Adult Care and Health Cabinet Panel Wednesday 20 May 2009 ...



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Health & Wellbeing

Action Plan

Improving the health and wellbeing of

Adults in Hertfordshire

2009 – 2011

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LIST OF CONTENTS

| |Page |

| | |

|Introduction |2 |

| | |

|Priority Outcome One – Having a say |4 - 6 |

|Priority Outcome Two – Access to high quality information and advice |7 - 12 |

|Priority Outcome Three – Keeping physically healthy |13 - 18 |

|Priority Outcome Four – Keeping mentally healthy |19 - 22 |

|Priority Outcome Five – Enjoying economic wellbeing |23 - 27 |

|Priority Outcome Six – Being active members of the community |28 - 32 |

|Priority Outcome Seven – Feeling safe and secure at home and in the community |33 - 36 |

|Priority Outcome Eight – Living independently |37 - 41 |

INTRODUCTION

By sharing and making better use of data sources, such as the Joint Strategic Needs Assessment, the Primary Care Trusts, Hertfordshire County Council and their partners can more comprehensively understand the local communities in Hertfordshire. Consequently, the PCTs’ Partnership Commissioners, Adult Care Services’ Community Commissioners and Local Authorities can target resources where they will have the biggest impact on the health and wellbeing of working age adults, vulnerable adults and older people in the county.

It is, however, essential that older and vulnerable adults are able to access universal services. Improving access to mainstream services is key to making independent life an option for as many older people as possible, for as long as possible. To achieve this, mainstream services need to be ‘age-proofed’, that is to say, designed and delivered with an older and vulnerable population in mind.

Failing to involve service users and patients in service design can lead to unforeseen negative impacts on their day-to-day lives. Errors in service design may be so fundamental that they are too expensive to rectify later on. Community engagement is the first priority in this Health and Wellbeing Plan.

When designing and commissioning new services that promote health and wellbeing, it is intended that statutory, voluntary and private sector organisations and groups will work in partnership to maximise opportunities for cross-cutting efficiency, effectiveness and capacity building. In developing this Health and Wellbeing Plan, 140 people from 40 different organisations and groups in Hertfordshire have been consulted, including representatives from Hertfordshire’s 10 District and Borough Councils who are key partners in driving this agenda forward.

Working together, we aim to ensure adults and carers are able to:

• Have their say

• Access to high quality information and advice

• Keep physically healthy and active

• Keep mentally healthy

• Enjoy economic wellbeing

• Be active members of their communities

• Feel safe and secure at home and within their communities

• Live independently

The Health and Wellbeing Plan will also help to deliver the agreed objectives set out in Hertfordshire’s Sustainable Community Strategy - An Ageing Population and Health and Wellbeing themes and the short term objectives of the Healthier Communities and Older People’s theme of Hertfordshire’s Local Area Agreement. In developing this plan, a review of Hertfordshire’s existing plans and strategies, relating to health and wellbeing and the Joint Strategic Needs Assessment, has been undertaken.

The following strategies and plans were included in this review (internet links and dates are given where known):

• PCT Health Improvement Strategy for Older People – February 2008

• PCT Health Inequalities Action Plan – July 2008

• West Herts Hospitals Public Health Strategy – October 2007

• Hertfordshire Carers Strategy – May 2007

• Adult Care Services Plan 2006-2009

• ACS Commissioning Strategy for Older People – January 2008

• ACS Commissioning Strategy for People with Physical Disabilities - 2007

• ACS Commissioning Strategy for People with Sensory Needs - 2007

• Joint Commissioning Strategy for Mental Health Services for Older People – November 2007

• Mental Health Promotion Strategy 2007-2009

• Alcohol Harm Reduction Plan 2007/08

• Hertfordshire Drugs Strategy

• Local Transport Plan Accessibility Strategy 2006/07–2010/11

• East Herts Public Health Strategy 2008-2013

• Broxbourne Community Plan 2007-2009

• Towards 2021: Dacorum’s Sustainable Community Strategy

• East Herts Community Strategy Action Plan 2007-2010

• Hertsmere Together Community Strategy 2006-2020

• Community Strategy for North Hertfordshire – November 2003

• Stevenage 2021: Our Town, Our Future

• Shaping Our District Together for 2021: St Albans

• Three Rivers Community Strategy 2006-2012

• Watford Community Plan 2006-2021

• Welwyn-Hatfield 2021

• Hertfordshire Joint Strategic Needs Assessment – Core Dataset – April 2008

|Priority Outcome 1 |Adults and carers are able to have their say and are able to influence policies and the |

| |development of services that promote health and wellbeing. |

|Health and Wellbeing Objectives – long |Improve the health and wellbeing of all our residents in the 20% most deprived wards; |

|term |reduce mortality between deprived and non-deprived areas; improve life chances and |

| |access to healthcare for all, especially in areas of deprivation and those with learning|

| |disabilities. |

|An Ageing Population Objectives – long |Focus on prevention of illness; Help older people maintain their independence; Ensure |

|term |older people have the opportunities to be active members of their communities. |

|SCS Links |Safer and Stronger; Promoting Sustainable Development; Housing, Affordable Housing and |

| |Quality Neighbourhoods. |

|What specific groups of people will this priority outcome focus on? |

| |

|This priority outcome will focus on all adults in Hertfordshire. |

|What positive conditions of wellbeing do we want to see? |

| |

|In order to achieve this outcome, we need to ensure that: |

|A wide range of formal and informal means are used effectively and regularly to engage local people. These mechanisms will |

|have been tested with the target groups to check that they are the most appropriate. |

|All sections of the community systematically have opportunities to express their needs and experiences. Age, language, |

|physical access, gender, sexuality or sensory impairment should not be barriers to engagement. |

|Feedback on the results of consultation and engagement is provided to participants and demonstrates the resulting outcomes. |

|Complaints and customer feedback information is collected, coordinated and analysed and used effectively to improve service |

|quality. |

|How have we been performing against this outcome? |

| |

|Many different organisations in the county are trying to establish better means of engaging with local people and to allow |

|them to have their say about local services. |

| |

|A Local Involvement Network (LINk) was established in September 2008, with the aim of ensuring that everyone in the community |

|– from individuals to voluntary groups – have the chance to: |

|Say what they think about local health and social care services – what is working and what is not |

|Influence how services are planned and run |

|See how their feedback helps services to improve |

| |

| |

|The Patient and Public Engagement Team at Hertfordshire PCTs facilitate systematic and ongoing engagement between the NHS and |

|patients and the public. They do this through regular consultations, stakeholder events, local patient involvement groups and |

|working with partner organisations. More information can be found at enherts-pct.nhs.uk/Category.asp?cat=1193 |

| |

|Adult Care Services works closely with its service users to plan, review and collect feedback on its services. The |

|department’s emphasis on person-centred planning, self-directed support and direct payments give service users strong control |

|over the decisions which affect them. |

| |

|Each local authority in Hertfordshire has its own arrangements for community engagement, using methods such as surveys, |

|citizens’ panels, focus groups and area committees. These activities are coordinated through the Hertfordshire Public |

|Engagement Partnership, which also includes the PCTs and Hertfordshire Constabulary. |

| |

|In spite of this range of activity, community engagement can still sometimes be a token gesture, undertaken when strategies |

|and plans have already been agreed. The 2008 Place Survey[1] (which covered all public services, not just health) found that |

|only 26.8% of people in Hertfordshire feel that they can influence decisions affecting their local area. This is a fall from |

|27.9% in 2006, when Hertfordshire was already worse than the national average of 32%. |

| |

|Older and vulnerable adults, and their carers from all sections of the community, should be given the opportunity to be |

|involved in the design of services that promote independence, well-being and active ageing, and their opinions should be |

|sought on the quality of service delivery. Under-utilised, poorly regarded and ineffective services are often the result of |

|insufficient or nonexistent engagement at the design stage. |

| |

|There is therefore significant scope for improvement. Best practice should be shared more widely and engagement should, where |

|possible, be better co-ordinated. More innovative ways of engaging the community should be considered and best practice should|

|always be observed. Engaging the community is not an activity that has no cost but the cost of not engaging effectively can be|

|high. |

|Which key performance indicators will tell us if we are improving? |

| |

|NI 4 - % of people who feel they can influence decisions in their locality |

| |

|We will monitor the effectiveness of engagement through evaluation of feedback from participants. |

| |

| |

Action Plan for Outcome 1: Adults and carers are able to have their say and are able to influence policies and the development of services that promote health and wellbeing.

The following key actions will make the greatest contribution to improving performance against this outcome in 2009/10. Please note these do not represent all actions taking place to improve this priority outcome, but the actions that will have most impact.

|No |Actions |

|Health and Wellbeing Objectives – long |Improve the health and wellbeing of all our residents in the 20% most deprived wards; |

|term |reduce mortality between deprived and non-deprived areas; improve life chances and |

| |access to healthcare for all, especially in areas of deprivation and of those with |

| |learning disabilities. |

|An Ageing Population Objectives – long |Focus on prevention of illness; Help older people maintain their independence; Ensure |

|term |older people have the opportunities to be active members of their communities. |

|SCS Links |Children and Young People; Transport and Access; Sustaining Hertfordshire’s Unique |

| |Character and Quality of Life; Promoting Sustainable Development; Jobs Prosperity and |

| |Skills; Safer and Stronger, Housing, Affordable Housing and Quality Neighbourhoods. |

|What specific groups of people will this priority outcome focus on? |

| |

|In working towards this outcome, our focus will be on all adults, prioritising the needs of older people in particular. |

|What positive conditions of wellbeing do we want to see? |

| |

|When seeking information and advice, people should ideally know what number to call and what website or centre to visit, |

|without having to search for that contact. Information systems should be easy to navigate so people can find what they need |

|quickly and efficiently. |

| |

|Although the internet is now becoming increasingly popular, many people still prefer and trust face-to-face information above |

|all other methods of communication. |

| |

|Older and vulnerable adults should be offered outreach support to enable them to access information, advice and services and |

|they should have access to an advocate, who can speak on their behalf, if necessary. |

| |

|Simply providing people with information and urging them to be healthy is not good enough. We need to understand why people |

|act as they do and find ways to reach them so that they choose to change their negative behaviours and lifestyles. Those |

|responsible for the health and wellbeing of their communities need to become experts in social marketing. |

| |

|How have we been performing against this outcome? |

| |

|At national, county and district level, there is a wealth of information produced by many different organisations. There are |

|help lines, call centres, directories, information guides (such as Ageing Well in Hertfordshire), websites and leaflets. Many |

|websites provide links to other appropriate information sources. There are also services which offer face to face information |

|and advice. |

| |

|However, this provision of information and advice has developed from a range of separate initiatives, rather than as part of a|

|coherent strategy. Sources of information and advice are therefore often poorly linked together and there are many different |

|routes into information – few of which are well known to the public or even to staff. |

| |

|It is very difficult for front line staff to know where to access the vast array of |

|information and support that could be suited to an individual’s needs. In some situations staff are not given the time to make|

|connections with services for the individual or they may be encouraged to look holistically at a person’s circumstances but |

|pressures on time and resources mean they can often focus only on the immediate and most pressing problem. |

| |

|In the 2008 Place Survey[2], less than 50% of Hertfordshire residents told us that they feel well informed about local public |

|services. |

| |

|A Peer Review of public information produced by Hertfordshire County Council’s Adult Care Services Communications Team was |

|also carried out in late 2008. This found that, although ACS produces a wide range of information covering many different |

|services, the information is not always provided or presented in a way which meets the diverse needs of people in |

|Hertfordshire. |

| |

|It is agreed that much more can be done in order to achieve a properly joined up approach to information, advice and access to|

|services. As part of the Pathfinder Programme, council leaders have agreed that customer information, access and engagement |

|remain a priority and that further work on exploring how authorities can jointly improve customer access arrangements is key |

|to the progress of Pathfinder and to improving services to the public. |

| |

|Communication teams have now agreed that they wish to pursue more shared arrangements, in particular for telephone and website|

|services to customers. It has been agreed that work must now be undertaken to map the current information arrangements in |

|place in each of the councils. |

| |

|There have also been discussions with local authority Chief Executives regarding improving arrangements for face to face |

|responses, to a range of customers, through various outlets and offices at all council tiers. |

| |

| |

|Which key performance indicators will tell us if we are improving? |

| |

|NI 14 – Avoidable Contact |

| |

|NI 135 – Carers receiving needs assessment or review and a specific carers service or advice and information |

|NI 139 – Extent to which older people receive the support they need to live independently |

|NI 175 – Access to services and facilities by public transport, walking and cycling |

| |

|VSA09 – Proportion of women aged 47-49 and 71-73 offered screening for breast cancer |

|VSA10 – Extension of NHS Bowel Cancer Screening Programme to men and women aged up to 75 |

|VSB13-03 - % of population aged 15-24 screened or tested for Chlamydia |

|VSB18-01 – Number of patients receiving NHS primary dental services located within the PCT area within a 24 month period |

Action Plan for Outcome 2: Adults and carers have access to high quality information which will help to improve their health and wellbeing. They are aware of the choices available to them and are able to access appropriate services, where and when they are needed.

The following key actions will make the greatest contribution to improving performance against this outcome in 2009/10. Please note these do not represent all actions taking place to improve this priority outcome, but the actions that will have most impact.

|No |Actions |

|Health and Wellbeing Objectives- long |Improve the health and wellbeing of all our residents in the 20% most deprived wards; |

|term |reduce mortality between deprived and non-deprived areas; improve life chances and |

| |access to healthcare for all, especially in areas of deprivation and of those with |

| |learning disabilities. |

|Health and Wellbeing Objectives- short |Increase physical activity across all ages particularly in Broxbourne; Stevenage and |

|term |Watford; |

| |Reduce smoking in areas of deprivation, particularly in Broxbourne; Stevenage and areas|

| |of Three Rivers; |

| |Reduce obesity in areas of deprivation, particularly in Broxbourne; Stevenage and |

| |Watford; |

| |Improve the sexual health of young people; |

| |Give greater support to carers. |

|An Ageing Population Objectives – long |Focus on prevention of illness; Help older people maintain their independence; Ensure |

|term |older people have the opportunities to be active members of their communities. |

|An Ageing Population Objectives – short|Increase physical activity amongst older people |

|term |Support independent living for older people |

|SCS Links |Transport; Promoting Sustainable Development; Jobs Prosperity and Skills; Safer and |

| |Stronger; Children and Young People. |

|What specific groups of people will this priority outcome focus on? |

| |

|This outcome is aimed at all adults in Hertfordshire. However, we know that actions to improve people’s physical health need to|

|be targeted in particular areas: |

|Levels of smoking are highest in Broxbourne, Stevenage and certain parts of Three Rivers. |

|Levels of physical activity are lowest in Broxbourne, Stevenage and Watford. |

|Levels of obesity are highest in Broxbourne, Stevenage and Watford. |

| |

| |

| |

|What positive conditions of wellbeing do we want to see? |

| |

|We want people in Hertfordshire to be physically healthy and active. |

| |

|One of the best and most cost-effective ways of achieving this outcome is to reduce the prevalence of preventable diseases, by |

|supporting people to make positive changes to their lifestyles. |

| |

|This means: |

|More people stopping smoking, and fewer starting |

|More people with a healthy weight |

|More people eating healthily |

|More people drinking sensibly, within national guidelines |

|More people participating regularly in sport and physical activity. |

|How have we been performing against this outcome? |

| |

|Over the years there have been significant improvements in the health of the population of Hertfordshire. Mortality rates are |

|falling, and on average people are living longer; life expectancy is higher than the average in England. Fewer people are dying|

|prematurely of the major killers, including cardiovascular disease and cancer. A ‘Health Profile’ for Hertfordshire can be |

|found at |

| |

|In the 2008 Place Survey[3], 80.5% of people in Hertfordshire reported that they have ‘good’ or ‘very good’ general health. |

| |

|However, there is still significant room for improvement: |

|A significant proportion of ill health and premature death is potentially preventable. |

|Health inequalities continue as a symptom of underlying social economic inequalities and poor access to high quality health |

|care for some population groups. |

|Although tobacco use has fallen in all social economic groups, the prevalence of smoking is far higher in the lower social |

|economic groups, compared to the higher social economic groups; there are still an estimated 200,000 smokers in Hertfordshire. |

|The difference in prevalence of smoking and tobacco use between the most and least deprived groups is still the biggest single |

|cause of health inequalities. |

|Premature mortality and morbidity rates for cardiovascular disease, cancer and respiratory disease account for most of |

|inequalities between the most and least deprived areas. |

| |

| |

| |

| |

| |

|Smoking |

| |

|Across the county, around 21% of adults (16+) are smokers, which is lower than the national average of 24%. However, there are |

|significant differences within the county. Rates of smoking vary between 10% and 30%, and tend to be highest in the most |

|deprived areas of Hertfordshire. There are over 1500 deaths caused by smoking each year. |

| |

|The free Hertfordshire Stop Smoking Service offers clinics across Hertfordshire for individuals who would like to quit smoking.|

|The success of this service is measured by National Indicator 123 (rate of self-reported 4-week smoking quitters per 100,000 |

|population aged 16 or over). On current projections, it is unlikely that the targets set for this indicator in Hertfordshire’s |

|Local Area Agreement will not be reached this year. |

| |

|Obesity |

| |

|It is estimated that one in four adults in Hertfordshire is obese, and that only the same number eat the recommended five |

|portions of fruit and vegetables each day. |

| |

|Alcohol |

| |

|Across the county, rates of hospital admissions attributable and specific to alcohol are significantly lower than in England |

|and the Eastern Region, for both men and women. Rates are highest in Watford and Welwyn-Hatfield, where there are larger |

|student populations. It is estimated that binge-drinking (consuming more than 6 or 8 units of alcohol on the heaviest drinking |

|day in a week) is less common in Hertfordshire than the rest of the country, but there are pockets in the county where it is |

|relatively high. |

| |

|Physical Activity |

| |

|Levels of physical activity are measured through the national Active People Survey[4]. In 2007/08, 22.1% of adults (16+) took |

|part in 30 minutes of moderate intensity sport on at least 3 days a week, up slightly from 21.8% in 2005/06. This is higher |

|than the averages in England (16.5%) and the Eastern region (21.2%). |

| |

|Within the county, participation rates vary significantly. The lowest rates of participation recorded in 2007/08 were in Welwyn|

|Hatfield (18.5%), Broxbourne (20%) and Stevenage (21.1%). The highest rate of participation was in St Albans (24.9%). |

| |

| |

| |

| |

|It is estimated that the costs of physical inactivity in Hertfordshire amount to around £12.25m pounds each year. Despite this,|

|and despite the fact that changing people’s behaviour can take a long period of time and must be sustained, it can be difficult|

|to secure funding for anything more than short-term interventions and programmes. Activity programmes for priority groups |

|particularly need to be commissioned for longer periods to ensure that they are sustainable and reduce health inequalities. |

|Funding is already being sought for a range of interventions such as health walks, over-60s swimming sessions, work-based |

|interventions, exercise opportunities at luncheon clubs and for mothers of young children and for community outreach. |

|Which key performance indicators will tell us if we are improving? |

| |

|NI 8 – Adult participation in sport |

|NI 39 – Alcohol-harm related hospital admission |

|NI 41 – Perceptions of drunk and rowdy behaviour as a problem |

|NI 119 – Self-reported measure of people’s overall health and wellbeing |

|NI 120 – All-age all cause mortality rate |

|NI 121 – Mortality rate from all circulatory diseases at ages under 75 |

|NI 122 – Mortality from all cancers at ages under 75 |

|NI 123 – Stopping Smoking |

|NI 134 – The number of emergency bed days per head of weighted population |

|NI 137 – Healthy life expectancy at age 65 |

|NI 173 – People falling out of work and on to incapacity benefits |

| |

|VSA09 – Proportion of women aged 47-49 and 71-73 offered screening for breast cancer |

|VSA10 – Extension of NHS Bowel Cancer Screening Programme to men and women aged up to 75 |

|VSB01-01 – Mortality rate per 100,000 population, ACAA, males |

|VSB01-05 – Mortality rate per 100,000 population, ACAA, females |

|VSB02-01 – Mortality rate per 100,000 population from heart disease and stroke related diseases in people under 75 |

|VSB03-01 – Mortality rate per 100,000 population from cancer in people aged under 75 |

|VSB05-01 – Smoking quitters (aged 16 and over) |

|VSB13-03 – Percentage of the population aged 15-24 screened or tested for Chlamydia |

|VSB14-04 – Number of drug users using crack and/or opiates recorded as being in structured drug treatment who were discharged |

|from treatment after 12 weeks or more, or who were discharged from treatment in a care planned way |

|VSB18-01 – Number of patients receiving NHS primary dental services located |

|within the PCT area within a 24 month period. |

| |

Action Plan for Priority Outcome 3: Adults and carers are encouraged and supported to stay physically healthy and active

The following key actions will make the greatest contribution to improving performance against this outcome in 2009/10. Please note these do not represent all actions taking place to improve this priority outcome, but the actions that will have most impact.

|No |Actions |

|Health and Wellbeing Objectives- long |Improve the health and wellbeing of all our residents in the 20% most deprived wards; |

|term |reduce mortality between deprived and non-deprived areas; improve life chances and |

| |access to healthcare for all, especially in areas of deprivation and of those with |

| |learning disabilities |

|Health and Wellbeing Objectives- short |Increase physical activity across all ages particularly in Broxbourne; Stevenage and |

|term |Watford; |

| |Reduce smoking in areas of deprivation, particularly in Broxbourne; Stevenage and |

| |areas of Three Rivers; |

| |Reduce obesity in areas of deprivation, particularly in Broxbourne; Stevenage and |

| |Watford; |

| |Give greater support to carers. |

|An Ageing Population Objectives – long |Focus on prevention of illness; |

|term |Help older people maintain their independence; |

| |Ensure older people have the opportunities to be active members of their communities. |

|An Ageing Population Objectives – short|Increase physical activity amongst older people; |

|term |Support independent living for older people; |

| |Ensure older people have opportunities to work, volunteer and learn. |

|SCS Links |Transport; Promoting Sustainable Development; Jobs Prosperity and Skills; Safer and |

| |Stronger; Children and Young People. |

|What specific groups of people will this priority outcome focus on? |

| |

|This outcome applies to all adults in Hertfordshire, but this Action Plan has a particular focus on older people at risk of |

|dementia, people with learning disabilities, people with mental illness and those who care for them. |

|What positive conditions of wellbeing do we want to see? |

| |

|According to the World Health Organisation, mental health is a state of well-being in which the individual realises his or her|

|own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a |

|contribution to his or her community. |

| |

| |

|We want all adults to enjoy good mental health and emotional wellbeing. In particular, we want to increase the emotional |

|resilience of older people at risk of dementia, people with learning disabilities, and those who care for them. |

|How have we been performing against this outcome? |

| |

|In Hertfordshire there are 13,261 people aged 65 plus (8.47%) with dementia, and it is estimated that 20,873 people aged 65 |

|plus (13.34%) suffer from depression. It is expected that the number of people aged 65 plus with dementia will rise to 15,778 |

|by 2020, an increase of 15.95%. There are 7,732 people, aged 50 plus, with learning disabilities in Hertfordshire. |

| |

|In 2007 Hertfordshire published a Mental Health Promotion Strategy which runs until the end of 2009. This covers a range of |

|different areas including: |

|Reducing Stigma and Discrimination |

|People in Later Life |

|The Working Population |

|Diversity and Mental Health |

|Special Needs Groups and Other Vulnerable Groups |

|Prevention of Suicide/Self-harm. |

| |

|The Strategy includes an Action Plan which describes the actions to be taken by a wide range of different organisations to |

|promote better mental health in Hertfordshire. |

|Which key performance indicators will tell us if we are improving? |

| |

|NI 119 – Self-reported measure of people’s overall health and wellbeing |

|NI 149 – Adults in contact with secondary mental health services in settled accommodation |

|NI 150 – Adults in contact with secondary mental health services in employment |

| |

|VSB04 – Suicide and Injury of Undetermined Intent Mortality Rate |

| |

Action Plan for Outcome 4: Adults and carers are encouraged and supported to stay mentally healthy and active

The following key actions will make the greatest contribution to improving performance against this outcome in 2009/10. Please note these do not represent all actions taking place to improve this priority outcome, but the actions that will have most impact.

|No |Actions |

|Health and Wellbeing Objectives- long |Improve the health and wellbeing of all our residents in the 20% most deprived wards; |

|term |reduce mortality between deprived and non-deprived areas; improve life chances and |

| |access to healthcare for all, especially in areas of deprivation and of those with |

| |learning disabilities |

|Health and Wellbeing Objectives- short |Increase physical activity across all ages particularly in Broxbourne; Stevenage and |

|term |Watford; |

| |Reduce smoking in areas of deprivation, particularly in Broxbourne; Stevenage and |

| |areas of Three Rivers; |

| |Reduce obesity in areas of deprivation, particularly in Broxbourne; Stevenage and |

| |Watford; |

| |Give greater support to carers. |

|An Ageing Population Objectives – long |Focus on prevention of illness; |

|term |Help older people maintain their independence; |

| |Ensure older people have the opportunities to be active members of their communities. |

|An Ageing Population Objectives – short|Increase physical activity amongst older people; |

|term |Support independent living for older people; |

| |Ensure older people have opportunities to work, volunteer and learn. |

|SCS Links |Jobs, Prosperity and Skills; Children and Young People; Safer and Stronger; Promoting |

| |Sustainable Development. |

|What specific groups of people will this priority outcome focus on? |

| |

|We want all people to achieve economic wellbeing, but we recognise that particular attention needs to be paid to the needs of |

|older people, people with mental health problems and people with learning disabilities. |

|What positive conditions of wellbeing do we want to see? |

| |

|We want to maintain the high levels of employment in Hertfordshire in spite of current economic difficulties. In particular, we|

|want to provide more opportunities for paid employment to those whose circumstances – mental health problems or learning |

|disabilities – can put them at a disadvantage. |

| |

|We also want to increase economic opportunities and levels of prosperity in the parts of Hertfordshire which currently suffer |

|economic disadvantage. |

|How have we been performing against this outcome? |

| |

|Hertfordshire enjoys high levels of prosperity. Overall, the average weekly household income Hertfordshire is £755, |

|significantly higher that the average for the Eastern Region (£650) and England (£605). However, there are large differences |

|within the county: the lowest average weekly income is £470 and the highest is £1340. Over half of the wards in Stevenage and |

|Broxbourne fall within the lowest quartile average weekly income of between £470 and £620. |

| |

|Rates of employment are high across Hertfordshire, and slightly higher than the East of England and Great Britain. The lowest |

|rates of employment of working-age adults are in Welwyn-Hatfield. The percentage of working age people claiming out-of-work |

|benefits is low across Hertfordshire; with the exception of Stevenage (10%), all Local Authority areas in Hertfordshire are |

|below the averages for Great Britain and the Eastern Region. |

| |

|Within Hertfordshire, employment rates for older working age adults are particularly high in Hertsmere, where nearly 70% of |

|adults aged 50 to 69 are in employment. Employment rates of working age adults are significantly lower in Broxbourne and |

|Watford, where only 53% of older working age adults are in employment. |

| |

|Under the theme of ‘Jobs, Prosperity and Skills’, Hertfordshire has chosen four indicators of economic wellbeing for its Local |

|Area Agreement: |

|NI 152 – Number of people on out of work benefits |

|NI 163 – Proportion of the working-age population qualified to Level 2 or higher |

|NI163 – Proportion of the population qualified to skill level 4 |

|NI 172 – Percentage of small businesses showing employment growth |

| |

|Hertfordshire County Council now leads the Investing In Communities (IIC) programme, worth £2,413,949 in 2008-2009. The |

|programme has three intervention areas: education and skills development; economic, enterprise and business development; and |

|community, capacity and partnership development. It has so far targeted three economically disadvantages areas in |

|Hertfordshire: Bedwell (Stevenage), Cowley Hill (Borehamwood) and Waltham Cross. |

| |

|It is estimated that there are around 330,000 people in Hertfordshire who volunteer on a regular basis. People have very varied|

|motives for volunteering, but we know that it does contribute to their economic wellbeing by helping them to develop confidence|

|and acquire new skills. |

| |

|A stakeholder workshop held in February 2009 identified a number of issues which need to be addressed: |

|The impact of the recession is not widely understood, and its duration is uncertain. |

|Citizen’s Advice Bureaux are under-resourced to cope with the current increased activity. |

|Although there are a large number of agencies and organisations which offer advice and support to those in economic difficulty,|

|their work is often uncoordinated, and often not based on a holistic assessment of the needs of the people they work with. |

|The resources and infrastructure available to support volunteering are inconsistent across the county. |

|Which key performance indicators will tell us if we are improving? |

| |

|NI 146 – Adults with learning disabilities in employment |

|NI 150 – Adults receiving secondary mental health services in employment |

|NI 151 – Overall employment rate |

|NI 152 – Working age people on out of work benefits |

|NI 153 – Working age people claiming out of work benefits in the worst performing neighbourhoods |

|NI 166 – Average earnings of employees in the area |

|NI 173 – People falling out of work and on to incapacity benefits |

|NI 173 – Skills gaps in the current workforce reported by employers |

|NI 176 – Working age people with access to employment by public transport |

|NI 161 – Learners achieving a level 1 qualification in literacy |

|NI 162 – Learners achieving an entry level 3 qualification in numeracy |

|NI 163 – Working age population qualified to a least level 2 or higher |

|NI 164 – Working age population qualified to at least level 3 or higher |

|NI 165 – Working age population qualified to at least level 4 or higher |

Action Plan for Priority 5: Adults and carers achieve economic wellbeing

The following key actions will make the greatest contribution to improving performance against this outcome in 2009/10. Please note these do not represent all actions taking place to improve this priority outcome, but the actions that will have most impact.

|No |Actions |

|Health and Wellbeing Objectives- short |Increase physical activity across all ages particularly in Broxbourne; Stevenage and |

|term |Watford |

| |Reduce smoking in areas of deprivation, particularly in Broxbourne; Stevenage and areas |

| |of Three Rivers; |

| |Reduce obesity in areas of deprivation, particularly in Broxbourne; Stevenage and |

| |Watford; |

| |Give greater support to carers. |

|An Ageing Population Objectives – long |Focus on prevention of illness; |

|term |Help older people maintain their independence; |

| |Ensure older people have the opportunities to be active members of their communities. |

|An Ageing Population Objectives – short|Increase physical activity amongst older people; |

|term |Support independent living for older people; |

| |Ensure older people have opportunities to work, volunteer and learn. |

|SCS Links |Jobs, Prosperity and Skills; Safer and Stronger; Transport and Access; Sustaining |

| |Hertfordshire’s Unique Character and Quality of Life; Housing, Affordable Housing and |

| |Quality Neighbourhoods. |

|What specific groups of people will this priority outcome focus on? |

| |

|This outcome applies to all adults, but we are particularly concerned to improve the opportunities that older people, people |

|with mental health problems and people with learning disabilities have to participate as full and active members of their |

|communities. |

|What positive conditions of wellbeing do we want to see? |

| |

|We want the towns and settlements in Hertfordshire to be home to cohesive communities, where people have a shared set of values|

|and a shared sense of purpose and belonging. |

| |

|We want to create an environment which supports a thriving voluntary and community sector, encouraging more people to get |

|involved in volunteering and community life. |

| |

| |

| |

|We want to tackle social exclusion, so that the economic and cultural benefits of living in Hertfordshire are enjoyed by |

|everyone in all communities. This includes making sure that all people are able to get out and about and travel when and where |

|they want to. We also want all people in Hertfordshire to benefit from the opportunities for lifelong learning available in the|

|county. |

|How have we been performing against this outcome? |

| |

|The results of the 2008 Place Survey[5] show that most areas in Hertfordshire have high levels of social cohesion, but that |

|many people feel that they do not ‘belong’ to their local neighbourhood. |

|81% of people say that people from different backgrounds get on well together in their local area (NI 1), an increase from 79% |

|in 2006. Levels of cohesion are highest in Three Rivers, and lowest in Watford. |

|56.3% of people feel that they belong to their local area. Residents of East Herts have the strongest sense of belonging, and |

|those in Welwyn-Hatfield and Stevenage have the lowest. |

| |

|Levels of participation in community life have also been measured through the Place Survey5 and the National Survey of Third |

|Sector Organisations. |

|13.1% of people say that they have taken on a civic role such as being a councillor, school governor, or member of a community |

|safety group. |

|25.8% of people say that they have been a volunteer at least once in the last 12 months. |

|14% of voluntary organisations in Hertfordshire say that local statutory bodies play a positive role in their organisation’s |

|success, which is lower than the national average of 16.2%. |

| |

|Hertfordshire has nine Councils for Voluntary Service which aim to promote, develop and support voluntary activity across the |

|county. There are Volunteer Centres in most of the major towns in Hertfordshire. |

| |

|In 2009, the Hertfordshire Forward Local Strategic Partnership will be developing two new strategies: one to promote and |

|celebrate the development of stronger communities (community cohesion) and another to promote volunteering. Volunteering and |

|active citizenship in general are twin drivers in community cohesion; the more people engage in voluntary activities, the more |

|likely that they will feel part of their communities. |

|Which key performance indicators will tell us if we are improving? |

| |

|NI 2 – % of people who feel that they belong to their neighbourhood |

|NI 3 – Civic participation in the local area |

|NI 6 – Participation in regular volunteering |

|NI 7 – Environment for a thriving third sector |

|NI 9 – Use of public libraries |

|NI 10 – Visits to museums or galleries |

|NI 11 – Engagement in the arts |

|NI 13 – Migrants English language skills and knowledge |

|NI 138 – Satisfaction of people over 65 with both home and neighbourhood |

• Action Plan for Outcome 6: Adults and carers feel able to participate as full and active members of their local community

The following key actions will make the greatest contribution to improving performance against this outcome in 2009/10. Please note these do not represent all actions taking place to improve this priority outcome, but the actions that will have most impact.

|No |Actions |

|Health and Wellbeing Objectives- long |Improve the health and wellbeing of all our residents in the 20% most deprived wards; |

|term |reduce mortality between deprived and non-deprived areas; improve life chances and |

| |access to healthcare for all, especially in areas of deprivation and of those with |

| |learning disabilities. |

|Health and Wellbeing Objectives- short |Give greater support to carers |

|term | |

|An Ageing Population Objectives – long |Focus on prevention of illness; |

|term |Help older people maintain their independence; |

| |Ensure older people have the opportunities to be active members of their communities. |

|An Ageing Population Objectives – short|Support independent living for older people |

|term |Strengthen intermediate care provision |

|SCS Links |Safer and Stronger |

|What specific groups of people will this priority outcome focus on? |

| |

|We want all people to feel safe and secure, but in working towards this outcome, we will prioritise our work to help older |

|people. |

|What positive conditions of wellbeing do we want to see? |

| |

|We want to see even lower levels of crime and anti-social behaviour in Hertfordshire. We also want to reduce people’s fear of |

|crime and to increase their confidence that they are safe in their homes and in the community. |

|We also want people to be aware of and take action to tackle risks in the home, such as fire. |

|How have we been performing against this outcome? |

| |

|Hertfordshire is a safe place to live, and it is becoming safer. 2007/08 saw the lowest crime figures for six years; crime fell|

|by 12%, with 11,255 fewer victims. The incidence of violent crime and robbery fell even more sharply. |

| |

|A ‘Safer Herts’ campaign was launched in June 2008 to provide further reassurance to people who live, work or visit the county.|

| |

| |

| |

|Hertfordshire Constabulary and the local authorities in the council have established Crime and Disorder Reduction Partnerships |

|in each District area, and visible neighbourhood policing teams in more local areas. |

| |

|In addition to services provided by Hertfordshire Constabulary, a number of other services are available in Hertfordshire to |

|support this outcome: |

|All district and borough councils employ Community Safety Officers who focus on the prevention of crime and anti-social |

|behaviour. |

|Hertfordshire Home Safety and Security Service give people advice about staying safe in their homes, and can fit smoke alarms, |

|door chains, locks and spy holes. Last year almost 4000 homes were visited. |

|There are 5000 Neighbourhood Watch schemes in Hertfordshire, covering around 93% of homes in the county. |

|Telecare services include pendant, pull-cord and wrist-worn alarms and sensors which can detect falls, smoke or gas, or anyone |

|leaving the house at an unsafe time. 2,500 have already received a service. |

|Age Concern’s Aid Call service provides older and vulnerable people with personal alarms which allow them to call for emergency|

|help at the touch of a button |

| |

|Although statistics show that Hertfordshire is a safe place to live, it is important that we are not complacent – crime and |

|fear of crime can have a significant impact on people’s daily lives and therefore their health and wellbeing. |

| |

|Results from the 2008 Place Survey[6] show that many people in Hertfordshire do still feel affected by crime: |

|NI 17 – 16.4% of people feel that anti-social behaviour is a problem in their local area. Perceptions of anti-social behaviour |

|are highest in Welwyn-Hatfield and lowest in St Albans. |

|NI 27 – 21.8% feel that police and other local services seek the views of local people on ASB and crime. |

|NI 21 – 27.4% feel that police and other local services are successfully dealing with ASB and crime. |

|‘Teenagers hanging around the streets’ is seen as a problem by more than one third of residents. |

|28% of people feel unsafe in their local area after dark, compared to just 3% during the day. |

| |

|People also face risks at home or at work from fire. One of the major functions of Hertfordshire Fire & Rescue Service is to |

|keep people safe through community fire safety initiatives. Fire safety initiatives have helped to reduce the number of fires |

|attended and emergency calls received by HFRS, and the number of injuries resulting from fires. |

|Which key performance indicators will tell us if we are improving? |

| |

|NI 138 – Satisfaction of people over 65 with both home and neighbourhood |

|NI 15 – Serious violent crime |

|NI 16 – Serious acquisitive crime |

|NI 18 – Adult re-offending rates for those under probation supervision |

|NI 19 – Rate of proven re-offending by young offenders |

|NI 20 – Assault with injury crime rate |

|NI 21 – Dealing with local concerns about anti-social behaviour and crime issues by the local council and police |

|NI 22 – Perceptions of parents taking responsibility for the behaviour of their children in the area |

|NI 23 – Perceptions that people in the area treat one another with respect and consideration |

|NI 24 – Satisfaction with the way the police and local council dealt with anti-social behaviour |

|NI 25 – Satisfaction of different groups with the way the police and local council dealt with anti-social behaviour |

|NI 26 – Specialist support to victims of a serious sexual offence |

|NI 27 – Understanding of local concerns about anti-social behaviour and crime issues by the local council and police |

|NI 28 – Serious knife crime rate |

|NI 29 – Gun crime rate |

|NI 30 – Re-offending rate of prolific and priority offenders |

|NI 32 – Repeat incidents of domestic violence |

|NI 33 – Arson incidents |

|NI 34 – Domestic violence – murder |

|NI 35 – Building resilience to violent extremism |

|NI 36 – Protection against terrorist attack |

|NI 37 – Awareness of civil protection arrangements in the local area |

|NI 38 – Drug-related (Class A) offending rate |

|NI 41 – Perceptions of drunk or rowdy behaviour as a problem |

|NI 42 – Perceptions of drug use or drug dealing as a problem |

|NI 47 – People killed or seriously injured in road traffic accidents |

|NI 48 – Children killed or seriously injured in road traffic accidents |

Action Plan for Outcome 7: Vulnerable adults, older people and their carers feel safe and secure in their homes and communities

The following key actions will make the greatest contribution to improving performance against this outcome in 2009/10. Please note these do not represent all actions taking place to improve this priority outcome, but the actions that will have most impact.

|No |Actions |

|Health and Wellbeing Objectives- long |Improve the health and wellbeing of all our residents in the 20% most deprived wards; |

|term |reduce mortality between deprived and non-deprived areas; improve life chances and |

| |access to healthcare for all, especially in areas of deprivation and of those with |

| |learning disabilities. |

|Health and Wellbeing Objectives- short |Increase physical activity across all ages particularly in Broxbourne; Stevenage and |

|term |Watford; |

| |Reduce smoking in areas of deprivation, particularly in Broxbourne; Stevenage and areas |

| |of Three Rivers; |

| |Reduce obesity in areas of deprivation, particularly in Broxbourne; Stevenage and |

| |Watford; |

| |Give greater support to carers. |

|An Ageing Population Objectives – long |Focus on prevention of illness; |

|term |Help older people maintain their independence; |

| |Ensure older people have the opportunities to be active members of their communities. |

|An Ageing Population Objectives – short|Strengthen intermediate care provision; |

|term |Increase physical activity amongst older people; |

| |Support independent living for older people; |

| |Ensure older people have opportunities to work, volunteer and learn. |

|SCS Links |Jobs, Prosperity and Skills; Safer and Stronger; Transport and Access; Sustaining |

| |Hertfordshire’s Unique Character and Quality of Life; Housing, Affordable Housing and |

| |Quality Neighbourhoods. |

|What specific groups of people will this priority outcome focus on? |

| |

|Older people, people with disabilities and carers. |

|What positive conditions of wellbeing do we want to see? |

| |

|We want to ensure that all people enjoy the maximum independence, choice and control over their lives that their circumstances |

|allow. |

| |

| |

|By 2020, the number of people aged 80 or over in Hertfordshire is expected to rise from 40,644 to 64,400 (from 3.93% to 5.5% of|

|the population). The number of adults with learning disabilities, currently over 30,000, is also expected to increase |

|significantly in the next few decades. We want to ensure that these growing groups of people are able to live as independently |

|as possible, and to postpone the need for more intensive care packages or residential care for as long as possible. |

| |

|We want people to have the support they need to live at home for as long as possible. We want people who need extra support to |

|have choice and control over the services they receive. And we want people to have access to the care, treatment and support |

|that they need either at home or in community settings. We want more people with learning disabilities and mental health to |

|find paid work so that they can support themselves financially. |

|How have we been performing against this outcome? |

| |

|The number of people aged 75+ who live at home is slightly higher in Hertfordshire than in the rest of England. |

| |

|In 2007-08, Hertfordshire was placed in the top banding for supporting adults with learning disabilities and mental health |

|problems to live at home. For adults with physical disabilities and those over 65, Hertfordshire was given a lower banding than|

|average[7]. Hertfordshire has chosen NI 141 (% of vulnerable people achieving independent living after moving on from |

|short-term accommodation) as part of its Local Area Agreement for 2008-11. Hertfordshire’s baseline for NI 141 is 59.3%, with |

|targets of 65%, 68% and 71% from this year. Data being collected for other national indicators will mean that in future we will|

|be able to monitor more closely the number of people achieving and maintaining independent living. |

| |

|Adult Care Services has a strong focus on keeping people independent. |

|In addition the wide range of services and opportunities available through the private, voluntary and community sectors, there |

|are a number of services available in Hertfordshire which specifically aim to support those at risk of losing their |

|independence: |

|Hertfordshire Home Safety and Security Service offer checks, advice and equipment or adaptations to help people stay safe in |

|their homes. The service is free of charge to people over 60, people whose homes have been burgled, single parent households |

|and people who are housebound. |

|Hertfordshire’s Handyperson Service employs skilled technicians to carry out all kinds of jobs around the home that improve |

|safety or make life easier for people to look after themselves. |

| |

| |

|Hertfordshire Equipment Service delivers, collects, cleans, reuses and maintains a variety of items including beds, mattresses,|

|hoists and specialised equipment. In 2007-08, HES delivered over 56,000 and reissued over 25,500 pieces of equipment. |

|Hertfordshire Action on Disability also provides equipment to 15,000 people per year. |

|Telecare services have been provided to over 3,000 people. |

|Meals on Wheels services provide hot meals to hundreds of elderly and frail people across the county each day. |

| |

|In the 2008 Place Survey[8], Hertfordshire residents told us the following: |

|NI 138 – 85.8% of people over 65 are satisfied with both home and neighbourhood |

|NI 139 – 26.9% of people say that older people receive the support they need to live independently at home. People in St Albans|

|are most likely to say that older people receive the necessary support; people in Stevenage are least likely. |

| |

|Which key performance indicators will tell us if we are improving? |

| |

|NI 124 – People with a long-term condition supported to be independent and in control of their condition |

|NI 125 – Achieving independence for older people through rehabilitation/intermediate care |

|NI 127 – Self-reported experience of social care users |

|NI 129 – End of life access to palliative care enabling people to choose to die at home |

|NI 130 – Social Care clients receiving self-directed support |

|NI 131 – Delayed transfers of care from hospitals |

|NI 134 – The number of emergency bed days per head of weighted population |

|NI 136 – People supported to live independently through social services (all ages) |

|NI 138 – Satisfaction of people over 65 with both home and neighbourhood. |

|NI 139 – Extent to which older people receive the support they need to live independently |

|NI 141 – Number of vulnerable people achieving independent living |

|NI 142 – Number of vulnerable people who are supported to maintain independent living |

|NI 145 – Adults with learning disabilities in settled accommodation |

|NI 146 – Adults with learning disabilities in employment |

|PAF C29 – People with a physical disability helped to live at home |

|PAF C30 – People with a learning disability helped to live at home |

|PAF C31 – People with mental health problems helped to live at home |

|PAF C32 – Older People helped to live at home |

| |

|Challenge CH017 – Measure of safely maintaining older people at home e.g. trips/falls or fire alarms/assistive technology. |

Action Plan for Outcome 8: Vulnerable adults, older people and their carers are able to live independently for as long as they wish and are able.

The following key actions will make the greatest contribution to improving performance against this outcome in 2009/10. Please note these do not represent all actions taking place to improve this priority outcome, but the actions that will have most impact.

No |Actions

|Timescales for Delivery |Lead Agency |Lead Officer |Resources Required |How will we monitor progress | |8.1 |Implement LAA action plans for NI 135 (carers), NI 141 (vulnerable adults achieving independent living) and NI 125 (Independent living for older people). |2011 |ACS/PCTs |Tim Anfilogoff

Amanda Brown Andy Saunders |TBC |HCOP Executive

Herts Forward

| |8.2 |Design and commission ‘Green Aiders’ projects in Broxbourne and Stevenage to help older and vulnerable adults, living in their own homes, manage and maintain their gardens. This project also promotes physical health and activity. |March 10 |ACS/PCTs |Karyn Jones

Groundwork Herts |£120,000 |HCOP Executive

| |8.3 |Work with district LSPs to design and commission local services to reduce ill health related to fuel poverty in areas of deprivation. |March 10 |ACS/PCTs

LSPs |Karyn Jones

PH Colleagues |TBC |HCOP Executive

LSP Boards

| |8.4 |Consider the establishment of a multi-voluntary sector social enterprise/user-led volunteering scheme to provide practical support services to older or vulnerable people e.g. shopping, housework, pet care, transport, cooking etc. Especially needed when patient is discharged from hospital |March 11 |Voluntary sector consortium |TBC

Karyn Jones to support |TBC |HCOP Executive | |8.5 |Map the provision of good neighbour schemes in Herts and work to develop or expand schemes in areas of deprivation. |March 10 |ACS/PCTs |Karyn Jones

|TBC |HCOP Executive | |8.6 |Set up a series of self directed support workshops or a road show for voluntary sector organisations. |Oct 09 |ACS |Mark Janes |TBC |ACS Board | |8.7 |Develop peer support groups for recipients of self directed support. |Oct 09 |ACS/HPFT |Mark Janes

Sally Hickman |TBC |ACS Board | |8.8 |Submit Expression of Interest to DH for Personal Health Budgets for disabled people, people with learning disabilities and people with mental illness. |March 09 |PCTs |Karyn Jones |N/A |HCOP Executive | |8.9 |Increasing extra care provision to prevent avoidable admissions to residential care. |December 10 and ongoing |ACS |David Quirke-Thornton |Accommodation Services for Older People team |IPC Evaluation; SP Commissioning Body; ACS Board | |8.10 |Commission courses that support adults with learning difficulties to live independently within local communities. |July 2010 |Hertfordshire Adult and Family Learning Service |Sarvjeet Dosanjh |LSC Safeguarded Funding |HAFLS plan | |

Produced by Karyn Jones Healthier Communities and Older People’s Programme Manager, ACS Community Commissioning and PCTs Partnership Commissioning 01707 369625 email: Karyn.jones@herts-pcts.nnhs.uk and Ed Maguire, HCC graduate trainee

21st March 2009. Last updated: 20th April 2009

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[1] The 2008 Place Survey data is provisional unconfirmed.

[2] The 2008 Place Survey data is provisional unconfirmed.

[3] The 2008 Place Survey data is provisional unconfirmed.

[4]

[5] The 2008 Place Survey data is provisional unconfirmed.

[6] The 2008 Place Survey data is provisional unconfirmed.

[7] See

[8] The 2008 Place Survey data is provisional unconfirmed.

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