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    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:

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

    Week beginning

    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

    & Housing

    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

    Board Feb-10

    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


STRATEGY 2010-2014

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


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.

Local drivers

    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.



    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

    . greening


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

    decent housing.

    ? Supporting People is a crucial programme for people with housing and

    additional support needs, preventing or delaying their need for health or

    social care.

    ? 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



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

    of health:

    ? 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

    clearly manifested:

    ? 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.



    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

    young offenders

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

    models (1999)

     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.


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