South Cambridgeshire

Improving Health Plan

2003 – 2006

May 2003

SOUTH CAMBRIDGESHIRE IMPROVING HEALTH PLAN

CONTENTS

Page No

Introduction 1

Aim Work in Progress Priorities and Challenges

1 1 2

1. Vulnerable People

Falls Prevention Reducing Delayed Transfers Fuel Poverty & Affordable Warmth

4 7 9

2. Coronary Heart Disease

11

3. Children and Young People

14

4. Mental Health

17

5. Rural Access and Transport

20

6. Population Growth

22

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SOUTH CAMBRIDGESHIRE IMPROVING HEALTH PLAN 2003 - 2006

Introduction

This is the first Improving Health Plan for South Cambridgeshire. It has been developed by partner agencies with an interest in, and a responsibility for, improving health and providing services in the district. The Health Improvement Partnership has representation from South Cambridgeshire PCT, South Cambridgeshire District Council, Addenbrookes NHS Trust, Social Services and the Voluntary Sector. The plan is based on the recognition that health is influenced by factors that lie predominantly outside the provision of health services. These so-called ‘determinants of health’ are factors such as employment, economic status, housing, transport, education and the environment. The Health Improvement Partnership has focused on identifying the areas for health improvement that will be best achieved by working in partnership. Since the inception of the South Cambridgeshire Primary Care Group in 1999 and later South Cambridgeshire Primary Care Trust in 2002, there has been an increased focus on assessing and understanding the health and health needs of the communities living in South Cambridgeshire. As a result, health profiles (ref: South Cambridgeshire Health Profile 2002, October 2002) have been developed which have helped to provide a better understanding of the local population and to highlight inequalities in health. The Improving Health Plan builds on the work of the earlier locality Health Improvement and Modernisation Plan (HIMP) that formed part of the Cambridgeshire HIMP 2002/05. Aim The purpose of the plan is to set out a jointly agreed programme of work that will contribute to improving health and reducing health inequalities in South Cambridgeshire. The plan addresses areas where working in partnership particularly adds value and it makes a major contribution to the evolving Community Strategy through the ‘Health and Social Care’ theme of the Local Strategic Partnership (LSP). The plan forms an integral part of the Local Health Delivery Plan (LHDP) and contributes to local government objectives. Work in progress

The plan is a ‘living’ document and reflects work in progress. It is a partnership document and to that extent the action plan is evolving through a range of routes; this may be through existing multi-agency groups which were set up as sub groups under the previous Health Improvement and Modernisation Plan or through new groups such as the Children and Young People’s locality partnership. Most recently, a Rural Access and Transport Group is being set up as a theme group of the LSP and this will build on the work and of the South Cambridgeshire Rural Transport group initiated by the PCT.

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Priorities and challenges for joint working During 2001, a number of common priorities had been identified by South Cambridgeshire PCT and South Cambridgeshire District Council. In order to consult on these with a wider audience, a half-day workshop was held in July 2002. The event was attended by 75 people living and working in South Cambridgeshire and included a wide range of local agencies. It provided the opportunity to share understanding of local needs and to confirm priorities for future working. We know that in general, South Cambridgeshire:

is a healthy place to live with high life expectancy

has low levels of deprivation and disadvantage

However:

there may be small pockets of disadvantaged groups dispersed in such a way that they may not be readily identified by routine data sources

rural isolation can cause major physical and social problems

the main cause of death is circulatory diseases which includes coronary heart disease

there are relatively high death rates from accidents related to falls in older people andfrom accidents on the roads through the district

it is estimated that a third of GP consultations are for mental health problems The following local priorities were agreed:

LOCAL PRIORITIES

1. Vulnerable People a. Falls b. Affordable Warmth & Fuel Poverty c. Delayed Transfers

2. Coronary Heart Disease 3. Children and Young People 4. Mental Health 5. Rural Access & Transport 6. Impact of Population growth

These priority areas were discussed in groups during the workshop. Participants shared what was already going well and suggestions for areas to build on and take forward were recorded. A number of recurring issues and themes emerged throughout the event and these are summarised in the table below.

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ISSUES AND THEMES

Benefits and benefit uptake

Improved information sharing

Cultural awareness in relation to minority ethnic groups including Travellers

Methods of communication and need for flexibility of approach (making allowances for differing and low levels of literacy)

Funding mechanisms for the Voluntary Sector

Making more use of the media

Engaging local communities and public participation

Care pathway approaches

Ensuring evaluation is built into projects and good practice is shared

As part of the Local Strategic Partnership process, there have been subsequent discussions about the medium term challenges for Health Improvement and Social Care in South Cambridgeshire. As a result, a number of key challenges have been identified as outlined below.

KEY CHALLENGES (Medium Term)

Children and Young People – to develop a robust multi-agency approach to identify and support vulnerable children, young people and families

New settlements – to ensure partnership planning from early stages

Older People – to respond to the needs of the changing population profile

Voluntary Sector – to ensure that the voluntary sector is integrated into long term/core service provision

Role of NHS and Local Authority in local economy – to maximise their contribution to the local economy, environment and regeneration through employment and purchasing practice

These discussions on priorities, themes and challenges have been used as a basis for developing the Improving Health Plan. For each identified priority, the plan sets out

What the issues are

What we are already doing

What are we going to do?

How will we know that we have achieved it?

It is challenging task to implement all the areas and ideas that have been generated. The plan focuses on the areas where, given the resources available, we as partners believe that we can make a difference.

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1 (a) VULNERABLE PEOPLE - FALLS PREVENTION

Why this is an issue for South Cambridgeshire

South Cambridgeshire has high rates of death from falls among those over 75. (South Cambridgeshire - 144.3 per 100,000, Cambridge City - 136.1 per 100,000, England & Wales - 76.5 per 100,000 in the period 1998-2000).

The number of deaths from falls is fortunately relatively low, but falls contribute to the high mortality rates from hip fracture observed in South Cambridgeshire, cause significant disability and may be the event that triggers loss of independence.

Most falls occur in the home, and commonly in the bedroom.

The risk factors for falls at home are well known. Important risk factors include an unsafe home environment, risk taking behaviour, multiple medications and frailty. A history of a previous fall is a very strong risk factor.

Interventions that reduce accidental falls should be targeted at those with risk factors for falling. To gain most benefit, in terms of a reduction in both the morbidity and the mortality from accidental falls, the co-ordinated activity of many organisations is required.

The approach requires the detection of ‘at risk’ individuals and the targeting of specific intervention. This includes measures to minimise risk in the home, medicines management advice, the prevention and treatment of osteoporosis together with the reduction in the impact of falls through rehabilitation and long-term support.

What we are already doing. Some examples:

The Southern Cambridgeshire Falls Prevention Project was started in September 2000, with the appointment of a Falls Co-ordinator. This project is currently funded by South Cambridgeshire and Cambridge City PCTs and is supported by Cambridgeshire Social Services, South Cambridgeshire District Council and Cambridge City Council. A Community Exercise Group Co-ordinator was appointed in September 2001.

An Inter-Agency 3 tiered assessment process for identifying the falls risk in elderly care has been developed and implemented leading to improved targeting of appropriate interventions.

Falls Clinics have been established to investigate the causes of falls which include medical factors.

The ‘Walk Tall, Don’t Fall’ health information pack aimed at those at low risk of falling, is used in conjunction with community exercise activities (see below).

A Community Exercise Programme has been developed aimed predominantly at those at medium risk of falling.

In partnership with Age Concern, the ‘Full of Beans’ programme trains staff working in sheltered housing, day centres and residential homes to enable them to lead effective exercise classes aimed at improving mobility and independence with all activities of daily living.

Effective home exercise programmes including Balance and Exercise Courses are being provided for frail elderly fallers.

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Long term exercise opportunities have been developed for older people in the community e.g. through Fitness 4 Health exercise referral scheme. A local code of practice, supported by a training programme, is currently being developed to ensure that local instructors are appropriately trained.

The South Cambridgeshire Home Improvement Agency has worked together with Age Concern to develop the ‘Safer Homes Scheme’ which undertakes small jobs for vulnerable people in their own homes.

In partnership with the East Anglian Ambulance Service, a system has been developed for instances when a crew is called out to pick up an older person who has fallen, but where they do not need to be conveyed to hospital. In these circumstances, the patient’s details are sent, with their permission, to the Falls Co-ordinator for appropriate follow up, in order to try to prevent further falls.

Pharmacists in general practice have initiated medication reviews in order to reduce unnecessary multiple medications and to advise on medication that may cause side effects e.g. drowsiness.

What are we going to do? 1. Improve data collection on falls

Falls registers will be developed in residential and nursing homes, sheltered housing and in-patient facilities. The registers of vulnerable people being developed in GP practices will include falls. These registers will lead to an improved understanding of the numbers of falls in different settings so that appropriate local targets can be set to reduce the numbers of falls.

2. Preventing and managing falls in the community

In addition to continuing the services already set up as outlined above the following new areas will be developed:

Community Pharmacists will provide Medicines Management advice for those aged over 65 when they collect their prescriptions.

The Physical Activity Strategy and Healthy Eating Strategy currently being developed in South Cambridgeshire will incorporate the needs of older people.

The Private Sector House Condition Survey will be used to increase our understanding of the housing needs of older people. The range of services offered by the Home Improvement Agency will be expanded

Work with partner agencies to prevent falls by ensuring that pavements are kept clear and in good repair and that there is adequate street lighting.

3. Preventing and managing falls and osteoporosis in residential and nursing

homes

The objectives are to:

Develop a register identifying those at risk of falls and osteoporosis.

Ensure appropriate assessment and interventions, including medication review, targeted at those identified as being at risk of falls or osteoporosis.

Provide hip protectors for those identified as being at high risk of falls.

Provide appropriate staff training.

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4. Develop and implement a Primary Care Osteoporosis Strategy

The strategy will include the identification of those at risk of osteoporosis and the targeting of appropriate interventions at this group. This will include specific measures in residential and nursing homes as set out above.

How will we know we have achieved it?

Falls registers established in all relevant settings. Once these are in place local targets for the reduction in the numbers of falls will be set.

Medicines Management advice available to all people aged over 65 from Community Pharmacists when they collect their prescriptions.

Needs of older people incorporated into South Cambridgeshire Promoting Physical Activity and Healthy Eating Strategy.

Nursing and residential homes will have implemented a strategy for preventing and managing osteoporosis – including the provision of hip protectors for those identified at high risk.

Number of hip fractures in South Cambridgeshire reduced by 20% by April 2006.

Key Contact: Jackie Riglin

tel : 01223 883710 jackie.riglin@chesterton.lifespan-tr.anglox.nhs.uk

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1 (b) VULNERABLE PEOPLE – REDUCING DELAYED TRANSFERS

Why this is an issue for South Cambridgeshire A ‘delayed transfer’ occurs when, following assessment, a patient is ready for transfer from an acute hospital bed, but is still occupying such a bed.

On the 2nd July 2002, for example, Addenbrooke’s had 86 patients who were designated delayed transfers. 67 of these patients were over the age of 75, and of these, 52 were Cambridgeshire residents, the majority being South Cambridgeshire and Cambridge City residents.

The above example equates to 31,000 ‘lost’ bed days a year, which would roughly translate into approximately 4000 ‘lost’ procedures.

Intermediate care schemes in operation last year ‘saved’ approximately 27,000 bed days. Examples of such schemes are given below.

A recent analysis suggested a shortfall of approximately 150 Nursing and Residential Home beds in Southern Cambridgeshire.

40% of Nursing and Residential home places in Southern Cambridgeshire are not occupied by Cambridgeshire residents.

The recent increase in fees paid by Social Services to Nursing Homes (17.5%), and Residential homes (5%) has not stimulated the market.

The local health and social care system had to meet a target of a 50% reduction in delayed transfers in 2002/3 (to reduce the numbers of 75+ in Addenbrookes to 16 by the 31st March 2003). This was required in order to enable enough capacity to be freed up in Addenbrookes to deliver the maximum inpatient 12 month wait, and maximum 21 week outpatient wait.

What we are already doing. Some examples: A range of intermediate and preventive schemes has been introduced during 2001/2 and 2002/3 through partnerships with local authorities, NHS Trusts and the Voluntary Sector. Intermediate care comprises a range of services to promote faster recovery from illness, prevent unnecessary hospital admission, support timely discharge and maximise independent living.

A joint project with South Cambridgeshire District Council has led to the provision of 5 ‘halfway housing’ units at Sawston for patients needing a lower degree of support in the community.

Working in partnership with Cambridge City PCT, a new 30 bed rehabilitation facility has been opened.

The number of ‘Homeward bound’ schemes has been increased including Intermediate Care Rehabilitation beds at Coronation Street and Etheldred House.

The numbers of Social Care packages commissioned to support admission avoidance and early discharge has been increased.

Patient transport services at weekends have been enhanced.

Occupational Therapy Services have been integrated.

Directions Plus handbooks providing information for older people, disabled people and carers have been developed.

Last year the joint equipment service provided 3000 items of equipment to facilitate

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discharge from Hospital and 16,000 items to assist in the avoidance of admission to Hospital or to ensure independence was maintained.

What are we going to do? The work programme to reduce delayed transfers will be developed and implemented by a multi-agency group operating across South Cambridgeshire, Cambridge City and East Cambridgeshire. The South Cambridgeshire Health Improvement Partnership will continue to liaise with this group to ensure that our work programme continues to support the priorities identified by the reducing delayed transfers group. The Improving Health Plan contributes to the reduction in delayed transfers through its work in the following areas:

Falls prevention. A reduction in both the numbers of falls and also the proportion of falls resulting in hospital admission e.g. for hip fracture will reduce the numbers of people who might potentially become delayed transfers. In many instances a fall and subsequent hospital admission is the event that triggers loss of independence

Affordable warmth and fuel poverty. People who are cold in their homes are more likely to be ill, often requiring hospital admission, with a range of illnesses including respiratory disease and hypothermia. They are also more prone to accidents especially falls. Again such people admitted to hospital have the potential to become delayed transfers.

Developing a joint strategy and partnership approach to promoting uptake and awareness of benefits. Increasing the disposable incomes of vulnerable people can lead to a reduction in the risks to their health and safety, improve their quality of life, reduce dependence on statutory services and reduce the risk of avoidable admission to hospital or to residential or nursing care (see Coronary Heart Disease section).

Improving rural access and transport. Transport difficulties especially in rural areas and at weekends can contribute to delayed transfers.

Planning for population growth. It is important that we understand the impact that the proposed rapid population growth in South Cambridgeshire might have on hospital admissions and delayed transfers. By working in partnership with other agencies from an early stage of the planning process health issues can be considered and ‘designed in’ to plans as they are developed.

How will we know that we have achieved it?

The number of delayed transfers in Addenbrookes will reduce

More patients will receive intermediate care services in the community

Key Contact: Phil Wilson

tel 01223 885715 phil.wilson@southcambs-pct.nhs.uk

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1 (c) VULNERABLE PEOPLE - FUEL POVERTY/AFFORDABLE WARMTH

Fuel poverty arises from the combination of low incomes, poorly insulated housing and expensive or inadequate heating systems; people who are least able to afford the cost of heating tend to live in houses that are hardest to heat.

The government defines fuel poverty as where a household spends more than 10% of income, after housing costs have been met, in order to achieve a heating regime adequate for health and comfort. The ‘ fuel poor’ tend to be:

Single pensioners

Families on low incomes

Disabled people

It is the combination of circumstances e.g. poorer quality housing, which may also be damp, poorly insulated and lackingin adequate ventilation, which may increase ill health. People who are cold in their homes are more likely to be ill, and in the worst case to die. The illnesses which people may develop are:

Cardiovascular disease

Accidents (especially falls)

Respiratory diseases (including influenza)

Circulatory diseases

Hypothermia

Mental Health

Why this is an issue for South Cambridgeshire:

It is estimated that there are 10,600 households in South Cambridgeshire at risk of Fuel Poverty (Data from the 1996 English House Condition Survey).

Nationally there are 40,000 extra winter (December to March) deaths each year. It is estimated that there are approximately 80 excess winter deaths each year in South Cambridgeshire.

1% of all winter deaths are linked to properties with no central heating system.

The main underlying causes of excess winter deaths in South Cambridgeshire are pneumonia/influenza and Coronary Heart Disease.

0-4 year olds have the highest number of hospital admissions and the highest excess winter admission rate but the lowest average length of stay (1.5 days).

Over 75 year olds have high numbers of hospital admissions and considerable excess winter admission rates, and very long average length of stay (3 weeks).

What we are already doing. Some examples:

A joint action plan to reduce local levels of fuel poverty has been developed between South Cambridgeshire District Council, South Cambridgeshire PCT, Cambridge City Council and Cambridge City PCT. This work is directed by and linked to the work of the countywide Affordable Warmth Task Team. The focus of local work is to:

Ensure those most in need have access to grants for energy efficient measures including loft/cavity wall insulation and heating systems, by promoting Warm Front

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Grants and other schemes.

Establish efficient and effective referral systems between statutory organisations, and between statutory and non-statutory organisations. This issue is seen as a particularly important component of the action plan.

Ensure take up of benefits to those eligible.

Address the needs of those who cannot afford to install energy efficiency measures but who are not on benefit.

What are we going to do? 1. Develop a ‘Social Prescribing’ response to fuel poverty.

Train frontline staff within the NHS, South Cambridgeshire District Council and the voluntary sector in fuel poverty awareness.

Work with GP practices to provide information and develop a referral system whereby GP practices can refer patients in, or at risk of, fuel poverty to relevant agencies for suitable help. It is envisaged that this referral system would take the form of GP practices prescribing a ‘healthier home’.

2. Develop and run a 2003 Winter Fuel Poverty Campaign

Target those most in need, especially older people and those on benefit, through the Age Concern Winter Wise Campaign.

Use benefits data to promote the Warm Front scheme which gives grants to those on benefit.

Use fuel poverty as a means of increasing benefit uptake.

Identify and link up the existing service provision within the NHS, South Cambridgeshire District Council and the voluntary sector on fuel poverty and associated factors.

Link existing work on fuel poverty, falls prevention, benefit uptake and other related issues, which is currently being undertaken by various agencies to give a better co-ordinated effort to tackle fuel poverty.

3. Establish the ‘Healthy Homes Referral Project’

Set up the Healthy Homes Referral project, which will act as a single point of contact for those people in fuel poverty who need help, particularly linking those most in need with Warm Front and other grants.

How will we know that we have achieved it?:

Increase in the numbers of frontline staff in each agency trained to give energy efficiency/fuel poverty advice.

Effectiveness of winter publicity campaigns evaluated.

Healthy Homes Referral Project launched. If appropriate this will form part of the new county wide ‘Contact Centre’ which will be a single point of contact for all enquires relating to district council or county council functions.

Increase in the numbers of referrals to Warm Front.

Increase in the numbers of referrals to other grant giving organisations.

Key Contact: Iain Green

tel 01223 443209 iain.green@scambs.gov.uk

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2. CORONARY HEART DISEASE

Why this is an issue for South Cambridgeshire Coronary Heart Disease (CHD) is a major health problem in spite of the fact that death rates from CHD are falling and South Cambridgeshire has the lowest death rates from CHD in Cambridgeshire. Here are some reasons why:

CHD accounts for nearly a quarter of all deaths in South Cambridgeshire.

CHD causes premature death and ill health with a significant impact on every aspect of the life of those affected and those close to them, including their future employment and personal relationships. The costs of CHD to the NHS, Social Services and to society are high.

There is good evidence that much of the disease is potentially preventable – the three most important modifiable risk factors are smoking, diet and lack of physical activity.

The current estimate for the number of adults in South Cambridgeshire who smoke is 17,000. Of these, 11,000 may want to quit.

Treatment for established disease, although expensive, is becoming increasingly effective at improving the quality and length of life for individual patients.

The population of South Cambridgeshire has a higher death rate than the national averages for a number of European Countries.

There is likely to be inequity in access to services provided by the NHS and other agencies to prevent and treat the disease.

Coronary Heart Disease is known to be strongly associated with deprivation and social disadvantage.

What we are already doing. Some examples: This section should be read in conjunction with the CHD section of the Local Health Delivery Plan which sets out a comprehensive strategic approach to tackling CHD in South Cambridgeshire.

The PCT has developed a comprehensive smoking cessation service which is supported by a number of smoking policies. One example of a project that contributes to the smoking cessation work is the Proof of Age Scheme which aims to reduce smoking in underage children. Each 16 year old will be issued with a 16+ identity card to prove their age.

‘Fitness 4 Health’ - an exercise referral programme, has been developed in conjunction with local village colleges to enable GPs to ‘prescribe’ an exercise programme rather than medication where this is appropriate.

The PCT and District Council have supported the ‘Travel for Work’ project to help enable employees to use healthier methods of getting to work such as cycling and walking.

Local schools are participating in the county led ‘Safer Routes to School’ Initiative which promotes walking and cycling to school.

Every general practice has been supported to develop a CHD register which identifies all patients who have, or are at risk of developing, CHD so that they can be targeted for appropriate advice and treatment.

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South Cambridgeshire District Council has launched a Sports Development Strategy for 2002 –2004 and a youth sport strategy in conjunction with other local authorities is planned.

What are we going to do? 1. Develop and agree a joint strategy to promote physical activity

A small working group has been established and a strategy is being developed using Health Development Agency (HDA) guidelines. The strategy builds on existing policies and current work such as Fitness for Health and Health Promoting Schools, and addresses increasing physical activity under the themes: Health Care Services; Workplace; Media; Schools and Older People. By this token it also overlaps with other priority areas e.g. transport issues and the promotion of cycling. This project will be led by South Cambridgeshire PCT.

2. Develop and agree a joint strategy to promote healthy eating

The strategy will co-ordinate the various activities and agencies who have, or could have, an input into healthy eating and nutrition and will link with the Diabetes National Service Framework. This project will be led by the Environmental Health Dept, South Cambridgeshire District Council.

3. Smoking Cessation and Tobacco Control

Smoking Cessation: To support those smokers who want to quit, South Cambridgeshire and Cambridge City Primary Care Trusts will work together to:

strengthen the Smoking Cessation Service which is already available to people living in South Cambridgeshire.

increase the availability of outreach smoking cessation service available to motivated quitters in South Cambridgeshire who find it difficult to access services based in Cambridge City.

support primary care staff pharmacists, local authority staff and local workplaces to actively provide smoking cessation support.

promote these services specifically to those living on low incomes as well as women who are pregnant and their partners.

Tobacco Control: In order for smoking cessation to be successful it must be developed in the context of a wider programme to control the uptake and use of tobacco. South Cambridgeshire and City PCTs will work with partners to:

support quitters, particularly those from manual groups through the development of workplace No Smoking Policies. Local organisations representing the Health Improvement Partnership are employers of the large numbers of local people and have a key role in reducing smoking.

introduce tobacco control policies e.g. smoke free public places.

prevent the uptake and consumption of tobacco by young people through Health Promoting Schools and Proof of Age Card schemes.

become an active member of the Cambridgeshire Tobacco Control Alliance.

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4. Tackle deprivation and social disadvantage

Coronary Heart Disease is known to be strongly associated with deprivation and social disadvantage. Tackling deprivation and social disadvantage is a key issue for the South Cambridgeshire Local Strategic Partnership and is a theme that runs throughout the Improving Health Plan. One issue that has arisen consistently throughout the consultation on the Improving Health Plan is the need to increase awareness and uptake of benefits. Increasing the uptake of benefits contributes directly to prosperity, safety and a healthy and caring society.

Develop a joint strategy and partnership approach to promoting uptake and awareness of benefits.

How will we know that we have achieved it?

1. Physical Activity Strategy

Joint promoting physical activity strategy and action plan agreed by September 2003.

Tangible outcomes in workplan e.g. directory of different types of activity aimed at the 50+ age group; increase in young people taking up out of school sports.

Repeat of health related survey in Summer 2004 (see Children’s section) to measure differences in lifestyles of young people.

2. Healthy Eating Strategy

Joint promoting healthy eating strategy and action plan agreed by April 2004.

Action plan to include response to health needs assessment work e.g. development of appropriate initiatives for population sub-groups e.g. Travellers.

Repeat of health related survey in Summer 2004 (see Children’s section) to measure differences in lifestyles of young people.

3. Smoking Cessation and Tobacco Control

418 South Cambridgeshire smokers each year will have quit.

The rate of smoking amongst manual workers will be reduced from 32% to 26% by 2010.

The percentage of women who continue to smoke throughout pregnancy will reduce by 0.5% per annum from 7.3% in 2002 to 5.3% in 2006.

4. Promoting awareness and uptake of benefits

Targets to be agreed

Key Contact: David Kanka

tel: 01223 885733 david.kanka@southcambs-pct.nhs.uk

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3. CHILDREN & YOUNG PEOPLE

Why this is an issue for South Cambridgeshire

Ensuring good health and circumstances in early life and childhood sets the foundation for good health and prospects in adult life.

Local data show that in general, children and young people in South Cambridgeshire have relatively favourable health determinants in terms of housing, employment, income, skills and education. This is however a backdrop to pockets of disadvantage that exist and may be compounded by rurality and isolation.

Analysis of small geographical areas shows evidence of poor housing in several wards and a scatter of low incomes – particularly on the ‘borders’ of the district (mapped by enumeration district).

New settlements have been developed and are being planned for South Cambridgeshire (see population growth) and by 2016, 80% of the increased number of children will be from children who have moved into the area.

Children and families in transition to new homes and communities may be temporarily vulnerable and need additional support. They may also be moving into vulnerable communities.

Emerging results from the Health Related Behaviour Questionnaire survey (2002) indicate issues related to drug use and alcohol consumption, bullying and access to local sexual health information - areas which can addressed most effectively by agencies working together in partnership with children and young people. (The survey was conducted in all Cambridgeshire secondary schools with 13 and 15 year olds providing up to date information on a range of issues related to lifestyles including nutrition, physical activity, smoking, mental health, drug and alcohol use).

What we are already doing. Some examples:

Home-Start, in partnership with PCT, has extended its provision in South Cambridgeshire. There is still an area south of the A11 that is not covered.

South Cambridgeshire PCT and South Cambridgeshire District Council are partners in the Cambridgeshire Travellers Initiative. 2 child and family nurses from South and City PCTs are working with the multi-agency Initiaitive. Cultural awareness training for child and family nurses is being implemented. Welcome packs and appropriate health promotion materials for Traveller families are being developed.

South Cambridgeshire Youth Participation Scheme is encouraging young people to become involved in youth councils and local decision making.

South Cambridgeshire District Council is active in providing sport and leisure facilities which can promote social inclusion for vulnerable children, young people and families. A Youth Sport Strategy is being planned.

As the result of an outreach pilot project, young people living in Melbourn and Bassingbourn can use a text messaging service to get anonymous advice on issues such as sexual health, drugs, alcohol and relationships

Students aged 14-15 years at 2 village colleges were asked about anxieties they might have around the BCG immunisation. As a result a video and website has been developed and is being piloted in 3 schools.

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A WellFamily Service Co-ordinator is based Cambourne. This is an example of the voluntary sector providing family support in partnership with primary care

A Webster Stratton Parent training programme has recently been piloted in Histon by a joint team of education and health professionals. It focuses on parents of children aged 3-8 with behaviour problems. 2 further groups are now being rolled out as part of a county programme that is being evaluated by Cambridge University.

What are we going to do?

1. Develop a Local Preventative Strategy for Children and Young People (0 - 19

years) in South Cambridgeshire

South Cambridgeshire PCT is taking the lead in developing a multi-agency Children and Young People’s locality partnership. This will form part of the county structure and will also be linked to the Local Strategic Partnership (LSP) and forthcoming Community Plan. The terms of reference of this group are being developed but areas already identified by the PCT to progress include:

More in depth understanding of specific needs of children and families and systematic sharing of information between agencies to inform a strategic approach.

Joint and proactive approach to support secondary schools to take forward the Health Promoting Schools programme (from 2003). This will include sharing a summary of the collective South Cambridgeshire findings from the health related behaviour survey conducted with all students in years 8 and 10 in the summer of 2002. In addition, to encourage schools to analyse their own school’s results and in partnership, to respond to the issues identified.

Development of a mechanism to ensure that children and young people have a voice in the Local Strategic Partnership arrangements.

Extension of Home-Start services to provide coverage across the district.

Roll out of the Webster Stratton based programme for parents to support early behaviour difficulties in children (aged 3 – 8 years).

2. Address the health needs and improve access to health services for Traveller families by working in partnership with the Cambridgeshire Travellers Initiative

Influence and support the Initiative at strategic and operational levels through the Travellers Implementation Group, Travellers Health sub group and district wide groups.

Provide dedicated time to 2 child and family nurses to work with Travelling Communities and the Cambridgeshire Travellers Initiative to identify and cascade good practice. Collect statistics on health service uptake to inform planning.

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How will we know that we have achieved it? 1. Children and Young People’s Partnership

Local multi-agency group established (April 2003)

Have a shared view about where partners need to build the capacity of the community to provide an environment where children and young people have improved life chances (Oct 2003).

Jointly agreed action plan to develop a Local Preventative Strategy that links to other local policies and in particular: SCDC Community Development Strategy, Community Safety Strategy and Youth Participation Strategy. In addition agree an identification, referral and tracking system.

Training delivered for child and family nurses who are working in schools that are working towards the national healthy schools standard (March 2004). This will be delivered by a child and family nurse who is currently on secondment to Health Promoting Schools.

2 Secondary schools participating in the new ‘secondary’ wave of Health Promoting Schools Programme

2. Travellers

A project plan is being developed by the Child and Family nurses who are undertaking the project with Travellers. This will identify a number of performance indicators including:

Welcome Pack’ piloted, evaluated and made available to all new families on Traveller sites (December 2003).

New health promotion materials e.g. audio material made available or developed as appropriate from health needs identified e.g. accident prevention (March 2004).

Improved access to GP services / increase in number of permanent registrations.

Key Contact: Inger O’Meara

tel 01223 885731 inger.omeara@southcambs-pct.nhs.uk

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4. MENTAL HEALTH

Why this is an issue for South Cambridgeshire

Approximately 10,000 adults will have suffered from some kind of mental health problem in South Cambridgeshire within the last week.

Most people with mental health problems live in the local community and are cared for by their GP and the primary care team.

An estimated 40% of GP consultations are for mental health problems.

Suicide is the largest single cause of death for people under 35 in the UK.

There are approximately 3 male suicides to every 1 female suicide in Cambridgeshire.

Depression affects nearly half of all women and a quarter of men before the age of 70.

In 1999/00 over £4 million was spent on anti-depressants in Cambridgeshire.

By 2020 it is expected that depression will be the biggest global health problem after chronic heart disease.

Some people are more likely to suffer from mental health problems, e.g. unemployed adults, lone parents, people in rented accommodation, children in the poorest households.

What we are already doing. Some examples:

QEST (Quest Employment Support Scheme) helps people who have a mental health problem or physical disability to find suitable training or employment (Richmond Fellowship). The scheme has a rural employment outreach worker.

St Columba Group Therapy Centre provides a range of group therapies e.g. psychodrama and art therapy, and operates from Cambridge, Sawston, Willingham and Bar Hill.

A number of multi agency groups have been set up which address rural transport and service planning issues.

Social Services and Health Trusts have joined together to introduce a new weekend service to people who may experience mental health problems. This provides assessment, treatment and home visits and ensures a 7 day service.

Lifeline telephone helpline is available to all every afternoon 365 days a year.

Lifecraft is a local self help organisation which offers a range of support services and groups including the Mental Health Handbook produced in conjunction with Directions Plus.

The Spiers project (based in Sawston) provides rural day care.

Counselling service provision has been increased in GP surgeries.

The Bridge offers confidential advice/information and counselling for drug users, their friends and families.

‘Health for Life’ is a local community project which helps people to regain confidence, health and independence through attending community education classes. The project covers 32 villages in South East Cambridgeshire.

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What are we going to do? During 2002, a southern mental health promotion working party considered the existing county-wide Mental Health Promotion Strategy (developed by the former Cambridgeshire Health Authority) and identified a framework for taking forward local priorities. At that time there was insufficient capacity to facilitate this and a priority was made to identify funds for a post.

1. Establish a Mental Health Promotion Facilitator post to work across South and City PCTS

Identify and confirm funding for a full or part time post.

The broad areas of work will include:

Combating discrimination against individuals and groups with mental health problems and promoting their social inclusion.

Building a resource of those initiatives already underway which contribute to the promotion of mental health for all (individuals and communities). This builds on the preliminary mapping work already undertaken.

2. Contribute to Youth Inclusion Worker post for Kite Project

This multi-agency funded project tackles discrimination and supports inclusion of lesbian, gay and bisexual young people. A fully worked up plan is available for this project which addresses health inequalities. The plan includes objectives to improve access to health services and health information for LGB young people through site based and outreach work.

3. Fitness 4 Health Scheme

Increase take up of existing scheme on basis of mental health promotion benefits.

Through partnership with Community Mental Health Team, expand scheme to provide sporting activities for mental health service users.

How will we know that we have achieved it?

1. The following process measures will have been achieved:

Recruitment of Mental Health Promotion Facilitator.

Re-established multi-agency Mental Health Promotion group.

Development of Action Plan to address key areas which relates to other relevant strategies and work areas e.g. future Local Preventative Strategy for Children and Young People; Older People - Health and Wellbeing; Community Safety; Physical Activity; Cambridgeshire Travellers Initiative: Health Issues Project (Cambridge Ethnic Community Forum);Transport and Arts strategies.

Specific outcome measures will be identified in the plan and may include:

Work with schools to address issues identified around emotional health and wellbeing in the Health Related Behaviour Survey (Summer 2002). Changes in reported behaviour related to emotional health can be tracked using a repeat survey of the health related behaviour survey in Summer 2004.

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Development of more user friendly services for young people.

Directory of mental health promotion initiatives.

2. Kite Project Outcomes. Health Services specific:

Availability of appropriate health information through Health Promotion Resources Service and through outreach work including schools.

2 sessions held to provide LGB young people with information on advice on sexual health, mental health and available services.

Note: A wider range of outcomes related to needs assessment and discrimination issues are detailed in the Kite project plan.

3. Fitness 4 Life

Increased referrals to current scheme on basis of mental health promotion and through referrals from Health for Life Project.

Provision of new sporting activity courses for mental health service users at 6 locations.

Key Contact: Mental Health Promotion Facilitator – to be appointed Temporary contact: Inger O’Meara

tel: 01223 885731

inger.omeara@southcambs-pct.nhs.uk

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5. RURAL ACCESS AND TRANSPORT

Why this is an issue for South Cambridgeshire

4 wards in South Cambridgeshire rank amongst the most disadvantaged in Cambridgeshire in terms of geographical access to essential services. This is a characteristic feature of rural areas.

9 of the general practices in South Cambridgeshire identified problems with access and poor transport in their Practice Plans 3 years ago.

Public Transport links to hospital services from many parts of South Cambridgeshire are poor; there is no transport to Papworth or Fulbourn from certain parts of South Cambridgeshire particularly in the northern part.

There are few alternatives to buses for the vulnerable who do not have transport. In addition, the information on bus services is poor and often incomprehensible. The provision of information in rural GP Practices on transport to health facilities is critical.

There is considerable population growth projected which will require change in the way health services are provided, e.g. more use of Hinchingbrooke by South Cambridgeshire residents, development of services at Community Hospitals in Newmarket, Saffron Walden and Royston.

Public transport links between villages and community colleges is poor.

Initiatives to improve rural transport need to be developed in the context of a need to reduce air pollution which is associated with risks to health and quality of life.

What we are already doing. Some examples:

South Cambridgeshire PCT is a member of the Cambridgeshire-wide Rural Transport Partnership (Cambs RTP). The partnership aims to ‘enhance rural transport services to secure long term improvements in rural people’s access to jobs, services and social activities, and improve visitor’s sustainable access to the countryside, where possible promoting inclusion and tackling problems of rural isolation’. (Action Plan 20002 – 2004).

A Community Transport Survey has been jointly commissioned by the PCT and South Cambridgeshire District Council.

The South Cambridgeshire Rural Transport sub group was formed in May 2001 with representation from Cambridgeshire County Council, South Cambridgeshire District Council, voluntary organisations, Ambulance Service, Addenbrooke’s Hospital and the PCT. In conjunction with Care Network, the group has been successful in supporting social car schemes, facilitating hospital and outpatient journeys and taking forward work on public sector transport integration.

Establishment of a designated parking area adjacent to outpatients for social car schemes at Addenbrooke’s.

South Cambridgeshire PCT has conducted a retrospective Health Impact Assessment of the Local Transport Plan.

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What are we going to do? It has been agreed that a local Transport and Access Group will be set up as part of the South Cambridgeshire Local Strategic Partnership. The existing members of the PCT led group will form the core membership of this new group, while the work related to public sector transport integration will be progressed through the Cambridgeshire Rural Transport Partnership. The work programme for the new group will build on the common terms of reference for LSP groups developed by Cambridgeshire County Council. It will be informed by 3 key documents/events:

South Cambridgeshire Community Transport Study (under review)

Retrospective Health Impact Assessment of the Local Transport Plan

Issues identified at the South Cambridgeshire Improving Health Workshop (July 2002) and this Improving Health Plan

Other specific plans include:

Active exploration through the Community Transport project of the Call Centre concept – One Call for Transport for those who are sick, frail, elderly or vulnerable. A seminar ‘Integrated Transport : Moving Together’ took place in April 2003 to share good practice from elsewhere.

Work with the Cambridgeshire and Peterborough Public Health Network to develop a clearer understanding of the issues related to transport and social exclusion and the links with other priority areas such as children and family support, and mental health and wellbeing.

How will we know that we have achieved it?

Establishment of a new LSP Access and Transport group with agencies signed up to an agreed set of priorities and an action plan (December 2003). The action plan will include providing input to the development of the replacement Cambridgeshire Local Transport Plan.

Key Contact: Sue Smith

tel 01223 885732 sue.smith@cambcity-pct.nhs.uk

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6. POPULATION GROWTH

Why this is an issue in South Cambridgeshire

South Cambridgeshire has the highest forecast population growth within the county. It is forecasted that by 2016 the South Cambridgeshire resident population will have increased by 33% from the 1999 estimate. The figure below shows that the greatest expansion will be in the 25-39 and 65-74 age groups.

Source: Cambridgeshire County Council Research Group

78% of this forecast population increase will be accounted for by inward migration. Provision has been made for the construction of 20,000 homes in South Cambridgeshire between 1999 and 2016.

Population growth on this scale will present a major challenge to partners in the LSP.

This increase in population will place demands on infrastructure and capacity of local services e.g. health services, transport and leisure facilities. However, there will also be a less easily defined impact on societies and communities.

It is possible that an influx of predominantly affluent people into South Cambridgeshire will further mask pockets of deprivation.

What we are already doing

The Local Strategic Partnership is currently working on a twin track project, Track A focusing on ‘Building the Community Strategy’ and Track B focusing on ‘New Settlements’. Track B has already looked at the lessons to be learned from the new development at Cambourne and is bringing together the various agencies who will be involved in the new developments at Arbury Camp on the northern fringe of Cambridge and in the Oakington/Longstanton area.

It has been agreed that issues relating to the determinants of health and health inequalities are important areas to be addressed through working in partnership as well as issues relating to the delivery of services.

South Cambridgeshire Mid 1999 resident population estimate

and 2016 forecasted resident population growth

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

0-4 5-10 11-15 16-19 20-24 25-39 40-59 60-64 65-74 75+

Age band

Po

pu

lati

on

nu

mb

er

2016 forecast population

Mid-1999 Estimate

Source : Cambridgeshire County Council Research Group

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The Cambridgeshire & Peterborough Joint Structure Plan Review incorporates the statement that health facilities will be a key element of new housing developments. Health care infrastructure provision will form part of the comprehensive approach taken by local authorities and key partners in forming a development strategy for South Cambridgeshire.

Addenbrooke’s Hospital in its ‘2020 Vision’ document has acknowledged that the predicted population growth is one of key drivers for the expansion of the Addenbrooke’s site.

What are we going to do?

Work with partners to ensure that all agencies have consistent up to date information on population growth forecasts together with an understanding of the size, nature and timescales associated with planned developments.

Ensure that the above information is available to all relevant agencies and groups so that planning for the impact of population growth can be incorporated into their work programmes e.g. ensuring that the needs of the forecast 77% increase in people aged 65-74 are appropriately identified and met.

Work closely with a range of departments in South Cambridgeshire District Council and partner agencies from an early stage to ensure that new developments are sustainable and will promote social inclusion and health in its widest sense. This will include ensuring that community development input is sustained in new and evolving settlements.

Aim to incorporate Health Impact Assessment into the work of the developers who are required to undertake an Environmental Impact Assessment.

Ensure that we respond to any Health Impact or Environmental Impact Assessments undertaken by developers.

Explore opportunities with partner agencies to develop the capacity and capability within the local system to respond effectively to the health issues associated with population growth.

Ensure that the lessons learnt from recent experience e.g. the Cambourne development are incorporated into the joint planning of planned developments e.g. Oakington/Longstanton.

Work with partners to ensure that full use is made the Section 106 agreements, that set a legal obligation on developers to provide certain facilities in order to secure planning permission, to ensure best outcomes for our population.

Ensure that the developments of the county and regional multi modal transport programme tie in with local needs and planning.

How will we know that we have achieved it? In the short term:

Up to date information on population growth forecasts will be available to all relevant agencies and groups.

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There will be evidence of active multi-agency involvement in planning for new developments which takes into account experience from previous developments.

Future Section 106 agreements will reflect multi-agency involvement.

Key Contact: David Kanka

tel: 01223 885733 david.kanka@southcambs-pct.nhs.uk