Agenda Item 41

Although a formal committee of Brighton & Hove City Council, the Health & Wellbeing Board has a remit which includes matters relating to the Clinical Commissioning Group (CCG), the Local Safeguarding Board for Children and Adults and Healthwatch.

Title:

Joint Health and Wellbeing Strategy - Outcome measures update

Date of Meeting:

7 March 2023

Report of:

Alistair Hill, Director of Public Health

Contact:

Caroline Vass, Consultant in Public Health

Tel: 07717 303300

Email:

caroline.vass@brighton-hove.gov.uk

Wards Affected:

All

FOR GENERAL RELEASE

Executive Summary

Health and Wellbeing Boards have a duty to prepare a Joint Health and Wellbeing

Strategy to describe the vision and strategic aims to address the population needs identified in the Joint Strategic Needs Assessment.

The Brighton & Hove Health and Wellbeing Strategy 2019-30 was approved by the

Board in March 2019. It sets out the vision: ‘Everyone in Brighton & Hove will

have the best opportunity to live a healthy, happy and fulfilling life’.

This paper provides:

An update on the agreed outcome measures identified in the Health and Wellbeing Strategy
Advises on the programme of updates for subsequent Health and Wellbeing Boards

Glossary of Terms

JHWS - Joint Health and Wellbeing Strategy

JSNA – Joint Strategic Needs Assessment

1. Decisions, recommendations, and any options

1.1 That the Board notes the current trend status of the Joint Health and Wellbeing Strategy outcome measures

1.2 That the Board notes that they will receive future updates at each meeting to reflect different ‘Wells’ at each meeting accompanied by a brief narrative to provide a more integrated council-wide understanding of the outcomes

2. Relevant information

2.1 Health and Wellbeing Boards have a duty to prepare a Joint Health and Wellbeing Strategy to describe the vision and strategic aims to address the population needs identified in the Joint Strategic Needs Assessment (JSNA).

2.2 The Brighton & Hove Health and Wellbeing Strategy was approved by the Health and Wellbeing Board in March 2019. It is a high-level, strategy that sets out the vision of the Board for improving health and wellbeing and reducing health inequalities in Brighton & Hove.

2.3 The vision of the Boards is that: ‘Everyone in Brighton & Hove will have the best opportunity to live a healthy, happy and fulfilling life’.

2.4 The strategy states our overarching ambition that by 2030:

· People will live more years in good health (reversing the current falling trend in healthy life expectancy) and

· The gap in healthy life expectancy between people living in the most and least disadvantaged areas of the city will be reduced.

2.5 To deliver the ambition, the strategy identifies a number of outcomes for local people that are reflected under four key areas known as the ‘Wells’: starting well, living well, ageing well, and dying well.

2.6 The Board agreed the outcomes measures for each of the four Wells in July 2021 and minor amendments in October 2022. This paper provides an update on the current outcome measures, including a reflection of activity against England average outcomes

Development of the outcome measures

2.7 The initial outcome measures were based on the needs set out in the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy vision and ambition. The criteria for inclusion are:

7.1.1. where they are population level outcomes (not system/process indicators)

7.1.2. where Brighton & Hove performs poorly against defined comparators

7.1.3. where there are significant inequalities within the city, and

7.1.4. now also include where the Covid-19 pandemic response is likely to have had a significant impact eg: physical activity.

2.8 The outcome measures are predominantly taken from: the Public Health Outcomes Framework; NHS Outcomes Framework; Adult Social Care Outcomes Framework; and Office for Health Improvement and Disparities (OHID) Wider Impacts of Covid-19 dashboard.

2.9 The choice of outcome measures was informed by the engagement carried out on the Joint Health and Wellbeing Strategy in 2018/19 and by discussions across Public Health, Adult Social Care, Families Children and Learning and the NHS.

Monitoring the outcome measures

2.10 At the November 2022 Health and Wellbeing Board meeting it was agreed to monitor progress of our Health and wellbeing Strategy by agreed ‘direction of travel’ of each outcome measure, for example: ‘increase rates of year 6 healthy weights’, ‘reduce rates of alcohol use in under 15 year olds’, etc. This is reflected in the terminology in this report.

Outcomes measures update

2.11 Appendix 1 presents the key outcome measures dashboard and shows trends in the outcome measures, including the latest published data.

2.12 Tables 1-5 below show the current status of the outcome measures with the corresponding direction of travel and comparison to England average data.

Table 1: Overarching outcomes

	Improving trend	Static trend	Worsening trend
Better than England
Similar to England		• Male healthy life expectancy at birth • Female healthy life expectancy at birth
Worse than England

Note: An update on inequality in healthy life expectancy at birth within LAs is expected in 2023 as the detailed Census data required becomes available

Table 2: Starting well

	Improving trend	Static trend (*no trend could be calculated)	Worsening trend
Better than England		• Average attainment 8 score (15-16 years)*	• % of children achieving a good level of development at 2-2.5 years • Year 6: prevalence of overweight, including obesity
Similar to England	• % children achieving a good level of development at the end of reception	• % children with free school meal status achieving a good level of development at the end of reception • % of physically active children and young people • Average attainment 8 score of children in care (15-16 years)*
Worse than England		• MMR vaccination (two doses in 5 years olds) • Hospital admissions as a result of self-harm (10-24 years)

LOCAL MEASURES, for which there is no national comparison:

Improving trend: The percentage of pupils in years 10-11 who have ever tried alcohol; The percentage of pupils in years 10-11 who smoke

Worsening trend: Percentage of pupils who feel happy; Percentage of pupils who feel sad

Static trend: Having tried cannabis (Year 10-11)

Table 3: Living well

	Improving trend	Static trend (*no trend could be calculated)	Worsening trend
Better than England	• Admissions for alcohol-related conditions (narrow definition)	• Virological success in adults accessing HIV care*
Similar to England	• % of adults overweight or obese* • % of adults walking for travel at least three days per week • % of adults cycling for travel at least three days per week • Domestic abuse related incidents are increasing, we want to increase reporting so this indicator will always require some narrative	• Smoking prevalence - all adults* • Smoking prevalence - those in routine and manual occupations* • % of physically active adults* • % of physical inactive adults* • Gap in employment rate – physical or mental health condition; learning disability and; in contact with mental health services* • People with a low happiness score* • % of cancers diagnosed at ages 1 and 2 • Prompt antiretroviral therapy (ART) initiation in people newly diagnosed with HIV*
Worse than England	• Sexually Transmitted Infection (STI) diagnoses – higher than England** • Flu immunisation – at risk individuals	• People with a high anxiety score* • Hospital admissions as a result of self-harm (20-24 years) • Suicide rate (persons)* • Deaths from drug misuse*	• HIV testing coverage (see para 2.13 below)

Sexually Transmitted Infection** – in this case, we have an improving trend in diagnoses rates, ie: they are going down, but we still have higher rates than the England average, however the data need to be reviewed critically because we know that during the Covid pandemic testing went down and so did diagnoses.

Table 3: Ageing well

	Improving trend	Static trend (*no trend could be calculated)	Worsening trend
Better than England	• Population vaccination coverage for flu 65+	• Emergency readmissions within 30 days of discharge from hospital
Similar to England		• U75 mortality from: cardiovascular diseases and cardiovascular disease considered preventable • U75 mortality from: cancer and cancer considered preventable • Social isolation: percentage of adult social care users who have as much social contact as they would like* • Social isolation: percentage of adult carers who have as much social contact as they would like*
Worse than England		• Emergency hospital admissions due to falls in people aged 65 and over • Permanent admissions to residential and nursing care homes 65+

Dying well

The percentage of deaths that occur at home is increasing in Brighton & Hove and similar to England. However, place of death has been affected by Covid19 pandemic.

2.13 In Brighton & Hove we have one worsening trend which is also lower than the England average and that is for HIV testing. However, the data accuracy for this is being explored because we know that HIV testing coverage broken down by men, women, and men who have sex with men (MSM) is higher in Brighton & Hove than regionally or nationally.

The programme of JHWS updates to the Health and Wellbeing Board

2.14 Subsequent reports will reflect the ‘Wells’ as follows:

14.1.1. Starting Well will be reflected in the first report of the new administration

14.1.2. Living Well will be second

14.1.3. The third report will comprise Ageing Well and Dying Well

2.15 It should be noted that there will be some overlaps between outcomes in Living and Ageing Well sections

2.16 Where there are outliers or notable trends in an outcome measure, then a narrative will be provided to elucidate the plans, activity, and outcomes.

3 Important considerations and implications

Legal:

3.1 The Health and Wellbeing Board is required to publish a joint Health and Wellbeing Strategy pursuant to the Health and Social Care Act 2012 Section 193.

Lawyer consulted: Sandra O’Brien Date: 15/02/23

Finance:

3.2 The Health and Wellbeing Strategy informs priorities, budget development and the Medium Term Financial strategy of the Council, Health and other partners. This will require a joined up process for future budget setting in relation to all local public services where applicable. This will ensure that the Council and NHS have an open, transparent and integrated approach to planning and provision of services. Where applicable organisations will align their budget procedures whilst adhering to individual financial governance and regulations.

Finance Officer consulted: Sophie Warburton Date: 15/02/23

Equalities:

3.3 The strategy, and the outcomes measures set out within this paper, includes a strong focus on reducing heath inequalities. The strategy and its delivery is underpinned by the data within our Joint Strategic Needs Assessment which takes the life course approach identifying specific actions for children and young people; adults of working age and older people; and key areas for action that reflect specific equalities issues including inclusive growth and supporting disabled people and people with long-term conditions into work. An Equalities Impact Assessment is not required for the strategy itself but should be completed for specific projects, programmes and commissioning and investment decisions taking forward the strategy, as indicated within this delivery plan.

Supporting documents and information

Appendix 1: Brighton & Hove Joint Health and Wellbeing Strategy: Key outcomes measures update January 2023