THE BASILDON HEALTH
PARTNERSHIP
The BRP Basildon Health Partnership
Draft Commissioning Framework
1.
Introduction
The BRP Health Partnership was formed in March 2013 and brings together relevant local public, private and voluntary sector professionals from across the Health sector.
In September 2013, the Partnership identified the following three priorities based upon the findings of local health data and the recently published Joint Strategic Needs Assessment (JSNA) –
Smoking Cessation
Obesity (including Physical Activity)
Educational Attainment/Poverty
It was agreed to initiate the development of an outcome-based Commissioning Framework to establish a clear, collective understanding of the priorities that the Partnership would wish to focus their efforts.
This Commissioning Framework will:
Provide the strategic direction that will shape the Partnership’s approach to the commissioning of activities and projects and guide individual organisations going forward. It is intended to bridge the gap between the strategic vision provided by the Community Strategy, local need as identified by Partners and Stakeholders and service delivery/availability within the Borough;
Provide an opportunity to establish positive working relationships and shared commitment
to key issues within the Borough. This will result in a shift of emphasis away from activities/processes and support a greater focus on results and outcomes to be achieved, providing scope for innovation and flexibility in meeting the desired outcomes.
Enable the Partnership to identify appropriate funding streams, which align with the desired outcomes. This can be used as the basis to influence at a County and Regional level to bring about change and deliver benefits to those who live and work in the Borough. By establishing and committing to key outcomes, the Partnership is provided with an opportunity to collectively influence and shape beyond the direct remit of individual, contributing organisations.
Public Health Financial Summary
The cost of providing Public Health services are increasing due to the demand placed upon them. In 2014/15, the following expenditure has been approved for contracts that target the priorities as follows -
£395k was allocated to Smoking Cessation initiatives;
2.
Vision and Outcomes
Vision Statement
Our Partnership vision is “To improve the health prospects for residents of Borough”.
In determining the outcomes to be realised in the Borough, the Partnership has taken into consideration the key messages that emanated from a local health profile which in themselves have helped inform the local priorities for Basildon.
The commissioning outcomes identified in this framework complement the existing aims of the Basildon Renaissance Partnership (BRP) as set out in the Community Strategy, specifically those assigned to the following objective:
To support local people to improve their health and well-being.
It is the Health Partnerships ambition to better understand the various contracts that are being commissioned by both Public Health and CCG colleagues.
The Partnership will explore the effectiveness of these contracts and whether the services being delivered are in the most appropriate location(s) within the Borough with a view of influencing the scope of future contracts.
3.
Outcomes and Priorities
3.1 Smoking Cessation
Outcome
Reduce the number of people who smoke in the most deprived wards within the Borough.
Context
All Public Health Outcomes related to Smoking indicate that Basildon is not significantly different to the England Average. The Essex Joint Strategic Needs Assessment (JSNA) has identified that smoking attributable deaths are higher in the most deprived areas, for both males and females, than those in the least deprived areas.
In 2013, there were around 2,372.27(1)hospital admissions in Basildon attributable to smoking in
35+ year olds. The cost of these admissions is approximately £6m per year. If a reduction of attributable hospital admissions in Basildon is made in line with the England average, this would result in a reduction of 386, equating to an estimated net saving of £900K(2) per year.
COPD related hospital admissions is a particular cause for concern with all four wards studied being considerably higher than the Essex Average (EA) of 77.2 with residents in Lee Chapel North who are admitted being nearly three times 196.6 more than the EA.
Smoking Prevalence
Smoking Prevalence is greater in the more deprived wards in the Borough. The numbers of people who smoke was studied in Lee Chapel North, Vange, Fryerns and Laindon Park. It is apparent that
the number of people smoking across the Borough is highest in the manual work socio-economic
sector. Research has shown the majority of smokers that quit, return to smoking before 10 weeks of quitting(3). This would suggest that a more concentrated programme of cessation support could
be considered for those people living in areas of greatest risk.
Partners are to consider the smoking cessation support and advice currently available in these wards and to determine whether alternative initiatives need to be developed.
Partners to apply a greater focus on the development of STAY QUIT initiatives. This could comprise of completing additional research in high risk areas to determine the factors that lead to someone returning to smoking. This could be in the form of neighbourhood GP surgeries or through a community engagement event in local community facilities.
To help illustrate the problem of Smoking further, the findings of a recent “5 Why’s” exercise can be found on Page 19. This diagrammatic analysis not only identifies the main behavioural characteristics of individuals who smoke but also the lifestyle choices that also contribute towards this problem.
The table in Fig 3.1.1, identifies the smoking related data across four particular wards in Basildon. (1) - Deep Dive Analysis – Lifestyle JSNA document (July 2013)
(2) - Estimated figure provided by the Essex Public Health Intelligence Team (July 2013). (3) - Deep Dive Analysis – Lifestyle JSNA document (July 2013)
Basildon Health Partnership Priorities
Priority 1 - Work in deprived communities to promote the “Smoking Cessation” campaign. Priority 2 - Target both teenage smokers and pregnant mothers promoting the dangers of
smoking in particular risky estate areas in Basildon (Lee Chapel North, Vange, Fryerns and Laindon Park);
Priority 3 - Promote a greater range of “Stay Quit” initiatives across the Borough.
Key Public Health Indicators (Smoking Related Conditions)
Ward Performance Data (2011)
The following table provides smoking related data in those areas of Basildon identified as having higher levels of deprivation. These figures are based on ward data provided in 2011 by Public Health England. These figures are currently the most up to date available at ward level.
The use of “outcome target indicators” in particular geographies will help inform partners of the current situation in Basildon, the effectiveness of the current support provided and whether alternative solutions are required. These indicators will become measures which will assist the Partnership monitor the progress made against each of the agreed smoking priorities, as detailed above.
Partners are asked to consider whether these are the right outcome measures and whether alternatives need to be investigated?
Fig. 3.1.1 - Smoking (Mortality and Health Related Statistics)
Health Indicator Lee Chapel
North
Vange Fryerns Laindon Park
SMOKING CESSATION Actual Target Actual Target Actual Target Actual Target (SAR) – Number of Emergency hospital admissions COPD 196.6 TBC 190.2 TBC 169.1 TBC 159.3 TBC Essex Average 77.2 (SRR) Incidence of Lung Cancer 158.4 TBC 102.2 TBC 158.8 TBC 77.0 TBC Essex Average 85.3
(%) Low Birth Weight
7.3 TBC 7.8 TBC 6.9 TBC 6.8 TBC
Essex Average 6.9
(SMR) Deaths from respiratory disease (all
ages) 128.6 TBC 174.4 TBC 165.3 TBC 139.7 TBC
Essex Average 93.6
(SMR) Deaths from Coronary Heart Disease (all ages)
117.8 TBC 95.0 TBC 108.1 TBC 141.8 TBC
Essex Average 91.8
(SMR) Deaths from Circulatory Disease (all ages)
99.9 TBC 106.7 TBC 106.1 TBC 121.0 TBC
Essex Average 92.5
Figures provided from Public Health England – Local Health Indicators (localhealth.org.uk)
TBC – Target Measures to be confirmed by the Basildon Health Partnership.
Formation of a Smoking Cessation Task and Finish Group
The Partnership have agreed the formation of a Smoking Cessation Task and Finish Group that will focus on the support networks available and the effectiveness of these current health arrangements.
Ward health data will be explored to determine the local need and links made re the accessibility of tobacco cessation support services. The group will challenge their effectiveness and alternative health solutions explored through collaborative neighbourhood institutions. This will include greater interaction with Schools, Community Groups and established neighbourhoods to promote a greater Community focus that improves the health prospects of all local residents.
3.2 Obesity/Physical Activity
OutcomeWeight Management is better controlled across the Borough with particular focus on Year 6 children (changes to year 6 as it is increasing from reception year).
Context
Obesity has become a national health problem in the UK. In February, Public Health England announced that on average (2 in 3 people) are classified as Overweight/Obese in England. A similar picture is developing in Basildon with (7 in 10 adults) classified as overweight or obese. This statistic has now extended to young children aged only 5 years old (Reception). Local data has identified that children who are overweight at this age are becoming obese by the time they reach the age of 11 (year 6). Furthermore, if a child’s weight has been effectively managed before embarking into Secondary education, the more likely that this will be successfully controlled between Years 6 – 11 and into adulthood.
This outcome also aims to understand the underlying factors that influence people who decide not to partake in physical activity. This will include investigating the accessibility of services, affordability, and the problem of low self esteem that all contribute to weight management conditions developing.
To help illustrate the problem of Obesity further, the findings of a recent “5 Why’s” exercise can be found on Page 20. This diagrammatic analysis not only identifies the main behavioural
characteristics of individuals who become overweight but also the nutritional and lifestyle choices that also contribute to this problem.
Local research has shown that the probability of people with a Body Mass Index of 30+ is greater in areas of higher deprivation. In Basildon, those people who reside in the St Martins, Lee Chapel North , Fryerns and Vange wards are those at most risk.
Partners should consider what nutritional advice can be provided in these areas and how best to communicate these messages. Investigate the weight management services that are currently available and whether more can be done to promote physical activity initiatives across the Borough.
Basildon Health Partnership Priorities
Priority 1 – Greater emphasis of joined up working with local stakeholders to ensure that Weight Management facilities are more accessible in Basildon;
Priority 2 – Dietician courses promoted with Community Facilities including schools within the Borough;
Key Public Health Indicators (Obesity Related Conditions)
Ward Performance Data (2011)
The following table details the current Public Health outcome data relating to Obesity in the areas of Basildon with greatest need. These figures have been provided by Public Health England Ward level data.
The following health target indicators will help inform Partners of the effectiveness of the current support provided in these areas. Furthermore, these indicators are required to monitor progress made against each of the agreed obesity priorities, as detailed above.
Partners are asked to consider whether these are the right outcome measures and whether alternatives need to be investigated?
Fig. 3.2.1 - Obesity (Health Related Statistics)
Health Indicator Vange Lee Chapel
North
St Martins Fryerns
WEIGHT
MGMT/OBESITY Actual
Target Actual Target Actual Target Actual Target
% Obese Children (Reception Year) 10.1 TBC 9.0 TBC 8.8 TBC 9.7 TBC Essex Average 8.5 % Obese Children (Year 6) 19.2 TBC 22.0 TBC 19.5 TBC 17.8 TBC Essex Average 17.0 Obese adults 29.2 TBC 27.0 TBC 28.4 TBC 28.0 TBC Essex Average 24.2 (SAR) Emergency hospital admissions for myocardial Infarction (Ht. Attack) 88.8 TBC 111.3 TBC 101.7 TBC 109.4 TBC Essex Average 84.6 % Binge drinking adults 20.0 TBC 21.5 TBC 17.4 TBC 18.0 TBC Essex Average 19.4 % Healthy eating adults 21.0 TBC 21.1 TBC 22.0 TBC 22.1 TBC Essex Average 29.6
3.3
Educational Attainment
OutcomeReduce Poverty in the Borough to help residents make better life choices.
Context
Deprivation in Basildon is currently higher than the England average. Approximately 8,500 children currently live in poverty within the Borough.
Life expectancy for men is currently higher than the England average. However in areas of deprivation, life expectancy is 10.1 years lower for men and 7.3 years lower for women in the most deprived areas of Basildon than those living in the least deprived areas.
This outcome aims to understand the underlying causes of deprivation within these areas, how this links to an individual’s health and to explore ways of intervening earlier to help residents make better, and more informed health choices.
Research has shown that Poverty negatively impacts on an individuals ability to learn through ill health.
An example of this are the problems associated with Fuel Poverty. In some cases, this leads to substandard living conditions which develop into associated health problems within the household. In this example, it is important to understand how the Partnership can best support this household. If this household live in social housing, it could be that the property requires better insulation to reduce the health risks associated with the property which the local authority can help improve.
To help illustrate the problem of Educational Attainment/Poverty further, the findings of a recent “5 Why’s” exercise can be found on Page 21. This diagrammatic analysis not only identifies the main behavioural characteristics of individuals who live in Poverty and how this impacts on the health of these individuals.
The Partnership to consider targeting particularly deprived wards in Basildon working with schools to provide educational health support.
Basildon Health Partnership Priorities
Priority 1- Investigate the potential of school clubs to include Nutritional advice. Priority 2 – Promote parenting health advice (to include):
• What can families do to ensure that their children are more school ready?
• Health related advice provided re Health Eating, Building Aspirations, Healthy Lifestyles, • Investigate the current level of health services available in a locality (re the above) and
whether these could be delivered differently to tailor the needs of local residents; • Increased activity within schools to promote healthier lifestyles.
Key Public Health Indicators (Educational Attainment/Poverty) –
Performance Data (2011)
The following table details the current Public Health outcome data that relate to Educational Attainment/Poverty in the areas of greatest need. These figures have been provided by Public Health England ward level data.
The following health target indicators will help inform Partners of the effectiveness of the current support provided in these areas. Furthermore, these indicators are required to monitor progress made against each of the agreed educational attainment priorities, as detailed above.
Partners are asked to consider whether these are the right outcome measures and whether alternatives areas need to be investigated?
Fig 3.3.1 - Educational Attainment/Poverty (Health Related Statistics)
Health Indicator Vange Lee Chapel
North
Fryerns Pitsea North West Pitsea South East EDUCATIONAL ATTAINMENT/ POVERTY
Act. Target Act. Target Act. Target Act. Target Act. Target
Income Deprivation – Income deprived households (%) 26.5 TBC 26.3 TBC 22.7 TBC 24.6 TBC 20.4 TBC Essex Average 11.4 Child Poverty – (%) 40.0 TBC 43.0 TBC 33.7 TBC 39.0 TBC 31.5 TBC Essex Average 16.5
Older People in Deprivation (%) 30.8 TBC 24.5 TBC 27.5 TBC 33.7 TBC 27.4 TBC Essex Average 14.9 Unemployment (%) 6.7 TBC 6.2 TBC 5.1 TBC 5.0 TBC 5.2 TBC Essex Average 2.9 Long Term Unemployment Rate/1,000 working age pop. 11.2 TBC 9.2 TBC 6.9 TBC 7.1 TBC 8.5 TBC Essex Average 4.4 GCSE Achievement (5A*-C inc. Eng & Maths) (%)
33.4 TBC 39.3 TBC 35.3 TBC 39.1 TBC 42.2 TBC
Essex Average 59.3
4.
Health Contract Commissioning
In order to embed an ethos of partnership and joint commissioning, it is important to capture from partners, the key services, programmes and contracts that partners are commissioning (that align to the shared outcomes for the partnership) in a forward plan, spanning up to 3 - 5 years into the future.
Having the Framework and a schedule of future commissioning activity will in itself enable and facilitate collaboration in commissioning.
Given this, the Framework will identify the following principles that partners will be asked to “sign up” to:
1. The Health Partnership will be formerly consulted at the outset of Commissioning exercises
that contribute to the shared outcomes identified in the Framework (as identified in the forward plan);
2. The procurement process of individual partner organisations will need to be amended to
make provision that the Partnership will form part of the consultee list for relevant projects, services and contracts;
3. The Partnership will be given 6 weeks to provide input and feedback provided from the Commissioner to the partnership in response to this input (positive or otherwise).
The following table summarises the various contracts that will be commissioned across various parts of the Borough in the next 18 months.
Fig 4.1 – Contract Commissioning Dates
Outcome Contract Name Summary Consultation Date Renewal Date Expiry Date
APPENDIX 1
-
GOVERNANCE ARRANGEMENTS
The Basildon Health Partnership will agree the formation of Task and Finish Groups to deliver the agreed actions.
These groups will comprise of representatives from a range of partner organisations who will report progress against the priorities at future Partnership meetings.
Task and Finish Groups will meet on a bi-monthly basis or as and when required. These will be scheduled in line with the main Health Partnership meeting where progress against the Commissioning Framework will be presented.
The approach to developing this framework will enable collaborative working and with a shared agreement on the areas to be tackled through the Partnership, Partners are better placed to identify opportunities to work collectively and to better utilise limited resources. No additional funding will be provided to the Partnership to deliver the Commissioning Framework. Its delivery is reliant on stakeholders who form the BRP Health and Well Being Partnership to maximise the use of existing resources. This could be in the form of directly funding projects, officer time or using existing budget provision in a different way.
Other contributions to the delivery of the framework may also include the following:
Identifying and bidding for funding;
Re-aligning existing provision to deliver identified priorities;
Identifying ways of working with others to utilise resources;
APPENDIX 2 - KEY ACTIONS, PERFORMANCE MANAGEMENT & MONITORING
Key Actions
The below action plan sets out the key actions which will be undertake to deliver the identified priorities. It allows the partnership to monitor the delivery of priorities and thereby determine the extent to which Outcomes are achieved.
The Basildon Health and Wellbeing Partnership Action Plan
The following tables set out the priorities and Key Actions as agreed by the Partnership.
SMOKING CESSATION
Priority Key Actions Start Date End Date Responsible
Officers
Work in deprived communities to promote the “Smoking Cessation” campaign
Target both teenage smokers and pregnant mothers promoting the dangers of smoking in particular estate areas (Vange, Lee Chapel North, St Martins and Fryerns);
OBESITY & WEIGHT MANAGEMENT
Priority Key Actions Start Date End Date Responsible
Officers
Work with local stakeholders including ECC to reinstate Active Basildon
Dietician courses promoted with Community Facilities including schools within the Borough
Resurrect Active Basildon to increase participation in Physical Activity
EDUCATIONAL ATTAINMENT / POVERTY
Priority Key Actions Start Date End Date Responsible
Officers
Investigate the potential of school clubs to include Nutritional advice
Promote parenting health advice
Performance Measurement and Monitoring
The following table outlines the agreed key action across the 3 health priorities. These actions will be monitored by a series of Performance Measures.
APPENDIX 3 – FINANCIAL INFORMATION
APPENDIX 4 – CAUSAL ANALYSIS
The following diagrams explore the reasons/factors of why people suffer ill health against the agreed health
priorities.
APPENDIX 5 – LINKS TO OTHER PARTNERSHIPS / PARTNER DOCUMENTS
This Framework will be recognised by the Basildon Renaissance Partnership (BRP). The delivery of outcomes will be regularly reported to the BRP as part of the Basildon Borough Community Strategy 2012-2036.
Partnership Links
The Basildon Education, Employment and Skills Partnership Public Health England – Health Statistics www.publichealth.org
