Item number Ealing Local Strategic Partnership
thDate: 9 December 2009
Report for: Stronger Communities Board
6 Report Title: Draft Health Inequalities and Well-Being Strategy
Report Author: Stephen James, Head of Partnerships and
Diversity, Ealing Primary Care, Tel: 020 3313 9318, Email: firstname.lastname@example.org
Purpose of report
To inform and consult the Stronger Communities Board on the development of
Ealing‟s Health Inequalities and Well-Being Strategy.
The Health and Well-Being Board is developing a strategy to set a common vision
for health and well-being in the borough, and how we will work together to reduce
health inequalities in Ealing. Key points of the strategy
? The Joint Strategic Needs Assessment (JSNA) informs the key priorities and
activities in the strategy. Some key summary conclusions from the JSNA are
suggested in Part one of the strategy: the need analysis.
? Delivery priorities in response to these conclusions are suggested in Part two.
These will be cross-referenced with priorities in other strategies, such as NHS
Ealing‟s Strategic Plan.
? A high-level action plan to deliver the priorities will be developed as delivery
priorities are finalised. A template for the plan is set out in Appendix 1.
? Each activity will have related indicators (success measures) attached. These
will be pooled into a summary of performance measures Local Strategic
Partnership Boards and Scrutiny Panels can use to monitor progress.
Action required from the Stronger Communities Board:
1. Comment and make suggestions on the following:
a. The key conclusions in Part One of the strategy, and suggested strategic
b. Suggested delivery priorities in Part Two.
2. Recommend any other formal bodies that need to endorse and adopt the
3. Agree to delegate delivery and implementation to the Health and Well-Being
Next steps and milestones for developing the strategy
Below are the key milestones in developing the strategy. We are currently in the first
stage of consultation.
CONSULTION ON 17-Sep-09 ? Health and Well-Being Board
FIRST DRAFT (Sept to Dec 09) ? Consultation with (3rd tier)
September to 13-Nov-09 ? Equalities and Human Rights
December 2009 reference group
27-Oct-09 ? ECVS Social Care Conference
26-Oct-09 ? Health Improvement Partnership
10-Nov-09 ? Ealing Executive Group
? Consultation with relevant service
REDRAFTING ? Evaluation of consultation response
16-Nov 09 ? Redraft of strategy
16 Nov 2009
CONSULTATION 30 Nov 09 ? Health Improvement Partnership ON FINAL DRAFT 8 Dec 09 ? Ealing Executive Group
10-Dec-09 ? Health and Well-Being Board December 2009 to Dec 09 meetings ? Other LSP Partnership Boards: January 2010 o Economy, Enterprise 10-Dec-09
o Stronger 10-Dec-09
o Safer Ealing TBC
o Children‟s Trust 3-Dec-09
o Arts, Sports and TBC
FINALISE ? Finalise strategy Jan-10 STRATEGY ? Sign off strategy at following
Boards: January to March o Health and Well-Being 04-Mar-09 2010 Board
o West London Mental
Health Trust Board Feb-10
o Ealing Hospital Trust
o Ealing Council
Corporate Board Feb-10
o NHS Ealing Board Feb-10
o LSP Executive 01-March-10
o Ealing Council Cabinet 23-March-10
EALING HEALTH INEQUALITIES AND WELL-BEING
27 NOV 2009 DRAFT
PART ONE: NEEDS ANALYSIS ................................................................................ 1
PART TWO: DELIVERY – WHAT WE WILL DO ...................................................... 19
PART THREE: GOVERNANCE ............................................................................... 22
Appendix 1: Action plan ............................................................................................ 25
Appendix 2: Summary of performance measures .................................................... 30
Appendix 3: HWB Strategy in the bookcase of Strategies and Plans ....................... 32
PART ONE: NEEDS ANALYSIS
Why do we need a Health and Well-Being
Strategy in Ealing?
In Ealing many people are well and live healthy lives. However, not all Ealing residents enjoy equally good health. The aim of this strategy is to address health inequalities, and in doing so realise the ambitious vision for health and well-being set out in the borough‟s Sustainable Community Strategy.
As the determinants of good health are many and varied, this vision can only be achieved through effective partnership. This first section of the strategy describes the factors that determine good health, assesses Ealing‟s performance in promoting health, and provides insight into the challenges faced by the Local Strategic Partnership in tackling health inequalities.
The Ealing Sustainable Community Strategy and Local Area Agreement set out clear joint commitments to improve the health and well-being of Ealing residents and to reduce health inequalities. Health and Independence is a key theme of the Strategy and a strategic goal of the Local Strategic Partnership (LSP) is to “Reduce health
inequalities and promote well being and independence for adults and older people.”
Joint Strategic Needs Assessment (JSNA)
The council and NHS Ealing have a statutory duty to undertake a Joint Strategic Needs Assessment of health and social care needs. The full Ealing JSNA is an online resource, designed to show residents and commissioners the critical health and well-being issues for the borough, and the main issues to be addressed in strategic planning and commissioning. The JSNA can be found at:
The objectives of this strategy are based on conclusions taken from the JSNA, are set out in greater detail below.
Audit Commission review
A review in 2009 of Ealing‟s approach to tackling health inequalities found much valuable work, together with a need to co-ordinate partnership working between sectors, define outcomes, make the best possible use of data and intelligence and engage communities more effectively. The actions arising from the audit have been incorporated in this Strategy.
VERSION: S JAMES – 26 NOV 2009
Local strategic links
There is a wide variety of social and economic determinants of health, including
housing, income, social networks and being safe and secure. Public sector strategy
in many different areas can therefore be used to reduce health inequalities and
promote well-being. Co-ordinating local strategies within a common purpose is the
role of the Local Strategic Partnership and some of the key strategies that affect
broader determinants are as follows:
Local Development Framework
The LDF looks forward to 2026 and plans for an increasing population and
consequent expansion of infrastructure, improved public transport and development
of green spaces. The borough will comprise a range of prosperous, cohesive and
sustainable communities developed on the basis of balanced growth, protection and
Some of the key elements of housing strategy relevant to health inequalities are as
? A major programme to regenerate areas of social housing will help to
increase numbers of people, particularly with low incomes, who live in
? Supporting People is a crucial programme for people with housing and
additional support needs, preventing or delaying their need for health or
? Fuel poverty affects some of the most vulnerable and hard to identify
households and we are developing an Affordable Warmth Strategy in
order to address this issue.
? Social Landlords, including Ealing Homes, offer a range of support to
tenants, e.g. help with access to training and employment.
Personalisation means that, instead of the Council deciding which social services
people need, they will give an Individual Budget so that people can choose their own
kinds of support. This policy is a key element of promoting independence and
recognising that people‟s needs are individual and cannot be met by single solutions.
Older People’s Health and Well-being Strategy
„Growing Older, Growing Bolder, Living Well‟ is a joint strategy to promote
independence and well-being in later years for an increasingly diverse older
population. Themes include mobility, income, housing, community safety and
managing long term conditions.
Children and Young People’s Plan
VERSION: S JAMES – 26 NOV 2009
The Children and Young People‟s Plan is the single, strategic and overarching plan
for all local services for children and young people and their families. It is overseen
by the Children‟s Trust, which is the partnership responsible for delivering the plan.
The overall aim of the Children and Young People‟s Plan is to deliver on the five
outcomes outlined in Every Child Matters.
The Ealing Children and Young People‟s Plan identifies local priorities for work to
deliver on the five outcomes. Some of these we expect to have an impact on
reducing health inequalities in the Borough. They concern healthy lifestyles, access
to services, early intervention, safeguarding children and improving the environment.
Statutory equalities schemes and human rights
As public bodies Ealing Council and NHS Ealing have statutory schemes to show
how we promote equality of opportunity and tackle discrimination in the areas of
Race, Gender and Disability, as well as promoting good community relations. The
schemes go beyond the statutory requirements to include also age, faith or religion
and sexual orientation. The link between discrimination, exclusion and poor health
outcomes is a focus of this Strategy.
Other key strategies focus on specific topics or risk factors and they aim directly to
tackle health inequalities and promote well-being. They include:
? Tobacco Control Strategy
? Healthy Weight Healthy Lives: Ealing‟s strategy to reduce obesity.
? Alcohol Strategy (under review)
? Teenage pregnancy and sexual health strategy
Regional and national drivers
A number of national and regional drivers support the Health Inequalities and Well-
Being Strategy. It is important to underpin our local efforts to reduce health
inequalities with national and regional priorities.
“Health Inequalities: A Programme For Action” is the Government‟s current strategy
to reduce health inequalities through the integrated work of national and local
government as a whole. Health Inequalities: Progress and Next Steps (2008) set out
what will be done to sustain a focus on health inequalities beyond the life of the 2010
national health inequalities target.
World Class Commissioning (WCC)
World Class Commissioning (WCC) enables the local NHS and partners in all
sectors to meet the changing needs of the population by commissioning and
delivering interventions which are
? based on the best evidence for improving health and reducing
VERSION: S JAMES – 26 NOV 2009
? responsive to local needs
? relevant to patients‟ experiences of health services.
The London Health Inequalities Strategy (2009)
The London Mayor is consulting on the first Health Inequality Strategy for London. It
is recognised internationally that societies where the difference in overall life
chances between richest and poorest are narrowest are also the most cohesive,
contented and healthy overall.
The draft strategy has five objectives to tackle the social and economic determinants
? Empowering individuals and communities.
? Equitable access to high quality health and social care services
? Income inequality and health
? Health, work and well-being
? Healthy places
The population of Ealing, like that of London as a whole, has very good health in
general, but with large inequalities between communities driven by social and
economic determinants. Ealing‟s strategy will therefore promote the aims of the
wider London initiative.
Choosing Health (2004)
The Choosing Health White Paper has an over-arching aim to reduce health
inequalities and tackle the health and disease topics where inequalities are most
? Reducing the numbers of people who smoke
? Tackling obesity
? Improving sexual health
? Improving mental health and wellbeing
? Reducing harm from alcohol
Targeting interventions to the needs of communities through social marketing is a
core aspect of the strategy. In Ealing, the use of social marketing to reach specific
sub-populations is growing in importance and there is a wide range of initiatives
targeting diverse communities.
VERSION: S JAMES – 26 NOV 2009
Healthcare for London
This programme of work aims to reshape services in London to improve service
quality and outcomes, reduce difference in health and healthcare provision across
the city, improve access to specialised care and improve choice and access to
localised services. Reducing health inequalities is at the heart of the strategy.
Current main strands of work are maternity, cancers, stroke, major trauma, mental
health and children and young people.
Children’s Plan (2007)
This ten-year strategy builds on the aspirations set out in Every Child Matters and
sets out a series of ambitions to which reducing inequality will be imperative. The
Plan outlines a focus on intervening early with children and families who need extra
support before problems arise, in other words, implementing a targeted approach to
at risk or vulnerable children and families.
The ambitions in the Children‟s Plan include delivering improvements in child health,
and reduce the number of children overweight; and reducing the number of first-time
Child Health Strategy: healthy lives, brighter futures (2008)
The Child Health Strategy sets out priorities for the health of children through three
? Pregnancy and the early years
? School-age children
? Young people
It proposes actions to reduce persistent health inequalities for families and children.
In line with the Children‟s Plan, it focuses on work to improve health behaviours and
to provide more support to children and families most at risk of poor health outcomes.
The main principles are health education, appropriate services, healthy
environments and targeted support for those most in need.
National Service Framework for Children, Young People and Maternity Services
The framework sets 11 national standards for children, young people and maternity
services that focus on:
? Preventative action
? Promoting child health with universal and targeted approaches
? Delivering holistic services designed around the needs of children
? Empowering children and families to make better use of available services
? Safeguarding children from harm as a priority for all agencies working in
partnership to deliver services to children and young people
? Tackling health inequalities by addressing the needs of disadvantaged of
communities and families who are likely to achieve poor outcomes
VERSION: S JAMES – 26 NOV 2009
Safe. Sensible. Social. The next steps in the National Alcohol Strategy
The update and review of the Alcohol Harm Reduction Strategy (2004) focuses on
reducing types of alcohol related harm of most concern to society:
? Reduction in levels of alcohol-related violent crime, disorder and anti-social
? Reduction in the public‟s perceptions of drunk and rowdy behaviour
? Reduction in chronic and acute ill-health caused by alcohol resulting in fewer
alcohol-related accidents and hospital admissions
Children and young people‟s drinking behaviour is linked to that of their parents,
creating a legacy in areas of deprivation of negative health behaviours and poorer
health outcomes. In Ealing we are refreshing the local Alcohol Strategy as part of the
wider strategy to tackle health inequalities.
National Service Framework for Mental Health: Modern standards and service
is a strategic blueprint for services for adults of workingage. It sets The framework
obligatory standards and gives advice on best practice.
It aims to:
? drive up quality;
? remove the wide and unacceptable variationsin provision;
? set national standards and define service modelsfor promotingmental health and treating mental illness;
? support local delivery;
? set performance measures for services.
Mental health promotion is the first standard. In the years since its publication the
scope has widened from specialist care to the mental health and wellbeing of the
community as a whole.
National Drugs Strategy: Tackling drugs, changing lives 2008-18 (2008)
The drug strategy aims to reduce the harm that drugs cause to society, to
communities, individuals and their families. It comprises four strands of work:
? tackling drug supply, drug-related crime and anti-social behaviour
? preventing harm to children, young people and families
? delivering new approaches to drug treatment and social re-integration
? public information campaigns, communications and community engagement
The strategy outlines a wider preventative view that is not focused only on illegal
drugs, but on all substances and the risk factors that are known to lead to drug use,
alcohol misuse and volatile substance abuse.