Health and Wellbeing Board	24 July 2024
Report of the Director of Public Health

Update on Goals 8 and 9 of the Joint Health and Wellbeing Strategy 2022-2032

Summary

1. This paper provides the Health and Wellbeing Board (HWBB) with an update on the implementation and delivery of two of the ten big goals within the Local Joint Health and Wellbeing Strategy 2022-2032. It also includes information on performance monitoring.

2. The Board are asked to note the report.

Background

3. At the January 2023 meeting of the Health and Wellbeing Board (HWBB) members of the Board agreed a framework for an action plan and a Population Health Outcomes Monitor for the Joint Health and Wellbeing Strategy 2022-2032. This was followed by agreement at the March 2023 meeting of a populated action plan and a Population Health Outcomes Monitor. Over the last six to eight months updates have been presented on Goals 1 to 7 of the strategy and their associated actions.

4. Today’s report provides an update on two further goals:

i. Goal 8: Improve diagnosis gaps in dementia, diabetes and high blood pressure to above the national average, and detect cancer at an earlier stage

ii. Goal 9: reduce sedentary behaviour, so that 4 in every 5 adults in York are physically active

5. This report also provides information on the 6 associated actions for these two goals along with updates on the agreed key performance indicators associated with the goals.

6. The agreed actions cover the first 24 months of the strategy’s 10-year life span.

Goal 8: Improve diagnosis gaps in dementia, diabetes and high blood pressure to above the national average, and detect cancer at an earlier stage

7. Action A19: deliver an increased number of blood pressure checks and pulse monitoring through GP, community and pharmacy routes, to increase the number of people diagnosed and treated for cardiovascular diseases

8. Progress: The ICB Place team and public health are collaborating on a CVD prevention programme which aligns to regional and national CVD priorities. A Health Housing and Adult Social Care Scrutiny Committee item on the 23^rd April 2024 focussed on ‘Tackling Cardiovascular and Metabolic Disease’ and gives a broad summary of this work and what has been achieved.

9. One example of the programme is the work with Nimbuscare and healthya, to deliver a city-wide hypertension screening project. Three health kiosks have been rolled out in York as part of a groundbreaking initiative to improve the health of the city's population. Free to use, the kiosks measure a person's height, weight, BMI, blood pressure, heart rate, and oxygen saturation. Three locations have been identified and kiosks are now live in areas of relative deprivation. These include Tang Hall Community Centre, Morrisons Foss Islands, and Energise Leisure Centre in Acomb.

10. The health kiosk provision aims to build upon the existing NHS Community Pharmacy Blood Pressure Check Service, with 31 pharmacies currently providing this service in York delivering nearly 8,000 checks so far. Working with Community Pharmacy North Yorkshire LPC, the health kiosks act as a feeder into the pharmacy blood pressure check service from more deprived parts of the city, by offering an initial check outside of a clinical setting.

11. Health Innovation Yorkshire and Humber have committed £40k to fund the scheme's evaluation. Work on this is underway and is being performed by the York Health Economics Consortium (YHEC).

12. In total, 141 patients have used the health kiosks at least once. This represents 256 individual health assessments. Thus far, 8% of patients have provided a high BP reading (>=140/90). Additionally, 29% of patients have been identified as Obese (BMI >=30 or >=27.5).

13. Whilst initial throughput has been promising, the team are conscious that to make a meaningful difference to diagnostic rates, overall utilisation must increase. Initial communication and marketing of the project has been intentionally limited to ensure that the system does not become overwhelmed. With increased confidence in the backend processes, the team are now ready drive footfall with a several intentions:

· An SMS campaign targeted at patients most at risk of hypertension.

· A 'train the trainers' programme, upskilling staff at sites to promote the kiosk.

· An increase in local marketing materials to be displayed in general practice and online.

· A cardiovascular disease event to be held at York Designer Outlet to coincide with the national Know your Numbers week. 

14. Action A20: increase the number of people identified with diabetes through targeted NHS Health Checks

15. Progress: NHS Health Checks in York are delivered under contract from the local authority by Nimbuscare. Since the contract began in October 2021, 5,249 health checks have been delivered to York residents. 62% of these health checks were delivered to people who are living with one or more of the following: the 50% most deprived wards in York, or current smoker, or currently obese or currently diagnosed with anxiety or depression. At present, the data is not available to as to how many of these health checks were coded with a high-risk marker for diabetes, however systems are being put in place to allow for the detection of this measure going forwards.

16. Action A21: support the implementation of the Dementia Strategy

17. Progress: the following work has taken place to support the implementation of the Dementia Strategy:

i. Develop the work of the Ageing Well partnership to ensure greater public awareness about dementia and increased understanding to reduce stigma.

ØWe have had two events in York to increase awareness and ensure there is effective signposting through a multi-agency approach. This was at the launch of the strategy in September 2022 and then one year on in September 2023.

ØWe carried out a range of social media messaging as well as promoting dementia events during national dementia week in May.

ii. Develop a dedicated space for information and advice about Dementia on Live Well York (an information and advice community website for all adults in the city).

ØA dedicated dementia page has been created on Live Well York.

iii. The York Population Health Hub has conducted a deep dive into the Dementia Diagnosis gap in York and will shortly be publishing this work on the JSNA website.

iv. Ensure that information, advice and guidance is readily available, accessible and provided in different formats, including in person.

ØLive Well York provides dementia information through an information page; service directory; what’s on directory. This can be translated immediately into a wide range of languages and has an audio tool through a wide range of languages

ØAny of the pages on Live Well York can be put into a personal booklet and sent electronically as a PDF or printed and posted. There are different print sizes to choose from.

v. Establish a framework for dementia training to ensure all people receive training relevant to their role so that the whole workforce has the right skills, behaviours and values to support people living with dementia.

ØDementia Forward are working with Access Able and the commissioner to provide dementia training for accessible venues to ensure people with dementia have a positive experience. These venues will then be awarded a dementia friendly symbol.

vi. Contribute to the work of the Ageing Well Partnership, meeting an objective of the City of York Council’s Plan to promote dementia friendly services and buildings.

ØRegular updates are provided to the Ageing Well Partnership regarding the progress of implementing and now delivery against the Dementia strategy

vii. Develop information, guidance and advice to address the different stages of the Dementia Well Pathway.

ØA dementia pathway is being developed through a co-produced approach ensuring key questions asked by people with dementia and their carers are covered.

18. Action A22: reduce the numbers of York patients waiting over 62 days for a cancer diagnosis and achieve the 75% target for the 28-day Faster Diagnosis Standard

19. Progress: For York place GP practice patients, the target for percentage of patients commencing treatment within 62 days of referral was met in March 2023; however, the Faster Diagnosis Standard, which sets a maximum 28-day wait for communication of a cancer diagnosis or ruling out of cancer for patients referred urgently for investigation of cancer (including those with breast symptoms) and from NHS cancer screening, was not (72.2% vs target 77.3%). There are continued impact of diagnostics delays on cancer performance.

20. 24/25 Humber &North Yorkshire cancer alliance funding planning is ongoing, and York and Scarborough Hospital have developed a range of plans to support earlier diagnosis, faster diagnosis and operational performance. Cancer site pathways are being reviewed against Best Practice Timed Pathways (BPTP) to achieve the Faster Diagnosis Standard. A specific improvement workstream has been set up to support Urology, and mapping is underway with Skin and Head and Neck to review streamlining opportunities.

21. The most recent cancer screening data (2023) shows that York’s breast cancer screening coverage is better than the national average (72.5% vs 66.2%), and bowel cancer screening coverage is better than the national average (77.1% vs 72.0%); however cervical cancer screening coverage in the young age group (25-49) is lower than the national average (64.6% vs 65.8%). Regular public communications around cancer screening are released from ICB and public health comms teams to support call-recall systems.

Goal 9: reduce sedentary behaviour, so that 4 in every 5 adults in York are physically active

22. Action A23: ensure that the built environment supports children and young people to access green space to enable increased activity, using the local plan to inform the development of playparks and community spaces through the planning process

23. Progress: The local authority is in the process of updating their Playing Pitch Strategy and Built Facilities Strategy, which are used to audit current provision, grade the standard of provision and forecast future demand requirements. When published, these documents will be used along with the local plan to direct developers to the type of provision required to increase physical activity opportunities. Physical activity and sport guidance is also being included in the Health Supplementary Planning Document, to be published alongside the local plan.

24. Action A24: support the implementation of the Physical Activity and Sport Strategy

25. Progress: The Physical Activity and Sport strategy was published in 2022, as a 10-year strategy. An action plan was developed with multi-agency input; however, the lasting effects of the pandemic halted the delivery of much of the action plan. The physical activity strategic group is set to be re-established in the latter part of 2024, to refresh the action plan and set clear aims for the remaining years of the strategy.

26. Population Health Outcomes Monitor: this is linked to the ten big goals and is designed to provide board members with a holistic view of whether the strategy is making a difference to the health and wellbeing of York’s population, using outcome data rather than data on what health and care services are ‘doing’. Today’s updates at Annex B to this report provide information on Goals 8 and 9 of the strategy.

Consultation and Engagement

27. As a high-level document setting out the strategic vision for health and wellbeing in the city, the new Local Joint Health and Wellbeing Strategy capitalised on existing consultation and engagement work undertaken on deeper and more specific projects in the city. Co-production is a principle that has been endorsed by the HWBB and will form a key part of the delivery, implementation, and evaluation of the strategy.

28. The actions in the action plan have been identified in consultation with HWBB member organisations and those leading on specific workstreams that impact the ten big goals.

29. The performance management framework has been developed by public health experts in conjunction with the Business Intelligence Team within the City of York Council.

Options

30. There are no specific options for the HWBB in relation to this report. HWBB members are asked to note the update and provide comment on the progress made.

Implications

31. It is important that the priorities in relation to the new Local Joint Health and Wellbeing Strategy are delivered. Members need to be assured that appropriate mechanisms are in place for delivery.

        Recommendations

32. Health and Wellbeing Board are asked to note and comment on the updates provided within this report and its associated annexes.

Reason: To ensure that the Health and Wellbeing Board fulfils its statutory duty to deliver on their Joint Local Health and Wellbeing Strategy 2022-2032.

Contact Details

Author:	Chief Officer Responsible for the report:
Tracy Wallis Health and Wellbeing Partnerships Co-ordinator	Peter Roderick Director of Public Health
	Report Approved	ü	Date	12.07.2024
Specialist Implications Officer(s) None
Wards Affected:					All	ü
For further information please contact the author of the report

Annexes:

Annex A: Update on Action A19

Annex B: HWBB Scorecard (for Goals 8 & 9)