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Cheshire EastPartnership

Five Year Plan

2 | Cheshire East Partnership Five Year Plan

“Our vision is to enable peopleto live well for longer; to liveindependently and to enjoythe place where they live. “

01 Foreword

02 The Cheshire East Place

03 Our Local Vision

04 Why do we need change?

05 Outcomes

06 Conclusion

07 Appendices

4

6

8

10

13

29

30

Cheshire East Partnership Five Year Plan | 3

Contents

4 | Cheshire East Partnership Five Year PlanForeword

01 ForewordThe vision of our five-year plan is to improvethe health and wellbeing of local communities,enabling people to live longer and healthierlives. We will do this by creating and deliveringsafe, integrated and sustainable services thatmeet people’s needs by the best use of all theassets and resources we have available to us.Wellbeing comes from everyone takingownership of what they can do for themselvesand their community, with support availableand focussed when and where it’s needed.

The Cheshire East Partnership is an alliance ofpartners working together to improve thehealth and wellbeing of the residents of theCheshire East local authority area. The Five YearPlan sets out what we want to do, why we wantto do it and the difference we believe we canmake to the health and wellbeing of localresidents.

We want this document to start a communitywide conversation about our health andwellbeing and what we can all do to enhance it.Good health and wellbeing are not just aboutNHS and care services nor are they just abouttreating illness and accidents. Good health andwellbeing come from every aspect of our lives,environment, wealth and society. The qualityof our education, employment, housing,neighbourhoods, friendships, relationships,families, jobs, safety, food and air are amongthe many things that influence our health,happiness and wellbeing, for better or worse.

We want children and young people to getthe best start in life and be ready for school;we want people to live well andindependently for longer; and we want olderpeople to be able to maintain theirindependence for as long as possible,through more dementia friendly communitiesand active ageing initiatives, as well as byreducing social isolation. We also want toencourage people to take responsibility forlooking after themselves, their families andneighbours, and to enable more care to bedelivered in the community.

Across our communities there are differencesin the levels of ill health and wellbeing, oftenlinked to big differences in other aspects ofthe quality of life. Our approach is to focus onreducing these inequalities and use thewealth of our community’s, knowledge,power and resources to achieve this. This isnot so much about what we can do directly aspublic bodies, though that is hugelyimportant, but about what we can supportpeople, families and communities to do forthemselves and with us. That is somethingwe need to talk about and it’s a conversationwe want everyone to be involved in.

In summary, our vision is to enable people tolive well for longer; to live independently andto enjoy the place where they live. We wantto keep people well and healthy rather thanjust try to fix things when they go wrong.

Cheshire East Partnership Five Year Plan | 5Foreword

Mark Palethorpe Acting Executive Director ofPeople,Cheshire East Council andSenior Responsible OfficerCheshire East Partnership Board

Clare WatsonChief Officer of the fourCheshire ClinicalCommissioning Groups

Denise Frodsham Director of StrategicPartnershipsMid Cheshire Hospitals NHS Foundation Trust

Tina CooksonNurse DirectorSouth Cheshire and Vale RoyalGP Alliance

Steven MichaelIndependent ChairCheshire EastPartnership Board

John WilbrahamChief Executive forEast Cheshire NHSTrust

Sheena CumiskeyChief Executive Cheshire and Wirral PartnershipNHS Foundation Trust

Justin JohnsonChief ExecutiveVernova Healthcare Community Interest Company

6 | Cheshire East Partnership Five Year PlanThe Cheshire East Place

The term place-based health is becoming morecommonly used across the country. Cheshire EastPlace covers the area of Cheshire East LocalAuthority. It brings together the leadership,planning and delivery of health and local authoritycare services, working together without barriers andbureaucracy getting in the way. Additionally taking aplace-based approach requires working effectivelywith other local authority departments, for example,Children and Families, Housing, Planning, Revenuesand Benefits, and Culture and Leisure; with otherpublic sector organisations, for example the Police,Fire and Rescue, Department for Work and Pensions;and with the many community, voluntary and faithsector organisations that add such value throughdelivery of services in Cheshire East.

Others working closely with us, through the Healthand Wellbeing Board and other partnerships includethe Cheshire Constabulary and Cheshire Fire andRescue service, the University Hospital of SouthManchester NHS Foundation Trust, Stockport NHSFoundation Trust, University Hospitals of NorthMidlands NHS Trust, health and care commissionersand providers across Cheshire, Merseyside, Wirral,Greater Manchester, North Midlands and Wales.

As a Place we sit within the Cheshire and MerseysideHealth and Care Partnership (C&MH&CP), one of ninePlaces, all based upon the local authoritygeographies of Cheshire and Merseyside. ThisPartnership was established to confront the healthand care challenges of population health, the qualityof care, and increasing financial pressures.

As its name suggests, the Partnership is not a singleentity but a collection of organisations responsiblefor providing health and care services that havecome together, to plan how best to deliver theseservices in future so that they meet the needs oflocal people, are high quality and are affordable.Their priorities feature in our local Plan and ourinteraction with the Cheshire and Merseyside work-streams will influence our on the ground delivery.

We shall also contribute to the ambitions of theC&MH&CP in relation to Social Value and havecommitted to the Social Value Charter that thePartnership has recently published.

A vibrant and diverse economy andcommunity

Cheshire East is an area of contrasts. It is a place ofagriculture and industry, countryside, villages,market towns and urban centres with distinct needs,assets and characters. We are preparing to capitalise

02 The Cheshire East Place

The core Cheshire East Place Partnership ismade up of the following organisationsworking together:

• Cheshire East Council

• Cheshire and Wirral Partnership NHSFoundation Trust (CWP)

• East Cheshire NHS Trust (ECT)

• NHS Eastern Cheshire Clinical CommissioningGroup (ECCCG)

• Mid Cheshire Hospitals NHS Foundation Trust(MCHFT)

• NHS South Cheshire Clinical CommissioningGroup (SCCCG)

• South Cheshire and Vale Royal GP Alliance

• Vernova Healthcare CIC

• Healthwatch.

Cheshire East Partnership Five Year Plan | 7

on the arrival of high speed rail (HS2) as a catalystfor growth in Cheshire East. This will create newopportunities for regeneration and employmentand new demands on public services.

Cheshire East is a great place for people who wantto balance work and life because we are locatedbetween the Northern Powerhouse and theMidlands Engine and we are close to Wales andMerseyside. We are ideally located to capitalise onboth the quick links to these centres and to be ahaven from them.

Our plans will recognise the value of ourcommunities and respond to the needs of ourcommunities, delivering integrated health and caredesigned with and for local care communities. Weplan to deliver continuous improvements inproductivity in the private and public sectors,harnessing local world class businesses and our richresearch and development infrastructure. Businessdevelopment, housing growth and education andtraining opportunities are key elements of widerstrategies designed to complement and benefitfrom health and care developments.

The Cheshire East Place

CHAWBDP

Knutsford

Maccles eld

Main hospital sites

Care Communities

Sandbach, Middlewich, Alsager,Scholar Green and Haslington

SMASH

BDP

CHAW

CHOC

Bollington, Disley and Poynton

Chelford, Handforth,Alderley Edge and Wilmslow

Congleton and Holmes Chapel

CHOCSMASH

Crewe

Nantwichand Rural

Leighton

Maccles eldDistrict General

EasternCheshireCCG

SouthCheshireCCG

8 | Cheshire East Partnership Five Year PlanOur Local Vision

Health and wellbeing go hand in hand witheconomic growth and prosperity. Good health isalso about good housing, good education, goodemployment and good infrastructure and services.They are all interlinked and need to complementeach other.

Our vision is to improve the health and wellbeingof local communities, enabling people to livelonger and healthier lives. We will do this bycreating and delivering safe, integrated andsustainable services that meet people’s needs bythe best use of all the assets and resources we haveavailable to us. Wellbeing comes from everyonetaking ownership of what they can do forthemselves and their community, with supportavailable and focussed when and where it’sneeded.

This means we need our services to be asintegrated as our lives are. To improve the healthand wellbeing of communities and reduce thedemand for health and social care, a focus onpreventing ill health needs to be at the heart of ourstrategic plans, actions, services and programmes.This also means that we need to think of healthand care in a new way and understand thatworkplaces, schools, leisure and communities area vital part of promoting wellbeing andpreventing, or delaying a need for care arising.

We want to make it as easy as possible to stayhealthy, supporting people where it makes adifference, intervening where it’s necessary butalso promoting a shared understanding ofindividual responsibility to lead a healthy life,reducing people’s need for help and keepingthem independent.

03 Our Local Vision

Our focus will be upon:• Tackling inequalities, the wider causes of ill-

health and the need for social care supportthrough an integrated approach to reducingpoverty, isolation, housing problems anddebt;

• Prevention of ill health, early intervention,health improvement and creatingenvironments that support and enable peopleto live healthily;

• Ensuring our actions are centred on theindividual, their goals, and the communities inwhich they live and supporting people to helpthemselves;

• Having shared planning and decision makingwith our residents.

Cheshire East Partnership Five Year Plan | 9Our Local Vision

Contributions to Health Outcomes

Education10%

Employment10%

Income10%

Family SocialSupport

5%

CommunitySafety

5%

Access to Care10%

Quality of Care10%

EnvironmentalQuality

5%

BuiltEnvironment

5%

Smoking10%

Diet andExercise

10%

Alcohol use5%

Poor SexualHealth

5%

HealthBehaviour

30%Socioeconomic

Factors

40%Clinical

Care

20%Built

Environment

10%

Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute 2015.

It is clear from this table that there are manyfactors that impact our quality of health. Andthose factors need to influence potential solutions.We tend to focus on hospitals and GPs when wethink about our health and how the NHS serves us.Whilst it is essential that our NHS services areexcellent, they make up a fifth of what contributesto the quality of our health. Our plans will look atinvolving all aspects of our health and wellbeingneeds, and especially on preventing ill health andavoiding harm so that we can enhance wellbeingand reduce the unsustainable pressure onoverstretched services.

The Five Year Plan complements the Cheshire EastHealth and Wellbeing Strategy and sits alongsidethe Cheshire East Connected CommunitiesStrategy and the Cheshire East Industrial Strategy.

Primarily, the People Directorate focuses onoutcomes 1, 3, 5 and 6 of the Corporate Plan

04 Why do we need to change?

10 | Cheshire East Partnership Five Year PlanWhy do we need change?

Many of us are living much longer, in betterhomes and communities, but we areexperiencing increasing fragility andvulnerability in older age.

Our lives are more connected digitally, creatingnew ways of living and working and new ways ofaccessing services and taking part in activitiesand it is increasingly clear that health and careservices need to be shaped around individuals tomake their lives better and easier.

People’s health and wellbeing is not simply abouttaking a pill, seeing a doctor or waiting for aservice. It involves helping people to takegreater responsibility for themselves and beingmore proactive in their own health andwellbeing. This means we need to be usinginformation more effectively to identifyvulnerable people who may be at risk andaddressing the wider determinants of healthsuch as housing, poverty, employment andeducation.

The main causes of death and illness in CheshireEast are cancer, heart disease and respiratoryillness.

Overall, risk factors (for example smoking) forcancer in Cheshire East are lower than theEngland average, but there are areas, particularlyin the south of the borough, where risk factorsare much higher. There are stark differences incancer outcomes across Cheshire East and canceroutcomes are particularly poor in Crewe.

The mortality rates for heart disease in CheshireEast are lower than the England and Northwestaverages but heart disease still accounts foraround a quarter of premature deaths in this areaand people who live in Crewe have a significantlyhigher risk of early death from heart disease.

Respiratory disease accounts for a tenth ofpremature deaths in Cheshire East. This is betterthan the national average but worse whencompared to similar local authorities. Outcomesare generally poorer in those from the mostdeprived communities.

Against this backdrop the demand for health andcare services continues to grow, for at least fivereasons. The first three are either desirable orunavoidable:

• Our growing and ageing population meansmore people need health and care support

• Growing concern about areas of unmet healthneed, for example, young people’s mentalhealth needs

• Expanding frontiers of medical science andinnovation, introducing new treatmentpossibilities that a modern health service shouldrightly be providing, for example, gene therapy.

Cheshire East Partnership Five Year Plan | 11Why do we need change?

But the other reasons we can dosomething about:

• Improving the early prevention of avoidableillness or need for care by making the most oflocal assets in the community or services thatsupport behaviour change. Examples includesmoking cessation to reduce the risk of cancerand heart disease; diabetes prevention andreducing the risk of cancer through reducingobesity; and reducing respiratory hospitaladmissions from lower levels of air pollution.

• Getting the right service in the right place forsomeone who is unwell or in need of care isoften difficult. This is because many currentservices were created for a different era withdifferent needs.

This document represents a commitment by all thepartners across Cheshire East to collaborate totackle the complex, difficult and inequitable healthand wellbeing issues together.

In general, the health and wellbeing of theresidents of Cheshire East is good, but there areclear inequalities within the area. There are alsostill very significant risks for everyone that need tobe addressed.

We recognise that services should be designed forlocal needs and that, for instance, what is neededand what works for people in Nantwich will bedifferent to what’s needed and what works inMacclesfield. Working with our differentcommunities, local networks and using theindividual strengths of our towns and villages wewant to ensure people have the best health andwellbeing from services arranged for their localcircumstances.

Meaningful engagement with our communities,patients and carers continues to inform all that wedo, and we will provide services to improve healthand social care for our local populations.

04 Why do we need to change?

12 | Cheshire East Partnership Five Year PlanWhy do we need change?

Healthwatch Cheshire East have recently undertakenengagement on the NHS Long Term Plan.

They conducted a survey and held focus groups withlocal people to hear views and ideas that help shapelocal plans. The key messages that have come out ofthis include:

• In order to live a healthy life people felt that accessto the help and treatment they need when theywant it was most important.

• In terms of maintaining their health andindependence in later life, people surveyedoverwhelming felt the most important factor wasbeing able to stay in their own home for as long asit was safe.

• When considering managing and using supportand treatment, people felt that the right treatmentshould be a joint decision between them andhealthcare professionals and they should beconsulted throughout the process.

• People in Cheshire East told us that being able totalk to their doctor or other health care professionalwherever they are was the most important factor inbeing engaged in health service delivery.

• People with, or caring for people with autism feltthat the time they had to wait to receive their initialassessment, diagnosis or treatment was too long.Waiting times ranged from eight months to threeyears. Members of our focus group also felt thatthere was a lack of understanding by front line staffof the autism spectrum. Funding and access toservices was a serious issue for the parents ofpeople with autism spectrum conditions.

• People with, or people caring for those with,dementia gave mixed responses to the initialsupport they received; most felt that it either mettheir needs or somewhat met their needs. Mostreported that ongoing care and support was easyto access.

• 94% of people who responded with a MentalHealth condition felt that their overallexperience of getting help was either average,negative, or very negative.

To address these challenges, the issues raised bylocal people and the needs evidenced through thechanging population demographics, we willcommission services that work seamlessly andwrap around the needs of people. “Together”, ourguide to co-production and collaboration withresidents, the community, faith and voluntarysector will be key to improving health andwellbeing.

Our intention is to:

• help people to live healthier lives for longer;

• enable people to stay out of hospital when theydo not need to be there;

• deliver more services at home or closer tohome;

• reduce the demand on all hospital services.

We will continue to involve and engage ourcommunities, staff and partners and we will drawon expertise and best practice from across theNHS, social care and beyond. We will formallyconsult where that is necessary, but only after wehave engaged and listened to our communities ina process of co-creation. This will include activitieslike focus groups, co-production events and reallyeffective communication.

We will ensure that the partnership of health andsocial care organisations in Cheshire East Place isintegrated in its approach and outlook and thatour plans are made in Cheshire East for the peopleof Cheshire East.

Cheshire East Partnership Five Year Plan | 13Outcomes

05 OutcomesWe want to develop clear plans that complement eachother and deliver measurable outcomes for ourcommunities. We want these outcomes to bestraightforward and understandable. We want tobuild support and agreement for them.

The chances of success will be greater if we are clearabout what we want to achieve and why. The prioritieswe have selected (as part of the Health and WellbeingStrategy) are focussed on supporting everyone inCheshire East, from childhood through to older age.

This document is about how we all can work towards,and benefit from, achieving these outcomes. Webelieve these outcomes are achievable and we believethey can only be achieved through the combinedstrengths and qualities of every part of ourcommunity, from the individual through to the publicservice. We all have a part to play and we will allbenefit from the achievement.

1. Create a place that supports health andwellbeing for everyone living in Cheshire East

2. Improve the mental health and wellbeing ofpeople living and working in Cheshire East

3. Enable more people to Live Well for Longer inCheshire East

4. Ensure that children and young people arehappy and experience good physical and mentalhealth and wellbeing

Our key outcomes are that we should:

Wealth and Wellbeing

The wealth of any community directlycontributes to its health and wellbeing.That is why we are making jobs, skills andopportunities a key part of our health andwellbeing work. Being healthy for and atwork, goes hand in hand with having thejobs necessary for everyone’s happinessand prosperity.

One of the things we can do to improvelocal prosperity is to spend our own fundsin our own community, whenever this givesus the best outcomes and provides bestvalue. We want to invest in Cheshire Eastand maximise the additional benefits thatcan be created by delivering, procuring orcommissioning goods and services inCheshire East. We don’t just want to buy aproduct or service; we want that money toalso support the income and wealth of ourresidents and businesses. We want ourlocal economy to benefit from the funds wehave to spend, and we want ourworkplaces to benefit our residents. So,when we spend money, we do so in a waythat achieves as many of the followingobjectives as possible:

• Enabling people to be well in work bydirectly supporting their mentalwellbeing

• Removing complex barriers toemployment and financialindependence through our ‘In To Work’

support programmes

• Ensuring that the skills strategyopportunities extend to people who arecurrently not in work and face thegreatest challenges

• Promoting employment and economicsustainability

• Raising the living standards of localresidents

• Promoting participation and citizenengagement

• Building the capacity and sustainabilityof the voluntary and community sector

• Promoting equity and fairness

• Promoting environmental sustainability.

The diagram below shows how health,happiness, jobs, services, neighbourhoods,communities and our economy areinterconnected. Health inequalities areunderpinned by the conditions in whichpeople are born, grow, live, work and age.The broad social and economiccircumstances which together influencethe quality of the health of the populationare known as the ‘social determinants ofhealth’. The ways which these socialdeterminants impact on both mental andphysical health are complex and inter-related, often acting over a long period oftime.

14 | Cheshire East Partnership Five Year PlanOutcomes

This shows:

• personal characteristics occupy the core of themodel and include gender, age, ethnic group, andhereditary factors

• individual ‘lifestyle’ factors include behaviourssuch as smoking, alcohol use, and physical activity

• social and community networks include familyand wider social circles

• living and working conditions include access andopportunities in relation to jobs, housing,education and welfare services

• general socioeconomic, cultural andenvironmental conditions include factorssuch as disposable income, taxation, andavailability of work

We will ensure that health and wellbeingconsiderations are taken into account inrelation to the many different elements of theCheshire East Place including for examplespatial planning, transport, housing, skills andemployment.


Individual Lifestyle Factors

Socia

l and Community Networks

Gene

ral S

ocio-economic, Cultural and Environmental Conditions

Age, sex andconstitutional

factors

Living andworking conditions

Workenvironment

Agriculture and food

production

Water and sanitation

Healthcare

services

Education

Unemployment

Housing

The Social Determinants of HealthSource: Dahlgren and Whitehead (1991)


Tackling inequalitiesPublic Health England says, “Health inequalities areavoidable and unfair differences in health statusbetween groups of people or communities.”

There are some stark differences across Cheshire Eastthat we have identified and must deal with. There is adifference in life expectancy of around 13 yearsbetween the lowest rates in Crewe Central and thehighest in Gawsworth for women. For men, there is an11-year gap between the lowest rate, again in CreweCentral, and the highest in Wilmslow East.

In general, there is more ill health in parts of Crewe andMacclesfield than in other areas. We know that this alsocoincides with areas of deprivation, poorer housing,education achievement and employment. Smoking,alcohol consumption and obesity are all alsocorrespondingly higher.

We have identified common health issues in CheshireEast which have a significant impact across a person’slifetime if left unaddressed and are key factors in healthinequalities. To make a difference in these areas weneed to focus on avoiding inequalities from entirelypreventable conditions. This concentrate will be on:

• Giving children the best start in life and ensuringthey are ready for school.

• Supporting children’s emotional health andwellbeing and tackling adverse childhood events.

• Reducing alcohol related harms.

• Helping people better manage long term conditionsand disability affecting day to day activity.

• Reducing heart disease and high blood pressure.

• Preventing the risks from frailty and falls andimproving mental health and wellbeing as weget older.

The human and communitycosts of preventable conditionsAlcohol misuseThe harmful effects of alcohol are a major cause ofill health in Cheshire East. Nearly three quarters of15-year-olds have tried an alcoholic drink. This issignificantly higher than the national average.

Drinking at levels that can harm health is far toocommon. Across Cheshire and Wirral, 27% of theadult population (270,045 people) consumealcohol at levels above the UK Chief MedicalOfficers lower-risk guidelines increasing their riskof alcohol-related ill health.

We estimate the direct, measurable impact ofalcohol harm costs Cheshire and Merseyside manymillions of pounds a year including:

• £86 million as direct costs to the NHS (hospitaladmissions due to alcohol, A&E attendances,Ambulance journeys, GP and outpatientappointments)

• £32 million in social services cost (children’s andadults social service provision)

• £100 million related to crime and licensing(alcohol specific and alcohol related crimes,costs of licensing)

• £185 million in the workplace (absenteeism,presenteeism, unemployment, prematuremortality)

Behind these numbers are individual stories ofharm and misery. There is an immeasurable costto people, their families and their children fromalcohol misuse. It can generate violence and abusecausing a terrible impact on other people’s safetyand physical and mental well-being.



High blood pressureWe have identified high blood pressure as a major issueaffecting about a quarter of people but most of themare either undiagnosed or untreated. We have an ageingpopulation who are increasingly at risk of high bloodpressure due to age, obesity and excessive drinking. Ifwe do not start to address this disease right across everycommunity, we will have increasing cases of stroke,heart attacks and vascular dementia that will requirelong term care and give people a poorer quality of life.

There are many ways of dealing with high bloodpressure. On a personal responsibility level, reducingweight and taking more exercise will have a majorimpact on reducing blood pressure and the health risksit creates.

At a community level we are training volunteers in localcharities, community groups and across the publicsector to take blood pressure measurements andproviding them with the equipment to do it. This isaimed at identifying people with high blood pressurewho do not yet know they have it and so can’t besupported.

At the NHS level we will make sure that everyonewith a diagnosis is supported or treated to reduceand manage their blood pressure.

The impact of smoking Smoking is the single most important driver ofhealth inequalities and is more common amongunskilled and low-income workers than amongprofessional high earners. It has a disproportionateimpact on children and young people fromdeprived areas, and its uptake in children is heavilyinfluenced by adult smokers, perpetuating thecycle of inequalities to the next generation. There isalso a strong association between deprivation andsmoking in pregnancy and negative impacts ofsmoking on children with asthma.

Data suggests that Cheshire East has relatively lowlevels of smoking among adults compared with therest of the North West, but rates vary considerablyacross Cheshire East with higher rates in Crewe.

New services for new needs asour population changesOur population will change in the coming years as weexpect HS2 to bring significant movement of workingage families to the Place and at the same time weexpect the population of older people to growsubstantially.

In the next ten years, in Cheshire East, we will seesignificant increases in the number of people aged over65 and dramatic increases (38%) in the number ofpeople aged over 85. Our over 85s are most likely toexperience the risks associated with increasing frailtyand to have three or more medical conditions thatrequire support and care. We therefore need to shift ourresources accordingly to better manage this demand.

We are also experiencing and anticipating a significantrise in people with dementia and we need to plan toprovide appropriate environments, supportivecommunities as well as care for them. Too many peoplewith dementia end up unnecessarily in hospital whenother community located options would be better forthem.

Our assumptions and planning for our eight CareCommunities (see below) will therefore be tailored tosupporting people to live with and manage frailty andseveral health conditions more effectively at home andin their communities by local teams of health and socialcare professionals, working in partnership with

community and voluntary services. We will work todecrease and, where possible, eliminate or reduce, thatdeterioration to crisis level which frequently requiresemergency hospital admission.

This requires different workforce skills and different waysof providing care and support locally, but it means ourtwo hospitals will see fewer people with avoidableconditions because they will have been identified earlyon and managed more effectively in the theircommunities.

Alongside changing demographics, Cheshire East hassome profound health and social care needs and someunacceptable health differences as outlined above. Weare focussed on reducing these differences in the causesof illness, the age at which ill-health happens andpatient outcomes.

Diabetes, dementia and mental health difficulties are allincreasing in Cheshire and we do not currently have theright resources in the right place at the right time totackle them effectively. We need to get better atpreventing these conditions developing, spot themrapidly if they do, provide treatment where it works bestand help people to become better at supporting theirown health over a long period.

If Cheshire East was a village of 100 people, their healthneeds would look like the picture below. Cheshire East’spopulation is 378,000 so multiply each of the numbersbelow by 3780 to understand the true scale of what ourcommunity’s needs look like.


If Cheshire East was a village of 100...

And in a year there would be...

23People over 65

21People

under 19

8People with

COPD/Asthma

4People with

Coronary Heart Disease

1Person

dependant on alcohol

48Adults

overweight or obese

21Adults who exercise

less than 30 minutes a week

16People with high blood

pressure

3Adults with

cancer

1Person with

severe mental illness

11Adults with depression

1Person with

dementia

5People with

diabetes

Accident & Emergency

Attendances

29Discharges

from hospital

Emergencyadmissions

11

90Outpatient

appointments

14Calls to

999

26



A strong start for our childrenGiving our children the best start in life will givethem the best chances for their future lives. Healthand care services are involved in supportingmothers to have a healthy pregnancy and a safeand healthy delivery. Reducing stillbirths andmother and child deaths during birth by 50% is akey national priority backed up by ensuring mostwomen can benefit from continuity of carerthrough and beyond their pregnancy. We will workto ensure that we provide extra support forexpectant mothers at risk of premature birth.Mothers’ mental health during and after theirpregnancy will also get much more focus andsupport.

We will support children to be healthy by focussingon avoiding childhood obesity and increasingmental health support for children and youngpeople who need it. School readiness for allchildren will be a priority and we will besupporting children who have had adversechildhood experiences so they can thrive as adults.We will provide the right care for children with alearning disability and reduce waiting times forautism assessment. We will also ensure that thebest treatments are available for children withcancer.

The high level of children 0-4 years visiting A&Eand high levels of childhood asthma are twoconcerns we are making a priority.

We will also focus on the health and wellbeing ofour most vulnerable children and young people. Inparticular we will be:

• Improving Services for Looked After Children asrequired by Promoting the Health andWellbeing of Looked after Children: StatutoryGuidance for Local Authorities, ClinicalCommissioning Groups and NHS England(2015): The performance and quality of healthinput for children in care and care leavers hasbeen constantly monitored by reviewing thetimeliness and quality of all health assessments,

and by close partnership working with LAcolleagues. An area for particular focus will bearound the use of the electronic informationsystems within both the LA and NHSorganisations and ways to improve functionalityand accuracy will be explored.

• Reviewing the Strengths and DifficultiesQuestionnaire strategy to ensure the completedscores inform the annual health assessment andcare planning

• Completion of a Self-Audit by the Cared ForChildren’s Nursing Team in line withcommissioning standards. This will be used tobenchmark current services provided againstcommissioning standards and identify areaswhere improvement/development is required.

• Strengthening of training arrangements:Undertake a training need analysis of the multi-agency workforce to identify existing gaps inknowledge to promote delivery of statutoryresponsibilities and role as corporate parents.Develop a training strategy to developinteragency training across the health economyto improve the workforce knowledge andunderstanding of the Looked After Children andCare Leaver population.

New ways of working

New ways of working will be key to meeting the risingdemand and achieving better outcomes for ourpopulation. They will also be needed to make themost of the new technology, medicines andtreatments that will have an impact on improvinghealth and wellbeing and making it easier to accesshealth and care services when this becomesnecessary.

Supporting people in the community to maintaintheir health and wellbeing will the number onepriority, with increased numbers of staff workingclosely with the community and voluntary services toaddress the wider determinants of health. All healthand care staff will take responsibility for positivelypromoting lifestyle and behaviour change, helpingpeople to understand what they can do to proactivelyimprove their health and wellbeing.

Our Care Communities We have created eight Care Communities acrossCheshire East, with staff from GP practices,community and acute services, social care, otherpublic sector organisations and the communityand voluntary sector beginning to work togethermuch more effectively. The Care Communities allhave a common ‘core offer’ but they can add tothat to reflect specific, local priorities, needs anddifferences. Care Communities will work closelywith the newly established Primary Care Networks.

Our intention is to offer a truly tailored, localservice which means:

• We can proactively identify people at high riskof needing services and we can then interveneearly and quickly to prevent their situationworsening.

• We can help people through self-care andbetter support their families and carers.

• We can make better use of the differentprofessionals working in therapies, pharmacies,social and primary care.

• We can recognise the existing strong localrelationships, skills and connections andsupport them to grow and flourish.

Our plans show that once our Care Communitiesare up to full strength, they will be providingservices that will release significant numbers ofhospital bed days – fewer people needing to be inhospital and their hospital stays being shorter. Thiswill lead to less people having to go to hospitalwith more services being provided more locally.Hospitals will be able to focus on those with themost serious health issues and those needingurgent emergency treatment. These changes willalso generate savings that can be used forinvesting in new services and ensuring a moresustainable health and care system going forward.

Our Care Communities model will allow services tofocus on individuals, supported by families andfriends within their local communities. We will be




able to link in more closely and in partnership withother community resources and assets that impacthealth and wellbeing such as housing, jobs andeducation and to work more collaboratively withall partners including the voluntary, communityand faith sector.

We will increase our support to communities byproviding information, infrastructure, networksand skills to help local groups and socialenterprises grow and overcome any hurdles theyidentify. This will enable our communities tobecome more enterprising, reducing dependencyand enabling more deprived areas to address theinequalities which impact on their lives.

We know that a one-size fits all approach will notwork. Instead we will develop evidence-based,community-led activities, which are designed toinvolve and connect people. We hope toencourage social connections between peoplewith similar experiences to provide peer support,helping residents to confront and cope with life’schallenges and benefit from its pleasures andopportunities.

Integration – health and care serviceworking together for you

Too often people are passed around the health andcare system before they get what they need.Increasingly people have more than one problemand need different specialists and teams workingtogether to help them. And too often there arepractical and organisational barriers that get in theway.

Our integrated approach in the Care Communitieswill bring teams together for the local population.We will match the right care for a patient’s needsand use integrated case management when itsright for the patient, such as for individuals withcomplex needs. Therefore, people who are olderwith longer term conditions, complex families andthose with mental illness will access servicesthrough a single point and benefit from theirneeds being managed and co-ordinated through amulti-agency team of professionals working to asingle assessment, a single care plan and a singlekey worker.


We will use this integrated approach in all aspectsof our service and planning. As Cheshire East Placewe will create an Integrated Care Partnership (ICP)bringing together the partner organisations thatprovide health and care services. This will allowthe right combined care to be provided regardlessof traditional organisational boundaries andbarriers.

In Cheshire this has also led to the four ClinicalCommissioning Groups (CCGs) proposing to mergeso that they can plan and budget for services thatwe know are needed on a large scale. Localvariations will be looked after through the ICP andour Care Communities.

When services are viewed from the patient andclient’s individual situation it becomes muchclearer what care and support will make the mostdifference to them. For some it will be a mix ofhospital and care at home. For others it will beabout supporting their independence withcommunity-based back up. Integrated careplanning and commissioning means we can createthe right mix of services to match the needs ofpatients.

Getting older is not a disease or illness, and we willeach do it on our own way. Our aim is to keeppeople living happily, healthily and independentlywhilst providing different levels of support andcare as needed.

Promoting wellbeing and preventingill health

The NHS has understandably been seen as therefor us when we need it, when we are unwell orinjured. But we would like it to be as well knownfor keeping us healthy and well, independent andable. Similarly, social care supports people in need.We would rather people keep well so that theydon’t need our services, don’t suffer from avoidableillness and harm. Our approach is to enable morepeople to Live Well for Longer.

The evidence shows that we need to focus on theroot causes of a lot of ill health such as alcohol,obesity, smoking, poverty, poor housing and pooreducation. The NHS and care system recognisesthat it is currently more focussed on managingand fixing problems when they happen ratherthan helping to avoid them and slow down theirimpact.

We want to act across the life-course, fromchildhood to older age, focussing on preventionand early intervention. So, we will be working toreduce alcohol and substance misuse, smoking,and obesity. We want to create opportunities tomake physical activity and eating well, easilyunderstood and easy for everyone to do.

We will support people to take responsibility fortheir own wellbeing throughout their lives, tokeep our communities healthy and independent.We also know there’s a close link between healthand wellbeing and basic prosperity. A healthypopulation is a healthy workforce.

As a health and care system we will make adifference across our communities. We won’tassume it is for someone else or another serviceto be responsible but rather recognise and takeresponsibility for the contribution we can maketoo. We want the result of our work to ensure:

• Our local communities are supportive with astrong sense of neighbourliness

• People have the life skills and education theyneed in order to thrive

• Everyone is equipped to live independently

• People have access to good cultural, leisureand recreational facilities

• Everyone has a home

• We support key employment sectors and localsupply chains

• We value and support the rural economy


Going digitalAchieving the step-change in prevention andearly intervention and the delivery of services willrequire effective use of new technology. We willharness data and digital technology to extend therange and reach of our services. We will usetechnology to support people in takingresponsibility for their own health. We will equipour teams and services with digital information,equipment and systems so that no one shouldhave to tell their story more than once, unlessthere is a clinical need to do so. Everyone shouldbe able to access their health and care services inthe way in which they access other services intheir day-to-day lives.

New ways of assessing health risks, earlydiagnosis and providing preventative care arebeing created by new digital technology andinformation analysis. We want to make thosebenefits available to people in Cheshire East. Ouraim is to use technology to support populationhealth management. This is the identification ofpeople at risk of illness and those who wouldbenefit from early intervention to help reduceillness and premature death. The money savedcan be used for other health and care services.

We will connect all health and care services andinvest in modernising systems and equipment sothat all services are linked, and information is notlost between different parts of the system. Thiswill improve the quality of care and reduce timelost by our staff chasing or missing information.We will also significantly reduce paper processesand records that cause inefficiency and delays incare.

We are already collaborating across Cheshire withthe Cheshire Integrated Care Record, and acrossthe wider Cheshire and Merseyside region toensure a single set of digital standards that arereliable, cost effective and consistent for allpatients and professionals using them.

In our Connected Care Communities, we will explorehow we can use telemedicine technology to keeppeople safe and give them rapid access to support.We will provide more convenient access to servicesand health information for patients, with the new NHSApp as a digital ‘front door’, better access to digitaltools and patient records for staff, and improvementsto the planning and delivery of services based on theanalysis of patient and population data. ‘Live Well’ willcontinue to be developed as the one-stop onlineportal and directory to useful information, guidanceand advice.

Building the right health andcare workforceOur workforce in health and social care in CheshireEast totals over 20,000 people; just over 11,000 insocial care and 9,000 in our NHS organisations butrecruitment and retention remains a significantchallenge.

Our Workforce and Organisational Developmentstrategy is being further developed as our changingclinical models evolve with the aspiration to have asingle workforce strategy and plan for health and careservices across the Cheshire East Place. We alreadyknow we will have great difficulty recruiting careworkers, GPs, nurses and consultants, so our strategywill include the development of services that can bedelivered by other health and social care professionals.We are placing a special focus upon future workforcesupply, recruitment and retention across Cheshire Eastand ensuring system-wide leadership.

We are concerned about being able to provide safeand recommended levels of staffing both now and inthe era of seven-day services. We will consider how wedevelop services, so they are both safely staffed,rewarding places to work and accessible to localpeople.



Using taxpayers’money wiselyThe NHS in Cheshire East spends almost£750million a year but its income is just under£700m a year. This deficit has arisen, in part,because of the huge increases in demand forservices that have outpaced budgets. Similarly, alllocal authority services have faced veryconsiderable financial challenges in recent yearsand increasing demand in both adults andchildren’s social care. With delays in the publicationof the Social Care Green paper, national changes tolocal government and school funding anduncertainty over the future of the Public healthgrant, the financial resources of the Cheshire EastPlace will continue to be fragile We recognise,however, that by focussing on keeping peoplehealthy and supported in their own communitiesand by reducing duplication we can save money.

Our plans will change the balance between care inour acute hospitals and care in the community. Wewill need to increase the range and choice of careprovided in people’s homes and in local clinics and

primary care centres. By reducing the pressure onour hospitals and keeping people well enough notto use them, we will be ensuring that you onlyneed to go into hospital when care cannot beprovided in your community. Our strategy is clearin that we will focus our future investment onkeeping people as well and as independent aspossible.

Where there are administrative barriers, we willremove them and where there is duplication ofeffort, or benefits of closer partnership andcollaboration being missed we will change. We willalso make existing commissioning structures moreefficient by consolidating our local CCGs.

Getting the most out of taxpayers’ investment inthe NHS means we will continue working withdoctors and other health professionals to identifyways to reduce duplication in how clinical servicesare delivered. We will make better use of the NHS’combined buying power to get commonly-usedproducts cheaper and reduce spend onadministration. We will make sure the Cheshirepound is invested in the health and care of thepeople of Cheshire East effectively, efficiently andaccountably.

Cheshire East Partnership Five Year Plan | 29Conclusion

Cheshire East thrives where people have theconfidence and pride to stand on their own twofeet, to compete and to fully participate incommunity life. We will support people to dothat and remove the barriers that get in the way.

Helping people to help themselves,understanding their own risks and what they cando about them is our priority. We would rathernever have to help, than treat an avoidable need.We would rather spend public resourcesenhancing lives than fixing them.

We recognise that our community health andwealth are linked and that our community andpersonal wellbeing are intertwined. We haverelied on the NHS to respond to problems thatwill keep happening if we don’t fix their causes.That is not something the NHS can do alone, norshould it. Prevention and wellbeing come frompersonal responsibility, community action andcombined public services working together toprovide the right care and support, where it willmake a difference, when it will make a difference.

We have many resources and abilities to achievethis and we need to make sure we can make themall count, but we will also work in new and moreeffective ways and make sure the benefits thattechnology and digital offer are available foreveryone.

There are unmet needs and inequalities inCheshire East that we know about and will focuson responding to. Cheshire East has so much tooffer and is a wonderful place to live. Our duty isto make sure we make that a healthy and well-lived reality for all our residents.

This document is designed to stimulate debateand conversation. We present here informationand issues about our health and wellbeing as weknow them. We share our optimism about whatwe think can be achieved and our concerns aboutinequalities that are unacceptable and avoidable.We also offer our commitment to work on ourcommunity’s behalf. If we work together, we candeliver a better quality of life and health for all ofus.

06 ConclusionWe want to use the strengths of our community in every meaning of the word to improve wellbeingand avoid illness and prevent death.

We have four clear outcomes that we believe we can achieve and will make themost difference to everybody’s health and wellbeing:

1. Create a place that supports health and wellbeing for everyone living in Cheshire East

2. Improve the mental health and wellbeing of people living and working in Cheshire East

3. Enable more people to Live Well for Longer in Cheshire East

4. Ensure children and young people are happy and experience good physical and mentalhealth and wellbeing

07 Appendix One

30 | Cheshire East Partnership Five Year PlanAppendices

How we will know we have been successful?We set out below some measures of success. The most important measures being how we impact people’s livesand wellbeing for the better. Other measures will include financial responsibility and balance for our budgets,good quality ratings from regulators such as the CQC and meeting NHS performance targets.

Indicators for Success

We want to: • Maintain the low numbers of 16-17-year olds not in education, employment or training (NEET) or whose

activity is not known • Increase the percentage of people aged 16-64 in employment • Reduce the number of people who are killed or seriously injured on the roads • Increase the number of people who use outdoor space for exercise/health reasons • Further reduce the number of households that experience fuel poverty

Key Deliverables • Ensure that health and wellbeing considerations are at the heart of all work related to spatial planning,

transport, housing, skills and employment • Develop a Supplementary Planning Document for Health and Wellbeing

Outcome One - Create a place that supports health and wellbeing for everyone living inCheshire East

Cheshire East Partnership Five Year Plan | 31Appendices

Indicators for Success

We want to: • Increase the numbers of adults who report good wellbeing • Reduce the levels of depression in adults • Increase the numbers of children and young people who report good wellbeing • Increase the proportion of adult social care users who have as much social contact as they would like• Increase the proportion of adult social carers who have as much social contact as they would like• Increase the proportion of adults in contact with secondary mental health services living independently • Increase the proportion of adults in contact with secondary mental health services in employment • Reduce the suicide rate

Key Deliverables • Deliver our responsibilities in ensuring that Cheshire and Merseyside achieve Suicide Safer Status –

demonstrating work to reduce rates of suicide. • Assess the levels of isolation across the borough

Outcome Two - Improve the mental health and wellbeing of people living and working inCheshire East

Indicators for Success • Increase the breastfeeding rates • Reduce the numbers of children with tooth decay • Reduce the numbers of 4-5- and 10-11-year olds who are overweight or obese • Increase the numbers of people meeting the recommended "5-a-day" at age 15 • Reduce the number of adults that smoke • Reduce the number of adults who are overweight or obese • Increase the number of adults that are physically active • Reduce the number of alcohol related admissions to hospital • Increase the number of people who successfully complete alcohol or drug treatment • Increase the numbers of people meeting the recommended '5-a-day' on a 'usual day' • Increase the number of people who are offered and accept a NHS Health Check • Improve health related quality of life for older people • Reduce the numbers of older people who fall and need to be admitted to hospital

Key Deliverables • Deliver four collaborative health and wellbeing campaigns across all partners per year • Deliver a physical activity programme in schools not currently participating in a programme • Develop a falls prevention strategy

Outcome Three - Enable more people to Live Well for Longer in Cheshire East

07 Appendix Two


The NHS Long Term PlanNHS England published the NHS Long Term Plan in January this year which set out the challenges the NHSfaces today and the pressures that it will face in the next decade. It made commitments on how the NHSwould respond to the opportunities that new ways of working, additional funding and technologyadvances can provide everyone. It set out for the whole NHS the plan for new services and betterexperience and outcomes for patients:

1. Doing things differently: we will give people more control over their own health and the care theyreceive, encourage more collaboration between GPs, their teams and community services, as‘primary care networks’, to increase the services they can provide jointly, and increase the focus onNHS organisations working with their local partners, as ‘Integrated Care Systems’, to plan anddeliver services which meet the needs of their communities.

2. Preventing illness and tackling health inequalities: the NHS will increase its contribution totackling some of the most significant causes of ill health, including new action to help people stopsmoking, overcome drinking problems and avoid Type 2 diabetes, with a particular focus on thecommunities and groups of people most affected by these problems.

3. Backing our workforce: we will continue to increase the NHS workforce, training and recruitingmore professionals – including thousands more clinical placements for undergraduate nurses,hundreds more medical school places, and more routes into the NHS such as apprenticeships. Wewill also make the NHS a better place to work, so more staff stay in the NHS and feel able to makebetter use of their skills and experience for patients.

4. Making better use of data and digital technology: we will provide more convenient access toservices and health information for patients, with the new NHS App as a digital ‘front door’, betteraccess to digital tools and patient records for staff, and improvements to the planning anddelivery of services based on the analysis of patient and population data.

5. Getting the most out of taxpayers’ investment in the NHS: we will continue working with doctorsand other health professionals to identify ways to reduce duplication in how clinical services aredelivered, make better use of the NHS’ combined buying power to get commonly- used productsfor cheaper, and reduce spend on administration.


Our plans in Cheshire East will reflect the nationalplan’s direction of travel but also our local priorities.We will involve and engage local people andcommunities in making plans and developingservices that reflect their views and needs.

National plan, local impactAs we have shown, cancer, heart disease, stroke,diabetes and mental health are the dominant healthconditions that will affect most of us. The NHS LongTerm Plan aims to prevent 150,000 heart attacks,strokes and dementia cases and provide educationand exercise programmes to tens of thousands morepatients with heart problems, preventing up to14,000 premature deaths over the next ten years. InCheshire East we will ensure that residents benefitfrom these plans getting the right specialist carequickly from the best NHS centre for their needs.

Diagnosing and treating cancer early is crucial tosaving lives. The NHS aims to save 55,000 more livesa year by diagnosing more cancers early and invest

in spotting and treating lung conditions early toprevent 80,000 stays in hospital.

Mental health includes our emotional, psychological,and social well-being. It affects how we think, feel,and act. It also helps determine how we handlestress, relate to others, and make choices. Mentalhealth is important at every stage of life, fromchildhood and adolescence through adulthood.

We will ensure that our children, young people andadults have improved emotional wellbeing andmental health thanks to a focus on prevention andearly support. Avoiding loneliness and isolation is akey objective and our Care Communities model ofservices will mean health and care professionals arecloser to the ground to both anticipate needs andrespond to them quickly and more personally.

As a society we are reducing the stigma of mentalhealth that has meant many people in the past werereluctant to seek help. We must now be able toanticipate and provide the support to all that need it.

07 Appendix Three


On production of the NHS Long Term Plan,NHS England commissioned HealthwatchEngland to gain the views of the public. Inturn, Healthwatch England asked the 152 localHealthwatch throughout the country to workwith their Sustainable TransformationPartnerships (STP) or Health and CarePartnerships (HCP), to engage with people tofind out what was important in regard to theway services will be delivered in the NHSunder the Long Term Plan.

As the coordinating local Healthwatch for thenine within Cheshire and Merseyside whoconducted the research, HealthwatchCheshire (consisting of East and West)oversaw the research across Cheshire andMerseyside and brought the informationtogether to produce final reports.Healthwatch Cheshire were also responsiblefor liaising with the Cheshire and MerseysideHCP regarding the work.

Research in Cheshire East was conductedthrough two surveys and three specific focusgroups, and took place following thepublication of the Long Term Plan from mid-March to the end of May 2019. The surveyswere designed nationally by HealthwatchEngland, with the first entitled ‘People’sgeneral experiences of health and careservices’, and the second survey looking at‘NHS support for specific conditions’. Thesurveys were available online and also in hardcopy which were available at Healthwatchengagement events at venues across CheshireEast.

In Cheshire East, Healthwatch Cheshire Eastreceived 270 survey responses, consisting of202 general surveys and 68 specific conditionsurveys. There were also 33 attendees acrossthree specific focus group events focusing onwhat is important in regards to health andcare for students and people with autism.These groups were conducted with studentsfrom the Crewe Campus of South and WestCheshire College, and two sessions withSpace4Autism in Macclesfield.

Healthwatch Cheshire East engagement report


Feedback Healthwatch Cheshire East received included:

• In order to live a healthy life people felt that access to the help and treatment they need when theywant it was most important.

• In terms of maintaining their health and independence in later life, people surveyed overwhelming feltthe most important factor was being able to stay in their own home for as long as it was safe.

• When considering managing and using support and treatment, people felt that the right treatmentshould be a joint decision between them and healthcare professionals and they should be consultedthroughout the process.

• People in Cheshire East told us that being able to talk to their doctor or other health care professionalwherever they are was the most important factor in being engaged in health service delivery.

• People with, or caring for people with autism felt that the time they had to wait to receive their initialassessment, diagnosis or treatment was too long. Waiting times ranged from eight months to threeyears. Members of our focus group also felt that there was a lack of understanding by front line staff ofthe autism spectrum. Funding and access to services was a serious issue for the parents of people withautism spectrum conditions.

• People with, or people caring for those with, dementia gave mixed responses to the initial support theyreceived; most felt that it either met their needs or somewhat met their needs. Most reported thatongoing care and support was easy to access.

• 94% of people who responded with a Mental Health condition felt that their overall experience ofgetting help was either average, negative, or very negative.

Your thoughts matter If you have any views on the Plan you can either:

Attend one of our two engagement events13th August 10-12pm

Crewe Alexandra Football Club, Gresty Road, Crewe

or

20th August 10-12pmMasonic Hall, 1 Riseley St, Macclesfield

Complete our online questionnaire by following this link:www.healthwatchcheshireeast.org.uk/get-involved/consultations

Email your thoughts and comments to:[email protected]

Cheshire East Council, Westfields, Middlewich Road,Sandbach, Cheshire, CW11 1HZ

General enquiries: 0300 123 5500Email: [email protected]

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