Warwickshire Health and Wellbeing Interim Strategy
Health is something that we collectively share not individually consume.
Inequalities in health arise because of inequalities in society – in the
conditions in which people are born, grow, live, work, and age. So close is the
link between particular social and economic features of society and the
distribution of health among the population, that the magnitude of health
inequalities is a good marker of progress towards creating a fairer society.
Taking action to reduce inequalities in health does not require a separate
health agenda, but action across the whole of society.
Professor Sir Michael Marmot
Marmot’s key enablers of equity:
1. Giving every child the best start in life
2. Enabling al children, young people and adults to maximise
their capabilities and have control over their lives
3. Creating fair employment and good work for al
4. Ensuring a healthy standard of living for al
5. Creating and developing healthy and sustainable places and communities
6. Strengthening the role and impact of il -health prevention
1) The purpose of this strategy
2) Resourcing health and wel being
3) Introduction and context
4) Our priorities explained
• Mobilising communities to develop and sustain their independence, health and
• Improving access to services
• Public agencies – working together
5) Our Vision for Warwickshire
6) Our Life Course Approach
7) Wider determinants of health and wellbeing
• Care and support at home
• Freedom from poverty
• Smoke free Warwickshire
• Living in Warwickshire
• Safer communities
• Schools and education
8) Reshaping the delivery of care
• Leading successful improvements
• Evaluating collective views on health and wellbeing
9) Health and wellbeing – building success
• Children and young people
• Healthy lifestyles
• Reducing health and wel being inequalities
• Ill health
• Older people’s needs
10) Turning the strategy into action
Appendix 1 Our Baseline Performance
The Purpose of our strategy
The Health and Wel being Board (HWBB) is a body tasked with the improvement of the
health and wel being of the population. It is required by Government to produce a formal
strategy outlining how it wil achieve these improvements. The Board wil be guided by the
intelligence and information contained within Warwickshire’s Joint Strategic Needs
Assessments (JSNAs) which can be found at www.warwickshire.gov.uk/jsna
and the Joint
Director of Public Health’s Annual Reports which can be found at
Using the JSNA tools, data and intelligence, and the Joint Director of Public Health’s Annual
Report 2012, all partners and statutory agencies can inform and influence their decisions
and policies to impact positively on the health and wel being of the population. It is a
fundamental principle of the Health and Wellbeing Strategy that all organisations will work
together to target agreed investment and efforts to where they are needed most and
proven to have the greatest effect.
The strategy wil continue to be informed by extensive engagement with not only our key
stakeholders (public representatives, clinicians and service providers, local authority
professionals and emergency services staff), but also by the public at large through a variety
of approaches – community forum discussions, special interest groups, engagement with
parent – teacher associations, Foundation Trust Governors and patient groups.
This Strategy offers a way of using our current health and social care services to best effect
and puts forward evidence-based measures that all Warwickshire’s major statutory and
independent sector bodies can adopt in order to improve the wel being of our residents.
Resourcing health and wel being
It is important to acknowledge that the wide range of organisations and services that
support the health and wellbeing agenda are in a period of significant financial challenge.
District and County Council budgets have been reducing under the current spending review
period and wil continue to reduce under the next one. Health budgets are not falling in cash
terms but demographic pressures are not being funded and are therefore driving the need
to continue to find significant savings and productivity improvements. It is not clear if or
when any of the key financial recommendations from the Dilnot review will be implemented
to help to manage the financial position locally. In the private and voluntary sector many
traditional sources of income are reducing, and the outlook for the economy and the
business to be won from public services is far from certain.
However, improvements in the use of public funds to promote health and wel being and to
provide care and support for those who need it are stil achievable. This strategy should
change where spending is focussed as services are reshaped, resulting in new costs and new
savings. This strategy does not quantify the potential financial impact of the priorities
proposed but key organisations and stakeholders wil need to ensure appropriate business
cases and plans are in place for particular initiatives before they are implemented. Crucially
this strategy is seeking to find ways to promote and champion early intervention and
prevention that by its very nature wil achieve savings and improved outcomes for
We need to use our current health and social care services to best effect and put forward
evidence-based measures that all Warwickshire’s major statutory and independent sector
bodies can adopt in order to improve the wellbeing of Warwickshire residents. We feel the
partnership approach to formulating and delivering this strategy will help avoid duplication
of effort and allow us to support and challenge each other in our delivery. We will always
consider how to deliver our services from a value for money perspective, making the most
of community assets and encouraging and stimulating change and innovation where
Introduction and Context Our aspiration is that:
“In Warwickshire people wil live longer, in better health and be supported to be
independent for as long as possible. We will see the people of Warwickshire free from
poverty, have a decent standard of living and no child wil start their lives at a
disadvantage or be left behind.”
This strategy identifies both the challenges we in Warwickshire face in achieving the very
best health for ourselves and the opportunities now available to us to dramatically improve
our health and wel being.
Warwickshire has an ageing population, in part because we are living longer, in part because
older people choose to retire here. Both trends are to be welcomed. Living longer and well,
must be a key goal for any compassionate society.
However, this county stil demonstrates unacceptable differences in life expectancy
between the north and south, between those on low incomes and those who are
comfortably off. In addition, despite being a relatively prosperous county, Warwickshire is
ranked 128th out of 142 local authority areas when it comes to ‘happiness’. Worryingly,
Warwickshire’s Observatory Quality of Life report shows that one in five people spend at
least ten percent of their income on fuel bil s and a quarter of children do not eat breakfast.
A rural county poses particular problems in accessing health and social care, whilst older
people are more limited in their own personal mobility and transport options.
This strategy is not a reference document to al key services. It highlights the highest
priorities, that if addressed would make the most significant difference to reducing our
health deficit. Many services are working extremely well in Warwickshire and provide high
quality care and support. These services are not the focus of this strategy, though they wil
in due course express their own strategic ambitions.
We have attempted to chart a path forward to a better, healthier and more independent life
for all Warwickshire residents. This is our ‘Life Course approach’,
and there are three aspects
of that path to improved health and wel being:
• Mobilising communities
• Improving access to services including 24/7 access to care
• Public agencies - working together
As Sir Derek Wanless pointed out, without the “full engagement” of al our citizens the
health and social care we seek will become unaffordable by the 2020s. The demand for care
by an ageing population wil be unsustainable if we do not improve our health in old age by
sensible preventative measures and offer more care and support closer to people’s homes
and neighbourhoods where informal support can also be offered. That in turn wil require
greater attention being paid to supporting carers and community infrastructure.
We also recognise that we have constructed a health and social care system that for many
of our residents appears to disappear at six o’clock on a Friday evening only to reopen at
eight o’clock the following Monday, unless it is a bank holiday! That experience is rare in all
other aspects of our society where supermarkets may be open 24/7, and the rest of the
service sectors work through the weekend.
Some of our Primary Care services are already looking to address this problem. Larger
practices are planning an integration of medical, nursing and social care with pharmacy and
even short stay care. The use of tele-health, e-medicine, remote alarm screening and the
development of nurse practitioners will make round the clock care sustainable and will
prevent the hospital admission that often leads not to cure but increasing dependence.
Some commentators now suggest that up to a third of current hospital admissions could be
avoided with such developments. That in turn will radically change the way our hospitals are
We have created environments in which healthy lifestyles are ever harder to maintain. And
the very fact that there are identifiable groups exhibiting health compromising behaviours
demonstrates that they do not result from random irresponsibility.
The evidence of the ban on smoking in workplaces and enclosed public places demonstrates
how individual changes in healthy lifestyles can be supported by col ective action. The Police
with zero tolerance of domestic violence, bearing down on speeding drivers and addressing
anti-social behaviour are as engaged in improving our health and wellbeing as our
immunisation and vaccination service. We are committed to the Department of Health’s
policy of “Making Every Contact Count” whereby all public services – with brief advice and
encouragement - can encourage healthier behaviours whether by ignoring the lift, giving up
smoking or walking along the “measured mile” marked routes appearing across the county.
Warwickshire can improve our health and wellbeing as long as individuals, local
neighbourhoods’ public and commercial services, serving the county together, all embrace
the message that “health and wel being is for the taking”. Our interim Health and Wellbeing
Strategy outlines how this can be achieved.
Professor Bryan Stoten
Chair of the Warwickshire Health and Wel being Board
Our priorities explained
Warwickshire has a health deficit. It is an affluent county but has only little better than
average health outcomes compared to the rest of England. We need to do much better.
1. Mobilising communities to develop and sustain their independence, health and
We want to concentrate our efforts on encouraging communities to set up support
networks which will help individuals to improve their lifestyle choices and which will
significantly reduce Warwickshire’s health deficit. In line with the localism agenda, this
• Mobilising community and neighbourhood support ensuring full engagement of local
communities, motivating an interest in social responsibility and the independence of
• Building a healthier, more productive and fairer society in which we recognise
difference, build resilience, promote mental health and wel being and chal enge
stigma and discrimination
• Working with local community and voluntary sector organisations to build the social
infrastructure of community facilities.
By mobilising communities, we are aiming to:
• Reduce the social acceptability and so the levels of smoking in the north of the
county compared to that in the south
• Reduce carbon monoxide (CO) levels in pregnant women through getting compliance
with CO monitoring at first booking
• Support independent living and enable al Warwickshire residents to enjoy the best
possible mental health, have a good quality of life and a greater ability to manage
their own lives in community settings
• Reduce the weight of schoolchildren by engaging local communities in creating
opportunities for physical activity
• Develop personalised, tailored and bespoke health prescriptions for wellbeing to
counteract poor lifestyle choices targeting diet, exercise and addictive behaviours
• Improve the monitoring of weight, blood pressure and cholesterol levels into old age
by the vulnerable, and where necessary, their carers
Improving access to services
We need to improve access to our public services. We will do this by:
• Ensuring that primary, community and social care facilities are of high quality across
the county with health and care pathways being easily accessible to all communities
• Developing the co-ordinated delivery of out of hours access that includes pharmacy,
general medical, general dental, mental health and wellbeing services, health visiting
and district nursing care
• Developing alternative models for out of hours services which better meet the needs
of the population and fit with models of independence and wel being that we see as
the basis for a sustainable health care system
• Ensuring that children and young people have timely access to support and service
to reach their full potential and make their right decision for themselves
• Investing in the development of tele-health and tele-care services
3. Public Services – Working Together
Demand for services is growing at a time when all services are under increased pressures. In
order to meet these chal enges we need to find new ways to work together to share
resources and improve the quality of services whilst delivering them more effectively.
We need to address the sustainability of services faced by increasing demands from an
ageing population and take account of the changing socio-demographic profiles for wellness
and ill health. We also need to work together to ensure children and young people are able
to reach their full potential to help ensure that health and wel being inequalities such as
differential levels of educational attainment are minimised.
Managing demographic pressures, the increases in long term conditions and complex
diseases such as dementia alongside the need to reduce costs creates an on-going
challenge. National policy such as Think Local Act Personal and the Care and Support White
Paper are re-stating the need to ensure that low level, early intervention services and
support are available to people at the earliest possible stage to prevent them needing to
rely on more costly health and care services at a later stage.
Housing plays a core and central role in maintaining and improving health and wellbeing.
Joint approaches should be developed to ensure that there is recognition of the role that
good housing has on people’s health and wel being. We need to work together to ensure
that Warwickshire residents have access to an adequate standard of housing as this has an
impact on the extent to which someone experiences good health and wel being.
We will work together to promote health and wel being by:
• Agreeing and, where possible, aligning our strategic commissioning intentions and
financial plans to achieve value for money across all public sector services. For
example jointly scoping the development of a co-ordinated primary, community and
social care delivery model that will help make the best use of scarce resources and
result in the best outcomes for patients, customers and the wider public
• Creating opportunities for joint commissioning – working with partners towards
shared objectives and outcomes, reducing duplication and making the best use of
• Ensuring frontline services support the delivery of preventative as well as treatment
strategies across all public services
• Identifying opportunities to address the impacts of the wider determinants of health
and wellbeing such as poverty, homelessness and obesity
• Supporting young people to aspire and achieve to their educational potential to
close the outcomes gap between vulnerable groups and their peers
• Promoting the message of Making Every Contact Count (MECC)
in frontline customer
and public interactions
• Integrating community and secondary care delivery. The management of community
health services by South Warwickshire NHS Foundation Trust offers such an
approach. This is where early discharge from hospital is enabled following planned
surgery e.g. a hip replacement, by providing outreach nursing and physiotherapy. It
helps ensure that people are enabled to recover in the best place for them with
efficient community support around them to help support a safe recovery
• Improving the public knowledge, awareness of and access to early intervention
• Jointly recognising the role that good quality housing has on people’s health and
wellbeing and prioritise joint approaches to securing decent housing for al
• Al agencies adopting the principles of early help and support, e.g. public sector,
voluntary organisations, community organisations, businesses, schools, col eges, GP
surgeries, housing services, clinical commissioning groups, etc.
• All public services working together in keeping people safe from harm.
By doing all of the above we will harness a strong joint sense of achievement by all
agencies, acknowledging their contributions and valuing the inter-dependency needed
to meet agreed outcomes.
‘We will be a healthy county, where al our partners are committed to supporting jointly
agreed priorities for action, embedding behaviours and approaches that wil make a
tangible difference to the economic and lifestyle prospects of al Warwickshire residents
enabling all to live wel .’
How healthy will Warwickshire be:
• Warwickshire will be in the best 20% in the UK for all major health and social care
• The educational attainment of children in Warwickshire will be consistently
improved in our most deprived areas – no school will demonstrate more than 20%
variance from the best in examination outcomes (GCSEs etc).
• All our local councils will be ‘Healthy Councils’ which champion health and wellbeing
in its widest sense with a focus on Marmot’s top six objectives (shown on the inside
of the covering page) and our local priorities.
• All our partners will actively role model health and wellbeing.
• Adults and children will have early access to high standard mental health and
wellbeing services that are community based and close to home.
• Our investment in preventative health and social care will be prioritised and
underpin our commissioning strategies.
• Statutory services will be much more integrated with, in particular, innovative joint
primary, secondary and social care teams that work together in the interests of the
public’s health rather than the interests of the organisations who employ them.
What working together for Warwickshire means for all public services?
It is our intention that Warwickshire residents should be able to maintain a healthy lifestyle,
in an environment that is supportive of their health and wel being, with access to the
highest quality health and social care at the most local level possible within the resources
available. This can be achieved most efficiently by the collaborative work of the NHS, Local
Authorities and the Voluntary and Independent Sector together with the fullest possible
engagement of the population at large in behaviours which are evidenced to improve their
health and wel being.
In our collaborative work and joint commissioning we wil be guided by the fol owing
1. We wil enable people to remain independent and wel for as long as possible, wherever
possible and in a place of their choosing.
2. We wil encourage more people in Warwickshire to have a greater say in how local
services are provided.
3. Every public service wil be involved in improving the health and wel being of
4. We wil invest in preventative approaches to keep people wel and identify where we can
act early to prevent il health.
5. We will look for all public services to work together towards the same aims and improve
the quality of people’s lives.
6. We will endeavour that people get the right care in the right place at the right time.
What needs to be done in Warwickshire?
This strategy asks every statutory agency in Warwickshire to articulate their commitments
to the strategy using the life course approach and demonstrate this in organisational
policies and plans as well as local area and joint partnership plans.
Our Life Course approach
Our approach is based on Marmot’s Life Course Approach. Thinking about the life course
should enable al statutory agencies to plan for the health and wel being of the population
In November 2008, Professor Sir Michael Marmot chaired an independent review to
propose the most effective evidence-based strategies for reducing health inequalities in
England from 2010. Fair Society, Healthy Lives: A Strategic Review of Health Inequalities in
. He looked at ways in which each stage in the populations’ lives could be enhanced
by appropriate interventions.
When Marmot commenced the review it was feared that he would make financial y
unsustainable recommendations. The review, however, looked at the cost of doing nothing.
Doing nothing is simply not an economic option. The human cost is enormous – 2.5 million
years of life potentially lost resulting from health inequalities alone.
There are important differences in the north and the south of Warwickshire – the health
deficit in Warwickshire overall is 13.7 years. A man in Nuneaton and Bedworth would live on
average 15.4 years less and a Rugby woman nearly 14.7 years less than people in the least
deprived areas of Warwickshire. The least deprived ward in all cases is Leek Wootton (ONS
Broader factors have a far greater impact on health and wellbeing than NHS and social care
services do alone.
39% of children in Warwickshire leave school with less than five good GCSEs
14% of children in Warwickshire grow up in poverty
20% of people in Warwickshire still smoke
25% of people in Warwickshire are obese
1 in 6 adults suffer from some form of mental illness
1 in 3 adults over the age of 16 live with a long term condition (147,000 people)
Wider determinants of health and wel being
Care and support at home
Housing has a central role in improving health and wellbeing. We know that most older
people and people with physical and learning disabilities want to stay in their own home
wherever possible and not have to go into residential or nursing care. In Warwickshire,
more than 30% of people with a severe disability are looked after in residential care whilst
in other parts of the UK this is 10%. Similarly, between one third and a half of people in
hospital could be cared for just as wel in their own home. Secure, warm and non-
overcrowded housing conditions mean people are less likely to suffer from physical or
mental illness, and children in similar settings are likely to do better at school.
Freedom from poverty
14.3% or 16,160 children in Warwickshire are growing up in poverty, an increase from 13.2%
in 2008. In some neighbourhoods over half of our children are living in poverty. Since 2008
the number of looked after children in our county has increased by 20%. Providing the best
start in life for children includes living in a home that offers healthy food, warmth and
opportunities. Protecting children in their early years from poverty has been shown to be
one of the most beneficial long term interventions to support their health and wel being.
Poverty in adults can lead to serious physical and mental health conditions. Such adults are
more likely to drink harmful amounts of alcohol and smoke. Much poverty arises from a lack
of employment as a result of ill health or disability, or lack of educational skills. However,
low-income working families with children remain the single largest group of people living in
poverty. Part of the ‘Going for Growth’ initiative within the County Council has been to offer
more apprenticeships to enable improved employment and life chances.
Smoke free Warwickshire
Over half of the health inequalities between the north and the south of the county result
from differential smoking behaviours. Three quarters of smokers begin smoking before it is
legal to buy a cigarette. Our Trading Standards colleagues are crucial in addressing this
Smoking has serious consequences for people’s health with one in two life-long smokers
dying from their addiction. The effect of second hand smoke on us al , but especial y unborn
babies and young children is harmful. In Warwickshire around 20% of people still smoke, as
do 15% of pregnant women. At least 20% of our children live in a house where people
smoke. Children of smokers are almost twice as likely to be admitted to hospital with
breathing difficulties as those that live in a smoke free home. Community attitudes to
smoking are probably the most powerful factor in shaping smokers preparedness to quit or
continue with their addiction. Our work with Warwickshire Fire and Rescue Services will be
important in both engaging in the Make Every Contact Count (MECC)
undertaking home safety visits to vulnerable people known to partners. Tobacco control is
the responsibility of al of us.
Stopping smoking even in later life can make big differences to people’s health and to how
long they live. Quitting on retirement will increase life expectancy by an average of three
Hundreds of frontline public sector staff go into thousands of people’s homes and see
thousands more. This presents opportunities to MECC.
We must support people who work with children in their own homes such as social workers,
health visitors and midwives to spend more time and be more confident in encouraging
parents to keep their homes and cars smoke free.
Living in Warwickshire
The environment where we live is crucial for our health and wellbeing. Well maintained
areas have low levels of crime and when people feel safe there is a greater feeling of
community cohesion which in turn leads to people taking greater responsibility for
themselves and their local community.
We have however created an environment that minimises the expenditure of effort. As a
society we must consciously build a “non-obesogenic” environment which encourages
walking, physical effort and minimises car use, sedentary game playing and recourse to
convenience foods and “grazing”. The school meal as a communal experience needs to re-
enter the school setting to support the development of desirable nutritional behaviours
from the earliest age.
Safe and green spaces encourage play and physical exercise. Maintaining the number and
quality of community spaces is especial y important when considering new housing
developments. Local plans can encourage walking, cycling or the use of public transport
instead of car use. Similarly, statutory agencies need to determine how our health and social
care systems will cope with a growth in new residencies. Equally, good quality leisure
facilities that are especially accessible to those living in more deprived areas are important
where people may be unable to pay for alternative leisure pursuits.
We need to plan our public sector buildings in a more co-ordinated way, so that we can
base several services in one place. ’Community hubs’ are developing across the country
where local people can access a range of public services such as GPs, social services,
housing, dentistry, pharmacists, optometrists, libraries and community healthcare. Often
these hub developments have been catalysts to shape and increase the level of joint
community and voluntary sector involvement.
Being a victim of crime or being afraid of crime has a major impact on people’s confidence,
mental health and wel being. Anti-social behaviour is a major factor in promoting this fear.
Complex family problems often include domestic abuse, alcohol or drug misuse and non-
attendance at school.
Drugs, alcohol and illicit substances
In Warwickshire, we estimate that drug misuse is a factor in 21% of crimes; alcohol in 43% of
crimes and half the prison population has some form of mental health condition.
“Well-mannered” alcohol consumption is killing too many of our citizens. Warwickshire had
164 alcohol related deaths in 2011 compared to the West Midlands average of 131. We
need a “wake up” call now. Alcohol admissions are increasing in prevalence nationally and
locally. Harmful and dependent lifestyle choices are limiting people’s ability to both improve
their life chances and their health and wel being. This is an area for significant concern and
needs continued investment and attention.
Improving the health outcomes for offenders can contribute to reducing re-offending rates
which in turn wil bring wider benefits to the community. Warwickshire Probabtion Trust
supervises approximately 2000 offenders in the community each year of which 29%
experience drug problems, 51% have alcohol problems and 31% report emotional wellbeing
concerns. Without access to good healthcare this group wil continue to place
disproportionate demands on health services. We will work with Warwickshire Probation
Trust, Warwickshire Police and the Prison Service on reaching offenders who have the
greatest need to improve their health and wellbeing.
Schools and Education
Education is an independent determinant of life expectancy. Together with its impact on
employment potential and earnings, educational attainment has a direct effect on people’s
health and wellbeing over their entire lifetime. The gap in achievement between our
schools is too great and we must demonstrate much greater equity in outcome.
39% of children in Warwickshire leave school without five good GCSEs. This means - for
many – poor employment opportunities, low income and resultant poor health.
Warwickshire’s aspiration for educational attainment needs to increase significantly. We are
performing below the standard to be expected given our levels of affluence and cannot be
satisfied with 39% of our children leaving school without good qualifications. We expect the
variation in attainment to reduce to no more than 20% by 2018.
Schools are important settings where children spend a lot of their life. Schools can
significantly influence the positive social and lifestyle behaviours we take into later life.
Children need to be encouraged to live their lives to their full potential. Healthy children
who stay safe, achieve economic wellbeing and make a positive contribution are key
indicators of success for this strategy.
We can show that school performance varies significantly depending on the culture and
leadership within the school. The experience of those with a proven track record of success
should be drawn upon by less successful neighbours to improve the attainment of al our
children. As schools such as Ash Green have shown dramatic improvement in school
performance is possible with the right authoritative leadership.
We believe the school meal is a vital component of social interaction and an excellent
means of supporting children to develop mature social skills and behaviours. The School
Food Trust found that healthier school food has a positive impact on pupils’ academic
achievement and therefore on earnings through the course of an individual’s life. (School
Food Trust (2009) ‘Healthy School Meals and Educational Outcomes’, Institute for Social and
Economic Research, Paper 2009-1)
We believe breakfast clubs can also make a positive contribution to children, particularly
those from low income and/ or priority families, achieving increased performance at school.
Re-shaping the delivery of care
Warwickshire’s ageing population will force changes in the way that we deliver both health
and social care. We expect to see a major increase in the over 75-year-old population in the
county in the next decade, and more than half of unplanned or emergency hospital
admissions are from this age group.
For too long the debate about hospital care has centred around waiting times, waiting lists,
patient choice in hospital referrals, and the “tariff” to be paid for such episodes of care. In
fact such referrals constitute no more than 11% of NHS activity. This pre-occupation has
resulted in insufficient attention being given to the management of emergency admissions,
the long term conditions of diabetes management, chronic obstructive pulmonary disease
(COPD), heart failure, Parkinson’s disease and cancers which increasingly require longer
term management as a chronic rather than acute condition. As a result there has been a
public demand to protect existing services rather than reconfigure them to meet the new
and increasingly complex care needs of patients, facilitate new techniques and technologies
and maximise the best care and patient safety. Evidence shows that this comes from high
volumes and short bed stays. The fear of hospital closures has led to maintaining suboptimal
services in the wrong place for too long. Increasingly, we need to support unpaid carers in
their caring role and their life apart from caring. Their involvement in developments
affecting them and the people they care for will be valuable in reshaping services.
This strategy looks to build on the strengths of our hospitals rather than their weaknesses
and continue to offer more care choices and greater independence for those living with
Long Term Conditions (LTC), supporting them to develop their own care plans that include
end of life preferences, and for those who are frail or ill. We want to see specialist and
major surgical interventions concentrated where such patients can be treated in high
volume by clinicians with the greatest experience of such procedures. The evidence shows
that outcomes for patients of all ages are safer and better as a result.
We want our local hospitals to offer increasing levels of day surgery, outpatient
attendances, imaging and diagnostic facilities. Rapid hospital discharge is shown to be safer
and we know of remarkable achievements in this area by hospitals in Warwickshire.
Integrated care pathways can significantly reduce the cost of emergency admissions and at
a time of great change across health and social care we must ensure that our joint working
can be maintained and enhanced.
People at the end of their lives are often unnecessarily admitted to hospitals when they and
their families could be more sensitively cared for at home. Hospice at home is vital in
supporting this aspiration. Our joint responses can ensure that we increase people’s ability
to live well with terminal illness and die where they prefer.
That will require changes in Primary Care, too. We know that there is clinical enthusiasm for
closer working between GPs, community and practice nurses, social care providers and
therapists – physiotherapists, chiropodists, podiatrists, community pharmacists and key
voluntary sector organisations.
Leading successful improvements
We know there are radical changes required to improve the health and wel being of
Warwickshire residents. We will need to gain their support and confidence. The Health and
Wellbeing Board, Overview and Scrutiny mechanisms and existing local area joint
partnership will all be important in delivering tangible improvements for this strategy.
The demise of the Primary Care Trust with its monthly publication of key performance
indicators must be replaced. We propose to publish outcome information from our
hospitals and GP practices on the JSNA website, so that residents can compare, and hold to
account, those serving their health and social care needs.
We expect to see in the plans of Clinical Commissioning Groups measures designed to bring
about changes in the way and the place where patients are treated and cared for, together
with an outline of the changes required in existing infrastructure.
There are four key outcomes frameworks that will drive the improvements in this strategy
and in core services. Department of Health performance frameworks guide delivery for
health overall, children’s’ services and adult social care services and are the key documents
that will indicate an improvement or deterioration in any given service area. These
frameworks are also referenced in, and integral to, the Health and Wellbeing Board review
Adult Social Care Outcomes Framework 2012-13
Every Child Matters Outcomes Framework
NHS Outcomes Framework 2012-13
Public Health Outcomes Framework for England 2013-16
The performance frameworks including at a glance summaries are on the JSNA website and
we will use additional indicator sets from these frameworks to assess overall progress.
These are cited at http://jsna.warwickshire.gov.uk/supporting-documents/government-
Evaluating collective views on our health and wellbeing
Local Healthwatch will play a key role in ensuring patients’ and public voice is represented
on the Board. ‘Healthwatch Warwickshire’ will be the local consumer champion for health
and social care. It will build up a local picture of community needs, aspirations and
experiences. It will do this by engaging with local communities, including local voluntary
organisations, networks, people who use services and the wider population.
Health and wel being – building success
Aligned to the Joint Strategic Needs Assessment, that underpins this strategy, we wil use the
fol owing outcomes and outputs to measure progress against our three priorities. These wil be
further developed through an action plan and aligned to the outcomes frameworks relevant to
Children and young people
• Pupils are ready for school, attend and enjoy school with key indicators measuring
attendance, exclusion and attainment.
• Children and young people achieve personal and social development and enjoy
• There are positive outcomes and destinations for pupils post 16 years.
• Transitions between settings and from children to adult services are well managed.
• 95% of children receive their vaccinations and immunisation.
• The variance in the percentage of children, in particular those looked after, attaining 5
or more GCSEs across Warwickshire schools wil be no more than 20%.
• We will narrow the gap in outcomes for looked after children and young people as
compared with that of the general population.
• Children and young people will sustain improved health and emotional wellbeing and
have opportunities to develop resilience and skills to prepare themselves for change,
independence and adulthood.
• There is a reduction in the number of people who start smoking coupled with an
increase in the number of people who are supported to quit.
• Pregnant woman wil be offered the opportunity to be assessed for smoking, alcohol use
and obesity and helped to adopt a healthy lifestyle.
• All relevant partner organisations will support the delivery of ‘Making Every Contact
• Children and adults will be encouraged to eat more healthily.
• At least three ”measured mile” walks will be available within every district and borough
• Warwickshire services will work with retailers to publicise the calorific content of
alcoholic drinks and to encourage fast food outlets to promote healthier and informed
• Supermarkets will be canvassed to promote healthy food and we wil develop a “healthy
hearts” award for local retailers in association with the British Heart Foundation.
• We wil continue to reduce the number of under 18s’ conception rates.
• More Warwickshire will reduce their alcohol consumption through good advice and the
number of alcohol related admissions also be reduced.
Reducing health and wel being inequalities
• We will reduce poverty and increase educational attainment and skills to improve jobs
prospects for those most in need.
• We will embed the reduction of health inequalities in the decision making process of all
public agencies and partners.
• We will improve equity of access to services, especially health and care services.
• We will continue to promote mental health and wel being as a foundation stone to good
health across the population, building on the notion of ‘No Health without Mental
• We will increase the promotion of positive sexual health with a focus and promotion on
• We will improve clinical outcomes for people with long term conditions.
• There will be a greater use of assistive technology including, tele-health, aids and
• We will imrpove rehabilitation services for people with long term conditions.
• Pregnant women and new mothers will all be offered assessment for post natal
depression and other needs in order to prevent, detect and treat early mental health
and wel being issues.
• People are supported to manage their condition themselves with improved access to
personal learning opportunities and services such as psychological therapies and “Books
• Greater use of risk stratification tools will identify people who are at high risk of being
admitted to hospital and will be proactively supported to prevent deterioration.
• We will reduce hospital admissions and improve discharges.
• All at risk patients will receive an annual health check.
• Warwickshire children and young people wil have improved and timely access to early
intervention mental health services.
Older people’s needs
• Universally older people will be offered appropriate and timely advice to support them
to maintain their independence and remain at home for as long as they choose including
good advice about housing and related support such as keeping warm and well.
• We will work to reduce the risk of falls and fractures in older people.
• We will work to decrease social isolation, in particular in rural areas, through improved
community inclusion and activities.
• We will promote and encourage the benefits of healthy living in old age, including health
eating and exercise.
• We will make sure at the end of life people die well and in a place of their choosing with
dignity and respect and their loved ones are supported.
• We will aspire to decrease winter deaths by 10% up to 2016 (baselined against 2013
population figures and environmental factors).
• We will develop a more extensive “trusted traders” scheme.
• Carers of older people will have access to information, advice and support services that
is timely and specific to their own needs and the needs of the person they care for.
• We will improve the rates of diagnosis and support for people with dementia and their
• We wil have created at least one integrated care hub that wil enable more people to be
cared for closer to home and in more local community settings without recourse to
being admitted to hospital.
Turning the strategy into action
The Health and Wellbeing Strategy covers a wide area of responsibilities and crosses the
remits of many different organisations. In order to turn this strategy into action each
organisation will make a formal response, or offer, to deliver parts of the strategy that they
think they can influence. For some organisations, such as the NHS Clinical Commissioning
Groups, these responses may form part of their annual commissioning plans that describe
the services that they wil commission to care for their population.
[Designer to integrate into the main body of the document with relevance to text as the
examples of where we are making progress] Partnerships
Unipart which employs over 2600 people in
Warwickshire and Leicestershire has embarked on
a programme of health and wellbeing initiatives
in partnership with Public Health Warwickshire.
Emma Dempsey, a Director at UTL said: “We are
delighted to work in partnership with Public Health
Warwickshire across a range of initiatives and
hope that by participating in the programme our
people become increasingly aware of the benefits
of healthy living, which means UTL wil benefit
from healthier, happier people working in the
The local community of Shipston on Stour and its health providers are proposing full integration of primary
community and social services around a health and social care hub. One of the aims of this initiative is to keep
people out of hospital, maintaining their independence wherever possible for as long as possible and minimise
lengths of stay when admissions to hospital are unavoidable.
Increasing physical activity in the North
For a small investment, we are targeting people with a CVD risk factor, who live in one of five of the most
deprived wards. The aim of the project is to get people more active, addressing diet and healthy eating at the
same time, thereby reducing health inequalities. Of 73 people seen, 17 have now completed the programme
losing 145 kg in total and an average 7.5% e body fat. Several cases show significant reductions in health-
threatening blood pressure and cholesterol levels. This has been a joint venture between Public Health and the
Nuneaton and Bedworth Local Leisure Trust. In addition, a recently agreed pilot study in North Warwickshire
wil build on the healthcheck screening programme and identify people who are at risk of developing diabetes.
Blood tests wil target patients who have abnormally high blood sugars and are pre-diabetic. They wil be
referred to exercise schemes and healthy living education to encourage preventative behaviours thereby
preventing them from becoming diabetic.
Healthy eating programmes for Children - NOSH
Public Health and the Mancetter Children’s Centre enhanced the original Baby and Toddler NOSH Porgramme
developed by the Centre and tailored it for families. Children's Centre Staff have been trained by health advisors
to deliver 4-6 week projects. Each project develops parent/carer skil s and knowledge on healthy eating, menu
planning, hygiene and cooking skil s. Al information given to parents/carers, aligns with national Start4life,
Change4life and The Healthy Child programme recommendations. Early indications are that as a result of this
programme, the families are carrying out on a budget, more healthy eating at home and cooking with their
children. The impact of each project assesses changes in parents’ knowledge and attitude to healthy lifestyle
Smoking in pregnancy
Together with the Tobacco Control Col aborating Centre (TCCC) we have been working to improve the way we
col ect data around smoking at the time of delivery in pregnant women. A new screening method is being
piloted at the labour wards of Warwickshire hospitals which tests Cotinine levels within the saliva of women
due to deliver on the test day. The saliva test is accompanied by a simple questionnaire. The new tests hope to
improve on the reliability and accuracy of the previous technique which involved monitoring carbon monoxide
levels. Tests results wil encourage women to stop smoking with support from the smoking cessation team.
Supporting independent living and re-ablement
A recently funded joint programme between Public Health and Stratford District Council is supporting people
with learning disabilities to learn how to cook and support their independent living. A ten week programme
guides the candidates through basic cookery skil s and provides them with a basic food hygiene safety
certificate. On a weekly basis they hold a luncheon club at the Buzz community café in Stratford town for
people with Parkinson’s disease. The people coming for lunch purchase the meal at a nominal charge and get a
copy of the menu and a recipe card to encourage them to eat more healthily at home. This is a sustainable
solution for promoting healthy eating and social inclusion. We are seeking to expand this initiative to meet a
range of needs.
Reducing harmful drinking
Warwickshire Police is supporting the Warwickshire Drug and Alcohol Action Team to implement the Alcohol
Diversion Scheme, targeting people who commit minor disorder offences. The scheme allows people subject to
a fixed penalty notice to attend a course where alcohol abuse and health related consequences are presented –
much like the speed awareness courses, and where the attendance results in the level of fine being reduced or
Linking offenders to appropriate treatment and interventions:
Warwickshire has designated treatment for offenders requiring treatment and interventions for substance
misuse which is provided through the recovery partnership and the Criminal Justice Mental Health Liaison
service. This initiative attempts to connect offenders with required mental health services from the point of
arrest onwards. This service has recently attracted favourable attention from the Government. This is an
important service that wil need to be strengthened as needs continue to grow.
A new Sexual Assault Referral Centre
A new Sexual Assault Referral Centre for Coventry and Warwickshire is being built at George Eliot Hospital and
wil open in November 2012. The centre wil enable those who have been sexually assaulted to be supported
and treated in a specialist environment. The Centre wil include support for children of sexual abuse and is a
combined approach by Warwickshire Police, NHS Arden, Coventry and Warwickshire Councils and the voluntary
Eliminating Child Sexual Exploitation
A new Child Sexual Exploitation (CSE) Task and Finish Group has been established with partners from
Safeguarding, Education, Police and the Respect Yourself Campaign. The group are seeking to Prevent, Protect
and Prosecute, particularly supporting the prevention aspects by:
• Advising that consultation commences with young people regarding the definition of CSE
Young people's forum to advise and influence CSE activity
Including CSE as a core aspect of www.respectyourself.info within the safer relationships aspects and
Embedding CSE training within the RYC training brochure and framework
[Insert Inside the end cover at the bottom]
If you would like this document in another format or in large print,
please contact us.
Warwickshire County Council
Public Health Department
Tel: 01926 413775
Fax: 01926 410130
To download this document, or for more information on the Warwickshire Health and
Wellbeing Board, please visit: http://healthwarwickshire.wordpress.com/
Published by Warwickshire County Council on behalf of the Warwickshire Health and