Cumbria Health and Wellbeing Strategy 2016 2019

Cumbria Health and Wellbeing Strategy 2016 – 2019 Delivery Plan 2016/17

1 Outcome 1: Every child has the best start in life

Key area of activity Measure Baseline Milestone/1 Year Frequency of performance Programme(s) of activity Measure/Target3–year reporting Measure(s) or Target(s) Promoting Breastfeeding Initiation of breastfeeding at 6-8 Data processes improved during To achieve England average rates Quarterly County-wide Implementation of weeks 2016. by 2017/18 WHO Baby Friendly Initiative

Implementation will take place across the County through % of all mothers who breastfed Cumbria: 64.9% progress towards accreditation of their babies in the first 48hrs after National: 74.3% Increase rate in line with England Annual different stages of BFI. delivery (over 3 years)

Allerdale: 64.8% Barrow: 50.1% Increase rates in the districts with Carlisle: 63.2% the lowest levels in line with Copeland: 59.2% England Eden: 76.2% SL: 78.9%

(PHOF, 2015) Tackling childhood obesity % of reception age (4-5 yrs) with Cumbria: 25.1% To reduce the rate of excess Annual Implement all aspects of the excess weight England: 22.5% weight in 4-5 year olds to 23% by National Child Measurement 2020/21 Programme – including timely Allerdale: 26.2% notification of results Barrow: 30.6% Carlisle: 20.4% Active Cumbria Early Years Copeland: 26.1% Programme Eden: 23.3% SL: 20.4% National Lottery Sport Programmes (Sportivate and (PHOF, 2013/14) Satellite Sports Clubs % of children aged 10-11 (Year 6) classified as overweight or obese Cumbria: 33.4% Reduce rates in the districts with Annual England: 33.5% the highest levels in line with England Allerdale: 35.4% Barrow: 33.5% Carlisle: 32.7% Copeland: 34.0% Eden: 33.9% SL: 31.4%

(PHOF, 2013/14) % of children aged 5 with decayed, missing or filled teeth

32.1% for Cumbria Reduce rate in line with England Annual (time lag of data)

2 % of children achieving physical A specific children’s weight literacy standards (KPI 4 in Govt management service may be Strategy) included in the new 0-19 HCP Establish a Year 1 baseline (later Annual contract due start in April 2017 New measure, baseline not yet in the year when data is made established available) % of Looked after Children (data capture method not Continuation of Smile4Life within classified as overweight or obese confirmed) Children’s Centres

New measure, baseline not yet established Establish a Year 1 baseline (later Annual (data capture method not in the year when data is made confirmed) available) Improving mental wellbeing of Percentage of inappropriate 33% Reduce by 5% (to 31%) Quarterly Implementation of Cumbria multi- children and young people referrals to specialist services agency whole system model.

Part of national project to develop common measures for mental Measures to be agreed in 2016 Improving access to specialist wellbeing, led by CORC and Anna services Tier 3 Programme and Freud/UCL expand Tier 2 Services

National Programme Outcome – Involvement of parents and carers socially significant improvement in in service design and delivery the mental wellbeing of at risk young people Implementation of Cumbria’s (range of measures pre and post Transforming Services plan exposure to commence in  Development of community September 2016) eating disorder service  Closer collaboration with schools % mothers who received an  Improved response to assessment following a Maternal young people in crisis Mood review, in line with local pathway by the time the infant is Implementation of Primary Mental aged 6 to 8 weeks of age Health Early Intervention Service Baseline to be established – new local measure HeadStart Phase 3 Strategy and Implementation Plan  Building resilience promoting environments  Building capacity in the CYP workforce  Equipping 10 to 16 year Self-Harm: olds with skills and Young people hospital admissions resources to have the ability for self-harm: rate per 100,000 and confidence to cope with aged 10 – 24 life’s inevitable ups and (PHOF, 2010/11-12/13) downs

Hospital admissions due to Development of a multi-agency

3 substance misuse (15-24 yrs) Cumbria: 461.2 maternal mental health pathway – (PHOF, 2011/12-13/14) England: 352.3 Health Visiting service Reduce rate in line with England by 2020-22 Community participation in Sport Project

Introduce fast-track access to Cumbria: 118.1 Child and Adolescent Mental England: 81.3 Health Services (CAMHS) for Reduce rate in line with England Looked After Children

Outcome 2: Adults lead healthy and fulfilling lives

Key area of activity Measure Baseline Milestone/1 Year Frequency of performance Programme(s) of activity Measure/Target3–year reporting Measure(s) or Target(s) Reducing unhealthy levels of Alcohol specific hospital Cumbria: 425 Reduce in line with England Annual Deliver the Cumbria Alcohol alcohol consumption admissions (persons) directly age England: 374 Strategy standardised rate per 100,000 Allerdale: 388 population Barrow: 619 (PHOF, 2013/14) Carlisle: 459 Develop alcohol harm reduction Copeland: 518 plans through the 6 Locality HWB Eden: 228 Forums SL: 334 Rate of alcohol related crime (Cumbria Constabularly, 2014/15) Cumbria: 14.3% Reduce to 12%; Annual Develop an alcohol related harm Allerdale: 12.1% pathway through The Health and Barrow: 19.3% Reduce rates in the districts with Social Wellbeing System Carlisle: 12.8% the highest levels in line with the Copeland: 16.1% county average Develop structured Alcohol related Anti-Social Eden: 9.2% communications plan to tie in with Behaviour (Cumbria Constabulary, SL: 14.9% National campaigns aimed at 2014/15) Annual reducing alcohol related harm Cumbria: 14.0% Reduce to 12%; Allerdale: 13.8% Increase the amount of hazardous Barrow: 13.0% Reduce rates in the districts with and harmful drinkers accessing our Carlisle: 14.9% the highest levels in line with the substance misuse services (Unity) Copeland: 14.4% county average Eden: 11.5% SL: 14.6%

Reducing the prevalence of Smoking prevalence (persons 18+) Cumbria: 19.1% To reduce smoking prevalence to Annual Develop smoking cessation activity smoking; tackle inequality by (PHOF, 2014; Integrated England: 18.0% 12% by 2019 across the through the 6 Local Health and reducing the percentage of people Household Survey) population as a whole and to Wellbeing Forums who smoke in districts currently Allerdale: 18.4% 17.5% in routine and manual above the county average Barrow: 23.5% groups. Promote and deliver community Carlisle: 22.2% pharmacy based smoking Copeland: 28.7% cessation services throughout

4 Eden: 11.3% Cumbria as part of the Health and SL: 12.1% Social Wellbeing System

Develop structured communications plans to maximise National Campaigns aimed at reducing smoking prevalence Tackling obesity % of people who have a BMI over Cumbria CCG: 9.72% Reduce in line with England; and Annual Deliver weight management 30 (GP Register) England: 9.03% reduce rates in the districts with programme as part of Health and (QOF, 2014-15) the highest levels in line with the Social Wellbeing System county average Develop actions targeted at % of people in Cumbria registered Cumbria CCG: 7.14% Reduce in line with England; and reducing obesity through the 6 with diabetes (GP Register) England: 6.37% reduce rates in the districts with Annual Local Health and Wellbeing (QOF, 2014-15) the highest levels in line with the Forums county average % of people physically inactive (Active Lives Survey) (KPI 2 in New measure, baseline not yet Establish a Year 1 baseline (later Develop structured Govt Strategy) established in the year when data is made communications plans to maximise available) Annual National Campaigns aimed at reducing obesity

Physical Activity Care Pathway for adults to include previously operated Exercise on Referral Scheme. This pathway supports the Cumbria Health and Social Wellbeing System.

Active Workplace to encourage employees of targeted businesses to become more physically active and healthy. This programme is aligned to CCC’s Better Health At Work Award Improving the mental health and Reduction in use of S136 128 (April – September 2014) 50% reduction (10 per month) Monthly Mental Health Transformation wellbeing of adults detentions (21 per month ) Programme – delivered through (Cumbria Constabulary) the implementation of the Cumbria Mental Health Strategy “Better Mental Health for all”. No children/adults in custody 33 adults; 1 child (April – Reduce to 0 suites as a place of safety under September 2014) To be finalised The 5 year strategy is made up of MHA 3 sections: (Cumbria Constabulary) -Vision to achieve parity of esteem and improved mental health and Reduce waiting times for Mental well being Health Act (MHA) Assessments Baseline to be finalised -Model of care development – that (ASC?) 50% reduction (currently between describes the delivery of a 2 – 15 hours) To be finalised seamless service to achieve the vision.

5 -Commissioning strategy – the Suicide rate (per 100,000 persons) mechanism to ensure delivery of Cumbria: 11.3 the model of care. England: 8.9 (PHOF, 2012-14) Reduce in line with England by Annual Support people with low level 2018 mental health problems through the Health and Social Wellbeing System

Improve access to mental health assessment and support for people experiencing a mental health Outcome 3: Older people are enabled to live independent and healthy lives

Key area of activity Measure Baseline Milestone/1 Year Frequency of performance Programme(s) of activity Measure/Target3–year reporting Measure(s) or Target(s) Reducing the number of falls Reduced conveyance of care To be established prior to To be established prior to Monthly North Cumbria Falls – establish home residents to hospital. commencement of project. commencement of project. current state with regard to falls services in North Cumbria and Cumbria: 1,695 identify gaps in support offered to Injuries due to falls in people aged England: 2,064 care homes. 65 and over (Persons) per 100,000 (PHOF, 2013-14) Retain levels below England and Develop a plan for the delivery of a continue to reduce comprehensive care home scheme to reduce and manage falls. This will be closely linked with the systems described below

Active Cumbria Older Adults Programme is a ‘pilot’ project to increase levels of participation in Physical Activity for Older Adults (65+ years) in order to improve the life quality and independence of participants through increasing confidence, self-esteem and mobility

Health and Social Wellbeing system to establish clear pathways for falls prevention for vulnerable groups Tackling social isolation % of Adult Social Care users who Cumbria: 47.9% Increase in line with England Annual Health and Social Wellbeing have as much social contact as England: 54.4% System working with wider third they would like sector to identify at risk individuals (PHOF, Adult Social Care Users and ensure appropriate social Survey, 2013-14) support Outcome 4: The people of Cumbria receive the quality of care they are entitled to

6 Key area of activity Measure Baseline Milestone/1 Year Frequency of performance Programme(s) of activity Measure/Target3–year reporting Measure(s) or Target(s) Ensuring that people who are at To be confirmed To be confirmed To be confirmed Quarterly Delivery of Family Nurse high risk of needing social care Partnership receive the care they need in time

Reduced non-elective admissions As featured in the Better Care As outlined in the Better Care Quarterly Fund plan for Cumbria (2016/17) Fund plan for Cumbria (2016/17) Delivery will be supported by ( draft ready early February) implementation of the Better Care To be confirmed Fund Plan (BCF) – to aid the Local measure to be devised re. To be confirmed establishment of an integrated coverage and efficacy of To be confirmed health and social care system that Integrated Care Communities is: more efficient; reduces avoidable hospital admissions and Delivery of Extra Care Housing in facilitates early hospital discharge. Cumbria As outlined in the Extra Care Housing Strategy As outlined in delivery plan for the As set out in the Strategy Establishment of Integrated Care Extra Care Housing Strategy Communities

Transformation of ‘landscape of care’ as outlined in Commissioning Strategy for Care and Support (2015/2020)

Extra Care and Supported Living Housing to be developed in Cumbria Working to ensure that the focus of To be defined To be identified. Delivery of a sustainable and Delivery of the learning disability services for people with learning suitably commissioned learning transformation programme as a disabilities, physical disabilities disability services across Cumbria. Transforming Care Partnership and mental health services is on (TCP). recovery and independence Implementation of findings and recommendations from Joint Health and Social Care Self- Assessment Framework and Autism SAF 2014 to continue to improve services for people who have a learning disability and/or autism.

Commencement of development of a Cumbria Learning Disability strategy. Delivering patient rights as set out All expected rights and pledges: As set out in the NHS Constitution National standards in place RTT, A&E, 8 High Impact changes -Through in the NHS Constitution - Referral to Treatment (RTT) Ambulance – Monthly; the Success Regime in North - Ambulance Cancer and Cumbria, Better Care Together - Accident & Emergency Community Psychiatric (Vanguard) Programme in South

7 (A&E) Assessment – Quartely. Cumbria and the System - Cancer Resilience Groups in North Cumbria and North Lancashire and Non-elective admissions. South Cumbria, development and Delayed transfers of care. Monthly via the Cumbria Joint delivery of specific programmes of Permanent admissions into care Commissioning Board work to achieve and maintain the homes – aged 65+ As detailed in the BCF plan constitutional standards. Patient/service user experience 2015/16 1-year targets detailed in the BCF Effectiveness of reablement. plan 2016/17 Delivery will be supported by implementation of the Better Care Fund Plan (BCF) – to aid the establishment of an integrated health and social care system that is: more efficient; reduces avoidable hospital admissions and facilitates early hospital discharge.

Developing services for the most Reduced non-elective admissions As featured in the Better Care To be established Monthly Development of a frailty service frail and vulnerable that enable Fund plan for Cumbria (2016/17) and end to end pathway – North them to lead independent lives for Fewer permanent admissions to (draft ready early February) Quarterly reports on BCF will be Cumbria longer residential care received by the HWB Board Delivery will be supported by To be established implementation of the Better Care Reduced length of stay Fund Plan (BCF) – to aid the Additional measure to be agreed establishment of an integrated To be established health and social care system that is: more efficient; reduces avoidable hospital admissions and facilitates early hospital discharge.

Establishment of Integrated Care Communities

Transformation of ‘landscape of care’ as outlined in Commissioning Strategy for Care and Support (2015/2020)

Extra Care and Supported Living Housing to be developed in Cumbria. Outcome 5: The system is put on a sustainable footing

Key area of activity Measure Baseline Milestone/1 Year Frequency of performance Programme(s) of activity Measure/Target3–year reporting Measure(s) or Target(s Ensuring that the capacity of the To be established paragraph 4.3 To be established paragraph 4.3 Will be agreed in May 2016 To be established HeadStart Capacity Building – formal and informal workforce from covering report from covering report making Emotional Resilience within the health and wellbeing everybody’s business

8 system is sufficient to meet needs Workforce development element of Cumbria Transformation Plan

BCT Success Regime Reducing the deficits and To be established paragraph 4.3 To be established paragraph 4.3 To be established paragraph 4.3 To be established paragraph 4.3 BCT pressures within the health and from covering report from covering report from covering report from covering report Success Regime care system Monthly

Cumbria County Council make Savings of £5million required in Savings made budgeted savings to meet budget Health and Care Services Adult Commissioning Strategy pressures Development of a 0-19 Integrated Healthy Child Programme for commencement April 2017

BCF Better Care Fund BCT Better Care Together CAMHS Child and Adolescent Mental Health Services CCG Clinical Commissioning Group CPFT Cumbria Partnership Foundation Trust HCP Health Child Programme HSCIC Health & Social Care Information Centre HWB Health and Wellbeing Board JCB Joint Commissioning Board LAC Looked After Children MHA Mental Health Act NWAS North West Ambulance Service PHA Public Health Alliance PHOF Public Health Outcomes Framework QOF Quality Outcomes Framework RTT Referral to Treatment TCP Transforming Care Partnership WHO World Health Organisation