HEALTH INEQUALITIES STANDING GROUP PROGRESS REPORT

Transcription

1 LOTHIAN NHS BOARD PAPER 13 Edinburgh Community Health Partnership Sub-Committee 12 December 2007 HEALTH INEQUALITIES STANDING GROUP PROGRESS REPORT 1 Purpose of the Report 1.1 The purpose of this report is to update the Sub-Committee on progress made by the Health Inequalities Standing Group (HISG) since June 2007, describe the current state of play of health inequalities for Edinburgh against some key indicators, and to update the CHP on the Prison Leavers Project, being undertaken as part of the Partnerships for Access to Health (PATH) project. 2 Recommendations 2.1 The Sub-Committee is invited to: note the progress made by the HISG since June 2007; note the update of progress in the city in addressing health inequalities and comment on the emerging priorities; approve the project plan for the Prison Leavers Project. 3 Summary of the Issues 3.1 The main issues are: SUMMARY This paper outlines the steps taken by the HISG in addressing its key tasks and the fair degree of progress that has been made. It also flags up the health challenges that still exist in the deprived areas of Edinburgh. The work of a project to address the needs of prison leavers is also outlined, and its project plan submitted for approval. 4 Background 4.1 The Health Inequalities Standing Group (HISG) was established in November 2006 as a pilot arrangement, following a review of health improvement/inequality planning structures in the city. It is jointly chaired by Dr Margaret Douglas, Consultant in Public Health, Lothian NHS Board, and David Jack, Head of Service, Corporate Services Department, City of Edinburgh Council. In June 2007 the CHP approved

2 the membership and remit of the HISG, including a list of current work tasks, and agreed to receive further progress reports. 4.2 Since June the HISG has met twice, in August and October, with a third meeting scheduled for 5 December. It also organised a stakeholder seminar on 28 June. Progress is outlined below in relation to the major tasks of the HISG. 5 Current work Programme for the Health Inequalities Standing Group - Progress 5.1 Joint Health Improvement Plan identifying more focused priorities. Four themes were identified in May and reported to the CHP in June 2007: food and health, physical activity, social capital and healthy environments. Consultation on actions to address these priorities was undertaken through a seminar held on 28 June 2007, which confirmed the selected priorities. Work in relation to the four priorities has been taken forward by four sub-groups, each of which has met at least twice. Each sub-group has been asked to define what is included in the issue; map existing provision and list stakeholders; identify gaps; and produce by the end of December an action plan identifying joint interventions and target groups with measurable outcomes in reducing health inequality. Brief updates on the work of each group follow. 5.2 Food and Health Sub-group. This sub-group has representation from the Council, NHS Lothian and Lothian Community Projects Forum and has met 3 times. An outline action plan has now been drafted, which includes the following actions: tackle the barriers associated with eating a healthy diet e.g. access, knowledge, skills, budget; implementation of national programmes e.g. Hungry for Success etc; capacity building e.g. training support for local projects. The group is now working to flesh out the plan with specific actions to address health inequalities. 5.3 Physical activity. This sub-group has representation from a range of local partners and has met 6 times since June. It has benefited from being based on an existing network, the Edinburgh Physical Activity and Health Alliance. It organised a workshop with stakeholders on 1 November to identify gaps in current provision across the key life stages and settings. Based on this a long list of possible areas for further action and target groups has been identified including the key transition stages of life and the following settings: workforce development; built environment and infrastructure; schools and communities. It estimates completing the task by early January. 5.4 Social Capital. This group has representation from the Council, NHS Lothian, the Volunteer Exchange and the Patient Participation Forum and has met 3 times to end November. It started by defining what it included the term social capital and identifying actions within existing health plans in deprived areas that contribute to this. Work has now begun to identify gaps and possible targets. Target groups for intervention identified to date include the following: prison leavers and families of people in prison; people learning English without options to practice; people at risk 2

3 of suicide or self-harm; looked after children and young people; older people in sheltered housing; prostitutes; and drug misusing fathers. 5.5 Healthy Environment. A small sub-group representing the Council and NHS Lothian has met twice and has identified a range of environment issues that affect health, including air quality, energy efficiency/conservation and affordable warmth, climate change, physical/built environment, access to services, physical activity and green space, and impact assessments. It has identified that other Edinburgh partnership groupings are already working on most of these areas. One identified need is for better engagement with the planning process to ensure that regeneration initiatives and new developments promote health and reduce health inequalities in the built environment. Health Impact Assessments are seen as one tool for inputting into existing groups. 5.6 Common issues across the four groups have begun to emerge including: access issues (to affordable food, green space, physical activities etc) and the importance of the built environment. Some groups have indicated that they are finding the timescale challenging, although most hope to complete the bulk of the task by end December. 5.7 Review of Community Health Initiatives. A project group was set up to look at options for providing a strong sustainable community health infrastructure across the city, particularly in areas of multiple deprivation. To help it with this task the group invited CHEX 1 to conduct a workshop with group members in October, the report of which has recently been received. These results will be analysed in order to inform next steps. 5.8 Examining the issues which lie behind health inequality. The following statistics in relation to health inequalities in Edinburgh have been submitted to the December meeting of the HISG. It is widely accepted that the determinants of health and health inequalities are wider than matters of lifestyle alone, but embrace factors such as poverty, unemployment, fear of crime etc. Attached in Appendix 1 are data drawn from Edinburgh Regeneration Outcome Agreement (ROA) Annual Report , published by Capital City Partnership (CCP). The two tables include indicators which give a measure of progress to date against these wider determinants of health, firstly in the most deprived areas and secondly in the city as a whole. These can be summarised as follows: positive messages on health improvement, with all of the key indicators showing positive movement at city and deprived area level; significant improvements in crime and community safety data at local level; an encouraging improvement in school attendance and secondary school attainment, however some primary school indicators are down; notable progress in tackling youth and adult unemployment and in linking opportunity and need; a reduction in child poverty, as reflected in fewer children in workless households. However, there are still some stark discrepancies between areas of affluence and areas of deprivation, so continued efforts are needed to address this gap. 1 CHEX is the leading agency in Scotland s health sector that provides a resource in supporting community development approaches to health improvement and challenging health inequalities. 3

4 5.9 Health Improvement Fund (HIF). As reported to the CHP in June, the intention in Edinburgh is to take a more strategic approach to the use of HIF in future in order to direct funding towards the four priorities. As a result it is planned to identify two thematic programmes within HIF: one for food & physical activity, and the other for social capital and healthy environments. All the existing projects have been evaluated against the current priorities, as a result of which it is proposed to continue funding all except two projects within these broad funding programmes The projects not recommended to continue in their present form are Sporting Chance and the Young Women s Intensive Support (YWIS) Initiative. Sporting Chance is focused on sport rather than wider physical activity and it is recommended that available funding for physical activity in schools would be more appropriately channelled into the Active Schools programme and specifically target schools in more deprived parts of the city. The YWIS Initiative was assessed as having a high cost for a small number of beneficiaries, is not consistent with the current objectives of HIF and therefore more appropriately funded elsewhere. These recommendations have gone to the NHS Board's EMT for approval Health Impact Assessment (HIA). Partners within the NHS Board have had discussions with planning colleagues and the developers about the possibility of Health Impact Assessments of aspects of the latest proposed developments by Forth Ports Ltd. However, most of the planning and environmental assessments have already been done, so these efforts are somewhat late in the process. 6 PATH Project Prison Leavers and their Families Health Improvement 6.1 One group at risk of poor health outcomes and inequality are prison leavers. The PATH project (Partnerships for Access Towards Health) aims to develop partnership working between local health and social care, community justice and voluntary sector agencies in order to improve access to mainstream health and health improvement services for those with multiple and complex needs leaving prison, their families and those serving community service orders. It is funded through the Multiple and Complex Needs Initiative from the Scottish Government, overseen by NHS Lothian Public Health Department and managed operationally within the Edinburgh Community Health Partnership. 6.2 The objectives of the Prison Leavers project are to: integrate NHS primary care services into the through-care and aftercare services provided by SACRO, in order to improve the connections between the criminal justice system and mainstream primary care and health improvement services, and create seamless pathways of care for those with multiple and complex needs leaving prison or on community disposals. develop and pilot a practice based approach for improving the integration of exoffenders with multiple and complex needs into mainstream primary care and 4

5 health improvement services and support local primary care services in becoming part of an effective network of agencies that support clients within mainstream services. 6.3 The PATH project will work closely with structures within Edinburgh CHP and the City of Edinburgh Council to progress its aims. A project plan has been developed which is now submitted to the CHP for its approval. (See Appendix 2) The CHP is invited to approve this plan. 7 Impact on Health Inequalities 7.1 The HISG has decided to undertake Equality Diversity Impact Assessment for each priority theme, once actions these have been agreed. 8 Resource Implications 8.1 Approval of the Prison Leaver s Project will enable the project to draw down the funding it has already been allocated. There are no other specific financial implications from this report. David Jack, Head of Service, CEC Department of Corporate Services Margaret Douglas, Consultant in Public Health Margaret Barbier, Senior Policy Officer, CEC Department of Corporate Services 28 November 2007 List of Appendices The following Appendices are attached: Appendix 1: Edinburgh Regeneration Outcome Agreement (ROA) Annual Report two tables of statistics Appendix 2: Project plan for the Prison Leavers Project Background Papers (Available on Request) Report of the seminar held on 28 June 2007 Reports and Minutes of the HISG meetings, August, October and December

6 Appendix 1 Edinburgh Regeneration Outcome Agreement (ROA) Annual Report Capital City Partnership Table 1: Progress in the ROA Focus Areas Outcome Indicator Movement 1b) Increased quality and variety of affordable housing options Affordable homes being built Increase 1d) Reduced crime, fear of crime and increased domestic and Overall crimes recorded Decrease community safety Serious and indecent assaults Decrease Crimes of violence Decrease Crimes relating to housebreaking Decrease Alcohol and drug deaths Increase Crime related to anti-social behaviour Increase 2a) Reduced unemployment rates in target areas JSA unemployment rate Increase 2b) Increased employment rates for key groups and areas Number of Workless working age people Decrease 2c) Reduced benefit dependency overall and y in target areas IB/SDA claim rate Decrease Income support claimants Decrease 2d) Better post school outcomes overall and closing the gap in positive School leavers who are NEET. Decrease post school outcomes for key groups and areas. 3a) A sustained reduction in health inequalities in the city, as a key step to improve the health and wellbeing of Edinburgh s people. Emergency admissions for under 15 year olds Decrease Hospital admissions relating to heart disease Decrease Hospital admissions relating to cancer Decrease Proportion of babies being breastfed Increase 4a) Reduce child poverty Children in workless households Increase 5a) Increased participation in learning School attendance (primary and secondary) Increase School leavers going onto FE and HE Increase Staying on rates post 16 Increase 5b) Improved educational attainment and closing of the gaps between Attainment at P3 (maths), P7 (reading & writing Increase key groups and the city norm ) Attainment at S4 Increase Attainment in P7 (maths) and P3 (reading & writing) Decrease indicates positive change indicates negative change

7 Table 2 Progress in the City as a Whole Outcome Indicator Data Set Movement 1b) Increased quality and variety of affordable housing Homelessness Static options 1d) Reduced crime, fear of crime and increased domestic and Overall crimes recorded Decrease community safety Serious and indecent assaults Decrease Crimes of violence Decrease Crimes relating to housebreaking Decrease Alcohol and drug deaths Increase Crime related to anti-social behaviour Increase 2a) Reduce unemployment rates in target areas JSA unemployment rate Static 2b) Increased employment rates for key groups and areas Number of Workless working age people Decrease 2c) Reduced benefit dependency overall and particularly in IB/SDA claim rate Static target areas Income support claimants Decrease 2d) Better post school outcomes overall and closing the gap School leavers who are NEET. Decrease in positive post school outcomes for key groups and areas. 3a) A sustained reduction in health inequalities in the city, as a key step to improve the health and wellbeing of Edinburgh s people. Emergency admissions for under 15 year olds Decrease Hospital admissions relating to heart disease Decrease Hospital admissions relating to cancer Increase Proportion of babies being breastfed Increase 4a) Reduce child poverty Children in workless households Decrease 5a) Increased participation in learning School attendance (primary) Decrease School attendance (secondary) Increase School leavers going onto FE Increase School leavers going onto HE Static 5b) Improved educational attainment and closing of the gaps between key groups and the city norm Staying on rates post 16 Increase Attainment at P3 (maths), P7 (maths, reading & Increase writing ) Attainment at P3 (writing) Static Attainment at P3 (writing) Decrease Attainment at S4 Static indicates positive change indicates negative change indicates static picture 7

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9 Appendix 2 Partnerships for Access to Health (PATH) project Multiple & Complex Needs Initiative Edinburgh CHP Prison Leavers project Project specification October 2007 Purpose This paper describes the project plan for the Prison Leavers Project, being undertaken by Edinburgh CHP as part of the Partnerships for Access to Health (PATH) project. Background The aim of the PATH project is to explore how health, social work, community justice and voluntary sector partners can work together to improve access to services for those with multiple and complex needs. PATH is funded by the Scottish Government, as part of the national Multiple and Complex Needs Initiative. Edinburgh CHP is one of three CHPs taking part in the PATH project. The focus of the PATH project is on developing existing practice, rather than on developing new services. The PATH process involves undertaking a rapid appraisal in each study CHP area to identify the local issues around multiple and complex needs and to identify areas for practice development. A rapid appraisal was undertaken with key professionals in the Edinburgh CHP area between April and August It quickly became apparent during the rapid appraisal that those leaving prison and those on community disposals are a key group with multiple and complex needs for whom access to services could be improved. Partnership working, developing the links between existing services and building on existing good practice within the community justice field, health and social care and voluntary sectors were identified as key themes that the CHP wished to pursue further. The PATH Prison Leavers project was therefore developed. Aim The aim of the Prison Leavers project is to: Develop partnership working between the local health, social care, community justice and voluntary sector agencies serving the residents of Edinburgh CHP, in order to improve access to services for those with multiple and complex needs leaving prison or on community disposals. Objectives The objectives of the Prison Leavers project are to: 9

10 1. Integrate NHS primary care services into the through care and aftercare services provided by SACRO, in order to improve the connections between the criminal justice system and mainstream primary care and health improvement services and create seamless pathways of care for those with multiple and complex needs leaving prison or on community disposals. 2. Develop and pilot a practice based approach for improving the integration of ex-offenders with multiple and complex needs into mainstream primary care and health improvement services and support local primary care services in becoming part of an effective network of agencies that support clients within mainstream services. 3. To assess the effectiveness of the approach taken and generate learning that will be of use to other CHPs wishing to improve access to mainstream services for those with multiple and complex needs. Target population Male and female adult offenders (aged 16 years and over) on community disposals or serving short term sentences (i.e. under 4 years) who are due for release from HM Prison Edinburgh, HMP & YOI CortonVale and HMP & YOI Polmont and who are returning to the Edinburgh CHP area. Approach The project will involve seconding an experienced public health practitioner to work on the project. The role of the public health practitioner will be to scope the issues involved, develop the relationships and links between the relevant agencies and services and capture learning from the process. Key to the process will be understanding the needs of those leaving prison, understanding the current services available and developing the relationships with the various agencies involved. An overview of the methods expected to be used is given below. However, these may be subject to change as the project progresses and evolves. Objective 1: To integrate NHS primary care services into the through care and aftercare services provided by SACRO, in order to improve the connections between the criminal justice system and mainstream primary care and health improvement services and create seamless pathways of care for those with multiple and complex needs leaving prison or on community disposals. Timescale: June to December

11 Task Methods Timescale (a) To explore the needs of those leaving prison and their families and assess whether their needs are being met by the current system. Brief literature review of the health needs of prisoners and their families. Focus groups with local prisoners and their families to identify their views on current services, followed by more detailed case studies with some of those participating in the focus groups. September 07 October December 07 Key informant discussions with staff to identify service providers views of the current system. (b) To develop links, systems and partnership working between the relevant agencies to ensure that NHS primary care and health improvement services are integrated with the through care and after care services for prison leavers and their families. Establish links with the relevant agencies (e.g. Sacro, the Scottish Prison Service and the relevant health, social care and voluntary agencies). Identify the key issues for health and SPS agencies and prisoners and their families, including current barriers to accessing health and health improvement services. June - September 07 June December 07. June December 07. Develop and implement action plan(s) with partners (for the 3 prison sites) June December 07. Objective 2: Develop and pilot a practice based approach for improving the integration of ex-offenders with multiple and complex needs into mainstream primary care and health improvement

12 services and support local primary care services in becoming part of an effective network of agencies that support clients within mainstream services. Timescale: December 07 to June 08. Methods: to be developed once the issues have been scoped in detail during objective one and the most appropriate approach identified. Objective 3: To assess the effectiveness of the approach taken and generate learning that will be of use to other CHPs wishing to improve access to mainstream services for those with multiple and complex needs. Timescale: September 07 to June 08. Methods: The PATH project team will develop a learning framework, in consultation with Edinburgh CHP, to capture the learning from the project. This will involve reflective learning among those taking part and collating supporting documentation (e.g. action plans, focus group & case study results etc). It will document the process undertaken, the lessons learnt and the learning for wider dissemination. Funding 150K will be allocated from the PATH project to Edinburgh CHP for the Prison Leavers project. This funding is non-recurring. A key part of the project will be ensuring that the relationships developed and any changes made during the project are sustainable beyond the life of the project. Role of the PATH project team The PATH project team will: Support Edinburgh CHP to develop the methods for the project. Support those involved to reflect on the lessons learnt from the project. Collate the learning generated from the project. Produce a final report & disseminate the findings. Role of Edinburgh CHP Edinburgh CHP will: Develop the methods for the project, in consultation with the PATH project team. Second and manage a public health practitioner to undertake the project. Capture the learning from the project, using reflective learning processes, and provide the PATH project team with the relevant supporting documentation. Provide the PATH project team with a summary of how the funding allocated to the CHP has been used. Submit a final report of the findings to the PATH team. Final products and dissemination of learning It is expected that the following final products will be produced: Project report by Edinburgh CHP. Project report by PATH. CHP Toolkit. The learning from the project will be disseminated in a variety of ways including: publication of the reports in various formats (e.g. full reports, executive summaries and one page summaries); presentation at workshops, conferences and local events; and publication on the PATH project website ( 12