Health and Wellbeing Board	24 January 2024
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 one 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 September 2023 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.’ This was followed by updates on Goals 2, 3 and 4 at the November 2023 meeting.

5. This report sets out updates on the five actions associated with Goal 5, including updates on the agreed key performance indicators associated with the goal. Annexes A & B to this report provide a detailed score card and trend data.

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

Progress Updates

7. Goal 5: Reverse the rise in the number of children and adults living with an unhealthy weight

8. Action A9: Support adult residents to achieve a healthy weight through the York Weight Management pathway.

· The pathway consists of several different tiers of service, commissioned/provided by a range of different organisations. Tier 1a/1b is provided by the CYC Health Trainer service and is aimed at those who are overweight, but not yet classed as obese. The Health Trainers work with residents on a 1:1 basis, using a person-centred approach to understand the perceived barriers to being a healthy weight alongside the opportunities to take positive action. The service provides advice and guidance on healthy eating, being physically active and how to maintain a healthy weight. In 2022/3, CYC Health Trainers supported 313 clients with weight / healthy eating. The proportion of Health Trainer clients achieving all their goals in 2022/3 was 65.3%. In addition, in a joint project with primary care, Health Trainers have this year contacted 12,500 patients on practice registers in the city, had 1,606 follow up conversations, and generated 1,747 referrals into Tier 2 weight management services (Apr-Nov 23)

· Tier 2 services are provided by the NHS in some instances, for example the Digital Weight Management Programme (for those who have high blood pressure and/or diabetes, alongside being obese) or The National Diabetes Prevention Programme (for those who are at risk of developing type 2 diabetes and are obese). The City of York Council Public Health department also commission a Tier 2 service, which while not being a mandated function of the Public Health grant, it is locally deemed as necessary to support the increasing number of people who are obese. The service has previously been provided by Greenwich Leisure Limited (GLL / Better) and Slimming World. At present there is a break in service, with a contract out to tender for this service to re-commence in April 2024.

· Tier 3 and 4 services are commissioned by the Humber and North Yorkshire ICB. The tier 3 service consists of a 24-month programme, where residents work with clinical specialists to develop an exercise and diet plan, and counsellors to understand their behaviour towards diet and activity. Residents may also receive pharmacological interventions, where there are no contra-indications. Tier 4 is bariatric surgery, which is considered upon completion of Tier 3. The decision to progress with surgery is taken between the ICB and clinical team, alongside the resident.

· The Healthy Child Service supports parents/ carers and young people wishing to make changes to reach healthy weight through referrals to the Health Trainer service. This achieves a whole family approach to healthy weight when parenting support about children’s healthy eating and physical activity is also required.

9. Action A10: Continue to deliver the National Child Measurement Programme and support those children identified as having an unhealthy weight

· Good coverage of the National Child Measurement Programme (NCMP) across York schools is achieved each year by the Healthy Child Service. In 2022/23, 96.0% of children at the cohort ages were weighed and measured in York, vs 93.2% nationally. Follow up support offered to children identified as overweight/ obese at the NCMP will be improved in 2024 including improving uptake of the HENRY programme for reception aged children and redesigning the follow up contact to parents of year 6 children.

10. Action A11: Work with parents through the Healthy Child Service to support healthy eating at the earliest opportunity, through routine appointments, supported breast feeding and clear nutritional advice

· Breastfeeding has been found to generally reduce a child’s current and future risk of overweight and obesity. The public health team has recently appointed an Infant Feeding Lead to progress the Healthy Child Service through UNICEF Baby Friendly Accreditation. Through implementation of standards over stages, the aim is to provide parents with the best possible care to build close and loving relationships with their baby and to feed their baby in ways which will support optimum health and development. Under the Infant Feeding strategy there are further ambitions to work more proactively with communities with low breastfeeding rates and with York businesses to understand barriers to breast feeding and improve support available.

· Healthy eating and physical activity remain a core health promotion element of Healthy Child Service contacts with parents. One to one support is provided when weight concerns emerge. In 2023 the “Next Steps for you and your baby” workshop was launched. All parents/ carers are invited to this group workshop when their child is 3-4 months old and take up is good. The workshop includes identifying readiness for weaning to solid food, healthy eating for children, breastfeeding duration support and healthy start vitamins.

11. Action A12: Deliver the HENRY approach in our 0–5-year population

· The HENRY programme continues to be delivered to families from children’s centres across York, with 5 programmes being delivered in 2023. The programme is aimed at parents and carers of those aged 0-5, with childcare provided at the weekly sessions to enable more families to access the programme. It delivers practical support around increasing self-esteem and emotional wellbeing, so children start school ready to learn, setting and achieving goals, active play ideas and getting active as a family, alongside guidance on diet, nutrition and oral health.  

12. Action A13: Support the implementation of HENRY awareness for professionals

· It is proposed that all Healthy Child Service staff will undertake “Raise, Engage and Refer” training during the first half of 2024. The training is delivered by HENRY and is designed to support staff to have conversations with parents and carers about their child’s weight and how the family can access relevant support. At present there are 6 trained HENRY facilitators, who deliver the 0-5 programme. These are made up of staff from the Healthy Child Service and the Health Trainer service.

13. 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 goal 5 of the strategy.

Consultation and Engagement

14. 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.

15. 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.

16. 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

17. 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

18. 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

19. 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 January 2024
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 Goal 5)

Annex B: HWBB Trends (for Goal 5)