MEETING THE CHALLENGE
THE CARDIFF
HEALTH, SOCIAL CARE AND WELL-BEING
STRATEGY
PREFACE
‘Meeting the Challenge’ is Cardiff’s first Health, Social Care and Well-being Strategy. Developed in response to the new joint statutory requirement placed on Cardiff Council and Cardiff Local Health Board, it is grounded in a partnership approach to improving health and well-being and makes reducing health inequalities that exist across the city an equal priority to providing effective and efficient health and social care services.
We have attempted to be innovative in our approach to developing the Strategy. Responsibility for producing the Strategy was vested with the Cardiff Health Alliance, a partnership of the Local Authority, the NHS and the voluntary sector.
An extensive process of consultation and engagement to develop the strategy has been central to our approach. It has involved the wider community in Cardiff as well as key stakeholders. This reflected the conclusions reached by Derek Wanless in the ‘Review of Health and Social Care in Wales’ namely the need to engage the public not only in improving their own health, but also in the process of refocusing health and social care services. The Strategy has also been subjected to a race equality impact assessment in Line with the Race Equality Amendment Act.
As a result the Strategy for Cardiff identifies a joint vision for the future shape of health and social care across the city, which responds directly to local needs and has been developed in collaboration with partners and the community at large. This Strategy sets out co-ordinated action to improve health, which in turn will fundamentally change service provision for the residents of the City.
Councillor John Dixon Dr Rob Jones Executive Member Chair
Health, Social Care and Well-being Cardiff Local Health Board Cardiff Council
Chair Vice-Chair
Further copies of this document and a summary in a range of community languages are available from:
Christine Jenkins Cardiff Health Alliance Social Care and Health Room 337 County Hall Atlantic Wharf Cardiff CF10 4UW Tel: 029-2087 3830 Fax: 029-2087 3851 E-mail: [email protected]
Table of Contents
PREFACE ... 1
1. - PURPOSE AND SCOPE OF THE STRATEGY ... 6
VISION AND VALUES ... 7
OVERVIEW OF DOCUMENT ... 8
2. - HOW THE HEALTH, SOCIAL CARE AND WELL-BEING
STRATEGY WAS FORMULATED... 9
PROJECT MANAGEMENT ARRANGEMENTS... 9
LINKS TO OTHER MAJOR PLANS AND STRATEGIES ... 10
PRIORITY SETTING PROCESS ... 11
3. - ABOUT CARDIFF ... 16
NEEDS OF THE LOCAL PEOPLE ... 16
EXISTING PROVISION OF SERVICES ... 21
RESOURCE MAPPING ... 21
NHS ESTATES... 29
LOCAL AUTHORITY ESTATES ... 30
HEALTH IMPACT ASSESSMENT ... 30
RISKS... 31
4. - HOW WE PROPOSE TO IMPROVE HEALTH, SOCIAL
CARE AND WELL-BEING IN CARDIFF ... 33
TACKLING THE ROOT CAUSES OF ILL HEALTH ... 33
TACKLING INEQUALITIES IN HEALTH ... 34
PROMOTING HEALTH AND PREVENTING DISEASE ... 37
PROPOSALS TO MEET LOCAL NEED ... 40
5. - ACUTE SERVICES AND MANAGEMENT OF CHRONIC
DISEASE... 41
6. - MENTAL HEALTH... 47
7. - OLDER PEOPLE... 53
8. - CHILDREN AND YOUNG PEOPLE ... 60
9. - PHYSICAL AND SENSORY DISABILITIES ... 75
10. - LEARNING DISABILITY ... 81
11. - CARERS ... 87
13. - SUBSTANCE MISUSE... 96
14. - HOMELESSNESS... 100
15. - ASYLUM SEEKERS AND REFUGEES... 107
16. - SEXUAL HEALTH ... 113
17. - GYPSIES AND TRAVELLERS ... 118
18. - COMMISSIONING AND SERVICE DELIVERY ... 121
19. - NEXT STEPS – DEVELOPING THE HEALTH, SOCIAL
CARE AND WELL-BEING STRATEGY IN THE FUTURE ... 123
REFERENCES ... 127
GLOSSARY... 132
Appendix 1 Vision and Values ... 139
1. - PURPOSE AND SCOPE OF THE STRATEGY
This is the first Health, Social Care and Well-being Strategy for Cardiff. It is set in the context of the Cardiff Community Strategy 2004-2014 and is focused on improving health and reducing health inequalities as an equal priority alongside effective and efficient health and social care services. Developed in response to the new joint statutory requirement placed on Cardiff Council and Cardiff Local Health Board, it is grounded in a partnership approach with the joint health and social care planning structure for Cardiff at the heart of the process. The Health Alliance, as the key strategic partnership for Cardiff for health and well-being, has driven the development of the Strategy. The multi-agency planning and advisory groups and the Joint Commissioning Group, which report to the Health Alliance, have been responsible for developing the individual client group proposals, based on the outcome of the extensive consultation and engagement exercise which has underpinned the Strategy’s development. This whole partnership approach was based on the premise that for progress to be made in improving the health and well-being of the people of Cardiff and reducing the inequalities that exist across the City, local organisations need to work together.
The Health, Social Care and Well-being Strategy for Cardiff:
• Is based on an extensive assessment of the needs of local communities. • Is centred on an innovative approach to engaging key stakeholders,
service users and the wider community.
• Reflects a top-level commitment to co-ordinated action between local partners.
• Provides a mechanism for taking forward national strategies in the local context.
• Sets out action plans that maximise the efficiency and effectiveness of health and social care resources.
• Identifies clear priorities that will provide a basis for resource allocation. • Sets out overall goals for improving health and well-being against which
progress can be monitored.
The Strategy is intended to be a living document with sufficient flexibility to change and adapt over time. It will run from 1 April 2005 to 31 March 2008. The next Strategy will be for 5 years up to 2013.
The Strategy addresses the health and well-being needs of the resident population of Cardiff. It recognises the specific issues faced by Cardiff as the Capital City of Wales. This includes all the ‘metropolitan’ factors that attract people to the City with high levels of health and well-being needs and the role of Cardiff as a major cultural and sporting venue, which attracts large numbers of visitors, impacting on health and social care services.
VISION AND VALUES
The long-term overarching vision for Cardiff as set out in the Cardiff Community Strategy is based on the following driving principles:
• Cardiff as a Capital City – the benefit accrued from Cardiff’s position as the Capital City of Wales is balanced by the interdependency of the immediate surrounding areas – the South Wales Valleys in particular – on Cardiff for work and leisure.
• Equality - equal access to opportunities, information and services
regardless of race, ethnic origin, language, gender, disability, age, sexuality, marital status, nationality, religious or non-religious belief, family background or any individual characteristic which may limit a person’s opportunities in life in the city.
• Social Inclusion – ensuring the inclusion of all groups by improving the opportunities and quality of life for those in Cardiff who may be excluded. • Sustainable Development - balancing economic growth, environmental
considerations and social progress in communities while also looking after the long-term interests of future generations.
• Children and Young People - acknowledging the crucial contribution that children and young people make to Cardiff, and will need to continue to make in the future.
This Health, Social Care and Well-being Strategy has brought together and reflects the vision and values of Cardiff Local Health Board and Cardiff Council’s Social Care and Health Services. Common core themes identified from these include:
• A focus on improving health and well-being.
• The importance of securing a range of services across the pathway of health and social care.
• Effective partnership working to ensure a co-ordinated approach to meeting local needs and maximum benefit.
Detailed statements on the vision and values of the respective organisations are provided in Appendix 1.
The development of the Health, Social Care and Well-being Strategy for Cardiff has also been guided by the vision and values of the Welsh Assembly Government. The Assembly Government’s approach recognises that to address the challenges, new ways of delivering policies, programmes and public services are needed in order to make a real difference to the people of Wales. It also responds to the Welsh Assembly Government initiative ‘Health Challenge Wales’ by setting out co-ordinated action to improve health, through a focus on promoting health and preventing disease and supporting individuals to do what they can to improve their own health.
The Welsh Assembly Government set out its principles for the Health, Social Care and Well-being Strategies as:
• Local Leadership and Responsibility – with the Local Health Board and Local Authority providing joint leadership of the Strategy and all other organisations, bodies and groups signing up to its adoption and supporting implementation.
• Local Co-ordination – providing a new approach to health, social care and well-being planning which embraces the wide range of local government functions that contribute to health and well-being.
• Local Co-operation – involving a wide range of organisations, bodies and groups and with the active involvement of patients, service users and carers.
• Local Analysis – underpinned by a robust and holistic needs assessment and identifying issues relating to social inclusion and equality of opportunity and access.
The Welsh Assembly’s stated aims for the Health, Social Care and Well-being Strategies are to improve health, social care and well-being, and to improve services through better planning and investment.
OVERVIEW OF DOCUMENT
This document is the culmination of an innovative process that has focused on partnership, engagement and consultation at key stages in its development. This methodology is set out in Chapter 2 along with a description of the partnership infrastructure of the whole project.
Chapter 3 summarises both the quantitative Needs Assessment and the
outcome of the engagement process, which underpinned the qualitative Needs Assessment. The Needs Assessment was published primarily as a web document so that it can be updated as a live resource for planning services. The Needs Assessment itself built upon the work of the Cardiff Community Profile commissioned by Cardiff Health Alliance in 2000.
The core of the Strategy, the proposals set out in Chapters 4-17, was developed through the joint planning structures, providing a direct link to those who will be responsible for its implementation. Detailed action plans underpinning these proposals are signposted throughout. Consequently, detailed performance indicators have been omitted and will be published with the action plans.
Some elements of this Strategy, notably the proposals relating to children and young people, substance misuse and homelessness are the subject of separate strategic processes. This document summarises this work and signposts readers to the relevant strategies.
Chapter 18sets out the commissioning and service delivery arrangements that will support implementation of the Strategy.
Chapter 19 sets out the future work that will flow from the Strategy and the
ongoing process that will lead to the roots of the 2008-13 Strategy, work on which will commence in early 2006.
2. - HOW THE HEALTH, SOCIAL CARE AND WELL-BEING
STRATEGY WAS FORMULATED
Cardiff’s approach to the development of the Health, Social Care and Well-being Strategy is based on an innovative partnership approach to engaging key stakeholders, service users, carers and the wider community. The key principles of this were:
• Involvement would be based on collaboration rather than consultation. • Wider stakeholder and community involvement, and active participation of
patients, service users and carers and the community in the development and review of the Strategy.
• Effective communication processes.
PROJECT MANAGEMENT ARRANGEMENTS
The project management arrangements for the development of the Strategy are set out in the following diagram:
Cardiff Health Alliance was the overarching partnership body overseeing the development of the Strategy as a key component of the Cardiff Community Strategy. The Health Alliance is a partnership of Cardiff Council, Cardiff Local Health Board, Voluntary Action Cardiff, Cardiff Community Health Council, Race Equality First and Cardiff and Vale NHS Trust.
A Strategy Steering Group was established with a specific responsibility to develop and deliver the Strategy. This in turn established:
• A Needs Assessment Task Group to co-ordinate the production of the quantitative Needs Assessment across agencies. The Task Group brought together statistical information on population health and well-being needs, and oversaw the consultation process on the Needs Assessment. • The User, Carer and Public Engagement Group to develop the key
principles to underpin engagement and consultation in the Strategy, as well as developing a detailed action plan for ensuring that as many people as possible have an opportunity to contribute and comment.
The Health and Social Care Joint Planning Structures, the Joint Commissioning Group and the Advisory Planning Groups, were central to the development of the key proposals in this Strategy. It is these groups that will lead the implementation of the proposals.
Advisory Planning Groups Joint Commissioning Group
Needs Assessment Group User,Carer and Public Engagement Group HSCW Strategy Steering Group
Funded by the Welsh Assembly Government Joint Working Special Grant – an allocation to encourage joint working between the NHS and Local Authority - a Joint Unit was established. The Unit supports the work of the Health Alliance and the Strategy Steering Group and co-ordinates the contribution of the joint planning groups. An innovative approach has been adopted by the Unit to securing consultation with service users, carers and community groups. This has involved commissioning Voluntary Action Cardiff to provide these services; by appointing a dedicated officer to work with the Unit.
The high-level commitment of all partners to the development of the Strategy within this structure was demonstrated by Chief Executive level approval to two key partnership agreements, namely:
• A Memorandum of Understanding agreed between Cardiff Local Health Board and Cardiff Council as bodies with the statutory responsibility for the Strategy.
• A ‘Procedure for Co-operation’ agreed between the Health Alliance and other partner agencies.
LINKS TO OTHER MAJOR PLANS AND STRATEGIES
To achieve real progress in improving the health and well-being of local people, close links have been established with Cardiff Community Strategy. This ensured there was consistency between the Strategies, they were mutually supportive and avoided duplication. In addition key linkages were established with wider partnerships and strategies operating under the umbrella of the Community Strategy, as well as Local Health Board specific strategies. These included:
Children and Young People’s Partnership Framework.
Unitary Development Plan.
The Community Safety Partnership. Neighbourhood Renewal Strategy. Housing Strategy Cardiff Physical Activity and Health
Strategy. Economic Development Strategy and
Plan.
Communities First.
Local Sustainability Strategy. Strategic Change and Efficiency Programme (SCEP)
Transport Strategy Service and Financial Framework (SAFF)
Youth Offending Strategy.
To initiate linkages of relevant issues between these partnerships and strategies a network of the Lead Officers for each of the above was established.
Review of Health and Social Care in Wales – Wanless Report
"The Review of Health and Social Care in Wales" (Wanless Report 2003) has been a major influence in the development of the Health, Social Care and
Well-being Strategy for Cardiff. The proposals take account of the key challenges for the future identified by the Review, including the:
• Over-dependence on the acute hospital sector.
• Decreasing ability of acute hospitals to meet elective demand. • Continued use of unsustainable service models.
• Need to rebalance health and social care provision and refocus to prevention and early intervention.
• Need for individuals and communities to accept greater responsibility for their own health.
The process to develop the Wanless Local Action Plan for Cardiff, as a joint response by the Council and Cardiff Local Health Board to the Review, and the development of the Strategy have taken place in parallel. The Wanless Local Acton Plan for Cardiff was set in the context of the emerging Health, Social Care and Well-being Strategy and similarly the Wanless Local Action Plan forms an essential component of the Strategy’s proposals.
PRIORITY SETTING PROCESS
Working within the agreed project management arrangements, a structured process was used to identify key strategic priorities for the Strategy. This involved consideration of the following:
‘Givens’
These included a range of policy and legacy issues, as well as the legislative framework that governs the overall provision of health and social care services. It was recognised that the Strategy would need to respond to National Service Frameworks, take account of plans already agreed and consulted upon, while at the same time identify local solutions developed in response to local needs.
The Quantitative Needs Assessment
The Quantitative Needs Assessment brought together data from the Census, the NHS, local government and from local services to compile a comprehensive database of information. This has not only informed the Strategy but is also a valuable resource in itself.
The Qualitative Needs Assessment
A broad approach to looking at the needs of communities for the Strategy was established for the Qualitative Needs Assessment process. This was undertaken in a variety of ways to maximise the contribution of a range of organisations, individuals and the public. An underpinning principle of the approach taken was to engage participants in prioritising needs and decision making throughout the process.
The sources of information involved:
‘Have Your Say’ Workshops – Designed specifically as the consultation mechanism for the Needs Assessment, four workshops were held in each locality of Cardiff (North, South-East, West and Central) in the Autumn of 2003. Around 200 participants attended drawn from operational staff from the health and social care sectors and representatives of community and voluntary groups.
The methodology adopted in the workshops was a modified form of the King’s Fund Community Orientated Primary Care (see figure below). This approach is recognised as an effective method of community needs assessment and enabled participants to work to jointly develop a profile of both individual and whole community based problems that impact on health, social care and well-being.
The Community Oriented Primary Care (COPC) Process
The workshops focused on the first three stages of the COPC framework, Community Diagnosis, Prioritisation and Detailed Problem Assessment. The outcome of the workshops was based on consensus building to agree a series of prioritised local needs.
Youth Congress - A Cardiff Council event to engage young people in the
Community Planning Process, inform the development of the Children and Young People’s Framework and to support the Council’s corporate approach to promoting youth democracy.
‘Your Future – You Decide’ - A public seminar to begin a dialogue with older
people about the Strategy for Older People in Cardiff. It gave older people the opportunity to become involved in influencing local policy and services, to establish the issues most important to older people and to translate these into future policy and service development.
Prioritisation Problem Assessment Intervention Planning Implementation Evaluation Reassessment Community diagnosis
Written Responses - Organisations were also asked to provide written
evidence to the Needs Assessment process through a questionnaire to identify needs and prioritise their three most important issues.
Priorities Workshop
The key priorities for the Strategy were decided by the Cardiff Health Alliance after considering the quantitative and qualitative Needs Assessments and the results of the ‘Have Your Say’ Consultation workshops in the context of the legislative and policy ‘givens’.
The key priority areas identified were: • Mental Health.
• Older People.
• Children and Young People.
• Communities with Specific Needs (Black and Minority Ethnic Communities, Homeless people, Asylum Seekers, Gypsies and Travellers).
• Improving Lifestyles and Well-being (Smoking, Overweight/Obesity, Sexual Health, Accident Prevention).
• Maximising the Use of Health and Social Care Resources.
In identifying the priorities it was agreed by Health Alliance partners that resources and management effort should be focused in these areas. Underpinning the identified priorities are the following principles:
• The need to reduce inequalities in health.
• Engagement with and empowerment of individuals and communities. • Early intervention.
• Whole systems approach.
• Links to other services (Housing, Transport etc).
Developing Proposals
Recognising that the finalised strategy would need to identify proposals for all client groups, a robust consultation and engagement process was used to develop the Strategy. At the heart of this process was the following:
‘Talk into Action’ Workshops - Building on the ‘Have Your Say’ workshops,
a further four workshops were held in the Spring of 2004 which also utilised the modified form of the Community Orientated Primary Care methodology. The focus of these workshops was on identifying local solutions to local issues by working through problem assessment and intervention of the COPC cycle Representatives were invited from the community, voluntary sector and statutory agencies. The aim was to focus on the redevelopment of existing services by encouraging partnership working and the sharing of expertise. Information from participants on local service configuration contributed to the service mapping exercise and possible interventions were fed into the Advisory Planning Groups for consideration. This ensured that front-line workers and local residents could contribute to the planning mechanisms.
Apart from specific contributions across service areas, 6 recurrent themes were identified by all four workshops. These were considered as having a major bearing on the future delivery of health and social care services, as well as the actions that individuals and communities could take to improve their health and well-being. These were:
• Improved information and communication. • The need for a partnership approach. • Securing appropriate resources. • Ensuring clear policies and strategies. • Effective leadership and support. • A commitment to change.
Joint Planning Structures – Following collation of the information from the
workshops, the Health, Social Care and Well-being Strategy Unit worked with the joint planning groups to formulate the proposals for the Strategy. Reporting to the Cardiff Health Alliance there are a range of health and social care joint planning structures within Cardiff. The Advisory Planning Groups (APGs) and the Joint Commissioning Group (JCG) were responsible for developing individual client group proposals and will form part of the key structure to implement, monitor and review the Strategy.
The 10 joint multi-agency planning groups operational in Cardiff are:
• Older People • Substance Misuse.
• Mental Health (including older people’s mental health).
• Refugee and Asylum Seekers Stakeholder Group.
• Physical Disability. • Homelessness.
• Learning Disability. • Carers
• Sexual Health. • Children and Young People.
The planning groups were asked to develop proposals for the Health, Social Care & Well-being Strategy based on a consideration of:
• Evidenced needs.
• Issues regarded as ‘givens’ because of legislation, national policies or plans locally agreed and consulted on already.
• The outcomes of the consultation and engagement process.
• The principles of the Wanless Review of Health and Social Care in Wales. The proposals were submitted to the Joint Commissioning Group to:
• Confirm the proposals from the APGs. • Identify competing or contradictory priorities. • Consider any cross-cutting issues.
• Identify any other key issues not addressed by the APGs.
• Consider the ‘fitness’ of the planning structures to implement the proposals.
These proposals form the core of this Strategy and are set out in Chapters 4-17.
3. - ABOUT CARDIFF
NEEDS OF THE LOCAL PEOPLE
A comprehensive needs assessment was undertaken as the first stage of the Strategy. A detailed report on the outcome of both the quantitative and qualitative Needs Assessment for Cardiff was produced in March 2004 and full copies of this can be found on www.cardiffhealthalliance.org. The following provides a summary of the broad profile of the needs of Cardiff residents. Further detail on local need can also be found in the client group proposals in Chapters 4-17. A map of the Cardiff localities is detailed below.
Over the last ten years Cardiff has rapidly developed into one of the UK’s most dynamic and enterprising cities, partly reflected by a population growth of 30,000 over ten years. In addition, Cardiff’s economy has developed strongly over the last decade. This economic regeneration has been supported by a number of major inward investments. These developments mean that, as a capital city, Cardiff experiences an approximate increase of 40% in the population each day as a result of commuters, tourism and sporting events.
While Cardiff wide data presents a picture of a prosperous and healthy city enjoying relatively low unemployment and lower than average mortality rates, this masks significant differences within and between localities. The Needs Assessment demonstrates that there are in fact two distinctly different Cardiffs: the relatively prosperous northern part of the City and what can be described as a ‘southern arc’ which experiences high levels of multiple deprivation. Communities in these areas experience:
• High levels of unemployment. • High rates of reported crime.
• Poor educational achievement rates. • High levels of housing benefit claimants. • High levels of means tested benefit uptake. • High mortality rates.
• High percentages of low birth weight babies.
The size of the population of Cardiff means that the high levels of deprivation in the ‘southern arc’ affect a large number of people. The population of the electoral divisions in the ‘southern arc’ is estimated to be over 120,000. Perhaps of more significance however, is the number of children experiencing poverty across the City. The fact that 26% of all children under 16 in Cardiff live in households, dependant on income support suggests that over 16,000 children are living in relative poverty.
THE QUANTITATIVE NEEDS ASSESSMENT
Cardiff is the largest local authority in Wales contains 29 electoral divisions and a total population of 343,289 according to the National Health Service Administrative Register (NHSAR). This population is expected to grow by 5% by 2007, with almost two thirds of this growth expected to take place in the South-East locality.
Population Age Structure
Cardiff’s population age structure has a much higher proportion of young people aged 15-24 than Wales as a whole partly due to a large number of students. Cardiff also has a lower proportion of persons of retirement age than the Wales average, and a slightly higher proportion of persons aged 0 to 15 years old, though this pattern is not consistent across the City. This has been demonstrated through the use of a locality approach to describe the population and needs of the City. In general children and the elderly represent the groups that make greatest use of health and social care services and the balance of these populations across the City are as follows. • The South East locality has a higher proportion of both younger and older
age-groups than Cardiff as a whole.
• The West locality has a higher proportion of children than Cardiff as a whole and a proportion of elderly almost identical to Cardiff as a whole. • The North locality has a lower proportion of children than Cardiff as a
whole and the highest proportion of elderly of any of the four localities.
Specific Health Needs
The City also has a number of specific groups not evident in other Local Authority areas in Wales. People within these groups often have diverse and complex health and well-being needs that create additional pressures on the health and social care system in Cardiff. Furthermore, these demands are exacerbated when the cumulative effect of ensuring responsive service
provision to the distinct and diverse need of each group is considered. Communities with specific health needs evident across the City include:
• A 9% minority ethnic population (in excess of 25,000 people), the majority of whom reside in inner-city Central, South East and West localities.
• Cardiff’s two formal Gypsy and Traveller sites providing residential accommodation for 77 families are both located in the South East locality. • The majority of Cardiff’s homeless are located in hostels in Central, the
southern portion of South East Cardiff and in the West locality Electoral Divisions closest to the city centre.
• Cardiff has approximately 25,000 students 58% of who are concentrated in Central Cardiff.
• Most of Cardiff’s 1,500 asylum seeker population are located in the inner-city electoral divisions of Central and South East Cardiff.
• The incidence of sexually transmitted diseases is rising rapidly. Most of Cardiff’s sex industry is located in the inner-city electoral divisions of the Central and South East and (to a lesser extent) West localities and it is likely that the majority of the sex worker population is also resident there. • Her Majesty’s Prison Cardiff is located in the city, which, with a population
of approximately 650 prisoners (due to increase to 750, in 2005), has a number of implications for the demand on drug, alcohol and mental health services. 63% of prisoners who are released from the prison remain living in Cardiff.
• The role of Cardiff and Vale NHS Trust as a tertiary centre means that families caring for chronically sick children and individuals with complex needs often relocate to the City to be nearer to the services they require.
Selected Population Health Problems and Indicators
Health inequalities across Cardiff mean that people in some electoral divisions, especially in those in the ‘southern arc’, experience poor health that is amongst the worst in Wales. Variations in health status as identified through the Needs Assessment include:
• Half of the ten Electoral Divisions with the highest all-cause standardised mortality rates (SMRs) for deaths under the “fair-innings” age of 75 years are in the South East locality of Cardiff.
• The single largest cause of death in Cardiff is cardiovascular disease. One of the major determinants is smoking, which is increasing in young women, and another is obesity, which is increasing rapidly throughout the population.
• The percentage of low birth weight (LBW) babies is higher in the South East than in Cardiff as a whole. Eight of the ten Electoral Divisions with the highest percentages of LBW babies in the city are located within the Central and South East localities of Cardiff.
• 18.5% of Cardiff’s household population suffer from a limiting long-term illness (LLTI) which interferes with their ability to perform tasks, activities or to be independent. The South East (21.3%) and West (19.5%) have the highest percentages of total household population with LLTI.
Health Determinant Indicators
The many wider influences that determine an individual’s health were recognised as part of the Needs Assessment process. Again considerable inequalities were found within and between localities in factors which can affect health and well-being. This included a tenfold variation in unemployment rates between electoral divisions in the City and a stark variation in the percentage of dependent children living in households in receipt of Income Support.
THE QUALITATIVE NEEDS ASSESSMENT AND CONSULTATION
A desktop analysis of the priorities identified in each `Have Your Say’ workshop was undertaken to provide a broad summary of the issues raised through these workshops. As a consequence nine themes were identified. It should also be highlighted that in each of the workshops a re-current theme was the many positive aspects of living and working in Cardiff’s diverse communities.
The following summaries are broadly presented in priority order as determined through the workshops.
Older People - The needs of older people was the single issue that was
highlighted across all four locality workshops. The key issues raised were the need to:
• Ensure a holistic approach to care addressing social, emotional and clinical needs.
• Improve joint working between agencies to ensure ‘joined up’ service provision
• Focus on supporting older people to stay in their own homes and local communities.
• Increase social support within local communities to prevent isolation.
The ‘Your Future – You Decide’ event highlighted additional issues, directly from the older person’s perspective, including a desire for participation in planning, improved information and tackling age discrimination.
Housing - A range of issues were raised in relation to housing, summarised
as the need to:
• Ensure affordable housing, to enable people to remain in their local community
• Provide a range of accommodation options to meet the varying demands of different residents • Address the housing mismatch e.g.
overcrowding vs. under-occupation
• Provide specific housing including nursing home places, sheltered accommodation, people with additional support needs and homeless people
• Address poor maintenance in the private sector, which causes deficits in quality.
• Improve waiting times for home adaptations.
Community Cohesion - This category covered a variety of themes, broadly
distinguished as the need to address: • Local services provided from poor
quality facilities that do not reflect the changing needs of the local population.
• The poor infrastructure to support the sense of community in new housing developments
• Building in methods to encourage community cohesion (not just in disadvantaged communities) e.g. community development work
Young People – The issues raised included the need to:
• Improve social and leisure activities for young people.
• Address the increasing mental and emotional problems, substance misuse and poor diet.
• Provide flexible services to reflect the needs of young people
• Improve information on opportunities available to young people.
• Address the perceived threat of young people by older people.
These issues were reflected in the Youth Congress where issues of concern included the need for tailored services for young people in relation to sexual health and substance misuse, improved information and the impact of bullying.
Young Families - A number of specific issues were raised that included:
• Improving support for young parents including parenting skills. • Addressing Speech & language
development delays.
• Preventing injuries to children. Addressing the high levels of mild to moderate mental health problems.
•
• Improving social networking opportunities to prevent social isolation.
• Improving access to extended families through improved transport
Primary Health Care - Specific issues highlighted included the need for:
• Improved local access to primary care.
• Health services delivered in a way that is acceptable to young people particularly in relation to sexual health & substance misuse.
• Improved provision of speech therapy & physiotherapy.
• Primary care to adopt an ‘Outreach’ approach including referring patients to non-traditional forms of treatment e.g. exercise. • Shortened waiting times for health
services in general and particularly orthopaedics.
Crime - Crime and the fear of crime was highlighted across all localities, with
specific local issues identified. Crime experienced in those parts of the city as a result of increased leisure seekers being present in large numbers who do not necessarily respect the local community was also raised. Drug and alcohol related crime was highlighted with concerns over drug dealing being a strong theme.
Equality - This issue was highlighted as one of the six priorities in one locality
but was also a theme running through each workshop. This was expressed in terms of the need for mainstream services to be tailored to the needs of specific client groups to take account of differences in race, age, gender disability and sexuality.
Transport - Transport was also prioritised in one locality and was raised as
an issue across all the workshops. In particular, the need for people without access to a car to be able to cross the City, problems in accessing some of the key sites of service provision such as University Hospital of Wales and limitations in public transport from some of the outlying communities. Greater use of voluntary transport schemes was felt to be one solution to these issues.
EXISTING PROVISION OF SERVICES
The extensive range of services in health and social care, provided across the NHS, local authority, voluntary sector and private sector to support the health and well-being of the local population, are described in the appropriate sections of Chapters 4-17 and in Appendix 2. These include:
• Primary Health Care Services • Acute Services
• Intermediate Care and Community Services
• National Public Health Services – Health Promotion Team
• Local Authority Social Services Provision
Adult Services
Children’s Services • Voluntary Sector Services
• Independent Sector Services • Local Services Supporting Health
and Well-being including:
Housing and Homelessness
Employment Opportunities
Education and Training
Youth Services
Environmental Health/ Environmental Services
Leisure Services
Transport & Community Transport
RESOURCE MAPPING
For the purposes of the Strategy it has not been possible to identify the precise pattern of resource allocation to particular client groups across the range of public, private and voluntary sector organisations. These difficulties resulted from a variety of factors which included each organisation developing separate financial, IT and other systems to respond to needs, targets and performance indicators which have evolved separately or from external sources. It is proposed therefore, that identifying and mapping current patterns of resource allocation to particular client groups should form an
essential component of the implementation plans for the Strategy. This section does, however, provide an overview of the current resource framework of the statutory organisations in Cardiff.
Health Services
Cardiff LHB’s funding is currently provided via an allocation from the Welsh Assembly Government. There may be additional in year allocations as well, usually targeted at specific initiatives. The funding allocation is considered as a unified budget that comprises the following elements:
• Hospital and Community Health Services (HCHS) Revenue Discretionary Allocation.
• HCHS Protected/Ring fenced Services.
• General Medical Services (GMS) Contract Allocation. • Revenue Allocation for Drug Prescribing.
There is flexibility in the use of the individual funding streams and for the purpose of the allocations the LHB is responsible for the following:
• For general purposes including Planning Commissioning and Public Health, the LHB is responsible for the resident population (i.e. all residents living within Cardiff).
• For GMS/Prescribing allocations the LHB is responsible for the registered population (i.e. patients registered with GP Practices within Cardiff).
The total confirmed allocation to Cardiff Local Health Board for 2004/5 was £280.967m, divided into the categories as identified in the figure below.
67% 3% 12% 17% 1% Hospital and Community Services Protected Services General Medical Services Prescribing Free Nursing Care
The specific amounts are divided as follows:
£m Hospital and Community Services 187.637
Protected Services 9.667
General Medical Services 33.612
Prescribing 46.519
Free Nursing Care 3.531
Total £280.967m
Additional funding may be received during each financial year usually for a specified purpose. This may fall within any of the above categories and may be recurring, non-recurring or time limited in nature.
The implementation of the new General Medical Services contract from 1 April 2004 has provided the basis for a new approach to building the role of primary care. Initially the focus has been to ensure a smooth transition in the provision of core, additional, enhanced and out of hours services from the old arrangements to the new. The contract does, however, provide the key opportunity for the long term development of the role of primary care to develop the skills and infrastructure needed for primary care in Cardiff to take on new and enhanced roles.
Funding for Specialised Services
The total Hospital & Community Health Services discretionary allocation is £2494.557 million for Wales. Of this total £309.823 million is deducted from LHBs to Health Commission Wales for them to commission specialised services. Overall this equates to 12.4%. The amount deducted for Cardiff LHB totals £41.192 million which is 13.3% of the all-Wales total compared to the health needs formula of 9.5%.
Strategic Change and Efficiency Plan (SCEP)
Along with other ‘Bro Taf’ area LHBs Cardiff inherited an opening deficit as a result of the recurring financial deficit from the former Bro Taf Health Authority. Cardiff’s proportion of this inherited deficit was £9.988m. Consequently the LHB, working jointly with the Cardiff and Vale NHS Trust, has been required by the Welsh Assembly Government to establish a Strategic Change and Efficiency Plan which will ensure:
• The LHB returns to financial balance by 2006. • Repayment of interim brokerage by 2009.
• Repayment of the LHB’s share of a loan out by the former Bro Taf Health Authority by 2009.
The total value of loans to be repaid is calculated as follows:
£m
2003-04 brokerage 5.016
2004-05 brokerage 4.3
Bro Taf Loan 2.261
Total repayment
11.577The key themes against which savings are to be released as identified in the SCEP are:
• Releasing hospital capacity through developing new service models for older people working across the boundaries of social and health care. • Reducing the need for hospital/care home admission through
strengthening services in the community and by facilitating self-management in the individuals own home.
• Reviewing the balance of provision across District General Hospital sites including a further review of provision across the UHW and Llandough sites stemming from the Trust’s earlier Clinical Services Review, and work at Regional level.
• Establishing a Cardiff and Vale Medicines Management Executive comprising professional, clinical and finance representatives from the three partner organisations which will have as its main focus an ongoing reduction of drugs expenditure across both primary and secondary care. • Securing efficiency improvements across the whole range of services
through the use of benchmarking. The emerging work from the Assembly-led financial information strategy will be important in identifying outlying as compared to expected expenditure.
• Optimising the NHS Act Flexibilities arrangements in respect of pooled budgets. The LHB, Trust and Local Authority are committed to progressing these arrangements.
Achievement of the SCEP presents a challenging financial agenda for the Local Health Board. It has confirmed, however, that achieving and sustaining financial balance is the top priority for the organisation and has formally adopted a policy that this must take precedence over any investment decisions.
Local Authority Social Care Finance
In 2004/5 the Council has a total net revenue budget of £401m of which approximately £79m was allocated to Adults’ and Children's social care services.
The total Council Revenue Expenditure is funded through a number of sources. The most significant item is the Revenue Support Grant provided by Welsh Assembly Government that funds approximately 59% of total spending. The Council also receives an allocation from the National Pool of Business
Rates. The Council also levies a Council Tax that funds approximately 21% of total net expenditure.
Within Social Care significant elements of expenditure are funded through specific grants such as Mental Handicap Strategy, Ely Resettlement and Children First. The Council also has statutory authority to charge for certain services. These other income sources result in a combined gross expenditure budget for Adults and Children's social of £106m.
This funding comprises the following elements:
£m
Adults Directly Provided Services 24.952
Adults Commissioned Services 45.325
Children’s Services 27.474
Performance Management, Support and Training 8.264
Total £106.015m
Adult Services Budget
The net expenditure budget for Adult Services in 2004/5 is £54.959m. This represents 13.7% of the total net budget for the Council. The net budget for Adult Services is made up of gross expenditure of £76.254m offset by income of £21.295m.
The split of the budget in line with the overall structure of the service area is identified below. A d u l t S e r v i c e s G r o s s E x p e n d i t u r e B u d g e t 2 0 0 4 / 5 D i r e c t S e r v i c e s 3 2 . 7 % C o m m u n i t y C a r e & A s s e s s m e n t 5 9 . 4 % P o l i c y R e v i e w a n d S u p p o r t 4 . 4 % S t r a t e g i c D e v e l o p m e n t 3 . 4 %
The chart below identifies the commissioning and fieldwork budget apportioned to service user groups
C o m m is s io n in g a n d fie ld w o rk e x p e n d itu re b y s e rv ic e u s e r g ro u p O ld e r P e o p le /P h ys ic a lly D is a b le d 4 3 % M e n ta l H e a lth fo r O ld e r P e o p le 9 % L e a rn in g D is a b ilitie s 3 7 % M e n ta l H e a lth 8 % S u b s ta n c e M is u s e 2 % O th e r, In c lu d in g C ity C e n tre T e a m 1 %
Approximately £33m of the gross budget relates to expenditure on employees, £36m relates to payments for commissioned care and support services, the balance being made up of expenditure on transport, supplies etc.
Disabled Facility Grants (DFGs) and Home Repair Assistance (HRAs) are financed through an annual capital finance bid. The combined programme for 2004/2005 amounts to £6.56M.
In 2003/4 increasing pressure on certain areas, notably in relation to commissioning budgets for external care services, caused the service area to record an overspend of £360,000.
Financial Development
• Medium Term Financial Forecasts, for the service area suggest that, due to increased market pressures and demographic and legislative changes, there will be a significantly increased pressure on budgets in the short to medium term.
• Commissioning Strategies for the service area are currently being developed. The strategies will review service provision, including which new services should be developed and which should be decommissioned. • The Budget Management Forum has been established with a view to
ensuring equity, consistency of decision-making and the maximisation of resources. The group has the responsibility of authorising the allocation of financial resources for all service user groups.
Children’s Services Budget
The net expenditure for Children’s Services in 2004/5 is £20.690m - 5.1% of the total net budget for the Council. The net budget for Children’s Services is made up of gross expenditure of £26,017,000 offset by income of £5,513,000. The budget is split into 8 main categories in line with the overall structure of the Service Area. £13m relates to expenditure on Employees, £7.5m on third party payments and the remainder on premises, transport and supplies and services.
Childrens Services Gross Expenditure budget 2004/5
Fieldwork & Intake/Assessment
28%
Child Health & Disability 4%
Family Support/ILSS 13% Looked After Children
23% Service Development
10% Child Protection
1% Management & Support, including central support
16%
Youth Offending 5%
Income is made up mainly of Grants, for example, Children First Grant (£3.9m) and Carers Special Grant (£164k).
In 2003/4, an overspend of £3.4m was reported, arising mainly due to the increasing use of external placements for looked after children.
Financial Development - A commissioning strategy is currently being
developed to identify how to use the resources available to obtain the best possible outcomes for children and young people in need in Cardiff.
Other Funding Streams
There are a number of other sources of funding which the Local Health Board and Council have successfully accessed to increase the overall resources available to improve the health and well-being of Cardiff residents.
Supporting People Programme - Supporting People, is a new integrated
policy and funding framework for delivering housing related support to vulnerable people. In Cardiff there is a budget of over £19 million which is jointly administered by the Local Authority and the Welsh Assembly Government. This assists over 5,000 vulnerable people to maintain their independence in the community.
Supporting People helps a range of people with support needs, including; older people, people with mental health problems, people who are homeless or at risk of becoming homeless, people with learning, physical or sensory disabilities, ex-offenders, women escaping domestic violence, vulnerable 16 and 17 year olds. It does not pay for personal care.
Cardiff is facing a number of challenges to the development and delivery of Supporting People, in particular the potential reduction in funding available to the Authority 2005/2006. In preparation for this, all existing interim contracts will be subject to a service review to identify non-housing related support, realise efficiencies, assess service against ‘value for money’ and benchmark costs against similar services.
Cymorth - The Cymorth Fund is the Welsh Assembly Government
ring-fenced funding that supports the work of the Children and Young People’s Partnership. It amounts to £5.32m in Cardiff in the financial year 2004-5 and this figure is expected to rise in future years until March 2008. This funding is used to support existing programmes of work such as Sure Start, Play Provision, Youth Access and childcare services as well as to fund support systems for the Partnership itself. In future it will increasingly be used to progress the partnership priorities, which are listed Chapter 8.
New Opportunities Fund - The New Opportunities Fund Coronary Heart
Disease, Stroke and Cancer programme in Wales was announced in 2002, inviting bids of up to a maximum £300,000 over a period of 3 years. There were 5 successful project bids from Cardiff, totalling £1.2 m.
Joint Funding of Emergency Pressures - Through the work of the Cardiff
and Vale Emergency Pressures Partnership Board the Local Health Board and Council, working with partner organisations have successfully set up mechanisms for the joint agreement of initiatives to address emergency pressures in Cardiff. The total identified funding for Cardiff is £272,000, with a further £500,000 of Wanless monies dedicated to supporting partnership schemes.
Inequalities in Health Fund - This was set up in 2001 by the Welsh
Assembly Government to stimulate and support local action to address inequalities in health and the factors that contribute to it including inequities in access to health services. The projects supported by the fund in Cardiff are: • Heart Disease and Diabetes: Action in Black and Minority Communities in
South West Cardiff ‘Heartlink’ - £85,000.
• Cardiovascular Disease Delivering Health Improvement, Riverside Health Centre- £19,000.
• Multi-disciplinary approach to developing patient focused Coronary Heart Disease prevention programme - £109,000.
• Barefoot Health Workers Project - £87,000.
Joint Working Special Grant (New Flexibilities) - This grant is intended to
Service. The allocation for 2004/5 – 05/06 for Cardiff is £1,062,904. Schemes set up using this funding cover the areas of unified assessment, children’s services, intermediate care, aids and equipment, mental health, language and communication and carers.
Wanless Local Action Plan Funding – The Wanless Local Action plan will
take forward the development of a system of Health and Social Care that is sustainable and financially efficient. It will ensure that planning is undertaken on the basis of local need and the involvement of wider stakeholders and the public. For Cardiff, the Welsh Assembly Government funded the proposals with £2.2m which was supplemented by a further £0.900m from the Local Authority Delayed Transfer of Care Capacity Grant, providing a total of £3.1m. This will be used to take forward action against the four priorities of Mental Health, Older People, Children and Acute Services.
ESTATES NHS ESTATES
The LHB, Local Authority and Cardiff and Vale NHS Trust are in the process of developing a comprehensive Estates Strategy to ensure the appropriate infrastructure is in place to deliver the Health, Social Care and Well-being Strategy. A series of workshops have been held involving a range of professionals to examine priorities for an Integrated Primary Care Estates Strategy. The Strategy, when completed, will ensure that primary care premises – surgeries, health centres and clinics – are fit for purpose and meet the needs of a modern healthcare system.
The LHB also established a multi-agency ‘Task and Finish Group’ to examine all the issues surrounding ‘Proposals for Service Developments to meet the Health Care Needs of the Residents of Central and Eastern Cardiff’. A Strategic Outline Case (SOC) was developed for a range of services including:
• Mental health. • Intermediate care.
• Outpatient services, to include Genito-Urinary Medicine (GUM). • A primary care resource centre and services for vulnerable groups.
These proposals contribute towards the development of new and innovative service models to help deal with the level of demand for sessions in Cardiff. These proposals aim to:
• Provide services to enable the LHB to meet a number of its standards and targets within the Service and Financial Framework (SaFF) particularly in relation to waiting lists and improving capacity issues within Cardiff and Vale NHS Trust.
• Provide a wide range of services from a single community-based site thereby improving patient access and cost effectiveness in accessible and modern facilities in line with the local authority’s urban regeneration plan. • Offer a range of integrated primary and intermediate care services to
provide appropriate and timely support to patients within community settings particularly vulnerable groups ensuring that their health needs are appropriately met.
LOCAL AUTHORITY ESTATES
The former Social Services Department of South Glamorgan Council was decentralised 15 years ago and locally based Resource Centres were introduced. Each Centre relates to a service user group such as children, older people, people with learning disabilities etc. These buildings are still in use. Although models of service have since changed significantly.
Social Care Services are currently undergoing a major restructure to ensure that they are positioned to meet changing needs. Services are being restructured to meet the function needs and not specific community needs. Substantial financial resources will be required to bring all the buildings acceptable standard in order to meet the Disability Discrimination Act (DDA) 1995 and Health and Safety legislation.
The existing accommodation stock therefore does not allow an efficient and consistent response to needs and so it is proposed to identify replacement accommodation for a number of buildings.
In terms of Social Care Services the Day Care Service for Older People and In House Residential Care services are being modernised in order to deliver more flexible, responsive and sensitive care for service users. These proposals will help the service respond to different levels of care needs and provide services appropriately and proportionately.
HEALTH IMPACT ASSESSMENT
In implementing and reviewing this strategy, all partners will be asked to use health impact assessment as a tool that will assist the development of an integrated approach to the further development of the Health, Social Care and Well-being Strategy.
This approach will:
• Ensure that the health consequences of decisions – positive and/or negative – are not overlooked.
• Identify new opportunities to protect people’s health and,
• Identify new opportunities to improve health by building action into other local services, activities and developments.
• Ensure the balance of equalities in health and social care is considered.
This will also include the new statutory requirement to undertake Race Inequality Impact Assessment of any key proposal or policy.
It is intended that the process will be further enhanced by work that is currently ongoing through the Welsh Health Alliance Network to integrate the sustainable impact assessment and health impact assessment, therein creating a tool that can be used to inform a variety of purposes.
RISKS
As a result of the work to identify the needs of the population of Cardiff it has been possible to identify a number of potential health and well-being risks which can be grouped as follows:
Demographic Changes
• Projected increases in the local population over next 10-15 years of mainly older people who have increasing needs for health and social care.
• An increasing population as Cardiff continues to be developed as a dynamic, enterprising European capital city, both in terms of people coming for work/leisure purposes and vulnerable groups due to the ‘metropolitan effect’.
• An increasing student population impacting on services and on community cohesion in terms of local service provision and the local economy.
• Improved medical experience resulting in people with chronic disabling conditions living longer often with complex health needs.
• Increasing inequalities through a polarisation between the wealthy North Cardiff and those communities that live in the ‘southern arc’.
Service Responses
• Achieving the significant changes necessary to ensure the development of sustainable health and social services for the future.
• People’s expectation of health and well-being, and of services, continuing to increase.
• The recruitment and retention of staff across at all levels and all agencies to deliver appropriate services in response to local needs
Influences on Health and Well-being
• Individuals/communities accepting greater responsibility for their own health.
• Expensive house prices resulting in a reliance on the rented sector by young/deprived population and the associated lack of regulation.
Increasing Trends of Illness and Disease
• The Needs Assessment identified a number of illnesses and diseases where there is an upward trend most notably sexually transmitted disease and coronary heart disease.
4. - HOW WE PROPOSE TO IMPROVE HEALTH, SOCIAL CARE
AND WELL-BEING IN CARDIFF
This chapter identifies how the health, social care and well-being needs will be met and proposals for improving the health and well-being of the local population.
TACKLING THE ROOT CAUSES OF ILL HEALTH
It was recognised that a partnership approach was needed between the NHS, local government, the voluntary sector, the private sector and individuals and communities to address the factors that affect health and well-being. The overarching vehicle that brings together these partners locally to promote the economic, social and environmental well-being is The Cardiff Community Strategy. The Community Strategy 2004-2014 not only includes Health, Social Care and Well-being as a key priority but its development also provides a link to other key strategies and plans for the City whose actions involve tackling the root causes of ill health. Through the community planning partnership a commitment has been given by agencies to continuing to work together to tackle the causes of poor health and health inequalities, as well as to support and encourage people to take responsibility for their own health. The overarching vision and values for promoting the economic, social and environmental well-being as contained within Cardiff’s Community Strategy are summarised in Chapter 1. Key priorities for action are set out under the following headings:
Education and Training for Life – Ensuring that all children and young
people reach the very highest standards, developing lifelong learning partnerships and promoting recognition of young people’s achievements.
Environment – Improving the fabric and cleanliness of Cardiff; preventing
nuisance and health risks associated with pollution; developing sustainable lifestyle and developing the natural and built environment.
Communities, Housing and Social Justice – Involving: joint work to
promote social inclusion, supporting an active and thriving community sector, developing good quality affordable accommodation to meet need, promoting equal opportunities, tackling the causes of crime and fear of crime; reducing deaths and serious injury from fire and reducing re-offending.
Enterprise and Transport – Supporting the establishment and growth of
small businesses and the diversification of the city’s economic base, promoting investment in Cardiff’s information and communications technology infrastructure, utilising the strong academic research base, generating social capital and economic activity in deprived areas, further developing Cardiff as a significant European capital city and UK premier shopping centre and developing a sustainable and integrated transport system.
Sport, Leisure and Culture – Increasing and widening participation in active
recreation, leisure and sporting activities, further developing Cardiff as a centre of sporting excellence, increasing opportunities for participation in cultural activities and maintaining and develop Cardiff’s reputation as a world class events and tourism destination, and a designated Centre of Culture.
TACKLING INEQUALITIES IN HEALTH
The Needs Assessment confirmed that considerable inequalities in health exist within and between the Cardiff localities. In addition it highlighted that Cardiff, as the capital city and the largest metropolitan area in Wales, attracts a number of vulnerable groups with diverse and complex health and well-being needs.
Advisory Planning Groups will work to develop implementation plans that ensure local solutions to local issues are identified in line with the agreed strategic aims and objectives.
Responding to communities with specific needs has been agreed as a key priority issue for this Strategy. These communities are identified as black and minority ethnic communities, homeless people, asylum seekers, Gypsies and Travellers and people with HIV and AIDS. While these communities (and indeed communities within communities) have their own diverse needs, collectively they face a number of common challenges, which include:
• Inequalities in factors which affect health – these people often live in the poorest parts of the city and rank amongst the most impoverished of the city’s inhabitants.
• Inequalities in health status – communities with special needs experience poor health and often multiple and complex health problems.
• Inequalities in access to services – people in these communities often find access to mainstream health and social care services difficult due to issues such as language and culture.
Specific proposals relating to asylum seekers, Gypsies and Travellers, homelessness and people with HIV and AIDS are identified within the client group sections that follow. For black and minority ethnic communities there will be established a formalised joint planning group to ensure a co-ordinated approach across all client groups/service areas.
Neighbourhood Renewal Strategy
The Neighbourhood Renewal Strategy is a key mechanism for implementing the Community Strategy at a local level and will serve to ensure that communities themselves have the opportunity to help shape local priorities on the basis of local needs. In the most deprived areas of the City Communities First Projects will provide a comprehensive approach to addressing needs in the area. In other area less intensive approaches will be used reflecting the particular priorities in each locality.
