Director of Public Health’s

Annual Report 2016 – Update on progress

Healthy People, Healthy Communities Update on progress Healthy People, Healthy Communities Introduction

Director of Public Health - Annual Report - Annex 2017

My 2016 Annual Report focused on how the physical environment in which we live and work affects our health, and the effects of our own choices and behaviour, such as smoking, eating a poor diet, using drugs or alcohol, and not being physically active. The report contained recommendations about encouraging cycling and walking, improving the food environment, and using planning powers to improve the physical environment with the aim of improving health. There were also recommendations on supporting community capacity and resilience to help people in communities tackle challenges affecting their health and wellbeing. Encouraging changes in behaviour was addressed through recommendations to deliver Making Every Contact Count, offer targeted health checks, and reduce variation in the identification and care of patients with diabetes.

The following pages provide an update on activity undertaken to implement these recommendations during 2017.

Barbara Brady Interim Director of Public Health for November 2017

01 Healthy People, Healthy Communities 2016 DPH Annual Report Recommendation Continue to invest in safe walking and cycling infrastructure developments linking people to jobs, training and services (including the development and delivery of a joined up, safe and well connected cycle network across the County).

Actions for: Bike shelters have been installed at County Council, District Councils Newark Sports and Fitness Centre to encourage cycling to/from the centre, Progress to end September 2017 which is located close to the Sustrans NCC has secured £2.15m of D2N2 LEP cycle track NCN 64. Newark and Local Growth Funds, to develop cycling Sherwood District Council also reports infrastructure. ongoing work with Nottinghamshire County Council /Via in connection with District Councils are developing cycling D2N2 funded Newark Cycling Strategy trails and investing in complementary Improvements. facilities such as improved cycling parking and secure cycle shelters at their District Councils are also supporting facilities. provision of footpaths and cycling provision within their local plans. Some examples are listed below: Council supports the In , projects have been provision of footpaths and cycling developed with partner organisations provision in relation to development and developers building on the work proposals via the existing Local Plan. that has already been carried out In Gedling, Policy LPD 58 (Cycle Routes, in developing the pedestrian and Recreational Routes and Public Rights of cycle network in and Way) is being put in place in emerging Rushcliffe. These include prevention of Local Planning Document. cycle crime, improving accessibility and linkages to the six key rural settlements Gedling Borough Council has in Rushcliffe and encouraging cycling completed feasibility work that supports and walking, leading to healthier the former Mineral Line between lifestyles and reduced traffic pollution. Netherfield and Gedling Country Park being open as a recreational walking Secure cycle shelters have been and cycling route to link communities, provided at Rushcliffe Arena, Holme schools and green spaces. Pierrepont Country Park and and Stragglethorpe pocket park and ride NCC Public Health is working sites, as well as improved cycle parking with transport planners to ensure in the six settlements and signage developments take into consideration improvements. population health needs, and to integrate the implementation of these developments with the Tackling Excess Weight Steering group (TEWS) plans.

02 Additional actions planned for In Gedling and Mansfield, adoption of the future local plans will seek improvement to West Bridgford, Mansfield and Newark accessibility including public transport, cycle networks will be completed by walking and cycling. Adoption of plan is March 2018. anticipated in summer 2018 in Gedling. Publication of draft plan is due in Spring Arnold/ cycle network is 2018 in Mansfield. scheduled for completion by March 2019. District Council expects to work with Via over the next In Ashfield, a Run Walk Cycle project 6 months to support the delivery of is planned for the district. This will planned cycle network improvements identify routes which need upgrading/ described above. creating and prioritise future projects/ investment.

2016 DPH Annual Report Recommendation Target travel behaviour change campaigns to inform, encourage and enable people to make more walking and cycling trips more often

Actions for: Two Cycle centres run by Ridewise and County Council, District Councils funded by Broxtowe Borough Council in Stapleford and Beeston ran until the Progress to end September 2017 end of September 2017 providing cycle Nottinghamshire County Council has training/advice and led rides. secured Department for Transport In July Broxtowe Borough Council Access Funding for Personal Travel in partnership with Nottinghamshire Planning (PTP) to complement the Police Crime Prevention team promoted above infrastructure developments. ‘Take Some Pride in Your Ride’ at £845K for work with businesses, Beeston Carnival, with posters sent to jobseekers, residents and school leavers schools/public places, on social media in Mansfield and Newark; £150K for PTP and to partners in Broxtowe. in Daybrook and West Bridgford to help address air quality issues. Broxtowe Cycling Quest has been promoted through the summer by In Rushcliffe, promotional activity takes Broxtowe Borough Council and place at public events - including try- Ridewise. The Cycling Quest consists it bike events, bike postcoding, route of 8 routes in the Borough for families planning and Dr Bike maintenance. and individuals to download and follow A programme of adult ‘bikability’ with a set of questions. The aim is to get training, guided cycle rides and people out on their bikes with friends bike maintenance training is being and family. rolled out across the borough. The Council also operates a bike to work promotional scheme for its employees. This work was covered in the Pedals Newsletter at pedals.org. uk/wp-content/uploads/2017/05/ PedalsNewsletterNo105

03 Other promotional activity in Broxtowe Additional actions planned for includes a promotional stand in the future Eastwood on 6 September - Stage Four Travel planning activity is scheduled of the Tour of Britain and promotion of as follows: Mansfield 2018/19; Newark cycle to work day on 13 September to 2019/20; Daybrook 2019/20 and West the public/partners and employees at Bridgford 2018/19. Broxtowe Borough Council. In Ashfield, promotional activity is In Gedling, targeted work continues anticipated e.g. Promote Cycle to work, with ‘Everyone Health’ to deliver guided Schools Active Travel, One You Walking walks in key sites e.g Gedling Country campaign. Park. Gedling Council-promoted ‘walk leaders’ continue to prove successful In Broxtowe there will be on-going locally in attracting local people to start promotion of cycling routes, trails, cycle walking in the area. The Cycle to Work security and other sustainable travel Scheme is also actively promoted and options at events and in public places used locally. (such as Libraries, Leisure Centres) until the end of March 2018. Mansfield Council supports the efforts to reduce car usage via the use of Mansfield DC anticipates ongoing travel plans within new developments. requirement for travel plans within Rushcliffe Council also works with major developments. developers to include modal change Newark and Sherwood District Council promotion within travel plans. plans further external promotion of Newark and Sherwood District Council Active 10 initiative in October with encourages staff to walk or cycle to follow up in the Spring of 2018. work following a move to new premises in town location. Secure cycle storage, showers, changing rooms, drying facilities and lockers are provided at Castle House. A Cycle to Work scheme was introduced Sept 2017 with the benefits of walking/cycling/ being active regularly promoted to staff via a staff wellbeing facebook page.

04 2016 DPH Annual Report Recommendation Continue to protect, increase and improve green space particularly in our most deprived communities and to improve access to open and green space for local residents

Actions for: County Council, District Councils

Progress to end September 2017 exercises which will help to add a NCC Public Health works together with richness of local knowledge and the County Council Planning division check and challenge to the findings. to ensure District Council Planning The second phase of consultation is Authorities adopt the Planning and underway focusing on neighbouring Health protocol. This incorporates local authorities, Sports and the these issues in its rapid Health Impact CCG. Assessment (HIA)/checklist for Planning In Gedling, LPD Policy 20 (Protection of and Health. The Protocol has so far been Open Space) and LPD 18 (protecting and formally adopted by Mansfield, Gedling Enhancing biodiversity) are being put and Rushcliffe Councils. in place in an emerging Local Planning In Ashfield, several green space Document. improvement projects were completed External funding was obtained and new including Milton Rise open space, play area and trim trail installed at Ley Titchfield Park and Butler’s Green (all Street in Netherfield. Warren Action ) 2016, and Acacia Avenue Group was supported to obtain external Recreation Ground, Annesley, August funding for a new multi-use games area 2017. on Muirfield Rec. Broxtowe District Council is working Gedling Council has funded a new towards Green Flag awards for its open parkrun at Bestwood Country Park, spaces. Broxtowe District has also after funding both an adult and junior secured funding to improve footpaths parkrun at Gedling Country Park in in green spaces and improve play areas. previous years. A play area refurbishment at Smithurst Road Giltbrook has been completed. Mansfield Council has recently adopted a Parks and Open Spaces Strategy which Rushcliffe has a new Borough wide outlines a Green Space Standard for playing pitch strategy (referenced access and quality across the District. in the Leisure Strategy) which will Part of the vision is to improve and safeguard sports pitches and secure maintain high quality green spaces and future investment. To ensure that the many parks are supported by Friends new strategy is robust it is important Groups which provide opportunities for to understand the current supply and community cohesion. demand for facilities. This involves a process of information gathering from a number of sources including desktop research and a range of consultation

Chapter 1 05 Use of parks and open spaces to support reducing dog fouling along the routes. healthier lifestyles is also encouraged Bassetlaw Parks & Open Spaces have and a specific objective states that over the past year organised seven Mansfield Council will work with events during the school holidays on the public health, education and local skate parks with Extreme Wheels who communities to tackle poor health and put on roadshows to encourage young obesity. people to take part in activities such as Newark and Sherwood District Council BMX riding and skateboarding. playparks went Smokefree in summer 2015 – there is a voluntary ban in Additional actions planned for place, and links with local schools who the future designed the signs. Further improvements in Ashfield are planned to Warwick Close open space, Green Flag awards have been received Kirkby (within one of five priority areas for 4 District Council sites and 1 Newark in Ashfield) and to play areas at the Oval Town Council site. Improvement and Ashfields Estate, all by March 2018. projects have been implemented at Sconce & Devon Park, A new open space at Halls Lane Country Park and Sherwood Heath Local Giltbrook will be transferred to Broxtowe Nature Reserve (LNR). Borough Council in early 2018. This includes footpath routes. New open A voluntary ban on smoking in play spaces at Smithurst Road Giltbrook are areas was adopted by Bassetlaw DC expected to be created by Autumn 2018 Cabinet 5th September 2017 following consultation with both the public and The Rushcliffe playing pitch strategy will other key stakeholders. Results from the cover a 10 year timescale from 2017- consultations showed levels of support 2027 (with an interim update after 5 for the voluntary ban of over 90%. years). Adoption of healthy options in park Adoption of Gedling plan is anticipated concessions is included in Bassetlaw in summer 2018. Policies will be DC Parks and Play Policy agreed by implemented through determining Bassetlaw DC Cabinet 5th September planning applications (weight to be 2017. given to policies increases following adoption). Green spaces in Bassetlaw are being maintained to encourage people to use Gedling Council is working jointly with the sites for activities such as football, Sports Nottinghamshire to develop golf, bowling, cricket and health walks. a Healthy Lifestyles Strategy for the Borough. Bassetlaw DC has worked with the Dogs Trust on a pilot project aiming to help reduce dog fouling within parks in addition to promoting healthy lifestyles for both humans and pets. The pilot has involved creating a number of walks within one of BDC parks which have adequate waste bins along the routes to encourage their use. Initial results have shown good local support for the walks and potential indications regarding

06 A key Objective within the Mansfield NSDC aims to retain all Green Flags (July Draft Local Plan seeks to promote health 2018) and wellbeing by ensuring everyone has Bassetlaw reports that the next period access to a good range of good quality will also see a Family fun day organised green space, green corridors, cycle for the October school holiday within trails, leisure and community facilities Langold Country Park with lots of and well planned green infrastructure. activities for younger children which (Publication Local Plan Spring 2018) will be free of charge. This allows Mansfield plans to implement the newly everyone to be involved with the adopted Parks & Open Spaces Strategy – activities on the day. with immediate effect. Bassetlaw play sites are also being NSDC will approach family friendly developed using funding from local licensed premises to join in with developments, for both District Council Smokefree playparks. Follow up spring and Parish Council play sites. 2018. NSDC plans to renew Vicar Water Country Park play area (April 2019)

2016 DPH Annual Report Recommendation All public sector organisations should provide healthy food for staff and visitors in line with what the NHS is doing

Actions for: healthy food choices / options along Public Sector organisations with nutritional advice throughout the day event. Progress to end September 2017 Council is silver Some Council premises are signed accredited for Work Place Health and as up to the Healthy Options Takeaway part of this includes nutrition and diet (HOT) merit scheme. Other district and advice within a programme of activities. borough councils have been contacted. Healthy options are available in the Civic At Rushcliffe Borough Council, catering Centre Café. includes healthy options buffets and Kelham Hall Ltd (who provided food at vegetarian alternatives. An annual previous Newark and Sherwood DC HQ) Nutrition & Hydration awareness week was awarded the HOT merit. The new is held as part of the Workplace Health District Council offices do not have food Award scheme. provision. Gedling Council doesn’t have a canteen facility but does run a very successful

Health Fare that promotes (and provides)

07 Additional actions planned for MDC will be encouraging and the future supporting other local organisations to As part of working towards the Gold become Work Place Health Accredited - Health award, Rushcliffe Council ongoing expects Borough owned or operated Café 1920 at National Civil War Centre in food concessions will have a healthy Newark has been approached regarding food offer as a default position in future HOT merit. Follow up due October procurement. 2017. It is also planned to follow up with Nutrition and Hydration Week planned Rumbles cafe at Sconce and Devon in Rushcliffe 12-16 March 2018 Park to get them merited to extend availability of healthy food options. Mansfield District Council aims to Follow up in October 2017. maintain silver accreditation – ongoing

2016 DPH Annual Report Recommendation Continue to increase the proportion of fast food businesses who take part in the Nottinghamshire Healthy Options Takeaway (HOT) merit scheme

Progress to end September 2017 Additional actions planned for NCC Public Health leads the the future development of the HOT merit Individual districts will continue to scheme working with District Council promote the scheme. Environmental Health Officers. The aim Rushcliffe has set a target to add another is for all districts to sign up a minimum 12 businesses by the end of March 2018. of 12 businesses. Broxtowe has scheduled follow-up visits As of 31 July 2017, 125 businesses were with 15 premises, and identified another signed up to HOT with a distribution 6 food businesses as potential sign ups – across the districts as follows: initial visits to be held by end December Ashfield 46 2017 Bassetlaw 12 Gedling plans a targeted approach with Broxtowe 3 a number of retailers who the Council Gedling 8 feel could benefit from the scheme. Newark & Sherwood 9 Mansfield 23 Newark and Sherwood DC is following Rushcliffe 25 up with three outlets who have expressed interest in joining the District Councils report active scheme. Other premises will be revisited, monitoring, follow up and promotion who have expressed an interest but not of the scheme within their areas. For completed the self-assessment. example, Bassetlaw DC promoted the NSDC will continue to use a mapping scheme on line with a video and ran tool to identify and focus on outlets in a promotional campaign. Gedling areas of deprivation and high levels of Members and officers are continuing to obesity. promote the scheme and its merits as a part of all food premises inspections and New digital self-assessment form should visits through the year. make it easier for businesses to sign up.

08 2016 DPH Annual Report Recommendation  Ensure that planning applications for new developments prioritise the need for both adults and children to be physically active as part of their daily life  Work with developers to promote active travel and ensure that developments are appropriately designed  Work with developers to provide new green, safe, accessible and pedestrian-only spaces and to improve the quality of existing green spaces  Utilise planning powers to restrict the number of fast food outlets in line with NICE guidelines  Encourage house builders to use the Building for Life 12 government endorsed industry standard for well-designed houses and neighbourhoods.  Encourage housing developers to up to the Building Research Establishment (BRE) Home Quality Mark (HQM) scheme.

Actions for: District Councils Progress to end September 2017 Adopted ACS Policy 10 Design and Districts are addressing some of Enhancing Local Identity. Supporting these elements through section 106 text encourages improvements in agreements and through negotiation environmental performance and with developers for provision within energy efficiency but there is no new development. specific reference to HQM Scheme. Council reports: Mansfield District Council has worked with Public Health Nottinghamshire Engagement with developers through County Council and the Town & each individual planning application Country Planning Association to and S106 contributions. look at building healthy places. This Gedling Borough Council reports: is an area of special interest to the Policy LPD 35 (Safe, Accessible and Nottinghamshire Health and Wellbeing Inclusive Development) being put Board and Public Health which have in place in emerging Local Planning championed the role of planning Document. and health and well-being, as a key priority of the Nottinghamshire Health Policy LPD 54 (Fast Food Takeaways) and Wellbeing Strategy, to develop will restrict fast food outlets close healthier environments within local to schools and seek to prevent health communities. There was a joint unacceptable concentrations of workshop which brought together a outlets. Policy being put in place in range of disciplines from health to emerging Local Planning Document. planners and developers to gain their Policy LPD 37 (Housing Type, Size collective perspective on building and Tenure) and supporting text healthy places. The project reinforced refers to Lifetime Homes and latest the need to bring together Government technical Standards

Chapter 2 09

Additional actions planned for and develop ways of working between the future Planning Authorities, Public Health and Ashfield District Council: Developers. The round table discussion Implementation of elements as part of encouraged listening and networking forthcoming policies within the Local to encourage the dialogue about spatial Plan and consideration of the Council’s planning and its important role. adopted Supplementary Planning Document Design Guide Newark and Sherwood District Council reports: Gedling Borough Council – adoption of Local Planning Document anticipated All major housing developments are in summer 2018. Policies to be making an appropriate contribution implemented through determining to green space provision, planning applications (weight to be improvement and maintenance, given to policies increases following either on-site or via off-site adoption). Timescale on-going. commuted payments. Mansfield District Council: As part of The District Council seeks through preparing the site selection criteria the policies of the plan to promote to select the Preferred Local Plan sustainable transport. This includes sites for residential development, through travel plans and the consideration will be given to how promotion of well-designed schemes. new development can contribute to The District Council has not at this local residents living healthier and time agreed to utilise planning more active lifestyles. For example powers to restrict fast food outlets. sites that can potentially contribute NSDC aims to encourage the highest to enhancing green infrastructure standard in the delivery of new linkages within the district are favoured development; however this has to be as it encourages residents to walk and done within the context of scheme cycle rather than use the car – Spring viability. 2018. The Publication of the Local Plan will itself be subject to a Health Impact Bassetlaw has identified a lead Officer Assessment – Spring 2018 and actions in BDC Health and Wellbeing Plan 2017/2020 to progress Adoption and implementation of these recommendations. the New Local Plan for Bassetlaw – proposed adoption 2019.

10 2016 DPH Annual Report Recommendation

Endorse the “Spatial Planning for Health and Wellbeing of Nottinghamshire” document Secure support for the Nottinghamshire ‘Planning and Health Engagement Protocol’.

Actions for: In Bassetlaw, a lead Officer and action District Councils are identified in BDC Health and Wellbeing Plan 2017/2020 to progress. The Protocol has so far been formally This is also referenced in the Council adopted by Mansfield, Gedling and Plan 2017/20. Rushcliffe Councils. Rushcliffe reports use of the document Additional actions planned for and protocol in order to assist in the the future determination of planning applications, Mansfield plans to implement with and when drawing up planning policies immediate effect, both the ‘Spatial for the development of land. Planning for the Health & Wellbeing of Nottinghamshire, City and In Gedling, the Cabinet approved Erewash’ Protocol and the engagement the Health & Wellbeing Checklist for protocol. use in Local Plan policy preparation and determining major planning In Gedling, policies will be implemented applications. The Borough Council through determining planning also responded positively to the applications. Timescale on-going. consultation on the Planning and Health Health is a golden thread running Engagement Protocol (17th January through Ashfield District Council’s 2017). submitted plan. The protocol has not Ashfield District Council has developed yet been endorsed by Cabinet as it was a new validation list, presented to not considered urgent as the Council is planning committee on Thursday 28 already doing a lot of the actions. September 2017 for approval. It also Bassetlaw DC will seek to endorse the requires health impact assessments elements of the protocol where they (HIA) on larger housing schemes. align with the council’s wider strategies. Newark and Sherwood District Council has not formally endorsed the Spatial Planning document however through the work of the Council’s Planning teams is addressing its aims. NSDC works closely with the NHS on strategic and site specific planning matters including participation at the Mid Notts Local Estates Forum. It is the Council’s approach to engage the CCG as early as possible in major development schemes.

11 2016 DPH Annual Report Recommendation Continue to support the voluntary and community sector in order to improve health and wellbeing

Actions for: There is joined up working with both Local Councils Mansfield & Ashfield CVSs around the Health & Well Being Agenda eg Progress to end September 2017 Get up and Go Events, Self Help UK, The Voluntary and Community Older Person Group, Dementia Action Sector (VSC) is represented on the Alliance, Walking Groups, Social ‘Sustainability and Transformation Plan Prescribing. (STP) workstream for prevention, self- Ashfield also has a START- partnership care and independence. project with Sport Nottinghamshire to Examples of district council activity: develop community projects to increase activity. Bassetlaw Council has an annual grant scheme to fund voluntary, Mansfield promotes physical activity community and social enterprise within the community; supports local organisations. In 2016/17 this supported sports clubs to develop, improve and a range of activities in the VCS, become sustainable; provides cooking including for children and young and nutrition education to community people, older people, and vulnerable groups and schools. groups. Activities improving health Gedling Council in this area and sees and wellbeing included support for this as the area for continual effort and organisations tackling drug and energy, for example: alcohol addiction, homelessness and bereavement. Men in Sheds – the group has increased their attendance by In partnership with Voluntary Action socially isolated older men – Council Broxtowe, Nottinghamshire County supported and promoted. Council and Citizens Advice Broxtowe, the first Broxtowe Community The Arnold Mental Health and Voluntary Sector community Be Friending Service (Arnold conference was held on 9th March 2017, Methodist Church) – Council entitled ‘Reach Out and Connect’. An supported and promoted providing outcome from the conference was to essential community support to the create a South Broxtowe Community most vulnerable in the area (with Forum (complements the forum in the support from Nottinghamshire north of Broxtowe). The first meeting County Council co-production team was held on 18th May 2017. A follow to strengthen community capacity up conference in Broxtowe titled and create resilience) “Working Together” was scheduled for The Council has asset transferred 19 September 2017. Eagle’s Nest Community Centre in In Rushcliffe, the Council has a service Arnold which is now a community level agreement with Rushcliffe CVS to hub seeking to address social deliver the volunteer centre as part of its isolation amongst vulnerable local contribution to promote the five ways to people wellbeing.

12 The Beacon Project has been Newark and Sherwood has an Arts supported and a new community Development fund which supports a hub opened in Killisick offering local varied programme of arts and creative health and wellbeing service activities for older people across the district, targeting local charities such A new support group for parents as MIND and Reach and with autistic children, ‘The Complete Workshop, Men in Sheds, Live at Home Puzzle’ has been offered advice and and dementia support groups. Also start-up funding and is now opened targeted rural villages such as Bilsthorpe in Bestwood Village. and Clipstone, and groups in need Gedling Homes was supported to such as our homeless families, Syrian establish Dementia Memory Cafés in families, and low-income families. Mapperley and Netherfield. The Gedling Community Development Additional actions planned for Partnership brings together the future commissioned community workers Council will support to ensure community resources and a range of voluntary organisations capacity is built to full effect in Gedling. delivering activities around health and Newark and Sherwood District Council wellbeing in 2017/18. reports two events with Self Help UK Constitute Mansfield and Ashfield – on diabetes awareness and cancer Dementia Action Alliance (Autumn awareness. The diabetes event led to 2017) Diabetes UK looking into forming a local Mansfield DC will review the current support group. Active Volunteers Policy. NSDC also provides ongoing support Gedling plans to support the community to community groups to develop to develop a Mental Health Crisis Café. community engagement programmes Gedling is also considering options for a such as Petanque clubs, Friends of community and voluntary hub to work Groups, Dementia Friends through alongside other statutory partners at NSDC grant aid support and Section 106 the Civic Centre/Jubilee Depot site in investments as appropriate. Arnold. There is weekly monitoring of local In future, Gedling plans to roll out a media and social media accounts for programme of community asset transfer sharing information via the councils’ of community centres to develop Active4Today websites and social media community hubs promoting well-being channels. in local neighbourhoods. NSDC supports joined up activities Continued support for Newark and with the Sports Development Team Sherwood parks-based volunteer at Active4Today such as Larks in groups. the Park programme (circus skills, hooping for fitness, sports challenges). Establish community priorities in the Halloween lantern walks, fitness western area of Newark and Sherwood trails, bird watching walks, fungi district to identify priority community walks etc. The parks also benefit from projects. continued support for park-based volunteer groups. Active4Today also work in partnership with N&S CVS to undertake older people’s work delivery, encouraging them to stay active, attend local groups and socialise with others. 13 2016 DPH Annual Report Recommendation Enhance social prescribing and related initiatives to help individuals and communities to tackle challenges affecting their health and wellbeing and reduce social isolation

Actions for: isolation. All the GP practices within HWB partners Bassetlaw are signed up to and are referring into the scheme. The benefits Progress to end September 2017 of participating in the scheme seem to Rushcliffe CCG is currently developing be being maintained, with a number a Social Prescribing model. NCC Public of patients engaging in the activities Health has input into the model’s on an ongoing basis, and some even development to ensure physical activity becoming volunteers themselves. and mental health early prevention is Another aim of the scheme was to considered. “grow” the voluntary sector i.e. increase capacity in order to provide ongoing The 12 month social prescribing pilot support to referred patients. will involve working with communities to grow resources to meet health and Following referral, information is fed wellbeing needs and build a network back to the patient’s GP on what the of supported health coaching and agreed plan is. volunteer roles. The social prescribing team is now As part of being a registered site for an integrated part of the integrated Enhanced Primary Care, Rushcliffe neighbourhood management teams CCG is required to deliver systematic in Bassetlaw and is also involved in the self-care support for people with COPD emergent primary care home mode. (chronic obstructive pulmonary disease), Direct feedback from patients and from diabetes and with 3 or more long term GPs is almost universally positive and conditions. it is an approach which it has been Rushcliffe Council is contributing to identified has potential across a wide the social prescribing model as part of range of other target groups. the pilot project. Related activities in Bassetlaw District Council reports Rushcliffe include supporting projects engagement with the GP social via the Healthy Lives Healthy Futures prescribing scheme through the Fund and promoting health related Council’s Leisure Management Trust. initiatives via the Rushcliffe Reports An outreach scheme to develop newsletter for residents. seated exercise programmes and falls Bassetlaw CCG has been commissioning prevention activity has been developed. a social prescribing scheme locally Bassetlaw District Council is also for 2 years. It has proved extremely working to engage with service resistant successful both in terms of patients’ adults – Blue Light Project operational own self-assessment against the since January 2017. The project has 9 Independent Living Star, and in terms referrals, a part time worker in post and of a reduction in the use of statutory over 100 partner staff trained. primary care services. The target group to date has been those over 65, particularly those at risk of social

14 There are initiatives to develop Additional actions planned for social prescribing in other parts of the future Nottinghamshire. In Newark and A social prescribing pilot launched Sherwood, Newark MIND is involved in at the end of October 2017 in three a bid for social prescribing activity. practices across Rushcliffe. After three months the pilot will be rolled out to Other activities to address social all 12 practices. The pilot will run for 12 isolation and social exclusion have been months until the end of September 2018. reported specifically, as follows: Evaluation will be conducted mid-year An Age Friendly pilot project in to inform decisions on continuation. partnership with Nottinghamshire Bassetlaw CCG is considering extending County Council has been launched in the age range, and accepting referrals Beeston wards of Broxtowe to reduce for certain mental health conditions. social isolation. In Bassetlaw, the number of people The Mansfield Museum has set up completing the referral pathway will be ‘dementia café’ events which aim to reported at the end of the year. Further reduce isolation and loneliness for falls prevention activity is planned those with dementia and their carers before the year end. too. Bassetlaw will work to secure external As part of working with Framework funding to continue this activity. to deal with rough sleepers, Mansfield Council is working with Dear Gedling Council will be exploring Albert who specialise in mutual aid funding opportunities with partners facilitation, peer mentoring and for implementing a social prescribing making recovery from drugs/alcohol model in Gedling. more visible by bringing together Mansfield Council plans to Implement existing resources. the Lighthouse Scheme - working in In Mansfield the Sanctuary Café aims partnership with the Lighthouse who to reduce use of primary care and provides comprehensive support to A&E by people in crisis including people that are wanting to change their those with mental health, drug chaotic lives away from substance and alcohol issues, by providing misuse. alternative support. Working in partnership Mansfield Council will fund the provision of a winter shelter during severe weather and implement the Men in Sheds project to enable men who are in need of peer support to have somewhere to go and develop gardening skills but also have someone to talk to.

15 2016 DPH Annual Report Recommendation The development of community capacity, empowerment and resilience should be a key component of the next version of the Joint Health and Wellbeing Strategy.

Actions for: Additional actions planned for Health and Wellbeing Board the future Stakeholder consultation from 6th Progress to end September 2017 September to 3rd November 2017. The refresh of the Health and Dedicated HWB session to receive Wellbeing Strategy was planned, results of consultation 8th November including identification of timeframes, 2017. Final Health and Wellbeing stakeholder analysis, and development Strategy to be signed off in January of a consultation draft. Vibrant and 2018. Supportive Communities is identified as an element of the new strategy within the consultation draft.

2016 DPH Annual Report Recommendation Protect resources which enable the ongoing delivery of activities related to diet and exercise, alcohol and tobacco use.

Actions for: Additional actions planned for County Council, NHS Partners the future Intentions for future Public Health Progress to end September 2017 services commissioned by the County Forward budget plans for use of Public Council are due to be considered by Health grant enable ongoing delivery the Adult Social Care and Public Health of activities related to diet, exercise, Committee of the County Council in alcohol and tobacco use. Contractual early 2018. arrangements are currently in place Gedling Borough Council has led for delivery of Obesity Prevention an innovative Expression of Interest and Weight Management Services, to Sport England’s Families Fund in Substance Misuse Services and Tobacco partnership with Ashfield, Mansfield Control. and NCC Public Health. If successful, inactive families from lower socio- economic backgrounds, many of which who are engaged in the Troubled Families programme, will be empowered to become more active. The learning and evaluation by Nottingham Trent University will inform future commissioning.

16 2016 DPH Annual Report Recommendation All those organisations represented on the Nottinghamshire HWB Board have an implementation plan that secures the delivery of Making Every Contact Count to include: Identification of a Board Level Public Health Champion with responsibility for MECC Inclusion of MECC in the mandatory training programme for all appropriate frontline staff. Working with local Health Education providers to include MECC in local graduate and post-graduate training programmes for relevant staff.

Actions for: Some districts report individual HWB Partners participation in the MECC plan. Gedling Borough Council has a Cabinet Member Progress to end September 2017 for Health, Housing and Wellbeing and a Health and Wellbeing Board received Director post with health and wellbeing a paper on Approaches to Disease as a significant part of their portfolio, Prevention to support a wellbeing who together with a small dedicated approach combining Making Every team, provide input into the action Contact Count (MECC), the Tobacco plan. The Gedling Health and Wellbeing Declaration and the Wellbeing@Work Delivery Group coordinates delivery scheme. Following on from this, a of local partnership at a district level. PH Wellbeing Operational Group was At Mansfield District Council, health established to formulate a collaborative has been included within corporate approach, communications strategy priorities and specific priority areas in and resources. An online training line with the Nottinghamshire Health programme was identified supporting a and Wellbeing Strategy will be featured range of training options. in service plans. Promoting Wellbeing, Independence and Self Care Steering Group has been Additional actions planned for

established, covering Nottingham City the future Identification of opportunities will and Nottinghamshire County. A Sub include MECC in Health Education Group was established to coordinate England programmes and local Health and link MECC into the wider Literacy programmes. Promoting Independence agenda (MECC plus) Identification of Board level champions will form part of the Health and Support is provided to the CCGs to Wellbeing Strategy refresh due by help measure the quality improvement January 2018. plans that encourage care providers to continually improve the health and Significant stakeholders identified from wellbeing of their staff and service users. the Steering Group work will form a peer network. All local hospitals, through support from PHE, have completed a self- A workshop was planned for the 29th assessment which has enabled them November regarding how MECC can to reflect on and evaluate how they be taken forward in an organisation embed health and wellbeing across their and how training and support can be organisations. provided to organisations.

17 2016 DPH Annual Report Recommendation GP practices target those on their patient lists eligible for the appropriate health check that are most likely to be at high risk (5 yearly NHS Health Check for those aged 40- 74).

Actions for: a) Practices have become more GP Practices proactive (with the help of CCG and Public Health input) Progress to end September 2017 b) Increased use of text message Nottinghamshire County Council Public reminders Health is using commissioning levers to incentivise practices to prioritise those c) Inclusion of health check uptake in most likely to be at high risk, overseeing CQC inspection criteria implementation of new IT system to d) Top tips in health check newsletters underpin this. Monitoring elements of the new system were configured and As well as providing the comparative live by end September. data for practices Bassetlaw CCG has focussed on identifying patients at risk All practices have been issued with of diabetes and providing interventions, the 2017-18 Locally Commissioned both through in house structured Public Health Service (LCPHS) contract education sessions and joining and updated health check service the National Diabetes Prevention specification. New IT system to support Programme. In the first few months practice targeting of at-risk groups is following the launch of that programme live (except Bassetlaw practices planned 175 completed referrals have been to go live April 2018). made. Rushcliffe CCG identifies that one of the changes in the new service specification Additional actions planned for relates to all health checks including a the future HbA1C blood test as standard to support PH and Connected Notts to advocate the identification of pre-diabetes. development of Yorkshire IT systems to ensure seamless interface with Overall in Rushcliffe, the number of Connected Notts health check system offers made reduced this year, in line by April 2018. with many other mature programmes across England such as the National PH to monitor impact of high risk Diabetes Prevention Programme incentivisation by end December 2017 (NDPP), but the proportion of uptake of in order to plan for 2018-19 contracts. those offers made has increased. This Practices are continuing to undertake may be in part to do with the following: the above and this is being monitored

18 2016 DPH Annual Report Recommendation GP practices systematically and consistently invite relevant individuals from their patient lists for annual Learning Disability health checks.

Actions for: learning disabilities. It is recognised GP Practices that this group have low take up and the project aims to engage GP practices in Progress to end September 2017 promoting the screening and embed Practices are commissioned under an processes in order to influence future enhanced service by NHS England to GP Practice activity. deliver the following: Bassetlaw Practices receive direct “This Enhanced Service is designed comparison data with their peers and to encourage practices to identify all discuss approaches for different groups patients aged 14 and over with learning within that cohort, have an agreed disabilities, to maintain a learning template for review completion and disabilities ‘health check’ register and have received facilitation and hands offer them an annual health check, on training. In 16/17 there was an 83% which will include producing a health completion rate (489/588) but still some action plan.” variation in practice scores which is addressed individually with them. PHE Learning Disability Profile (2013/14) showed that 1995 people (52%) of those 18+years with a LD in Nottinghamshire Additional actions planned for

accessed a GP health check. A Parity of the future Potentially, could see improvement in Esteem Task & Finish group has been set the uptake of LD health checks by April up to develop a Framework for Action 2018. with the aim of improving LD health check uptake. Parity of Esteem action ASCH has started work on an Adult plan was in place by Sept 2017. Learning Disability JSNA chapter which will identify health needs and service In addition to this, Rushcliffe practices gaps. are being commissioned on a short term basis to have an increased focus on increasing uptake of the four NHS Cancer Screening Programmes (Abdominal Aortic Aneurysm, bowel, breast and cervical) in people who have

19 2016 DPH Annual Report Recommendation CCGs and GP practices should reduce variation for the identification and care of patients with diabetes, with the aim of all practices achieving at least the national average.

Actions for: Additional actions planned for CCGs, GP practices the future CCGs / NHS England to continue to Progress to end September 2017 monitor practice variation in diabetes All the CCGs and NHS England care and provide feedback on best monitor and provide data to practices practice. highlighting variation and promoting The work is ongoing and any milestone best practice in diabetes care with the deadlines are set by the STP timeline. aim of ensuring that all patients access the same high standards of care. Review results of the annual National Diabetes Audit to identify areas for CCGs have encouraged all practices improvement. to participate in the annual National Diabetes Audit to enable benchmarking Notts South working group has and identify unwarranted variation. developed a Diabetes Management Plan for Patients with Diabetes to support CCGs address variations in quality of them in managing their own care – this care through service improvement is due to be rolled out by October. and enacting clinical network recommendations. Rushcliffe CCG has a target for 2017/18 to refer 337 patient to the Diabetes This recommendation – and the one Prevention Programme and 397 patients below - has been included in the have been referred to date. STP: in Mid-Notts this sits with the Diabetes Working Group and in Greater Bassetlaw CCG is increasing the Nottingham it sits with the Primary Care provision of structured education - Long Term Conditions Group. for patients who have diabetes in the second half of 2017/18, with an incentive Rushcliffe CCG includes personalised scheme to support completed referrals. care planning as part of the long term All practices complete the national conditions care standard for people with diabetes audit. diabetes. Rushcliffe CCG is also part of the Diabetes Prevention Programme where over 300 patients have been identified at high risk of developing type 2 diabetes. Bassetlaw CCG has a Locally Enhanced Service to provide in house pre-diabetic education and support the launch of the National Diabetes Prevention Programme.

20 2016 DPH Annual Report Recommendation A similar approach to identification and care of patients is rolled out across the other long term conditions that contribute most to ill health and demand for the use of NHS and care services.

Actions for: CCGs

Progress to end September 2017 Additional actions planned for the future Standardised case finding and CCGs / NHS England to continue to Personalised Care Planning is in place monitor practice variation in long term across all practices within Rushcliffe conditions care and provide feedback CCG. This is supported by systematic on best practice. and standardised operational procedures and clinical system templates. The work is ongoing and any milestone deadlines are set by the STP timeline.

21 Update on Progress Annual Report 2016 Director of Public Health’s facebook.com/nottinghamshire Nottinghamshire NG2 7QP Nottinghamshire Public Health, CountyHall, T E W 0115 9775781 [email protected] nottinghamshire.gov.uk @NottsCC

D&P/11-16/ASC&PP/70870