levels (those with diabetes) 3,742 3,637 3,532 3,428 3,323 3,218 524 105 26
uncontrolled cholesterol levels (those with CHD) 3,155 3,035 2,915 2,795 2,675 2,556 599 120 30
Falls in people aged 65+ (rate) 822 812 802 793 783 773 49 10 2
Flu vaccination in people aged 65 years and over 30,750 30,873 30,996 31,119 31,242 31,365 615 123 31
Flu vaccination in people under 65 years with a LTC 16,225 17,296 18,367 19,438 20,508 21,579 5,354 1,071 268
Many residents will fall into one or more of the above categories, and hence the importance of working with individuals and populations in a holistic manner. Evidence tells us that people from more affluent backgrounds that experience a higher quality education, have more fulfilling jobs and higher salaries are less likely to choose lifestyles that are detrimental to health and are more likely to have the confidence, knowledge and ability (health literacy) to take better care of themselves. Improvements in these outcomes will have a major impact on the health and wellbeing outcomes in 10 to 20 years. Reducing health inequalities is a matter of fairness and social justice. In England, the many people who are currently dying prematurely each year as a result of health inequalities would otherwise have enjoyed, in total, between 1.3 and 2.5 million extra years of life. There is a social gradient in health – the lower a person’s social position, the worse his or her health. Action should focus on reducing the gradient in health. Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health. http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review The table below illustrates the year on year improvements needed to reach the England average and to support our ambition to reduce preventable mortality rates and increase healthy life expectancy.
England
% number % % number Direction
Child Poverty 22.3 9,850 18.6 17% 1,634
School Readiness 57.8 1,812 66.1 13% 236
Qualifications of NVQ level 3 + 48.4 68,000 56.5 14% 9,520
In employment 70.5 102,500 77.8 9% 9,225
Out of work benefit claimaints 2.8 3,925 1.8 36% 1,413
Long term sickness 33.2 12,200 21 37% 4,514
Self reported wellbeing (low happiness) 11.5 20,402 9 22% 4,489
Self reported wellbeing (low staisfaction 7.3 12,951 4.8 34% 4,403
Tameside Change neededWider Determinants of Health & Wellbeing
Our health is influenced by a wide range of social, economic and environmental factors. We as individuals cannot always control them and they influence and often constrain the ‘choices' we make and the lifestyle we lead. Looking at the areas around the wider determinants, progress needs to be achieved over a longer time frame, but we still need to see year on year improvements to ensure future mortality rates continue to fall. Tackling the wider determinants will have the biggest impact overall because more affluent populations experience better health outcomes and are less of a burden on the health and social care economy People and Places The following section will highlight the geographic areas of Tameside and Glossop (LSOA & ward), where people live who have current health challenges and are likely to be high end users of secondary health and social care services and populations that are at risk of becoming health challenges. Each wellbeing segment will illustrate the top 5 Lower Super Output Areas.
HEALTH CHALLENGES People with health challenges in Tameside and Glossop account for 23% of the total population (approximately 51,000 people). A total of 133 LSOAs have people residing that fall into this category. The neighbourhoods in this category contain residents with some of the biggest health challenges in the borough. They are likely to include some of the oldest people with the highest number of medical conditions or relatively young people living alone or in a lone parent family in a small social rented terrace or flat. The proportion of individuals taking four or more prescribed medicines is almost 3 times the national average, in the older age group, with many treating issues concerning cardio-vascular, gastrointestinal, the central nervous system and the endocrine system. This population are likely to be at high risk of a hospital admission. The five LSOA areas with the most people in this category are: Typically 42% might be obese with over 40% reporting that they generally eat less than two portions of fruit or vegetables per day. A similar proportion may have been diagnosed with high blood pressure. Other ailments such as diabetes, heart problems and asthma may also be more prevalent here. Unsurprisingly, the view of more than a quarter of the population of these wards report that their health is bad or very bad.
LSOA
WARD
The health
challenges in these LSOAs
effect approximately 5,563 residents (11% of people
with health challenges)
E01005981 Denton South
E01005984 Denton South
E01006016 Dukinfield
E01006027 Hyde Godley
E01006052 Longdendale
Incidents of smoking are high in these communities with spending on tobacco at almost 70% above average resulting in high incidents of breathlessness, asthma and cancer. People in the health challenges group need a lot of support to manage their health conditions or lifestyle behaviours in order to prevent recurrent use of secondary hospital care. Examples of targeted interventions for this group:
Specialist Care in community settings
Self Care/ Self Management support
Case Management
Support with Healthy Lifestyle/ Behaviour change
Social Prescribing/ Community Referral
TARGET POPULATIONS PREVALENT IN HEALTH CHALLENGES GROUP Limited Living The group make up around 2.3% of the population of Tameside and Glossop (approximately 4,984 people). This population contain people with some of the biggest health challenges in the UK. They are likely to include some of the oldest people with the highest number of medical conditions. The 5 LSOAs with the most people in this category are:
Incidence of smoking are high in these
communities with spending on tobacco at almost 70% above average resulting in high incidents of breathlessness, asthma and cancer. However, alcohol consumption is low with almost 60% abstaining completely. Typically 42% might be obese with over 40% reporting that they generally eat less than two portions of fruit or vegetables per day. A similar proportion may have been diagnosed with high blood pressure. Other ailments such as diabetes, heart problems and asthma may also be more prevalent here.
LSOA
WARD
The ‘Limited Living’ in these LSOAs effect approximately 2,395 residents
E01005948 St Peter’s
E01005952 St Peter’s
E01006016 Dukinfield
E01006019 Dukinfield/Stalybridge
E01006028 Hyde Godley
SCENARIO Mary Mary is 72 and lives alone, in her own home in Denton. Her husband, Arthur died 4 years ago. Mary has complex health needs, and a diagnosis of heart failure. Prior to his death, Arthur cared for Mary and she was dependant on him for transport to social events, hospital appointments and getting prescriptions. Following Arthurs death, Mary became increasingly socially isolated and her heath and emotional wellbeing deteriorated. Mary’s daughter was very concerned that she would not be able to remain living independently. Mary’s daughter lives away from Denton and was increasingly worried about her mum. She contacted Age UK who have been able to work with a range of partners to ensure that Mary’s needs are being met, her health is remaining stable and she is able to get out and about. Paul, a Health and Wellbeing advisor based in the Locality Care Coordination Team met with Mary and her daughter and identified where efforts were being duplicated, and where gaps existed in Mary’s care, and they developed a plan together. Mary and her daughter also worked with Paul to describe the sorts of things that Mary liked to do and drew up a list of possible social activities that Mary could get involved in, including a gentle exercise programme designed for those with heart failure that will help to maintain Mary’s flexibility and physical fitness. Paul liaised with secondary care colleagues to co-ordinate Marys secondary care appointments which meant that Mary only now has to attend the hospital once every 6 weeks, rather than once every 3 weeks as previously. This means that Marys daughter is able to attend all her hospital appointments with her. Mary is now part of a number of groups in her local community, including time banking which gives her access to a meal sharing scheme guaranteeing three hot meals a week. She also attends a luncheon club twice a week. The local primary school have been doing some work on intergenerational projects. Through this work Mary has been linked to Year 6 pupils who work with her to do an online food shop and help her put it away once it is delivered. Mary also received financial advice from Citizens Advice Bureau, and is now in receipt of all the benefits she is entitled to which means she feels more able to keep her home warm. Mary is now physically healthier, happier and feels a more independent part of her local community.
Hardship Heartlands This population make up around 11% of the total resident population of Tameside and Glossop (24,113 people) A large proportion of this population are more likely to be either living alone or be a lone parent family in a small social rented terrace or flat. These relatively young people are likely to be employed in lower skilled trades with many being long term unemployed. The 5 LSOAs with the most people in this category are:
LSOA
WARD
The ‘Hardship Heartlands’ in E01005945 Ashton St Michael’s
For a community that has so many young people there are relatively high proportions that have oral problems. A number of key unhealthy behaviours are displayed here with many drinking in excess of double the recommended alcohol units. Smoking and low consumption of fruit and vegetables is also high. Interests and hobbies involving physical activities such as exercise, sports, hiking and walking are both less likely than the national average. The consequence of such an unhealthy lifestyle can be seen in high incidence of conditions such as obesity, bronchitis/emphysema, asthma, kidney complaints and angina. There are also above average levels of mental illness including anxiety and depression. AT RISK POPULATIONS People ‘At Risk’ in Tameside and Glossop account for 32% of the total population (approximately 69,325 people). A total of 127 LSOAs have people residing that fall into this category. These neighbourhoods do not generally have high incidences of illness. However, multiple unhealthy behaviours, as a result of their lifestyles, could put their health at risk in the future. They have the highest rates of smoking in the country along with some alcohol concerns. Social issues such as unemployment, debt and dissatisfaction with life overall contribute to one of the lowest scores on the mental wellbeing scale.
The 5 LSOAs with the most people in this category are:
Populations living within the at risk groups are usually families living on less well-off estates, private renters of smaller homes with school age children. The area will be ethnically diverse with a high proportion of people from BME backgrounds. Younger people in these areas tend to be single or lone parents living in small terrace type housing.
these LSOAs effect
approximately 6,056 residents
E01005953 St Peter’s
E01005956 Mossley
E01006065 Stalybridge North
E01005984 Denton South
LSOA
WARD
The ‘At Risk’ in these LSOAs
effect approximately 6,922 residents
E01005943 Ashton St Michael’s
E01005946 Ashton St Michael’s
E01005948 St Peter’s
E01005953 St Peter’s
E01005974 Denton North East
E01005999 Droylsden East
This group have low consumption levels of fruit and vegetables, higher than average consumption of alcohol and low levels of physical activity; a high proportion smoke or use tobacco. A high number of the population work in lower supervisory or semi-routine occupations or will be unemployed. There are higher levels of mental illness, anxiety and depression in these areas. Diets tend to be poor and there are higher than average levels of obesity and asthma. Examples of targeted interventions for this group:
Health and Wellbeing Services
Early Years Delivery Model – Healthy Child Programme
NHS Healthchecks
Mental Health Promotion programmes
Working Well Programme
Social Prescribing
Financial Resilience and debt advice outreach in primary care
SCENARIO CAZ Caz is 19 and has just moved into her first flat with her daughter Ellie. She receives benefits and money is tight. Caz is very anxious and has suffered from postnatal depression since Ellie was born 2 years ago. The flat is very small and in need of decorating and Caz has little furniture or toys for Ellie. Caz enjoys being outside with Ellie, and finds that it improves her mood but there is no usable outside space near the flats and the park is a long walk away. Caz has no local friends with children and is feeling increasingly isolated. Caz struggled at school, and has low literacy levels which makes claiming her benefits difficult. She would like to attend college once Ellie is 2 but is worried that she will not be able to do this. Caz was looked after by the local authority from the age of 7 when her mum went to prison and was unable to care for her. This means that Caz has no real family support network for herself and Ellie. Caz’s health visitor, Julie was aware that Caz and Ellie needed extra help after working with Caz to assess Ellie’s development at age 2yrs. Julie was able to work with the local children’s centre early years workers to identify existing groups that Caz and Ellie could attend and they are now part of several play and parenting sessions which they both enjoy. This has improved Caz’s parenting abilities and her relationship with her daughter. Ellie’s routine and diet has improved as a result. Caz now feels that her daughter will be ready to take up her free 15 hours of nursery care from September. Caz feels better able to manage her anxiety and feels more able to ask for help and support. The parenting sessions have helped Caz create a safer environment for her daughter and resulted in a decrease in the number of attendances at A and E for Ellie for minor injuries. Caz is now enrolled in an access course for college and is improving her reading and writing skills. Being able to read Ellie a bedtime story is very important to her. Through attending the children’s centre, Caz became aware of time banking groups that run in her local area, and she is now part of a visiting scheme for elderly neighbours and spends an afternoon a week with Mary who lives alone in her local area. Mary loves having Caz and
Elllie nearby and Ellie loves playing in Mary’s garden. Mary supports Caz, gives her advice when needed and enjoys supporting her while she is improving her literary skills. Through her local GP surgery Caz was made aware of a local voluntary group who were able to support Caz to improve her living environment by providing good clean furniture that they repurpose that would have previously gone to landfill. They also have access to a range of left over paints that householders bring to them rather than take to the tip and Caz plans to redecorate Ellie’s room soon.
TARGET POPULATIONS PREVALENT IN AT RISK GROUP Struggling Smokers This group make up around 4.3% of the population (approximately 9379 people). The proportion of people in receipt of job seekers allowance and illness or disability benefit is more than double the national average. Those who do work tend to work in low paid occupations. The 5 LSOAs with the most people in this category are: These areas have the highest levels of smoking in the country, almost half are smokers. Their expenditure on tobacco is 43% above the national average. Consequently, some 10% may register at 3 or above on the MRC Breathlessness Scale. Even though many of the people in this type express dissatisfaction with their health and rate their own health as bad or very bad, the actual number of conditions is well below the national average. The proportion taking 2+ prescribed medicines is about 23% below the average. There is a gender divide regarding hazardous drinking, whereas men are more likely to be above the recommended level, women are less likely to be so. Of the medications they do take, they are likely to be for respiratory conditions and problems with the central nervous system. However, this group or residents are at significant risk of future limiting long term conditions. Dangerous Dependencies This group make up around 3.3% of the total Tameside & Glossop population (approximately 7,283 people). These areas are made up of families that live in less well-off estates, often renting their terraced homes privately. Some households will contain a single parent and there are many children in these neighbourhoods, often under 10 years old. Almost half of the households have an annual income of less than £20,000 with benefits supplementing
LSOA
WARD
The ‘Struggling
Smoker’s’ in these LSOAs
effect approximately 2,395 residents
E01005945 Ashton St Michael’s
E01005953 St Peter’s
E01005956 Mossley
E01006065 Stalybridge North
E01005984 Denton South
many incomes. Debt levels are notably higher than elsewhere with almost a tenth of households struggling to pay debts of over £5,000The 5 LSOAs with the most people in this category are:
Although there is a sense of community here, with some people having membership of social and community groups, there are also significant problems within the neighbourhood with over a quarter experiencing some issue with vandalism or crime. There is also a lot of dissatisfaction with their houses and life overall. Diets tend to be poor with more than 35% eating less than 2 portions of fruit and vegetables and obesity levels are almost 50% higher than average. 36% are smokers and some of the highest proportions of people drinking more than twice the recommended alcohol units are found here – issues with the endocrine system is almost 30% above the national norm. (For example: Cushing's disease, Hyperthyroidism, Polycystic ovary syndrome). The number of prescribed medicines is close to national levels, but this is probably due to the age breakdown of this group. However, prescriptions for respiratory and skin complaints along with anxiety and depression are common.
LSOA
WARD
The ‘Dangerous Dependencies’ in these LSOAs effect approximately 2,938 residents
E01005941 Ashton St Michael’s
E01005946 Ashton St Michael’s
E01005947 Ashton St Michael’s
E01006051 Ashton St Peter’s
E01005953 Ashton St Peter’s
APPENDIX 3
VALUING OUR COMMUNITIES – AN ASSET BASED APPROACH 1. DOCUMENT PURPOSE
1.1 This report provides a summary of the recent Tameside work on asset based
approaches and outlines a scope of how we can develop and embed this into a systematic plan.
2. DEFINITION
2.1 Community centred approaches and an asset based approach 2.2 Public Health England (PHE) and NHSE published, ”A Guide to Community Centred
Approaches for Health and Wellbeing” (February 2015). Professor Jane South led the work and the report summarises the research and learning on community centred approaches. It provides guidance for a case for change, key concepts, varieties of approach and sources of evidence. Figure 1 shows the family of family of community centred approaches. The term community centred rather than community based is used because these approaches draw on community assets and are non-clinical.
2.3 Figure 1: The family of community-centred approaches with examples of common UK models
Source: South, J (2015) A guide to community-centred approaches for health and wellbeing: Full report
2.4 There is an impetus to shift to a more people and community centred approach to health and wellbeing. The core concepts that underpin this are:
Voice and control – Power and participation matter at an individual and collective level.
Equity – a decrease in avoidable inequalities.
Social connectedness leading to healthier, cohesive communities. 2.5 Community centred approaches do not tend to deliver neat, simple solutions.
Desired outcomes are often connected to improvements in mental and physical wellbeing. When interventions are working well these outcomes are reinforced by supportive processes so there is sustainable social action. Asset based approaches are not a prescriptive set of operations that can be easily ‘scaled up’ or ‘rolled out’ but are forms of engagement and relationship building that enable strengths, capacities and abilities to be identified and developed for positive outcomes. They all share the key features of valuing the positive capacity, skills and knowledge and connections in a community:
Assets are the strengths, skills, capacities and resources which enhance the capability of individuals and communities to sustain health and wellbeing.
An asset approach involves refocusing from an approach based on the deficits that produce illness to an approach based on the factors that produce health.
This includes how we describe, assess, evaluate and improve health through policy, practice and intelligence. We can identify assets through asset mapping, appreciative enquiry and participatory appraisal; create a Joint Strategic Assets Assessment (JSAA) to complement and/or integrate with an area’s Joint Strategic Needs Assessment (JSNA) which supports assessing what approaches and services are available locally, so our citizens can make informed decisions and choices about their health and wellbeing.
Community assets are the assets that exist within a community that people within it say are important to their health and wellbeing. Assets can be mobilised by asset based methods such as asset based community development (ABCD), time-banking, co-production, social prescribing (or community referral), participatory budgeting.
3. HEALTH OUTCOMES AND EVIDENCE
3.1 There are inherent difficulties measuring assets and their relationship to wellbeing.
Evaluating asset based approaches is therefore challenging. Much of the evidence available is case study based and a significant number of these may have been retrospectively labelled ‘asset based’. Outcomes cannot always be predetermined.
3.2 The National Institute for Health and Care Excellence (NICE) guidance endorses community engagement as a strategy for health improvement. There is a substantial body of evidence on community participation and empowerment and on the health benefits of volunteering. The current evidence base does not fully reflect the rich diversity of community practice in England. Cost-effectiveness evidence is still limited; nevertheless research indicates that community capacity building and volunteering bring a positive return on investment.
4. LOCAL EXAMPLES OF ASSET BASED APPROACHES
4.1 CVAT: Valuing Our Communities: (February 2014-March 2016) 4.2 The Steering Group (made up of representatives from the Public Health Team,
Neighbourhood Services, Community and Voluntary Action Tameside (CVAT) and
the Community Audit and Education Centre of Manchester Metropolitan University (MMU)) identified a number of key steps to further strengthen a partnership approach to embedding asset based approaches within community development (ABCD), as per the Healthy and Wellbeing Strategy. These include:
CVAT mapped local examples of asset based community development in Tameside that had previously been delivered via other programmes. These include local time-banking schemes delivered by the Volunteer Centre in Tameside in partnership with New Charter Housing Trust; and participatory budgeting work. In Tameside, CVAT have used participatory budgeting techniques in the You Choose Scheme, and also in the ‘I love Hyde’ Grants Scheme. Within the South Partnership area (the initial focus of the project); Hyde Community Action has good case studies and evaluation of the Bengali’s Women Programme (2011-2014) and the Young Voice of Hyde youth-led research project. Further information on these local case studies can be found on the CVAT website: www.cvat.org.uk/valuing-our-communities
Training of local residents to become community researchers to help create a framework for measuring the effectiveness of ABCD in Tameside.
MMU researched how best to identify changes in community resilience and social value in the context of wellbeing. This learning was then developed into an evaluation framework that is responsive to local community application and changes in the external environment. It also builds on and complements a number of on-going initiatives within Tameside:
o Joint Health and Wellbeing Strategy o The Tameside Wellness Offer o Strategic Neighbourhood Partnerships o Social Value
The evaluation framework is designed to be used at a strategic borough wide and area level, and with individual projects. See the end of this report.
Building on the initial asset mapping exercise carried out by the Neighbourhood Teams to help inform Neighbourhood Plans. The aim is to produce a JSAA, initially for the South Neighbourhood, to complement and/or integrate with the JSNA. The JSAA will be a web based portal that residents can access and gain information about health and wellbeing in their area and what help, advice and community assets are available to support them.
Established a network for practitioners, including volunteers, working directly with local people and groups to help build stronger and more resilient communities in Tameside. The network will provide the opportunity for workers to meet one another, exchange ideas and tackle common issues, access learning, and identify new ways of working and resources to help facilitate asset based community development.
Training for Managers (09.12.14) and front line staff (January – March 2015) on asset based approaches. Frontline staff undertook small scale appreciative inquiries themselves within their local localities as part of their action learning. The longer term aim is to use appreciative inquiry methods to build relationships with communities and support them in developing their understanding of what is good and positive within their community (i.e. assets) and what they can do to build on those to create stronger and more resilient communities.
The learning from the appreciative enquiries was used to underpin a Participatory Budget (PB) process delivered in December 2015. PB is a further AB method that engages community members directly in deciding how to spend part of a public budget. The funding was provided in the main by the Office of the Police and Crime Commissioner (OPCC), matched by the Valuing our Communities programme, as well as some funding from New Charter Housing. Local community groups could apply for up to £500 for local initiatives based on themes that would support stronger and more resilient communities. Members of the public were encouraged to attend a voting event where they were able to ask questions of the groups and then voted for who should be funded. Funding was allocated in rank order of number of votes and 89 groups across Tameside received funding.
4.3 Specification For The Provision Of An Asset Based Community Development
(ABCD) Programme (May 2015) 4.4 Public Health, TMBC have written a specification for the provision of an ABCD
programme. The aim was to contract with a Provider to develop and operate a flexible, innovative ABCD Programme that was focused on increasing community resilience and supporting the communities of Tameside in using their own assets to tackle the issues that affect their lives. This was intricately linked to the work on developing a Wellness Service. However due to national and sudden decision to make in year savings in the Public health Grant the tender was withdrawn. Public Health is currently awaiting its allocation for 2016/17.
4.5 Developing the Wider Public Health Workforce (December 2015) 4.6 A local event took place facilitated by Public Health England that looked at the
development of the wider public health workforce focussing on asset based approaches. Attendees came from the range of organisations represented by the Health and Wellbeing Board and the agenda covered an introduction to asset based approaches and ABCD. The aim was to further embed these approaches within organisational teams and in workforce development across the public and voluntary sector.
4.7 Vanguard: Health as a Social Movement (December 2015)
4.8 Social movements are a type of group action. They are large, sometimes informal,
groupings of individuals or organizations which focus on specific political or social issues. In other words, they carry out, resist, or undo a social change. A submission for an expression of interest (EOI) for health as a social movement was made on behalf of Stockport (as the Vanguard site), Oldham Council and Tameside; and the EOI was successful in December 2015. Before this announcement NESTA offered funding to develop the idea and so both elements are being joined up in one project. The NESTA funding will be available beyond 2015/16, however the NHSE monies must be spent within this financial year.
4.9 Locality based Asset Based Approach Training
4.10 The Greater Manchester (GM) Devolution Programme, Public Health England, GM
Public Health Network, Primary Care Transformation Programme, and the Innovation Unit have been working together to embed an asset based approach to primary care across GM. Staff training will be offered to a mix of professional groups and levels of responsibilities e.g. GPs, nurses, receptionists, pharmacists, dentists, opticians, health trainers, care assistants, social workers, etc.
4.11 Tameside and Glossop have been selected as one of five pilot sites across GM for
this training. The aim is to equip primary care teams with the skills, techniques and tools to embed asset based approaches across Greater Manchester. The workshops, which will take place over two half days, will strengthen the skills of primary care teams across Greater Manchester to empower them to place ‘assets’ at the heart of every conversation.
4.12 There are a number of asset based approaches to primary care such as: ‘Asset-based conversations between professionals and patients’ e.g. care planning, coaching and shared decision making and ‘Connecting individuals to community assets’ e.g. peer support and social prescribing.
4.13 Greater Manchester Voluntary Sector Reference Group 4.14 CVAT have been involved a GM voluntary sector reference group which has agreed
to prioritise leadership of this work. In summary there has been real commitment from the VCSE partners to support 'citizen-led social movements' that focus on a strategy to 'eradicate inequality in Greater Manchester by 2030'. They want to lead the delivery of the New Society vision and ensure that we can scale up what the VCSE sector and people do in particular through social action, active citizenship and creating solutions together. This would be about:
Leading delivery of New Society
Identifying existing effective action
Spreading good local action
VCSE-led intelligent commissioning and resourcing
Drawing in academic and intellectual partners e.g. Professor Marmot 5. STRENTHENING ASSET BASED APPROACHES IN TAMESIDE
5.1 Successful implementation of an asset based approach involves:
Organisational change.
A vision, a permeating culture which values community assets, and coordination and building of mutual understanding at all levels of the system (including strategic, commissioning and ground level).
Strong committed new models of leadership in organisations to achieve cultural change - to drive and respond to the fundamental changes in power sharing and the renewed focus on flexible, client-centred frontline relationships.
Staff of public services being valued as an asset and enabled through their training, development and day-to-day working to work in an asset based way.
People working for outside agencies should act as facilitators not drivers and should not try to second-guess what the assets could be; the focus should be on releasing capacity within the community.
Adaptable working structures.
Flexibility and creativity.
Time and a long term approach. 6. SCOPE FOR AN ASSET BASED APPROACH STRATEGIC PLAN
6.1 The following is a content outline for a strategic economy plan for developing asset
based approaches:
(a) Definition:
Evidence base - Jane South PHE report.
(b) The Communities We Work With:
Development of a JSAA.
Community profiles.
(c) Key themes for system change:
Tameside Locality Plan.
Devo Manc : Vanguard : Health as a social movement.
Opportunities and Barriers to system change: shifting power and co-production; to scale; risk mitigation e.g. third sector development.
(d) Commissioning for community centered approaches and social inclusion:
Joint Commissioning Unit and ICO outcome frameworks.
Inclusion of community centred approaches including AB in strategies and relevant organisational policies.
(e) Workforce Development:
Wider Public Health Workforce.
Local Community Care Teams (LCCTs)
Primary care localities
Public Services Reform (PSR) and Neighbourhood Hubs
(f) Governance.
(g) Finance:
Current and future funding sources.
Return on investment commentary.
Clarify expectation of £10m savings.
(h) Set out the direction of travel - short, medium, long term impact.
6.2 We need to use the family of community centred approaches to consider our options and understand our aims in this work. In co-designing services we strengthen communities. We also need to build the volunteer and public health workforce to act as agents of change. The bedrock of community action will be through grant availability, organisational support and commissioning volunteer led activities.
7. RECOMMENDATION
7.1 The Healthy Lives Workstream is asked to:
consider and comment on the headline themes identified
to comment on the scope for development of an asset based plan for the economy.
Tameside Valuing Our Communities Programme: Draft Evaluation Framework (developed by MMU (2015))
Outcomes Indicators
1. Individuals’ health and well-being is strengthened e.g. through self- esteem, coping strategies, resilience skills, relationships, friendships, knowledge and personal resources
1 Local social networks 2 Local communication networks including use of social media 3 Physical health of local people 4 Sense of wellbeing of local people 5 Sense of purposefulness of local people relating to
employment, volunteering, apprenticeships
2. Community networks, relationships and friendships that can provide caring, mutual help and empowerment are strengthened
1 Local social networks 2 Local communication networks including use of social media 6 Individual residents sense of connection with their community 7 Residents pride in their community 8 Engagement in activities and/or networks of vulnerable or
isolated members of the community 9 Community events include all age groups and include the
food/music/traditions of many different groups 10 Information about events is available in various languages of
the community
3. Community and voluntary organisations are flourishing and work well together
5 Sense of purposefulness of local people relating to employment, volunteering, apprenticeships
8 Engagement in activities and/or networks of vulnerable or isolated members of the community
11 Training and/or development activities to support local residents to participate in community initiatives
12 Range of opportunities to get involved 13 Volunteering levels 14 Range of local community groups 15 Diversity of people involved in community organisations,
activities or events 16 Networks between groups 17 Collaborative projects and event
4. Communities are actively participating in and have greater control over resources in their community
18 Residents have power and authority to be involved at the same level as organisational decision makers in programme design, implementation and evaluation in local agencies and organisations
19 Residents have power and authority to be involved at least at the same level as other decision makers in decision making about resources for the community
20 Diverse range of groups within the community has access to influence use of community resources
21 Community events include all age groups and include the food/music/traditions of many different groups
5. Organisations working in communities actively embed asset based approaches in all aspects of their work
18 Residents have power and authority to be involved at the same level as organisational decision makers in programme design, implementation and evaluation in local agencies and organisations
20 Diverse range of groups within the community has access to influence use of community resources
22 Partnership delivery of services, bringing together local expertise
23 Organisations engage in strategic forums, consultations and collaborative impact measurement
24 Training and/or development activities to support local organisations to work collaboratively with communities
25 Organisations have plans in place to ensure continued support for and the sustainability of asset based approaches