Health and Wellbeing Board	22 November 2023
Report of the Director of Public Health

Implementation, Delivery & Performance Monitoring 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 three of the ten big goals within the Local Joint Health and Wellbeing Strategy 2022-2023. 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 new Joint Health and Wellbeing Strategy 2022-2023. This was followed by agreement at the March 2023 meeting of a populated action plan and a Population Health Outcomes Monitor.

4. At the last meeting of the HWBB updates were given on Goal 1 in the strategy, namely ‘reduce the gap in healthy life expectancy between the richest and poorest communities’

5. This report sets out updates on the eight actions associated with Goals 2, 3 and 4, including updates on the agreed key performance indicators associated with each of the goals. Annexes A & B to this report provide a detailed score card and trend data.

6. The agreed actions cover the first 18 to 24 months of the strategy’s 10-year life span and HWBB will be asked to update these, if they feel it is required, during the course of 2024.

Progress Updates

7. Goal 2: Support more people to live with good mental health, reducing anxiety scores and increasing happiness scores by 5%

8. Updates on the 3 actions associated with this goal have been provided by the co-chairs of the York Mental Health Partnership, who are leading these actions on behalf of HWBB

9. Action A1: continue to develop the community mental health hub and its role in improving the mental health of users

· Following completion of the Community Mental Health Hub prototype phase, a report is being produced detailing the learning.  Current focus is on preparing for the upscaling of York’s Hub model.  Additionally, key activity has been focussed upon developing the York Joint Delivery Board (YJDB), which now oversees the Hub concept and delivery. The Board involves service leads with staff or teams involved in provision of Hub services.  Leads include York Council for Voluntary Services, York Mind, co-production lead, TEWV and CYC representation, and co-chairs of the York Mental Health Partnership. 

· The work of the Hub is also supported by an operational managers group.  The YJDB has been developing policies, protocols, and procedures for the Hub, including articulation of clinical responsibility, review of key findings from the prototype, and recruitment of a new Hub manager.  The Board meet monthly and have scheduled an extended meeting in December to identify and finalise a timeline for relocation of the original prototype Hub to a more permanent context and the upscaling through additional Hubs in one or two other areas of York.  Hub services are currently suspended to enable focus on relocation of the initial Hub, plus upscaling of the model.

10. Action A2: further embed a trauma-informed approach into systems in York to recognise people’s experiences as individuals, each with gifts, talents and skills

· The Hub team and colleagues involved in the delivery of community mental health in York have been supported to develop their understanding of trauma-informed practice delivered by TEWV.  The Hub team were supported through development activities aimed at enabling them to work in a trauma informed way. An event, scheduled for November 2023, will open the conversation around North Yorkshire becoming a Trauma Informed and Responsive County and seeks to demonstrate established learning in this arena to date.  It is important to note that training on trauma-informed working practices must be a regular and permanent offer.

11. Action A3: continue to support the VCS to capitalise on the community assets and community connections we have in York

· The VCSE are important contributors to community mental health provision in York. York CVS, York Carers, and York Mind are all key members of the York Joint Delivery Board (YJDB).  York CVS administrated the community mental health transformation grants (funded through the NHS transformation funding) that were made available through competitive bidding and were allocated to several VCSE and community facing groups in York.

12. Goal 3: bring smoking rates down below 5% for all population groups

13. Updates on these actions have been provided by the Public Health Team who are leading these 3 actions on behalf of the HWBB.

14. Action A4: continue joint working between Public Health and Public Protection to increase the amount of intelligence around illicit tobacco and utilise this intelligence to direct enforcement activity

· A programme of work has commenced through the CYC Public Protection function which concentrates on illicit tobacco and enforcement of age-of-sale legislation. This includes the response to intel on illicit sale through raids on premises, and the use of test-purchasing.

· In addition, a responsible retailer scheme has commenced with vaping shops in York, aimed at reducing the sale of vapes to under 18 through responsible marketing, age checks and the promotion of vapes as quit devices, not as recreational devices aimed at young people.

· So far, the outcomes of this activity have included engagement with numerous vape retailers across the area, which has resulted in intelligence gathering and targeted test purchasing.

· This work will be augmented by recent announcements around an illicit tobacco ‘flying squad’ from HMRC, and £30 million around enforcement activity, details of which are still to be clarified.

15. Action A5: implement Tobacco Dependency Treatment service in York Hospital in both acute and maternity pathways

· The acute pathways for Tobacco Dependency Treatment service in York Hospital have commenced, with a team of Tobacco Treatment advisors recruited, hundreds of smokers identified on wards and at admission, and a 30% quit rate so far.

· A successful Staff Reward Pilot has seen some quits, some drop-outs, some still on a quit journey. A Smoke Free Environments policy has been approved by the Trust board and is now in the process of being implemented, with significant signage changes around the hospital site now in place.

· Maternity pathways are proving harder to implement due to extreme pressures within maternity services at the Trust, however it is anticipated this will be up and running by April 24.

16. Action A6: increase the number of successful smoking quits through the health trainer service to 200 in 23/24

· The Health Trainer service continues to deliver its five key objectives of supporting people to quit smoking, improve diets, increase physical activity, reduce drinking levels and reduce isolation.

· In 2022/23, the target of 200 smoking quits set to achieve by 2023/24 was exceeded (221 quits achieved) and a more ambitious target for this year has been set of 250 quits.

· Significant government policy announcements on smoking recently have included:

- Funded incentives for quitting smoking in pregnancy

- 1 million vape started kits available for local authorities

- £70m nationally per year for 5 years into local stop smoking services (York will get £180k)

- The raising of the age of sale one year per year so that no-one born after 1^st Jan 2009 will be able to legally purchase tobacco

- A consultation on vaping regulation

17. Goal 4: Reduce from over 20% to 15% the proportion of York residents drinking above the Chief Medical Officer’s alcohol guidelines

18. Updates on these actions have been provided by the Public Health Team who are leading these 2 actions on behalf of the HWBB.

19. Action A7: roll out of alcohol harm reduction online tool and supporting app (Lower My Drinking) to residents over the age of 18 in York embedding into services and pathways across the city, with a target of 15,000 AUDIT questionnaire completions on the website by July 2024

· Lower My Drinking was launched in August 2022, and so far, has seen 7434 York residents complete the online quiz, with 106 downloading the associated app. A large communications campaign around reducing drinking levels has also been implemented, led by CYC.

· A significant proportion (38%) of people completing the quiz are drinking at above low risk but not possibly dependent levels, and 10% at possible dependence levels, which is in line with the intended audience for the digital tool as a population-level intervention designed to reduce mean ethanol consumption in York, but also a tool that increases self-referrals into specialist treatment where relevant.

20. Action A8: make Alcohol Identification and Brief Advice training available to organisations working with York residents to support conversations with individuals and enable signposting to appropriate services.

· Alcohol IBA training is offered by CYC public health team to any professional or volunteer in the city who regularly comes into contact with residents and is designed to help people raise the issue of alcohol consumption in a routine, non-judgemental way, use a simple screening tool (AUDIT either on paper or via the Lower My Drinking website), offer immediate advice and guidance, and signpost people on to the next appropriate step.

· Since 2022, 33 full IBA training sessions have been delivered to around 320 local professionals / volunteers. A further 18 briefing sessions attended by approximately another 290 staff have also been delivered to equip local professionals with awareness of relevant support services. Training participants have come from a wide range of teams and organisations across CYC, primary care, York Emergency Department and community services and the voluntary sector.

21. 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 Annexes A & B to this report provide information on the three goals that are set out in this report.

Consultation and Engagement

22. 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

23. 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.

24. 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

25. 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

26. 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

27. 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	Sharon Stoltz Director of Public Health
	Report Approved	ü	Date	14 November 2023
Specialist Implications Officer(s) None
Wards Affected:					All	ü
For further information please contact the author of the report

Annexes:

Annex A: HWBB Scorecard (for Goals 2, 3 & 4)

Annex B: HWBB Trends (for Goals 2, 3 & 4)