Gloucestershire Health Inequalities Action Plan 2016 – 2019 · 2017. 3. 21. · Gloucestershire has 13 LSOAs in the top 10% most deprived nationally - 10 in Gloucester City and

Gloucestershire Health and Wellbeing Board January 2016

Gloucestershire Health Inequalities Action Plan 2016 – 2019

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ContentsContents...................................................................................................................................................................................................... 2

1.0 Introduction........................................................................................................................................................................................... 3

2.0 What are Health Inequalities and why do they matter?........................................................................................................................3

3.0 Health Inequalities in Gloucestershire..................................................................................................................................................4

4.0 What are our priorities and how have we identified them?...................................................................................................................9

5.0 Who will do what? .............................................................................................................................................................................. 10

6.0 How will we track our progress?......................................................................................................................................................... 10

Priority Outcome 1: Give Every Child the Best Start in Life ......................................................................................................................11

Priority Outcome 2: Enable all Children, Young People and Adults to Maximise Their Capabilities ........................................................17

Priority Outcome 3: Create Fair Employment and Work For All ...............................................................................................................21

Priority Outcome 4: Ensure a Healthy Standard of Living for All ..............................................................................................................25

Priority Outcome 5: Create and Develop Healthy and Sustainable Communities ....................................................................................29

Priority Outcome 6: Strengthen the Role and Impact of Ill Health Prevention ..........................................................................................33

7.0 Glossary ............................................................................................................................................................................................. 46

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1.0 IntroductionGloucestershire’s Joint Health and Wellbeing Strategy, ‘Fit for the Future’ (2012) lays out the County’s long term aims and ambitions for a healthier Gloucestershire. This Delivery Plan is the second three-year plan developed by the Health and Wellbeing Board to tackle health inequalities in the county, one of the five key priority areas identified in ‘Fit for the Future’. National data tells us that health inequalities are worse than three years ago and in the context of public sector budget cuts we need to be realistic about what we can affect locally. It is more important than ever to work together in partnership to deliver short, medium and long term actions which will create sustainable improvements in health for all of our population.

2.0 What are Health Inequalities and why do they matter?Health inequalities are preventable and unjust differences in health status experienced by certain population groups. They arise from social inequalities, themselves the result of unequal distribution of factors influencing health, such as housing, environment, social background, income, employment and education.

Other factors contributing to health inequalities are: differences in individual behaviours (i.e. smoking, drinking, physical activity and eating habits), rural isolation and poor access to and effective use of healthcare, which contributes to at least 15-20 percent of inequalities-related mortality (NHS England, 2013). There is evidence (from routine health service data) that an inverse care law exists so that those who most need health care are least likely to receive it and those that are in least need of health care use services more (HSJ vol 111, 5760 pp37).

Among others who suffer poorer health and wellbeing outcomes are: people from black or minority ethnic communities; people living with a physical or learning disability; the homeless; young offenders and people with mental health problems. For example, people living in England with mental illness die on average 15-20 years earlier than those without, often from preventable causes (Chief Medical Officer, 2014).

There is a strong economic case for addressing health inequalities. Inequalities contribute to financial pressure on health and social care and to an estimated annual cost of between £36 billion and £40 billion through lost taxes, welfare payments and costs to the NHS (Marmot Review, 2010).

The Marmot Review (2010), 'Fair Society, Healthy Lives1', proposed a new way to reduce health inequalities in England post-2010. It argued that, traditionally, government policies have focused resources only on some segments of society. To improve health for all of us

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and to reduce unfair and unjust inequalities in health, action is needed across the social gradient. Key to Marmot's approach to addressing health inequalities is to create the conditions for people to take control of their own lives. A key message from the Marmot Review (2010) was that focusing solely on the most disadvantaged will not reduce health inequalities enough – actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage – an approach called ‘proportionate universalism’.

By adopting such an approach, and working together with individuals and communities, and with organisations across the system we can help to address these inequalities.

3.0 Health Inequalities in GloucestershireGloucestershire is one of the healthiest counties in England; overall health outcomes are better than the national average with premature death rates from all causes falling over the last ten years.

However, the health and wellbeing of some of our communities is not improving at the same rate as others and large health inequalities exist, with some groups having significantly shorter lives and suffering more illness and disability than others. For example,

A man living in Kingsholm has a life expectancy from birth of 73.2 years, 13.9 years shorter than a man living in Churn Valley (Cotswolds) A woman in St Paul’s has a life expectancy of 77.8 years, 13.3 years shorter than a woman in Wotton-under-Edge (Period: 2008 – 2012, www.localhealth.org.uk 2015)

The infant mortality rate in the Forest of Dean is 4.3 per 1000 live births, compared to 1.9 per 1000 in Cotswold.

We know that those areas that experience the highest levels of deprivation often have the greatest level of health inequalities. We can identify these areas through the Indices of Deprivation 2015 which are national measures based on 37 indicators, which highlight characteristics of deprivation such as unemployment, low income, crime and poor access to education and health services. They offer an in-depth approach to pinpointing small pockets of deprivation, using Lower Super Output Areas (LSOA) rather than wards. These are small geographical units averaging 1,500 people and provide a more in-depth appreciation of variations in deprivation at a local level. Nationally, there are 32,844 LSOAs in comparison to approximately 8,500 wards, and they are more consistent in size. In

1 Strategic Review of Health Inequalities in England post-2010: Fair Society, Healthy Lives: The Marmot Review 2010

http://www.localhealth.org.uk/

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Gloucestershire there are 373 LSOAs compared to 146 wards. This helps us identify the small pockets of deprivation that exist alongside some of our less deprived areas.

Gloucestershire has 13 LSOAs in the top 10% most deprived nationally - 10 in Gloucester City and 3 in Cheltenham which accounts for 20,170 (based on ONS MYE 2013, the latest available at LSOA level) residents amounting to 3.2% of the total population of the county. These areas are:

Figure 1: Gloucestershire Lower Super Output Areas in the top 10% most deprived nationally

LSOA – most deprived to least deprived

Location

Westgate 1 GloucesterPodsmead 1 GloucesterMatson and Robinswood 1 GloucesterKingsholm and Wotton GloucesterWestgate 5 GloucesterMoreland 4 GloucesterSt Mark’s 1 CheltenhamHester’s Way 3 CheltenhamSt Paul’s 2 CheltenhamBarton and Tredworth 4 GloucesterMatson and Robinswood 5 GloucesterBarton and Tredworth 2 GloucesterWestgate 4 Gloucester

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These are the hotspots in terms of overall multiple deprivation and a higher proportion of residents in these areas will experience higher recorded crime rates, more low birth weight babies, higher rates of prevalence of heart disease and bronchitis, more likely to leave school with no work, education or training destination, more likely to be dependent on Community & Adult Care services, have lower incomes, high unemployment rates and a poorer living environment compared to the rest of the county.

A further 17 areas fall into the most deprived 20%. They tend to represent a wider range of hotspots located around the market towns and account for a further 25,000 residents comprising 4% of the total population of the county.

Life expectancy is one of the main summary indicators we use to track inequalities in health. Whilst the life expectancy of the county overall continues to increase, the health of the less well off is improving more slowly than the rest of the population. As such, it has been selected by Public Health England as one of the key ‘overarching indicators’ in the Public Health Outcomes Framework. The table below shows the breakdown of the life expectancy gap between the most deprived district quintiles and the least deprived district quintiles in Gloucestershire, by broad cause of death. This is useful because it provides an indication of which conditions primary and secondary prevention programmes need to focus on to help address inequalities in morbidity and mortality.

County wide the three leading diseases contributing to almost three quarters of the life expectancy gap in both males and females are: circulatory conditions (31% of the gap in males; and 25% of the gap in females) followed by cancer and respiratory diseases (Figure 2).2

2 Segment tool, London Health Observatory, PHE. http://www.lho.org.uk/LHO_Topics/Analytic_Tools/Segment/TheSegmentTool.aspx

http://www.lho.org.uk/LHO_Topics/Analytic_Tools/Segment/TheSegmentTool.aspx

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Figure 2: Breakdown of the life expectancy gap between Gloucestershire’s most deprived quintile (20%) and least deprived quintile by broad cause of

death, 2010-12 (source: LHO segment tool, Public Health England)

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Figure 3 shows the breakdown by district. It can be seen that in most cases, though the relative contribution of each disease varies, the three leading diseases contributing to the life expectancy gap in both males and females are again circulatory conditions, cancer and respiratory diseases. The implication is that if work is focused on both the prevention of these conditions among people living in the most deprived communities, and the management of those patients already diagnosed, the life expectancy gap should be reduced.

Figure 3: Life expectancy gap by broad cause of death, 2010-12 (source: LHO segment tool, PHE)

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4.0 What are our priorities and how have we identified them?Action to reduce inequalities requires focus across the causes of those inequalities including: the wider determinants (education, employment, financial and environmental), the modifiable risk factors for disease (both primary and secondary prevention) and accessibility and responsiveness of health services.

Using the Gloucestershire Joint Strategic Needs Assessment (JSNA), analysis of the most recent Indices of Multiple Deprivation (2015) and the body of evidence built up by Public Health England, the UCL Institute of Health Equity and the Kings Fund amongst others, we have been able to identify key areas (both geographical and topical) which we would like to focus on.

We have organised our priorities under the headings of the six policy objectives recommended by Marmot in ‘Fair Society, Healthy Lives’ (2010). We are taking a life course approach and have included a range of interventions that will achieve short, medium and long term impacts. Interventions to achieve short term (less than five years) impacts can have a sizable impact on life expectancy. These include actions to prevent cardiovascular diseases, early identification of cancers and the management of long term conditions. However, these should be combined with other interventions that aim to impact on outcomes in the medium term (from 0 to 10 years), such as lifestyle changes, and an impact on outcomes in the longer term (from 0 to over 10 years), such as education and employment.

The actions and interventions identified within this plan are guided by the following principles:

Outcomes focused: monitoring our progress in terms of meaningful impact on local people (‘outcomes’) - not just looking at what activities have taken place (‘outputs’)

Service user and community voice will inform all that we do and how we do it Needs rather than demand-led: interventions will be focused where there is the greatest capacity to benefit Proportionate Universalism: actions must be universal, but with a scale and intensity that is proportionate to the level of

disadvantage All interventions will be informed by evidence of impact and where this is not available will be supported by a sound evaluation Sustainability: building capacity supporting individuals and communities to help themselves and each other and to become more

resilient; fostering self-care and independence and improving levels of health literacy Parity of esteem: ensuring we are equally focused on improving mental as well as physical health, and reducing inequalities in

both Starting early: Giving every child the best start in life through focusing on pregnancy and the first months and years of life Long-term commitment: A commitment to ‘seeing it through’ – a long term sustained strategic approach, which includes a range

of short and medium and long term actions and interventions

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Focusing on both communities of ‘place’ and communities of ‘interest’: (i.e. people who share common characteristics / challenges). Our actions will include those that are applied across the whole county and others that are district or locality-led.

Lifelong Learning: Embedding the principles of lifelong learning into actions, interventions and policies and maximising opportunities for formal and informal learning across the lifecourse.

5.0 Who will do what?Health and Wellbeing Boards have a vital role to play in delivering integrated care and transforming services to help tackle health inequalities and address financial and demographic challenges. This Delivery Plan will need the support of a wide range of partners if it is to achieve its objectives. By drawing together priorities and actions from across partner organisations we can take a coordinated approach to try to really make a difference in the lives of those Gloucestershire residents who experience the highest levels of health inequality.

The County Council will…

The CCG…

The NHS community…

The District Councils…

The Police…

The Fire Service…

Etc…

6.0 How will we track our progress?We want to know that the interventions we are using are having an impact and making a difference. We will track our progress in two ways: six monthly reporting on key performance indicators related to each of the six priority outcomes and an annual review where we

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will look back and learn from our actions over the previous year and forward plan for the following year, ensuring that we are responsive to changes in the economic and political environment and that we only invest in activity that is having a real impact.

For each of the six priority outcomes below we explain why they are a priority for Gloucestershire and detail the actions we are taking and how we will measure our progress.

PLEASE NOTE: This plan is still under development and discussions are ongoing with partners to finalise the detail of actions and KPI’s.

Priority Outcome 1: Give Every Child the Best Start in Life

Delivered through: Early Help and Children and Young People Partnership Plan; Public Health interventions

Local Priorities

1a: Support good health and wellbeing in pregnancy and the newborn

1b: Parents have the confidence and skills to support their child’s healthy development

1c: Mechanisms are put in place to enable children to be ready for school

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Why is this a priority for Gloucestershire?

The national evidence base clearly identifies that events that occur in early life, including pre-birth, affect health and wellbeing in later life. What happens in these years lays down the building blocks for the future. This is particularly the case at times of rapid brain growth in the early years (i.e. from birth to 2 years) and during adolescence. This understanding underpins the concept of the life course, that each stage of life affects the next. Therefore, to try to impact on the diseases of adult life that make up the greatest burden of disease, it makes sense to intervene early.

The development of a child begins before birth and the importance of parents (particularly mothers) adopting a healthy lifestyle during and after pregnancy, has a major positive influence over improving the health and life chances of their child (Gloucestershire JHWS, 2012). There are many factors that can increase the risk of complications in pregnancy and low birth weight babies which also have an impact on the child later on in life.

There were 6,880 live births in Gloucestershire in 2012, but outcomes are not evenly spread across the county.

Low birth weight births in Gloucestershire have generally been at a fairly consistent rate since data recording began in 2005. In 2011, 5.3% of babies born in Gloucestershire had a low birth weight <2,500 grams which is lower than the regional and national average. However there appears to have been a rise in 2012 and this will be monitored accordingly to see if the upward trend continues.

Smoking in pregnancy has detrimental effects on both the health of the mother and the growth and development of the baby. Smoking during pregnancy is associated with serious pregnancy-related health problems. These include complications during labour and an increased risk of miscarriage, premature birth, stillbirth, low birth-weight and sudden unexpected death in infancy.

Encouraging pregnant women to stop smoking during pregnancy and to remain as non-smokers after the birth also has longer term health benefits for both mother and child, such as reduced childhood exposure to secondhand smoke. The percentage of pregnant women smoking at the time of delivery in Gloucestershire is higher compared to South West and England.

In summary we can say that: Gloucestershire compares well with other areas in terms of most measures eg breastfeeding uptake, low birth weight babies,

infant mortality We have a good model of midwife-led births and provision (with more patchy pattern of home births)

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Our local services are working hard to improve normal birth rates and have received positive feedback on services in recent surveys.

But: We would expect these relatively good outcomes and performance given our demographic profile The outcomes gap between those women and babies who do well against these indicators and those who do not is

significant, with the overall position masking considerable variation (eg Gloucester City has the greatest need and the poorest outcomes)

The work of the Maternity Pathways Review Project that reported in 2014 tells us that:o Local / neighbourhood level working and service provision is very important in influencing take up of services by the groups

we would most wish to targeto Integration of maternity with other early years services (such as health visiting and children’s centres) is not as good as it

could beo Achievement of public health outcomes in pregnancy such as smoking cessation, obesity, maternal mental health and

practical parenting support, can be improved in vulnerable groupso Peri-natal mental health services can be improved o Current service provision is not matched geographically to need ie the same community caseloads across the countyo There is scope to change the way that unscheduled care is provided / accessed.

Research also tells us that there are direct links between neonatal outcomes and subsequent demand for / utilisation of a range of services (eg emergency care especially in the first year of life), and also on obesity in later life, lifetime risks for cardio-vascular disease and diabetes, learning difficulties, mental health status and educational attainment.

The quality of parenting that a child receives is considered the strongest contributory factor in the development of resilient, more confident and emotionally healthy children. Successful parenting is a key element in preventing children from developing behavioural difficulties which themselves are associated with adult mental health problems, crime, relationship and parenthood difficulties and substance dependence. Supporting parents to develop effective parenting skills is therefore an important part of prevention and early intervention (Parenting Early Intervention Programme evaluation, DoE, 2011).

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Priority Outcome 1: Action Table

Priority 1a: Support good health and wellbeing in pregnancy and the newbornAction How Key PartnersHealthy Start (Vitamins and Vouchers) Review.

Undertake a review of Vitamin D need and provision among groups at risk of deficiency – to include a review of provision and uptake of Healthy Start (food vouchers and vitamins) for pregnant women and young children

LEAD: Sue Weaver and Angelika Areington (GCC); Helen Ford (CCG); Midwifery and health visiting leads; Pharmacy leads; Early Years Providers

Review stop smoking services as part of the Health Behaviours Review and retender stop smoking support from January 2017.

Using national, local and other Local Authority data to benchmark current performance and assess future needs.

LEAD: Tracy Marshall GCC

Development of a shared action plan between Gloucestershire Stop Smoking Service (GSSS) and the midwifery service to improve the number of referrals received.

Provider to work with the Midwifery Service to ensure that referrals to the Stop Smoking Service are made in an appropriate and timely manner.

LEAD: Tracy MarshallGCC

Undertake a review of evidence for improving breastfeeding rates among groups least likely to breastfeed and develop multi-agency improvement plans.

Through discussion at the Children’s Clinical Programme Group and the Maternity Commissioning Group.

LEAD: David Squire, GCC and Helen Ford,CCG

Priority 1b: Parents have the confidence and skills to support their child’s healthy developmentAction How Key PartnersParent support programme review is completed and provides evidence for decision making. This includes a review of current programmes for efficacy and value for money.

During 2016, identify capacity to undertake and scope the review for 2017 - 2018

LEAD: Ruth Lewis, GCC /GCC PH

Family learning programme is implemented Family learning courses are already in LEAD: Lesley Dale and Jo Jackson Adult

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in Children’s Centres and schools. Impact of learning is measured and reported at agreed intervals

place. Tutors will work with learners to ensure learning outcomes are mapped to supporting children’s development as well as improving parents’ skills and future opportunities. Reporting on outcomes will be provided termly through the moderation process and learner evaluation/feedback as well as case studies.

Education Direct Delivery, GCC

Priority 1c: Mechanisms are put in place to enable children to be ready for schoolAction How Key PartnersIntervention is targeted at settings that require improvement and are inadequate.

All RI and inadequate settings are signed up to Early Years Intervention programme and receive support and challenge from Early Years Locality Advisers commensurate with level of programme they enter on. Local intelligence ensures that good and outstanding settings that are vulnerable to a poor inspection grade are also supported

LEAD: Jane Lloyd Davies and Julia Hawkes, GCC

SEND Early Years Service target support to improve provision and opportunity for inclusion in settings for children with SEND.

LEAD: Sarah Hylton, GCC

KPI Impact Table:

Indicator Baseline Target LeadPercentage of good and outstanding early years daycare settings

91.3 % (5/1/16) 95% Jane Lloyd Davies and Julia Hawkes, GCC

Percentage of good and 80.1% (5/1/16) 85% Jane Lloyd Davies and Julia

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outstanding early years childminder settings

Hawkes, GCC

Number of early years settings receiving targeted SEND support.

tbc tbc Sarah Hylton, GCC

Number of children with SEND being supported to access and achieve outcomes in EY education through additional resources/funding.

tbc tbc Sarah Hylton, GCC

Numbers of pregnant smokers supported to quit at 4 weeks.

Smoking status at time of delivery – 11.4% (742)

120 pa Tracy Marshall, GCC

Breastfeeding initiation. 77.1% 80% David Squire, GCC; Helen Ford, CCG

Breastfeeding prevalence at 6-8 weeks after birth.

49.2% 55% David Squire, GCC; Helen Ford, CCG

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Priority Outcome 2: Enable all Children, Young People and Adults to Maximise Their Capabilities

Delivered through: Early Help and Children and Young People Partnership Plan; Adult Education; Building Better Lives; Better Care Fund

2b: Narrow the gap in attendance and attainment for vulnerable young people

Local Priorities

2c: Increase access and use of lifelong learning opportunities across the social gradient

2d: Support older and disabled people to live safe, independent and fulfilled lives.

2a: A child’s progress, strengths and needs are identified at an early stage in order to promote positive health outcomes in health and wellbeing, learning and behaviour


There is a clear relationship between low educational attainment and poor physical and mental health over a person’s lifetime which also impacts on income, employment and quality of life. In Gloucestershire we know that in spite of an overall positive picture in terms of outcomes for children and families we still have some real challenges in terms of those who do less well or who are most vulnerable.

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The Gloucestershire Joint Commissioning Framework for Children and Young People (2015) has already picked up that there is scope for improvement in the areas of early years and disability/special educational needs. We know that age 2 – 2 ½ is a crucial stage as problems with development become visible but there is still time to make a difference and early identification of need and provision of support is a corner-stone of both the national changes as a result of the Children and Families Act 2014 SEND Programme, and our local Building Better Lives Strategy.

Local needs analysis indicates that there is a gap in achievement by the end of the early years for some children living in very disadvantaged areas when compared to their peers in other areas of the county. The educational outcomes for vulnerable young people, including pupils from Black and Minority Ethnic groups, pupils whose first language is other than English, pupils eligible for Free School Meals and pupils with Special Educational Needs (SEN) are generally worse overall. Outcomes for pupils with SEN are lower than for any other vulnerable group in Gloucestershire and lower than the regional and national comparators at all stages apart from KS2 in reading, writing and mathematics (RWM).

Marmot (2010) quotes several studies which provide evidence that participation in adult learning impacts positively on health behaviours and outcomes and argues that it is important to provide opportunities for people to acquire higher levels of skills and qualifications beyond compulsory education. Gloucestershire’s Community Learning and Skills Curriculum Strategy seeks to widen participation in learning, especially amongst those who are at risk of being excluded, by helping adults to overcome the barriers that prevent them from successfully taking part in learning. Current adult education priorities include employability and pre employability learning; sustainable communities and citizens and family learning programmes.

The number of older people aged 65 and above in the county has been growing by an average of 2,100 people per year between 2003 and 2013 and this is set to increase to 3,400 people per year by 2037. We know that age is a leading determinant for long-term conditions and for the majority of long-term conditions Gloucestershire has a significantly higher prevalence rate than for the country as a whole. Through this delivery plan and other key strategies such as Building Better Lives and the Better Care Fund we are striving to support older and disabled people to live safe, independent and fulfilled lives.

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Priority Outcome 2: Action Table

Priority 2a: A child’s progress, strengths and needs are identified at an early stage in order to promote positive outcomes in health and wellbeing, learning and behaviourAction How Key PartnersPilot the Integrated Review (integration of the early health check and the healthy child programme two year check) at two years of age, in Dursley.

Pilot up an running in Stroud Locality. Feedback and analysis in Spring Term 2016. Further extension of Pilot to Cheltenham leading to full roll out Autumn 2016

LEAD: Julia Hawkes; Ruth Lewis, GCC

The health, care and educational needs of children with SEND are identified at an early stage and addressed in holistic plans which enable them to be ready for school and for holistic needs to be addressed at the earliest opportunity to prevent escalation.


The health notifications process for pre-school children identified as having or likely to have SEND is implemented

Health Visitor identifies child with or potentially with SEND, notifies the Local Authority, provides information about the Local Offer and SEND pathway to parents/carers and offer to initiate My Plan for child.


Priority 2b: Narrow the gap in attendance and attainment for vulnerable young peopleAction How Key PartnersIncrease levels of school attendance in lowest attaining schools.

LEAD: Jane Lloyd Davis, GCC

Priority 2c: Increase access and use of lifelong learning opportunities across the social gradientAction How Key PartnersSupport people of all ages and abilities to access ‘arts’ activities especially for those on low incomes.

Artspace project LEAD: Tess TremlettForest of Dean District Council

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Priority 2d: Support older and disabled people to live safe, independent and fulfilled lives.Action How Key PartnersSafe at Home Scheme. The scheme helps older people and people

with disabilities carry on living in their own homes safely with repairs and improvements to their homes, so that they can continue to live in greater comfort and security. The service is available to people referred to Safe at Home by social care and health services, or by people who want to make changes for themselves.

LEAD: Deb HughesForest of Dean District Council

Community Alarm Service. Linkline service in the Forest of DeanCareline Service in the Cotswolds

LEAD: Deb HughesForest of Dean District Council

Provide transport for those who do not have their own access to transport.

The Community Transport Project LEAD: Lena MallerForest of Dean District Council

Safe and Well Checks. Details being finalised. LEAD: Sally Waldron, Gloucestershire Fire and Rescue Service

KPI Impact Table

Indicator Baseline Target LeadNumber of children aged 0-5 identified as having or likely to have SEND through health notification system.

Data not available as system not previously in place.

Baseline data being collected. Sarah Hylton, GCC

Number of children with SEND with early help assessments and/or plans in place.

Jane Morrisson to provide data Baseline Data being collected Sarah Hylton, GCC

Increase levels of school attendance in the lowest

Detail requested Levels of attendance are increased and persistent absence

Jane Lloyd Davis, GCC

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attaining schools. is reduced in the 30 schools with the lowest rates.

Placeholder for Safe and Well Checks KPI.

Meeting arranged to discuss detail

Sally Waldron, GFRS

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Priority Outcome 3: Create Fair Employment and Work For All

Delivered through: Building Better Lives; Youth Employment and Skills Strategy;

3.1 Improved employment opportunities and retention for young people; people with disabilities; people with mental health problems and older people

Local Priorities

3.2 Support and positive interventions are provided to people with multiple and complex needs facing disadvantage in accessing the labour market


The health of the Gloucestershire labour market, which deteriorated after the recession in line with national trends, has recovered gradually to a position of strength reflected in 2014 by an employment rate of 78%3, well above the national average of 72%. The corresponding unemployment rates have consequently reduced. Although worklessness may be less of a challenge than in other parts of the country there are however, still issues at county level that relate to youth unemployment and long term unemployment.

3 Annual Population Survey 2011-2014 ONS Crown Copyright Reserved (Nomis)

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We know that certain sections of the population such as those with mental health issues, with disabilities or low educational attainment find it much more difficult to get and retain work and as a consequence suffer worse health outcomes over the life course. Data from the latest Gloucestershire Joint Strategic Needs Assessment summary (UG-JSNA 2015) tells us:

People with disabilities in Gloucestershire are less likely to be in a job, do well academically or participate in sport In 2014 there was an estimated 11,360 people aged 18+ with a learning disability living in Gloucestershire. The number of people

aged 18+ with a learning disability is forecast to increase to 12,542 people by 2030. This represents an increase of 1,182 people or 10.4%.

The Forest of Dean and Gloucester had the highest proportion of their adult population with no qualifications and the lowest percentage with qualifications at level 4 and above in 2011. These two Districts performed worse than the South West and the country as a whole for the ‘Level 4+’ measure. The Forest of Dean also performed worse for both comparators for the ‘no qualifications’ measure.

Claimant unemployment rates across all districts have halved since 2013 and are at their lowest for over 20 years. However the rate of improvement across the county varies: in April 2015 Cotswold district had the lowest rate at 0.7% and Gloucester district the highest at 2%.

Priority Outcome 3 Action Table

Priority 3a: Improved employment opportunities and retention for young people; people with disabilities; people with mental health problems and older people.Action How Key PartnersEmployability Learning using GCC adult education direct delivery in partnership with other providers.

Pre-employability, employability, essential skills including ESOL related courses as well as English and Maths, traineeships and apprenticeships delivered in key areas focusing on those furthest from employment.

Outcomes monitored through survey of learners three months after end of employability courses. Could be extended to pre-employability. Feedback on outcomes for apprenticeships and essential skills to be agreed for 2016-17

LEAD: Lesley Dale, GCC Adult education direct delivery and Mark Hewlett Adult Education Commissioning

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Coordinating activity in relation to young people on healthy lifestyles; education; employment; housing and positive activities in Cheltenham.

Work with GAVCA to convene quarterly meetings of all youth providers of services for young people in the town. To include:

How resilience is built in the sector How best to consult and engage with young

people Reviewing and assessing data Supporting commissioners of young people’s

support services Supporting those with a service responsibility

for promoting healthy lifestyles among young people

LEAD: Cheltenham Partnerships

Priority 3b: Support and positive interventions are provided to people with multiple and complex needs facing disadvantage in accessing the labour market.Action How Key PartnersInvestigation of how Department of Work and Pensions European Structural and Investment Funds (ESIF) can be utilised to effectively provide support across the target groups (people with multiple and complex needs).

Detail to be confirmed. LEAD: Vikki Walters, GCC

KPI Impact Table

Indicator Baseline Target LeadIncrease the number of learners, including adults with learning difficulties and disabilities, who progress to or re-enter employment, who work for longer, who change their skills set, who embark on a new career or who progress into further training, volunteering or self-employment.

39% responding to survey reported they had gained employment; 8.5% continued in education.

tbc Lesley Dale, GCC Adult Education Direct Delivery, Mark Hewlett Adult Education Commissioning

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Measured through the adult education progression survey completed 3 months after the end of the course.

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Priority Outcome 4: Ensure a Healthy Standard of Living for All

Delivered through: District statutory responsibilities

4a: Promote and improve energy efficiency in the home to reduce cold related illness and reduce the number of households living in fuel poverty

Local Priorities 4b: Ensure occupants live in safe,

healthy homes through improving housing conditions

4c: Support financial capacity and inclusion


Limited affordable housing and the quality and condition of available housing are believed to contribute to poor and unsafe living conditions, social isolation, lack of community integration and increased likelihood of anti social behaviour as well as a range of health conditions. Overall the Building Research Establishment (BRE) has calculated that poor housing costs the NHS at least £600 million per

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year. Using modelling techniques, it is estimated that in Gloucestershire there are over 45,900 dwellings with a category one hazard which, if improved, would result in an annual saving to the NHS of £4.6 million.

Being in fuel poverty is defined as where 10% or more of the household income is spent on adequately heating your home. Or more recently if a household spends what is necessary to adequately heat their home then the household would be left with a residual income below the official poverty line.

Highest levels of fuel poverty are associated with single parent families and elderly households with family and also with households with a younger head of household (under 25 years). For example, the Cheltenham Borough Council Housing Condition Survey 2011 reveals that 11.8% of their population spend in excess of 10% of annual household income on fuel and are in fuel poverty. Rates of fuel poverty are higher for households living in housing constructed between 1919 and 1945 and in the St Pauls area.

The 2011 Gloucester survey shows that 10.8% of Gloucester residents spend in excess of 10% of annual household income on fuel and are in fuel poverty. Rates of fuel poverty are higher for households living in pre-war housing and in the Barton and Tredworth and Moreland Areas.

Priority 4 Action Table

Priority 4a: Promote and improve energy efficiency in the home to reduce cold related illness and reduce the number of households living in fuel povertyAction How Key PartnersGive advice on saving energy, renewable technologies and financial assistance.

Via the Severn Wye Energy Advice Line LEAD: Jon Beckett, Stroud District Council; NHS; GCC; SWEA

Target 2050 loans of up to £10,000 for energy efficiency improvements in the home.

LEAD: Jon Beckett, Stroud District CouncilNHSGCCSWEA

Priority 4b: Ensure occupants live in safe, healthy homes through improving housing conditionsAction How Key PartnersCategory 1 hazards are removed as a result Grants; loans; signposting; enforcement. District Local Authorities

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of interventions by Local Authorities.

Help improve housing conditions for residents of Stroud on low incomes with Healthy Home Loans.

Healthy Home loans for low income households where a category 1 hazard exists.

Jon Beckett, Stroud District Council

Priority 4c: Support financial capacity and inclusionAction How Key PartnersProvide support to those whose mental health is negatively affected by financial worries.

Support the continued presence of the Citizen’s Advice Bureau in Cirencester, telephone and online support and the roll out of outreach support across the district.

Stroud CABStroud District Council

Financial literacy, healthy cooking on a budget and independent living skills courses with adults in supported/first tenancy situations.

Courses are already offered at introductory level with supported housing tenants then learners referred onto more in depth support via CAB.

Lesley Dale and Sue Blackmon, Adult Education Direct Delivery, GCC

KPI Impact Table

Indicator Baseline Target LeadNumber and type of category 1 hazards removed.

Is this District Specific or across all six Districts?

Julie Wight, Gloucester City Council

Number of properties accredited on ‘fit to rent’ scheme.


Number of households in fuel poverty reduced.


Number of solid wall properties insulated.


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Number of properties connected to the gas main.


Number of properties with energy efficiency improvement made.


Number of homes inspected by an environmental health officer to ensure standards are met and the home is safe with adequate facilities.


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Priority Outcome 5: Create and Develop Healthy and Sustainable Communities

Delivered through: Enabling Active Communities Action Plan:

5a: Create active and knowledgeable communities

Local Priorities

5c: Reduce social isolation

5b: Improve capacity, resilience and motivation in local communities


For many people in Gloucestershire outcomes are good. However, as we have shown throughout this plan this is not the case for everyone. Some of the challenges we face include:

19,000 people in Gloucestershire classifying themselves as socially isolated (Marmot (2010) noted that several longitudinal studies have shown that social networks and social participation appear to act as a protective factor against dementia or cognitive decline over the age of 65 and social networks are consistently and positively associated with reduced morbidity and mortality.)

Comparatively high numbers of older people living in Gloucestershire mean there is greater pressure on health and care services;

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Challenges in supporting families and individuals who have benefitted from intensive professional support and preventing re-referrals;

The county covers a large geographical area, with some isolated rural areas and a widely distributed population with two main urban centres, posing a challenge for equality of access to health and care services, as well as leisure activities.

During 2013/14, following extensive community-wide engagement, the health and social care community in Gloucestershire developed a five-year strategic plan called ‘Joining Up Your Care’. This plan included a shared vision for the future of health and care services in Gloucestershire: “to improve health and wellbeing, we believe that by all working better together – in a more joined up way – and using the strengths of individuals, carers and local communities, we will transform the quality of care and support we provide to all local people”. Out of this vision the ‘Enabling Active Communities’ joint policy emerged with the aim of drawing upon and stimulating the diverse range of assets within each local community and addressing some of the issues mentioned above.

Priority 5: Action Table

Priority 5a: Create active and knowledgeable communitiesAction How Key PartnersDevelop a communication plan to clearly explain what advice, information and guidance is available to people who want to become actively involved in their communities.

Working with the Active Communities Commissioning Group to develop and implement the communications plan.

Steve Andrew, Programme Manager, GCC

Establish key information sources that communities can access to provide them with relevant information on subjects that equip them to make informed decisions on how to, and when to ‘step up’ in a safe and legal way.

Provide access and/or signpost to subject specific information and guidance to community groups on topics such as Human Resources, Finance, Health and Safety, Asset Management and Property Services etc. to enable them to fully understand what is required of them prior to them ‘stepping up’.

Steve Andrew, Programme Manager, GCC

Work in partnership across health and Through multi-agency partnership working Lead Commissioners, GCC

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social care organisations to enable identification of good practice, sharing of resources and evaluation of success and advertise examples of strong, active communities via web accessed portal.

including Health and Wellbeing Board; Gloucestershire Children’s Partnership; Building Better Lives Partnership; Learning Disabilities Partnership; Better Care Fund Provider Forum; Armed Forces Community Covenant; Community Engagement Network; GCC Adult Education Direct Delivery.

Partner organisations including CCG; VCS Alliance; District Councils; NHS Providers

Steve Andrew – Programme Manager, GCC

Priority 5b: Improve capacity and resilience in local communitiesAction How Key PartnersComplete the roll out of social prescribing to all GP Practices (81) in the county. As at end of December 2015, the scheme was available to 75 Practices. Referrals also to be accepted from staff in Integrated Community Teams (ICTs) and from staff in community hospitals. The aim of the scheme is to improve a person’s wellbeing (as measured by the short Warwick Edinburgh mental wellbeing tool), to reduce use of primary care and to reduce use of secondary care.

Social Prescription Pathway. GCCG, District, City, Borough and County Councils, GCS, G.DOC.

Inspiring Families. Establish male mentoring scheme Expand current holiday nutrition project Continue to expand the network of trusted

individuals Explore alternative therapeutic options for

chaotic families Complete a cost-benefit analysis for the

project.

Cheltenham Partnerships

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To provide advice, support and advocacy for those in greatest need.

Service level agreements with VCS orgs:CAB

FODDC (Tess Tremlett)

Community based approach to tackle health inequalities in the Westgate area of Gloucester City

Engage with local residents, using a systems leadership methodology to develop, test and pilot a community wide plan that provides clear evidence of the needs and priorities of the Westgate communities (communities of place and communities of interest) to help reduce health inequalities.

Gloucester City Council; CCG; GCC; Gloucester Locality Executive

Priority 5c: Reduce social isolationAction How Key PartnersTo reduce social isolation and support people in their own homes for as long as possible.

Deliver a hot meal service at home and provide befriending support

FODDC (Tess Tremlett)

Age UK FODTo provide transport for those who do not have their own access to transport.

The Community Transport project FODDC(Lena Maller)

KPI Impact Table

Indicator Baseline Target Lead

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Priority Outcome 6: Strengthen the Role and Impact of Ill Health Prevention

Delivered through: Joining Up Your Care; Public Health Commissioned Activity; NHS and District Partners

6a: Improve areas of poor performance on Gloucestershire’s health profile – smoking; obesity; oral health

Local Priorities

6c: Improve uptake of childhood immunisations

6e: Implement an evidence based approach to ill-health prevention in relation to cardiovascular diseases; blood pressure and diabetes

6d: Improved sexual health outcomes in vulnerable communities

6b: Improve access to screening and health services for vulnerable groups

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Prevention is a key focus of the Gloucestershire Health and Wellbeing strategy. Evidence shows that lifestyle factors are a significant factor in someone’s risk of developing a long term health condition or dying prematurely. According to the World Health Organisation almost half the burden of illness in developed countries is associated with the four main unhealthy behaviours: smoking, excess consumption of alcohol, poor diet and low levels of physical activity.4

The implication is that if we can support people to change their behaviour and adopt ‘healthier lifestyles’, their risk of ill-health and premature mortality should also be reduced. This has benefits for the individual and the wider society in terms of reduced costs for the NHS and social care.

The four main causes of death and serious illness both locally and nationally are: Circulatory diseases (heart disease and stroke); cancers; respiratory diseases such as chronic obstructive pulmonary disease (COPD) and liver disease. In the most deprived areas of the county early deaths from coronary heart disease (CHD) and stroke are more than double the county rate and the number of early deaths from cancer is well above those for the county. The pattern is similar for COPD (chronic lung disease usually caused by smoking) and other types of respiratory disease as well as for diabetes (strongly linked to obesity) and liver disease (usually caused by alcohol misuse). In the most deprived areas death rates for COPD are more than double the county rate and for diabetes, it is more than one and a half times the county rate.

Another example of the strong correlation between deprivation and unhealthy lifestyle behaviours is that people from the most deprived areas in Gloucestershire are 30% more likely than the least-deprived to have high blood pressure and the condition disproportionately affects some ethnic groups including black Africans and Caribbean’s. Rates of both obesity and alcohol related hospital admissions are significantly higher in the county’s more deprived neighbourhoods, which highlights the importance of targeted prevention work. Research by the King’s Fund found that clustering of unhealthy behaviours was more common in people from lower socio-economic and educational groups.

7.5% of adults smoke in Gloucestershire however rates vary across localities and between groups of people. Smoking rates rise to 28.2% in those working in routine and manual professions in the county and are as high as 45% among routine and manual workers in

4World Health Organisation (2002) cited in Buck & Frosini (August 2012) Clustering of unhealthy behaviours over time: implications for policy and practice, The King’s Fund.

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Cheltenham (2013). Increased smoking is responsible for most of the excess mortality of people with severe mental health problems. Two out of every five cigarettes in England are smoked by people with mental health problems. Many wish to stop smoking, and can do so with appropriate support (Department of Health, 2010).

Significant preventable local inequalities relating to oral health with poorer outcomes among: children in care; people living in deprived communities; people with diabetes; older people with dementia and those living in residential or nursing care; gypsy and Irish travellers and children and adults with disabilities. Poor oral health has a significant impact on health and wellbeing including school absence; mental health and wellbeing; quality of diet and there is strong evidence for oral health promotion (PHE, 2014; NICE, 2014). The NHS in England spends around £3.4 billion per year on dental care.

We know that access to healthcare is a known determinant of health and that low health literacy is associated with poorer health outcomes. It is often those people who require health care the most that are least likely to come forward and receive it. Improving access and levels of health literacy for vulnerable groups is key to reducing health inequalities.

Priority 6: Action Table

Priority 6a: Improve areas of poor performance on Gloucestershire’s health profile – smoking; obesity; oral healthAction How Key PartnersReduce the number of people with mental health problems who smoke.

Review stop smoking services as part of health behaviour review and retender stop smoking support from January 2017 GSSS to offer level 1 brief advice and level 2 smoking cessation training across 2gether trust staff from October 2015.

GCC; GCS; 2getherFT

Reduce the number of children aged 15 years who smoke.

We will extend delivery of ASSIST in secondary schools

Tracy Marshall, GCC

Reduce the number of routine and manual Review stop smoking services as part of Tracy Marshall, GCC

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workers who smoke. health behaviour review and retender stop smoking support from January 2017 Review care pathways to increase referrals from GP’s and secondary care.

Improve oral health in children and reduce the gap for high risk groups.

Develop a targeted multi-agency oral health promotion plan in response to the 2015 oral health needs assessment.

Temi Folayan, GCC

Adults with learning disabilities to be considered a high risk group for deaths from respiritory problems.

Work is ongoing to identify cohort considered high risk of death from respiratory problems currently supported by Community Learning Disability Teams (CLDT).

Work with CCG respiratory Clinical Programme Group to improve access to respiratory care pathway for people with postural management issues.

Improving early management in community settings. Improving acute services and treatment. Preventing recurrence after acute care.

Jan Hoskins, CCG

Jackie Hempkin, 2gether Trust

Co-ordinate activity in Cheltenham in relation to young people and healthy lifestyles; education; employment; housing and positive activities.

Work with GAVCA to convene a quarterly meeting of all youth providers of services for young people in the town to include:

how we build resilience in the sector how best to consult and engage with

young people reviewing and assessing data to support the commissioners of

Cheltenham Partnerships

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young people’s support services to support those with a service

responsibility for promoting healthy lifestyles among young people.

Placeholder for GHNHSFT Activity Catherine Boyce, GHNHSFT

Priority 6b: Improve access to screening and health services for vulnerable groupsAction How Key PartnersImprove access to Annual Health Checks and Health Action Plans, for people with a learning disability, meeting unmet need and monitoring.

Changes to the General Practitioner contract and Enhanced Service 2014/15.

Standardisation of Annual Health Checks and a clear pathway between Annual Health Checks and Health Action Plans. CCG, in partnership with GP’s have developed new annual health check and health action plan templates for 3 GP systems.

Development of new enhanced service for residential / care settings supporting people with learning disabilities.

LD community teams to develop liasion role to work with GP colleagues to support completion of Annual Health Checks and facilitate better integration of checks with action plans.

NHS England to review existing arrangements in light of Confidential Inquiry and other evidence, with a view to

CCG (Martin Ayres)

(Simon Shorrick)

2gFT

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assessing effectiveness of the service in improving outcomes.

Health Action Group to continue to develop and consult on easy read leaflets, My Health Books, HAP monitoring tools.

Identify gaps in people with a learning disability accessing: screening services; cervical screening; breast screening; bowel screening.

(Actions to be identified by the Learning Disability Programme Board following completion of Learning Disability Primary Care audit set for end of September 2015).

LD community teams to develop greater liasion role with screening services to increase awareness and support access to screening services.

LD community teams to support screening services to make reasonable adjustments to increase access to services.

CCG (Martin Ayres)

(Simon Shorrick)

Reasonable Adjustments for people with an LD or PMLD in accessing mainstream services and providing appropriate easy read information.

To be audited annually and examples of best practice to be shared across agencies and organisations

All commissioners to ensure that reasonable adjustment audit measures are built into all health provider contracts.

DoH has asked NHS England to look at the feasability of strenghening the contract to require an annual audit of reasonable adjustments.

Health Action Group to work with the ‘4 me about me’ group, partner organisations, to develop and produce easy read information,

CCG (Martin Ayres)

(Simon Shorrick)

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dvd’s, to share across all services.

Providing an information and resource library and central point of access.

Identify existing public health information, organisations like Healthwatch and develop a website to create a more holistic accessible information and resource service.

Currently Health Action Group are reviewing easy read pages for new 2gether trust website

GCC

CCG Health Facilitation Team- Simon Shorrick

Improve cervical screening coverage. Cervical Screening Pilot targeting Polish women under 30ys.

Targeted work with practises (GP list cleansing for specific population).

GCC Public Health: Teresa Salami-Adeti; Elizabeth Luckett, NHS England South

Breast Screening Campaign targeting women under 60

GCC Public Health: Teresa Salami-Adeti; Elizabeth Luckett, NHS England South

Improve outcomes for patient groups who have trouble accessing the health service in a traditional manner i.e. homeless people admitted to hospital.

Establish a clear pathway from hospital to safe discharge supported by community services.

CCG: Debbie Clark; Helen Vaughan

Health care services are accessible to all individuals irrespective of gender, race, disability, age, sexual orientation, religion or belief.

Assessment and grading of performance will be undertaken against the eighteen goals and outcomes of EDS2.

Caroline Smith (CCG)

Equality is embedded throughout health care commissioning.

Through the implementation of the CCG’s Equality and Valuing Diversity Strategy and associated action plan.

Caroline Smith (CCG)

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Improve equity of access to health care services.

Undertake analysis to establish the number of unregistered patients in Gloucestershire and explore.

Maria Metherall (CCG)

Increase access to services by providing information, advice and guidance on available services.

Develop a patient facing platform (reiteration of G-care) that provides clear, evidence based and understandable patient information.

Ruth Hallett (CCG) / Matt Pearce (CCG)

Reduction in avoidable variation in care. Use the principles of system leadership to understand the needs of a local community (i.e. Westgate corridor) and coordinate action around a particular health inequalities issue.

Shifting focus from the patients that present most frequently in practices to the wider population that they serve.

Matt Pearce; Becky Parish; Andrew Hughes (CCG) (TBC)

Priority 6c: Improve uptake of childhood immunisationsAction How Key PartnersImprove uptake of Childhood immunisations Targeted action in the five lowest

performing GP practices in each Locality.

Focus MMR 2nd Dose & Hib/Men C

Birthday Card scheme with 5 worst performing practices

Text messaging reminder service focus on 5 worst performing practices

GCC Public Health: Teresa Salami-Adeti

Elizabeth Luckett, NHS England South

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Targeted support for worst performing practices through facilitator practice visits.

Priority 6d: Improved sexual health outcomes in vulnerable communitiesAction How Key PartnersImproved sexual health outcomes in vulnerable communities (as identified in the Sexual Health Needs Assessment 2015).

Health Equity Assessment (Sexual Health)

Participatory Needs Assessment


Priority 6e: Implement an evidence based approach to ill-health prevention in relation to cardiovascular diseases; diabetes and blood pressureAction How Key PartnersReduce differences in under 75 mortality rate from all cardiovascular diseases.

Review performance of new NHS HealthChecks at end of Q1 2016-17.

Pilot outreach NHS Health Checks.

Review commissioning of NHS HealthChecks.

GCC, PH (Sue Weaver), CCG (Matt Pearce)

Improving the management of high blood pressure in the community.

Case finding for patients with hypertension via opportunistic checks, or NHS Health Checks or methodical review of caseload.

Implement a GP education programme improving skills of HCP’s in effective management of difficult hypertension in primary care.

Hannah Layton (CCG)

Improving the management of Atrial Fibrillation in the community to prevent stroke. Improved anticoagulant therapy for

Funded via Primary Care Offer 2015/16 and joint education project with the Academic Health Science Network

Hannah Layton (CCG)

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individuals with Atrial Fibrillation.

Promoting effective self management (of condition). Ensure self management services are sufficiently targetting areas of high health needs. 70% of EEP participants are from IMD deciles 1-4.

Matt Pearce (CCG)

Implement an evidence-based diabetes prevention programme as part of NHS England’s National Diabetes Prevention Programme (subject to successful bid).

To be confirmed, subject to successful bid Sue Weaver (GCC) /Matt Pearce (CCG)

KPI Impact Table

Indicator Baseline Target LeadNumbers of Smokers with a mental health problem supported to quit at 4 weeks.

100 Target is being negotiated with GCS.

Tracy Marshall, GCC

Numbers of routine and manual Smokers supported to quit at 4 weeks.

1500 Target is being negotiated with GCS.

Tracy Marshall, GCC

Number of key oral health information sessions to parents in pre-schools/ schools located in areas of high needNumber of toothbrushing packs distributed/supplied.

New intervention commenced September 2015

Collecting baseline data Temi Folayan, GCC

Percentage of looked after 68.8 75.0 (3 year target) Temi Folayan, GCC

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children who had theirteeth checked by a dentist. (to be confirmed – in discussion with NHS England))

Hospital admissions: 0-19 y/o for extraction of 1+decayed primary /permanent teeth.

0.4 (553) Being monitored. Temi Folayan, GCC

Percentage of 5-year-old children with decay experience.

28.0 25.0 (3 year target) Temi Folayan, GCC

Improved uptake of Childhood immunisations.

Q4 14/15 MMR uptake 95%<

Hib/MenC Uptake 95%<



Cervical Screening Coverage. Q4 14/15 Cervical screening 80%< GCC Public Health: Teresa Salami-Adeti


Breast Screening Coverage. Q4 14/15 Breast screening coverage <75%



Take up of the NHS Health Check programme (cumulative percentage of those eligible)

Uptake by age, gender,

16.9% (cumulative percentage for delivery during 2013-14 and 2014-15, first two years of five year cycle)

66% uptake (over five year cycle from April 2013 to March 2018)

GCC, PH (Sue Weaver and Karen Pitney), CCG (Matt Pearce)

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deprivation and ethnicity.Baseline to be determined through auditing 2015-16 performance in Q 1 of 2016-17

Number of recorded patients with hypertension against expected prevalence by practice.

Estimated total prevalence (diagnosed and undiagnosed) 2011 25.8%

Recorded prevalence (diagnosed)13.8% 2012/13

tbc Hannah Layton (CCG)

Number of recorded patients with Atrial Fibrilation against expected prevalence by practiceIncidence of Ischaemic Stroke.

Number of recorded patients with Atrial Fibrillation11,688 (1.9%)

tbc Hannah Layton (CCG)

Take-up of Expert Patient Programme and specialist self management services

tbc tbc Matt Pearce (CCG)

Estimated number of people aged 16 and over who have non-diabetic hyperglycaemia by local authority.

Recorded pre diabetes 59,111 (estimated via HSE data)

To be confirmed as programme is implemented in Gloucestershire

Sue Weaver (GCC) /Matt Pearce (CCG)

Number of homeless people admitted to GHT.

tbc tbc CCGDebbie ClarkHelen Vaughan

Individuals seen by Homeless Healthcare team.

Baseline data 13/14 125 individuals seen by Homeless Healthcare Team

tbc CCGDebbie ClarkHelen Vaughan

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Referrals to Time to Heal. Baseline data 14/15 155 individuals

tbc CCGDebbie ClarkHelen Vaughan

Awareness of the patient facing web based platform amongst the community particularly in areas of need.

Number of website hits Ruth Hallett (CCG) / Matt Pearce (CCG)

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7.0 Glossary

To be added once action plan is finalised.

Documents

Gloucestershire Health Inequalities Action Plan 2016 – 2019 · 2017. 3. 21. · Gloucestershire has 13 LSOAs in the top 10% most deprived nationally - 10 in Gloucester City and