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The Brent Health and

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Title: The Brent Health and


1

The Brent Health and Wellbeing Strategy 2012
2015 DRAFT Initial draft presented at the
shadow Health and Wellbeing Board on 25 July 2012

2
Introduction
  • The role of the Health and Wellbeing Board
  • Brents shadow Health and Wellbeing Board brings
    together senior representatives from Brent
    Council, Brent Clinical Commissioning Group and
    Public Health to work in partnership to improve
    the health of the population of Brent. The key
    functions of the Board include
  • To coordinate the development of the Joint
    Strategic Needs Assessment (JSNA) to understand
    and articulate the health and wellbeing needs of
    the residents of Brent
  • To determine the priorities for, and prepare a
    Joint Health and Wellbeing Strategy for Brent
  • To promote joint commissioning and integrated
    provision between the NHS, public health and
    social care.
  • To consider Brent Clinical Commissioning Plans
    and Social Care Commissioning Plans and ensure
    that they are in line with the new Health and
    Wellbeing Strategy.
  • What we hope to achieve
  • Through the development of the Health and
    Wellbeing Strategy, the Board aims to improve
    health

and wellbeing across Brent and to reduce the
health inequalities that exist within our
borough. This strategy is not a comprehensive
collection of all future commissioning intentions
across health, public health and social care.
Rather its aim is to focus on key priorities
where partnership working can bring real added
value to health and wellbeing across Brent over
the next three years. How we developed our
strategy The bedrock of this new strategy is our
refreshed local JSNA which articulates the
challenges which need to be addressed to improve
the health of our population. Second, we have
also developed our thinking bearing in mind the
wider changes that are occurring in the NHS and
social care. This strategy reflects existing
commissioning plans and in particular the new Out
of Hospital Care Strategy which outlines the
ambition to shift more care away from hospital
settings and to provide better integrated
services closer to patients homes within
community and primary care settings.
.
3
Introduction
  • How we developed our strategy (continued)
  • The third crucial element to develop this
    strategy has been stakeholder engagement
    throughout both the development of our JSNA and
    subsequently through consultation with both Brent
    LINk and Brent CVS on the key priorities for this
    strategy.
  • The shadow Health and Wellbeing Board has
    considered all of these three elements in drawing
    up its list of key priorities. This document
    lays out the vision and principles of the shadow
    Health and Wellbeing Board including the four key
    priorities for our strategy
  • Giving every child the best start in life
  • Helping vulnerable children and families
  • Empowering communities to take better care of
    themselves
  • Improving mental wellbeing throughout the life
    course

For each of these priority areas, key strategic
objectives have been defined with impact
indicators to enable us to monitor overall
progress over the next three years. A more
detailed breakdown is provided in the
accompanying action plans which have additional
supporting indicators. The action plans clearly
identify any proposed new initiatives for which
new mainstream funds will be required. These
proposed new initiatives are also described in
further detail in the appendices. Next
steps This draft strategy will be discussed by
the Health and Wellbeing Board in July 2012 and
pending amendments will be put out for a formal
two-month consultation in August 2012. It will be
formally approved in October 2012 In parallel
with the consultation we will also be conducting
an Equality Impact Assessment (EIA), reports for
both the consultation and the EIA will be
published in October 2012.
4
Background
Key challenges Living in poverty generally
contributes to poorer health, wellbeing and
social isolation. The statistics show that people
on low incomes are more likely to have a life
limiting health condition, take less exercise and
have a shorter life. While overall life
expectancy is in line with the rest of London
there are significant health inequalities within
the borough. For example the gap in life
expectancy for men between the most affluent and
the most deprived parts of the borough is 8.8
years. Our diversity is a great strength and our
various communities are valuable assets to bring
about real change for families and individuals.
But at the same time, many new communities are
still not accessing the information and services
available to help them improve their health and
wellbeing. Community engagement is a
cross-cutting theme which runs throughout this
strategy. Only by working together with our
communities, will we be able to improve health
and wellbeing for all of our population. There
are enormous organisational changes occurring
within the wider NHS including the
reconfiguration of commissioning organisations
and hospital providers and the replacement of
many non-acute services in
  • People and place
  • Brent is a place of contrasts. Home of the iconic
    Wembley Stadium, Wembley Arena and the
    spectacular Swaminarayan Hindu Temple, our
    borough is the destination for thousands of
    British and international visitors every year.
  • Brent is served by some of the best road and rail
    transport links in London and the area is
    accustomed to the successful staging of major
    events such as the Champions League Final in 2011
    and Olympic Games events in 2012.
  • Our population is young, dynamic and growing
    (311,200 according to the 2011 census). Our long
    history of ethnic and cultural diversity has
    created a place that is truly unique and valued
    by those who live and work here.
  • Despite these strengths Brent is ranked amongst
    the top 15 most deprived areas of the country.
    This deprivation is characterised by high levels
    of long-term unemployment, low average incomes
    and a reliance on benefits and social housing.
    Children and young people are particularly
    affected with a third of children in Brent living
    in a low income household and a fifth in a
    single-adult household. The proportion of our
    young people living in acute deprivation is
    rising.

5
Background
  • Mental health remains the single largest cause of
    morbidity within Brent affecting one quarter of
    all adults at some time in their lives.
  • Cardiovascular disease, chronic respiratory
    disease and cancers are the biggest killers in
    Brent and account for much of the inequalities in
    life expectancy within the borough.
  • Brent has high levels of many long-term chronic
    conditions which are often related to our poor
    lifestyles, relative deprivation and in some
    cases our ethnic make-up. Diabetes is a good
    example of such conditions and we currently have
    18,000 registered diabetic patients in Brent with
    numbers likely to grow in the future. We need to
    improve outcomes for these patients by helping
    more patients take a more active approach to
    their own care as well as improving the quality
    of our services in the community.
  • Given the high level of many preventable health
    conditions we need to increase access to, and to
    expand, key prevention and screening programmes
  • Rising levels of dementia amongst older adults
  • Rates of tuberculosis (TB) are amongst the
    highest in the country.
  • Key challenges (continued)
  • hospitals with better integrated services based
    closer to patients in the community and within
    primary care.
  • These organisational and service changes will
    bring about real improvements in the quality of
    care received by many patients. But at the same
    time there is a risk that organisational change
    will distract partners from much of the
    prevention work required to promote health and
    wellbeing more widely in our communities.
  • Our JSNA highlights a number of key health and
    wellbeing challenges which this strategy will aim
    to address including
  • Low rates of readiness for school amongst
    under-fives
  • Poor oral health amongst children
  • Rising levels of obesity 12 of under 5s and
    22 of 12 year olds are obese. Almost 25 of
    adults in Brent are estimated to be obese
  • Participation in physical exercise is low over
    50 of adults do no physical exercise
  • Increasing rates of alcohol-related hospital
    admissions

6
Our vision and priorities
Vision Brents Health and Wellbeing Board wants
to create an environment in Brent that enables
individuals and families to lead healthy lives,
where health and wellbeing is at the heart of
service delivery in the borough. This will
require a commitment to health and wellbeing from
a range of local organisations. Individuals will
also need to take more responsibility for their
health and wellbeing, working with professionals
to make choices that improve their health. Our
overall aims are to improve health and wellbeing
and to reduce health inequalities. Giving each
child in Brent the best start in life and
preparing them for school is one of the
strategys priority areas. The first years of
life are crucial for the physical, intellectual
and emotional development of individuals and have
lifelong effects on many aspects of health and
wellbeing. We recognise this and intend to divert
much of our energy to improving the quality of
life for our youngest residents, focussing on key
services such as maternity services, as well as
our offer from childrens centres and nurseries.
Particular attention will be paid to the health
and wellbeing of looked after children. Parents
and carers have the most important role to play,
and we will work with our communities to create
thriving families in the
borough where adults and children routinely make
healthy choices. In order to help Brents most
vulnerable families we intend to focus our
efforts on the social factors that have the
greatest impact on inequality low income,
unemployment and housing. There are no quick
solutions to any of these problems, but they will
be a major focus of the Health and Wellbeing
Boards work over the coming years, to ensure
that partner organisations in Brent are working
to help address these issues. Only through
creating an environment where families thrive,
can the needs of our youngest residents be
properly addressed. We want to create resilient
communities in Brent where people have the
information and networks needed to make positive
choices for themselves. Excellent services are
essential, but we also want (and need) people to
be able to make better choices for themselves,
including choices about the services they access
and how they manage their health and wellbeing.
Community engagement and investment in
preventative and community services will be at
the heart of this, but we will need to work with
communities and individuals to help them take
better care of themselves.
7
Our vision and priorities
Overview of our strategy Aims Improve health and
wellbeing Reduce health inequalities Vision/princ
iples Improving life chances Thriving
families Resilient communities Influencing wider
partners to sign up to the health and wellbeing
agenda Delivering better care, closer to home
the best possible care at the right time in the
right place Priorities Giving every child the
best start in life Helping vulnerable children
and families Empowering communities to take
better care of themselves independence
prevention Improving mental wellbeing throughout
the life course
Vision (continued) Mental health is a key
priority for this strategy and we recognise the
need to increase early interventions for groups
at risk such as new mothers or individuals with
low-level mental health problems which can be
effectively dealt with in the community. At the
same time we are committed to improving the
quality of care for individuals with serious
mental illness which includes the need to provide
people recovering from illness with meaningful
employment and secure housing. Ultimately,
Brents Health and Wellbeing Board wants to
reduce health inequalities in the borough. By
implementing the interventions outlined in this
strategy and focussing on our priority areas (see
box right) we believe that we can make real
inroads into health inequalities in the borough.
8
Giving every child the best possible start
  • What are our key issues?
  • The first few years of life have a crucial impact
    on the future development of children. Positive
    and supportive parenting is key to this and there
    is good evidence of the beneficial impact of
    parenting programmes. In Brent we have a range of
    parenting programmes, however the drop-out rate
    from local programmes is high and we need to
    examine how we can better tailor our services to
    meet the needs of our communities.
  • We are committed to supporting the early
    development of healthy behaviours and fostering a
    supportive community and accessible services for
    parents and families. There are a whole range of
    teams who contribute to this including midwives,
    health visitors, childrens centres, primary care
    teams and specialist services. However we need to
    do more to ensure that all communities have
    access to the same information and services. And
    we need to increase engagement with black and
    minority ethnic groups who have not
    traditionally accessed our local services.
  • Readiness for school is a key marker of future
    life chances. In Brent only 57 of 5-year olds
    reach a good level of development at age 5
    (compared to 59 across London). In addition to
    the support that is given

to families by Childrens and health services,
we are keen to expand on work with schools and
nurseries to improve the wellbeing of children in
their early years. Brent has seen an improvement
across a number of child health outcomes in
recent years including immunisation and
breastfeeding rates. However oral health and
childhood obesity remain two areas of real
concern. More than 11 of local children are
already obese in their reception year, this is a
significantly higher rate than the rest of
London. Similarly we have the highest rates of
dental decay in young children (44 of our
under-5s). The reported use of drugs, alcohol and
smoking amongst young people remains a high
priority and given our dynamic demographic
make-up we need to remain focused and build on
existing work to further reduce risk-taking
behaviour amongst adolescents.

9
Giving every child the best possible start
  • Key objectives
  • Our six key objectives to deliver progress on
    this priority will include
  • Strengthening and expanding our current parenting
    programmes with a focus on learning from
    evaluation.
  • 2. Ensuring the sustainability and delivery of
    the Child Oral Health Strategy
  • 3. To expand partnership working with schools,
    nurseries, playgroups and other Early Years
    settings to improve the wellbeing of children.
  • 4. Improve the offer of our current interventions
    to prevent and manage childhood obesity
  • 5. Engage with hard-to-reach individuals and
    communities through the use of community
    champions
  • 6. Improve the health of young people through
    addressing risk-taking behaviour.

Impact indicators We will monitor progress
around three key impact indicators Oral health
in children under-5s Obesity at reception
year Readiness for school Additional
output/outcome measures are described against
each objective in the action plan which follows.
10
Action Plan
Priority Giving every child the best possible start Priority Giving every child the best possible start Impact Measures Readiness for school U5 DMFT U5s Obesity in reception year Impact Measures Readiness for school U5 DMFT U5s Obesity in reception year Impact Measures Readiness for school U5 DMFT U5s Obesity in reception year
Key Objective Action Supporting measures Output / Outcome Lead Funding required in 2013/14
Strengthening parenting programmes Review and evaluate impact of accredited parenting programmes currently offered with a view to increasing compliance rates from 30 to 50 2014/15 commissioning strategy ready by June 2013 CS/PH -
Delivery of child oral health strategy Mainstream funding for Oral Health Strategy to sustain delivery beyond 2012/13 Oral health U5s and U12s CS/PH ?
Enhancing partnership working Expansion and mainstreaming of Enhanced Healthy Schools Model for Schools, Nurseries and Playgroups No schools and nurseries signed up to scheme PH/CS ?
Interventions to prevent and treat childhood obesity Review and evaluate impact of current programmes paying particular attention to medium-term outcomes for cohorts who access these programmes e.g. enhanced childhood measurement programme, Busy Feet. Obesity in reception year. Obesity in Year 6 children 2014/15 commissioning strategy ready by June 2013 PH/CS -
Engage with hard-to reach communities Build on current peer-support worker model for breast feeding to establish a team of community champions who will engage with hard-to-reach communities across a number of settings and impact on a range of child health indicators e.g. immunization, breast feeding, healthy eating etc. Number and ethnicity of children accessing childrens centers PH/CS ?
Risk-taking behaviour Review progress with implementation of existing strategies to address sexual health, alcohol, tobacco and substance misuse amongst young people Teenage conception rate Alcohol use Substance misuse Smoking prevalence PH -
PH Public Health CCG Clinical Commissioning Group CS Childrens Services S Schools PH Public Health CCG Clinical Commissioning Group CS Childrens Services S Schools PH Public Health CCG Clinical Commissioning Group CS Childrens Services S Schools PH Public Health CCG Clinical Commissioning Group CS Childrens Services S Schools PH Public Health CCG Clinical Commissioning Group CS Childrens Services S Schools
11
Helping vulnerable children and families
What are our key issues The importance of
working with vulnerable families to tackle health
and social problems cannot be overstated. A whole
family approach is being developed to help break
the cycle of poverty, unemployment, crime,
substance abuse and poor educational attainment
that affect some families in Brent. We are
developing an initiative to work intensively with
300 such families initially and this number will
eventually rise to 800. There are a number of
drivers behind the Health and Wellbeing Boards
decision to prioritise helping vulnerable
children, not least the Ofsted Inspection of
Safeguarding and Looked After Children in 2011.
This inspection identified key areas for
improvement that are being taken forward. The
importance of this work is understood and
recognised by the Board and is a central
component to this part of the strategy.   Many
households in Brent are affected by low income
and poor quality housing, and these families are
vulnerable to wider economic upheavals. These are
difficult, long terms problems that have no easy
solution.
Brents unemployment rate is higher than the
London and national average. Similarly, average
incomes in Brent are below London and national
averages, which makes much of the borough
unaffordable to live in for people on low
incomes. There are currently 18,000 people on the
Housing Register in Brent (11,000 who have an
identified housing need), but only 871 lettings
to social housing were made in 2011/12. New
changes to the benefit system may result in even
more overcrowding within the private and social
housing sectors and the accompanying detrimental
impacts on physical and mental health. Our
current regeneration strategy focuses on getting
people back into work. Work focuses on unemployed
hard to reach groups including NEETs, over
50s, those with English as a second language, BME
communities, people with disabilities, people
with mental health problems and the homeless.
Reducing the impacts of poor quality housing
and low income on health and wellbeing is one of
our key objectives. And the Health and Wellbeing
Board is determined that it does all that it can
to enable all families in Brent to thrive.  
12
Helping vulnerable children and families
Impact indicators We will monitor progress
around the following key impact
indicators Educational attainment of Looked
after Children Childhood poverty Overcrowding Lo
ng-term unemployment Additional output/outcome
measures are described against each objective in
the following action plan. To be developed
further
  • Key objectives
  • Our six key objectives to deliver progress on
    this priority will include
  • Improve the identification and assessment of all
    vulnerable children underpinned by robust
    safeguarding procedures
  • Better multidisciplinary working for children
    with additional or complex needs
  • Improve outcomes for Looked after children
  • Helping families with complex needs
  • Reduce the impact of poor quality housing on
    health and wellbeing
  • Reduce the impact of unemployment on health and
    wellbeing

13
Action Plan
Priority Helping vulnerable children and families Priority Helping vulnerable children and families Impact Measures Educational attainment of LAC Childhood poverty Overcrowding Unemployment Impact Measures Educational attainment of LAC Childhood poverty Overcrowding Unemployment Impact Measures Educational attainment of LAC Childhood poverty Overcrowding Unemployment
Key Objective Action Supporting measures Output / Outcome Lead Funding required in 2013/14
Identification and assessment of vulnerable children and families Train the wider workforce (including health and social care) on the use of the standardised Common Assessment Framework and local Safeguarding procedures. Use of CAF amongst children with needs (to be developed further) CS/CCG ?
Improving multi-disciplinary working for children with additional complex needs Scope and review community paediatric pathways for LAC and /or children with complex needs Produce commissioning strategy for 2014/15 by June 2013 PH/CCG/CS -
Ensure robustness of QA processes for LAC services Review the progress and recommendations produced by the LAC Steering Group paying particular attention to issues around improving data collection communication and the quality of the initial assessment. Produce commissioning strategy for 2014/15 by June 2013 LAC steering group -
Helping families with complex needs Review the success of the working with families initiative to determine the extent it improves health and wellbeing amongst the families involved. Improve school attendance Increase employment rates Working with Families Project -
Ensure that the councils housing and tenancy strategies contribute to improving health and wellbeing Ensure that the link between housing and health is central to the aims and objectives in the councils new tenancy and housing strategy. Overcrowding Proportion of households in fuel poverty Regeneration -
Reduce the impact of unemployment Implement Brents programme to work with people from priority groups to help them back into employment. Unemployment rate Regeneration
PH Public Health CCG Clinical Commissioning Group CSChildrens Services SSchools PH Public Health CCG Clinical Commissioning Group CSChildrens Services SSchools PH Public Health CCG Clinical Commissioning Group CSChildrens Services SSchools PH Public Health CCG Clinical Commissioning Group CSChildrens Services SSchools PH Public Health CCG Clinical Commissioning Group CSChildrens Services SSchools
14
Empowering communities to take better care of
themselves
their disease over the years. Too often we find
that many patients simply do not agree with or
understand their treatment and stop taking their
medicines, which often has serious adverse
consequences. If we want primary and community
services to be more pro-active and prevent more
future disease, than we need to ensure that we
use our resources more wisely. In these difficult
economic times we need to maximise the impact of
our doctors and nurses by reducing the number of
inappropriate visits which could have been dealt
with at home or by the pharmacist for example
common coughs and colds. Similarly, changes in
adult social care, mean that more families need
to become aware of the new personalisation agenda
and how this can maximise opportunities to access
better social care for themselves or their loved
ones. We need to reach out to all people in
Brent and promote healthy lifestyles, better
preventative services and a more responsible use
of our healthcare resources. And once people do
develop a chronic condition, we need to work with
communities to help ensure that patients are
engaged with, and understand their health and
social care package. .
What are our key issues Far too many of us in
Brent are not living well and are storing up
health problems for the future. We have a
relatively young population and yet we have the
third lowest levels of physical activity in
England. Sedentary lifestyles, poor diets and
stress are leading to a large proportion of our
population developing long-term chronic diseases
such as diabetes, heart disease, high blood
pressure and chronic bronchitis. Worryingly,
local people who do develop these long-term
conditions often have poor outcomes in terms of
complications and deaths. There are a multitude
of reasons for this, which include the need to
improve the quality of some community and primary
care services. However at the same time we need
to ensure that communities are able to promote
more independence and responsibility for their
health and healthcare needs. This includes
encouraging individuals to seek appropriate help
earlier, as good treatment started early can
prevent many future complications. In addition,
patients need to become more engaged and more
knowledgeable about their care so that they feel
happy to engage with their doctor or nurse and
agree with long-term treatment plans which will
control
15
Empowering communities to take better care of
themselves
  • Key objectives
  • Our six key objectives to deliver progress on
    this priority will include
  • Encouraging everyone to be physically active
  • Promoting healthy eating
  • Promoting independence and responsibility for our
    health and healthcare
  • Strengthening our tobacco control partnership
  • Strengthening partnership work around alcohol
  • Increasing early diagnosis and testing for HIV
    and TB

Impact indicators We will monitor progress
around the following key impact
indicators Cardiovascular admissions Cardiovascu
lar mortality Proportion of adults who are
physically inactive Smoking prevalence Additional
output/outcome measures are described against
each objective in the following action plan.
16
Action Plan
Priority Empowering communities to take better care of themselves Priority Empowering communities to take better care of themselves Impact Measures Cardiovascular admissions Cardiovascular mortality of adults who are physically inactive Smoking prevalence Impact Measures Cardiovascular admissions Cardiovascular mortality of adults who are physically inactive Smoking prevalence Impact Measures Cardiovascular admissions Cardiovascular mortality of adults who are physically inactive Smoking prevalence
Key Objective Action Supporting measures Output / Outcome Lead Funding required 13/14
Encouraging everyone to be more active Increasing opportunities for physical activity Investment in improved open spaces aligned to our Sports and Physical Activity Strategy e.g. outdoor gyms, multi-use games areas, school playgrounds. Encouraging group activities in local parks for formal and informal recreation e.g. health walks from GP practices Health trainers to work with community and faith groups to increase provision of more community based leisure activities Work with 3rd sector to train more local residents to deliver physical activity sessions in community settings Numbers of health trainers pro-actively promoting physical activity in the community Number of adult visits to community PA programs organized by the council (outside of leisure centers) PH/ SL/ CCG ?
Encouraging everyone to be more active Community engagement initiative supplemented by a social marketing campaign to work with community groups and health professionals to promote Physical activity and healthy eating Better self-care Self-management Increased engagement with the personalization agenda (social care) Consumption of 5 a day Individuals on primary care LTC registers Hospital admission rates for Ambulatory Care Sensitive Conditions Proportion of newly diagnosed Type 2 diabetics who attend the DESMOND programme PH/ CCG ?
Promoting healthy eating Community engagement initiative supplemented by a social marketing campaign to work with community groups and health professionals to promote Physical activity and healthy eating Better self-care Self-management Increased engagement with the personalization agenda (social care) Consumption of 5 a day Individuals on primary care LTC registers Hospital admission rates for Ambulatory Care Sensitive Conditions Proportion of newly diagnosed Type 2 diabetics who attend the DESMOND programme PH/ CCG ?
Taking control of our health promoting responsibility for our health and healthcare Community engagement initiative supplemented by a social marketing campaign to work with community groups and health professionals to promote Physical activity and healthy eating Better self-care Self-management Increased engagement with the personalization agenda (social care) Consumption of 5 a day Individuals on primary care LTC registers Hospital admission rates for Ambulatory Care Sensitive Conditions Proportion of newly diagnosed Type 2 diabetics who attend the DESMOND programme PH/ CCG ?
Taking control of our health promoting responsibility for our health and healthcare Review provision of key lifestyle and prevention programmes including weight management exercise-on-referral NHS Health Checks ILI rehabilitation programmes Desmond programme 2014/15 commissioning strategy ready by June 2013 Uptake rate for Health Checks Smoking quitters PH/ CCG/ SL
Continued on next slide PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure Continued on next slide PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure Continued on next slide PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure Continued on next slide PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure Continued on next slide PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure
17
Action Plan (continued)
Priority Empowering communities to take better care of themselves (continued) Priority Empowering communities to take better care of themselves (continued) Impact Measures Cardiovascular admissions Cardiovascular mortality of adults who are physically inactive Smoking prevalence Impact Measures Cardiovascular admissions Cardiovascular mortality of adults who are physically inactive Smoking prevalence Impact Measures Cardiovascular admissions Cardiovascular mortality of adults who are physically inactive Smoking prevalence
Key Objective Action Supporting measures Output / Outcome Lead Funding required in 2013/14
Strengthening our tobacco control partnership Expanding our existing tobacco control partnership to include Smoke-free homes initiative Peer-led youth prevention programme Number of homes participating in scheme Reported youth smoking prevalence PH ?
Strengthening partnership working around sensible drinking Expand existing DAAT partnership work around alcohol Extend brief alcohol intervention service in AE Better partnership working around licensing Alcohol-related admissions Alcohol-related crime PH ?
Increasing early detection of HIV and TB Review existing partnership work aimed to reduce stigma and encourage awareness amongst the community and health professionals to increase Testing for HIV in AE Majors (current pilot) and at first GP registration Latent testing for all at risk of TB (new migrants) new GP registrants and within DAAT services. Improve uptake of universal BCG and BCG for those at high risk up to age of 35 years including at school entry as in NICE (CG117) guidelines Nov 2011 Proportion presenting with HIV at a late stage of infection Incidence rate of TB CCG/ PH
PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure
18
Mental wellbeing across the life course
  • Mental ill health is the single most common cause
    of morbidity in Brent. It will affect around one
    in four of all adults and one in ten children.
  • Promoting mental wellbeing and intervening early
    to help children and adults before they develop
    serious mental health conditions is the most
    effective approach to tackle these conditions.
    This approach needs to be taken throughout the
    life course whether it is helping new mothers
    with post-natal depression, children who are
    finding it hard to adjust to school, or adults
    who are struggling with mild anxiety or
    depression.
  • We have made some progress to-date but need to
    continue to expand our service offer. For example
    we have some very good programmes which work with
    children with low-level conduct disorders in
    schools. Family group-therapy is an excellent
    intervention which can benefit children, families
    and schools and overall this is one of the most
    cost-effective mental health interventions.
    However at the moment this service is only
    provided to a limited number of Brent schools.
  • In 2010/11 there were over 16,000 Brent adults
    who were on a GP practice register for
    depression. We have recently made large increases
    in the provision of psychological therapies which
    can help many

individuals with anxiety disorders or depression.
However we still need to do more to match the
growing needs of our population. During the JSNA
consultation many individuals and organisations
raised concerns over the quality of services for
people with a serious mental illness. Our rates
of in-patient admission for individuals with a
serious mental illness are high. And we are aware
that we need to improve the general health and
wellbeing of these patients, rather than simply
focusing on medical treatments alone. This
includes the need to help individuals find
meaningful employment and secure housing
following recovery. Finally as our population
ages, older peoples mental health will becoming
an increasing priority with the need for better
early intervention to reduce the impact of
dementia on patients and families.
19
Mental wellbeing across the life course
  • Impact indicators
  • We will monitor progress around the following
    four key impact indicators
  • Dementia prevalence
  • Depression prevalence
  • Emergency hospital admissions for mental illness
  • Additional output/outcome measures are described
    against each objective in the following action
    plan.
  • Key objectives
  • Our six key objectives to deliver progress on
    this priority will include
  • Mental health promotion before people become
    unwell
  • Early identification of mothers with post-natal
    depression
  • 3. Helping children with low-level mental health
    problems in school
  • 4. Increase the provision of talking therapies
  • 5. Improving wellbeing for people with a serious
    mental illness
  • 6. Early identification and intervention for
    dementia

20
Action Plan
Priority Mental wellbeing across the life course Priority Mental wellbeing across the life course Impact Measures Dementia prevalence Depression prevalence Emergency hospital admissions for mental illness Impact Measures Dementia prevalence Depression prevalence Emergency hospital admissions for mental illness Impact Measures Dementia prevalence Depression prevalence Emergency hospital admissions for mental illness
Key Objective Action Supporting measures Output / Outcome Lead Funding required in 2013/14
Better mental health promotion Produce a mental health promotion action plan focusing on building resilience Action plan ready by June 2013 CCG/PH -
Earlier diagnosis of postnatal depression Review progress made by the recent introduction of a new specialist mental health midwife and the new CQUIN target for the Health Visiting Service. Number of women identified as high-risk after midwife review Number of HV referrals for PND CCG/PH
Improving wellbeing in schools Review and evaluate current TaMHS and Place to be services with a view to providing universal offer for all Brent schools Commissioning intentions for 2014/15 to be ready by June 13 CCG/CS/ PH/schools -
Talking therapies Continue and extend current IAPT programme including employment service. Meet 2015 target to expand service to meet needs of 5,652 people CCG _
Continued on next slide PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure Continued on next slide PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure Continued on next slide PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure Continued on next slide PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure Continued on next slide PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure
21
Action Plan
Priority Mental wellbeing across the life course Priority Mental wellbeing across the life course Impact Measures Dementia prevalence Depression prevalence Emergency hospital admissions for mental illness Impact Measures Dementia prevalence Depression prevalence Emergency hospital admissions for mental illness Impact Measures Dementia prevalence Depression prevalence Emergency hospital admissions for mental illness
Key Objective Action Supporting measures Output / Outcome Lead Funding required in 2013/14
Increase wellbeing of those with Serious Mental Illness Evaluate pilot scheme to improve wellbeing of those with serious mental illness through the use of community navigators to facilitate access to wider complementary therapies and employment services. Commissioning intentions for 2014/15 to be ready by June 13 Percentage of adult users of mental health services who are known to be in paid employment CCG/PH -
Earlier diagnosis of dementia Develop a specialist dementia service in the community to provide specialist advice and support to primary care on the assessment and management of people with problematic symptoms of dementia or other mental health problems. New service to be commissioned in 13/14 Number of patients on the QOF dementia register CCG _
PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure PH Public Health CCG Clinical Commissioning Group SL Sports and Leisure
22
Summary of impact indicators
  Priority Impact Indicator Brent Historical and Baseline Brent Historical and Baseline Brent Historical and Baseline London Baseline Target for 2015/16
  Giving every child the best start Oral health in children under-5s 47.0 (2004/05) 44.7 (2007/08) -(2011/12) -(2011/12)  
  Giving every child the best start Obesity at reception year 11.3 (2009/10) 11.5 (2010/11) 11.6 (2011/12) 11.1 (2011/12)  
  Giving every child the best start Readiness for school 41.0 (2008) 45.0 (2009) 43.0 (2010) 55.0 (2010)  
  Helping vulnerable children and families Childhood poverty 39.6 (2007) 34.4 (2008) 31.9 (2009) 29.7 (2009)  
Helping vulnerable children and families Educational attainment of Looked After Children ( to be developed) tba(tba) tba(tba)
  Helping vulnerable children and families Overcrowding - - 12.1 (2010) 7.5 (2010)  
  Helping vulnerable children and families Long term unemployment -  10.6 (2010) 11.4 (2011) 7.3 (2011)  
  Empowering communities to take better care of themselves Cardiovascular admissions (DSR per 100,000 population) 1696(2008/09) 1708(2009/10) 1722(2010/11) 1534(2010/11)  
  Empowering communities to take better care of themselves Cardiovascular mortality (DSR per 100,000 population) 81.7(2008) 75.3(2009) 76.5(2010) 68.1(2010)  
  Empowering communities to take better care of themselves Participation in Physical Activity (adults) 9.0 (2007-2009) 6.8(2008-2010) 7.7 (2009-2011) 9.9 (2009-2011)  
  Empowering communities to take better care of themselves Smoking prevalence 17.6 (2008/09) 16.3 (2009/10) 20.8 (2010/11) 19.8 (2010/11)  
  Improving mental wellbeing throughout the life course Dementia prevalence (Brent GP registered population) 0.21 (2008/09) 0.23 (2009/10) 0.25 (2010/11) 0.32 (2010/11)  
  Improving mental wellbeing throughout the life course Depression prevalence ( Brent GP registered population aged 18) 4.3 (2008/09) 5.7 (2009/10) 5.9 (2010/11) 7.8 (2010/11)  
  Improving mental wellbeing throughout the life course Emergency admissions for mental health (DSR per 100,000 population)  - -  266(08/09-10/11) 260(08/09-10/11)  

23
Summary of supporting indicators
Priority Supporting Outcome Indicators Brent Historical and Baseline Brent Historical and Baseline Brent Historical and Baseline London Baseline Target for 2015/16
Giving every child the best start in life Oral health in children under-12s - 43.2 (2000) 30.4 (2008/09) 28 (2008/09)  
Giving every child the best start in life No schools, nurseries, signed up to Early Years scheme tba(tba) tba(tba) tba(tba) tba(tba)  
Giving every child the best start in life Obesity in Year 6 children 22.9 (2009/10) 21.7 (2010/11) 23.7 (2011/12) 21.9 (2011/12)  
Giving every child the best start in life Number of children accessing childrens centres tba(tba) tba(tba) tba(tba) tba(tba)  
Giving every child the best start in life Teenage pregnancy (rate per 1000 females aged 15-17) 41.0(2006-2008) 41.0(2007-2009) 38.1(2008-2010) 40.9(2008-2010)  
Giving every child the best start in life Hospital admissions with alcohol specific conditions (crude ate per 100000 population Under 18) 25.6(05/06-07/08) 23.8(06/07-08/09) 27.8(07/08-09/10) 39.1(07/08-09/10)  
Giving every child the best start in life Hospital admissions due to substance misuse (age 15-24 years) - 43.1(05/06-09/10) 48.5(2008-2011) 49.3(2008-2011)  
Helping vulnerable children and families Uptake of CAF tba(tba) tba(tba) tba(tba) tba(tba)  
Helping vulnerable children and families Proportion of households in fuel poverty 4.7(2008/09) 3.1(2009/10) 3.4(2010/11) 3.1(2010/11)  
Helping vulnerable children and families Working with families initiative - indicators to be developed tba(tba) tba(tba)

24
Summary of supporting indicators
Priority Supporting Outcome/output Indicators Brent Historical and Baseline Brent Historical and Baseline Brent Historical and Baseline London Baseline Target for 2015/16
Empowering communities to take better care of themselves self-help and prevention Proportion of adults who are physically active 9.0 (2007-2009) 6.8(2008-2010) 7.7 (2009-2011) 9.9 (2009-2011)
Empowering communities to take better care of themselves self-help and prevention Numbers of health trainers pro-actively promoting physical activity in the community tba(tba) tba(tba) tba(tba) tba(tba)  
Empowering communities to take better care of themselves self-help and prevention Number of adult visits to community PA programs organized by the council (outside of leisure centres) tba(tba) tba(tba) tba(tba) tba(tba)  
Empowering communities to take better care of themselves self-help and prevention Consumption of 5 a day (proportion of residents aged 16) - - 37.0 (2006-2008) 36.4 (2006-2008)  
Empowering communities to take better care of themselves self-help and prevention Register prevalence of CHD 2.1 (2008/09) 2.1 (2009/10) 2.1 (2010/11) 2.2 (2010/11)  
Empowering communities to take better care of themselves self-help and prevention Register prevalence of hypertension 11.1 (2008/09) 11.3 (2009/10) 11.5 (2010/11) 11.0 (2010/11)
Empowering communities to take better care of themselves self-help and prevention Register prevalence of COPD 0.7 (2008/09) 0.7 (2009/10) 0.7 (2010/11) 1.0 (2010/11)
Empowering communities to take better care of themselves self-help and prevention Smoking quitters (per 100,000 population aged 16) 579(2009/10) 1222(2010/11) 1308(2011/12) 857(2011/12)
Empowering communities to take better care of themselves self-help and prevention Uptake of NHS Health Checks - - 45.1 (2011/12) 46.1 (2011/12)
Empowering communities to take better care of themselves self-help and prevention Hospital admission rates for Ambulatory Care Sensitive Conditions tba(tba) tba(tba) tba(tba) tba(tba)
Empowering communities to take better care of themselves self-help and prevention TB incidence rate (DSR per 100,000 population) 101(2006-2008) 115(2007-2009) 118.2(2008-2010) 43.3(2008-2010)
Empowering communities to take better care of themselves self-help and prevention Proportion of HIV cases which are diagnosed late (CD4 count lt 200) - 30 (2009) 31 (2010) 27 (2010)
Improving mental wellbeing throughout the life course  Number of women identified as high-risk for postnatal depression after midwife review  - - tba(tba) tba(tba)  
Improving mental wellbeing throughout the life course  Proportion of adult users of community mental health services known to be in paid employment - 10.1 (2009/10) 7 (2009/10) 5.1 (2009/10)  
Improving mental wellbeing throughout the life course IAPT provision (2015 target) - tba(tba) tba(tba) tba(tba)
Improving mental wellbeing throughout the life course Dementia prevalence (based on Brent GP registered population) 0.21 (2008/09) 0.23 (2009/10) 0.25 (2010/11) 0.32 (2010/11)

25
Appendices Summary of new initiatives

26
Oral Health Improvement for children
  • Description
  • Aim
  • To improve oral health and reduce oral health
    inequalities in
  • young children. The methods used would include
  • Train all professionals in contact with young
    children and their parents to provide advice to
    parents on Healthy feeding and weaning,
    particularly around avoiding sugary drinks in
    bottles and training cups Tooth-brushing
    technique and the use of fluoride toothpaste
    sign posting to dentists and raising awareness
    about the importance of check-ups for preventive
    advice and fluoride varnish application.
  • Oral health advice and Brushing for Life packs
    should be distributed by health visitor teams at
    child development checks - 9 month and 2 ½
    years
  • Ensure that all nurseries and children centres
    have healthy eating / drinking policies e.g.
    drinks between meals water or milk fruit juice
    as part of a meal reduce sugary snacks.
  • School nurses to deliver oral health
    questionnaire on school entry and sign-post to
    dental services. Data to be fed back to the
    Public Health for evaluation or planning social
    marketing.
  • Targeted primary school based tooth brushing
    initiative in 12 schools with highest level of
    free school meals
  • Benefits
  • To reduce proportion of children with caries
    experience - decayed, missing and filled teeth
  • To reduce number of children receiving general
    anaesthetic for dentistry
  • To increase the number children developing good
    tooth brushing habits
  • To increase the proportion of children who have
    visited a dentist and received oral health
    messages before starting school
  • Feasibility
  • The evidence base for oral health improvement
    initiatives has been extensively reviewed as part
    of the NWL Oral Health Improvement Strategy. One
    of the key evidence based reports is Delivering
    Better Oral Health an evidence based toolkit
    which is based on a number of systematic reviews
    by the Cochrane Collaboration.
  • The benefits of the programmes will only be
    realised if there is funding is in place for it
    to be sustained for a longer period (i.e. 2-3
    years) and there is an issue over Oral Health
    Promoter capacity to deliver.

Investment area 13/14 75K
Brushing for Life packs at health checks Oral Health Promoter additional capacity Training and teaching packs Healthy Tips resources Cups Schools programme Special needs resources 12k 20k 10k 10k 8k 10k 5k
27
Early Years Model
for healthy nurseries and playgroups
Costs
Description NHS Brent and Brent Council propose
that an Early Years Healthy Settings Framework
will be established to ensure that children in
nurseries and play groups are healthy. This is a
grant scheme with nurseries and playgroups
applying for a grant in return for work focused
on key health and wellbeing outcomes. This will
promote healthy eating, physical activity, mental
health and well being. Nurseries and playgroups
will be expected to adhere to defined standards
and gain Brent accreditation. Benefits 1.Contri
butes to the Department for Education Early Years
Framework This whole setting approach is
extremely effective, evidence based, and brings
about and embeds cultural change in settings. 2.
Each setting that is successfully validated with
Healthy Early Years settings will receive a
financial incentive to develop and implement
health promotion activities. 3. Settings will
have access to a variety of local health
professionals for advice, training and
support. 4. Settings will provide professional
development and build confidence of staff by
receiving training where necessary and
appropriate. 5. Enhances the health and
wellbeing, and development, of children. 6.
Enhances health and wellbeing of staff and
parents.
Investment area 13/14 200K
Early Years Healthy Coordinator (band 7) Early Years incentive scheme Health promotion resources Training 53K 97K 25K 25k
28
Community champions for childrens health
  • Description
  • This investment would be to support the increased
    use of local Children's services by young
    families with a particular focus on
    under-represented groups from BME communities.
  • The project would aim to develop Support Workers
    from the target communities using a train the
    trainer model. These Support Workers would liaise
    with their local community and faith groups to
    improve heath outcomes, raise awareness and
    facilitate access to the childrens centres and
    other services.
  • The project would contribute to improvements in a
    range of health and development indicators
    including breastfeeding, healthy eating, oral
    health, physical activity, uptake of
    immunisations, reducing exposure to cigarette
    smoke in homes, and readiness for school.
  • The project would work with all Children's Centre
    teams across the borough
  • Inputs that may be required include
  • Training package for community champions
  • Promotional materials for community groups
  • 6 WTE band 4 Support Workers
  • NB There is already an Early Years Co-ordinator
    post within the PH structure and this post could
    be re-designed to include the co-ordination of
    the support workers.

Benefits Approximately 6,500 under-5s access our
childrens centres each year. The programme would
be piloted for eighteen months with an evaluation
built in to assess local effectiveness. Process
measures would include numbers of kids and
ethnicities number of community champions
trained engagement with smoke free homes
initiative Overall measures would include U5
obesity, dental health, readiness for school
breast feeding rates etc
Feasibility Good evidence-base around the use of
community development approaches and also
improved outcomes for families who access
childrens centres
Investment area 13/14
6 WTE band 4 Support Workers 181,000
Training package, promotional materials 40,000
Total investment required 221,000
29
Empowering communities to take better care of
themselves
  • Description
  • This investment would be used for the
    development of community-based campaign to
    develop and promote clear messages around
    increasing physical activity, self care, self
    management and how to access social care.
  • The methods used would be
  • Train the trainer approach to develop champions
    within existing community networks and groups
  • To develop a branded social marketing campaign
    and materials including videos which would be
    used by these champions to convey key messages
    around self-care to their communities
  • To facilitate social groups/networks who meet on
    a regular basis e.g. Brent Heart of Gold
    cardiac rehabilitation group who meet on a
    regular basis for walks and to exercise in a gym.
  • Develop a website as part of the campaign which
    would include information around healthy
    lifestyles, self-care and self-management and
    information on access to adult social care
    including the personalisation agenda.
  • To ensure all front-line staff are engaged with
    key messages of the campaign to maximise
    dissemination e.g. social workers, district
    nurses, health visitors etc.

Benefits The aim of the campaign will be to
underpin other key strategic initiatives
including the Out of Hospital Care Strategy,
case-management and the personalisation agenda in
social care.
Feasibility Good evidence-base around the use of
community development approaches. However this
will be a difficult initiative to deliver on
large scale and hence will require long-term
investment and a willingness to evaluate and
re-design the intervention as required. Therefore
, the proposed implementation would be phased,
focusing on a limited number of messages at any
one time, and incorporating learning into the
design of subsequent phases.
Investment area 13/14 273K
Additional co-ordinator (Band 7 post) Training and teaching packs Social marketing resources Life Channel Website development and campaigns 53K 30K 100K 40K 50K?
30
Increasing opportunities for physical activity
  • Description
  • This investment would be used to develop
    opportunities that encourage everyone to be more
    physically active, recognising that this can be
    done in formal and/or informal settings as
    individuals or groups of people.
  • The methods used would be
  • Extend the programme of organised group sessions
    for physical activity in parks and community
    settings (including the private sector)
  • Provide additional outdoor gyms in Brent parks
    together with instructors to deliver sessions
  • Develop and recruit Health Trainers (local
    champions ) to work within existing community
    networks and groups to signpost residents to all
    known physical activity programmes and
    initiatives. Ensure they have the means to be
    access up to date information through the use of
    information technology and feed back unmet demand
    to deliverers. Health trainers could also be
    utilised in setting up and leading health walks
    directly from GP surgeries.

Benefits A reduction in the number of people
undertaking zero participation in sport or
physical activity An increase in the number of
visits by adults to activities held in community
settings (excluding sports centres) organised by
the Council
Feasibility Good evidence-base around the use of
community development approaches. However this
will be a difficult initiative to deliver on
large scale and hence will require long-term
investment and a willingness to evaluate and
re-design the intervention as required.
Investment area 13/14 195k
Additional co-ordinator and instructors for extended activity programme in community Outdoor gyms Outdoor gym instructors Hire for community or private venues Training and support for Health trainers Marketing/ publicity 95,000 40,000 10,000 30,000 15,000 5,000
31
Alcohol Brief Interventions Team
  • Benefits
  • To develop a database and profile of .
  • the number of people presenting to AE with
    Alcohol related problems.
  • the number of people who have received AE
    Alcohol brief intervention screening.
  • the number of people referred to Brent treatment
    services Single Point of Contact (SPOC) at
    Cobbold Road.
  • Effective tracing of medical files for the number
    of relapses from previous presentation.
  • Number of AE substance misuse presentations with
    other related problems such as domestic violence,
    anti-social behaviour, crime, and assaults.
  • Feasibility
  • There is a robust evidence base demonstrating
    that early interventions lead to improved health
    and provides value for money in relation to costs
    to public health and the criminal justice system.
  • The project will mainstream the pilot currently
    being developed at Northwick Park by Compass and
    will comprise of 4 elements data input and
    collection, staff training, advice and
    consultation and the provision of early
    interventions and short-term counselling.
  • Description
  • This investment would be used for the development
    of the AE Alcohol Brief Interventions Team which
    will be based in AE at Northwick Park Hospital,
    delivering interventions to divert dependent drug
    users and drinkers away from acute settings and
    problematic alcohol misuse into community-based
    treatment settings.
  • Aims and objectives
  • Divert dependent drug users and drinkers from
    acute services and increase early interventions
    in primary care settings.
  • Assess and provide brief interventions, including
    personalised feedback and motivational
    interviews, to dependent and other high risk drug
    users and drinkers attending AE.
  • Support increasing and high risk drinkers to
    access specialist community-based treatment and
    out-patients services, as appropriate.
  • Deliver preventative work in primary care and
    community based treatment settings, including
    increased screening and identification of harmful
    and hazardous drug users and drinkers.
  • Offer short term nursing interventions to
    identified harmful and hazardous drug users and
    drinkers.
  • Train clinicians and GPs heightening awareness
    and promoting appropriate use of hospital
    protocols in place to manage drug and alcohol
    withdrawal.
  • Offer specialist training and advice for GPs and
    to promote greater GP confidence in managing
    alcohol community detoxifications.

Investment area 13/14 160K
Team costs based on 1x Band 7, 2 x Band 6 1 Band 4/5.
32
Smoke-free homes initiative
  • Benefits
  • Will reduce the risks to health from exposure to
    second-hand smoke, especially among Brents young
    people
  • Contribute to a reduction in costs associated
    with smoking related accident and emergency
    admissions
  • Recognises a persons right to be protected
    from harm and enjoy smoke free air
  • Increase the benefits of smoke free enclosed
    public places and workplaces for people trying to
    give up smoking
  • Feasibility
  • The Brent Tobacco Control Alliance is currently
    developing a smoke free homes campaign pilot in
    conjunction with the Brent Stop Smoking Service
    and the London Fire Brigade. However there is
    appetite to upscale the project and develop an
    outer Northwest London supra-local smoke free
    homes campaign. Three North-West London boroughs
    have expressed interest. Administrative support
    and a sustained budget would be required to
    deliver the project. Evidence also suggests that
    mass media health promotion campaigns are needed
    in order to change attitudes. A supra-local
    campaign will optimise benefits of the recent
    national smoke free homes campaign.
  • Description
  • This investment would be used to develop,
    implement and evaluate a community based smoke
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