City of London Joint Health and Wellbeing Strategy · Corporation’s Joint Health and Wellbeing Strategy 2017-2020, which draws together the work of many key organisations working

Joint Health and Wellbeing Strategy

2017-2020City of London Corporation

Joint Health and Wellbeing Strategy is published by the City of London Corporation.

© City of London CorporationPO Box 270, GuildhallLondonEC2P 2EJ

www.cityoflondon.gov.ukTel: 020 7332 3002

Joint Health and Wellbeing Strategy

2017-2020

City of London CorporationMay 2017

JOINT HEALTH AND WELLBEING STRATEGY 2017/18-2020/21

1 Foreword 4

2 Introduction 5

3 Background 5 3.1 The City 5 3.2 City residents 6 3.3 Cityworkers 7 3.4 Roughsleepers 7

4 How are we going to achieve our vision? 7 4.1 Ourvision 7 4.2 Howthisstrategywilldeliverourvision 7 4.3 TheroleofourHealthandWellbeingBoard 8

5 Strategic context 8 5.1 Nationalcontext 8 5.2 Localcontext 8 5.3 Sustainability and Transformation Plans 9 5.4 Locality Plans 9 5.5 Devolutionpilotandintegratedcommissioning 9

6 Progress since the last strategy 10

7 Developing this strategy 11

0 Contents



8 Priorities 11 8.1 GuidingPrinciples 11 8.2 Priority1:Goodmentalhealthforall 12 8.2.1Whythisisapriority 12 8.2.2Whatwewillachieve 12 8.2.3Whatwewilldo 13 8.3 Priority2:Ahealthyurbanenvironment 13 8.3.1Whythisisapriority 13 8.3.2Whatwewillachieve 15 8.3.3Whatwewilldo 15 8.4 Priority3:Effectivehealthandsocialcareintegration 15 8.4.1Whythisisapriority 15 8.4.2Whatwewillachieve 16 8.4.3Whatwewilldo 16 8.5 Priority4:Allchildrenhavethebeststartinlife 16 8.5.1Whythisisapriority 16 8.5.2Whatwewillachieve 17 8.5.3Whatwewilldo 17 8.6 Priority5:Promotinghealthybehaviours 18 8.6.1Whythisisapriority 18 8.6.2Whatwewillachieve 19 8.6.3Whatwewilldo 19

9 Delivering the strategy 20 9.1 TheRoleoftheHealthandWellbeingBoard 20

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1 Foreword

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Message from the Chairman of the City of London Health and Wellbeing Board

IamdelightedtobeabletopresenttheCityofLondonCorporation’sJointHealthandWellbeingStrategy2017-2020,whichdrawstogethertheworkofmanykeyorganisationsworkinginpartnershiptoimprovethehealthandwellbeingofpeople in the City of London.

ThehealthandwellbeingdemandsintheCityaredistinctiveandthisStrategyreflectsthis.Everyonewholives,worksandvisitstheCityhasarighttogoodhealth.TheCityCorporationiscommittedtoitsvisiontoworkinpartnershiptoachievelonger,happier,healthierlivesintheCityofLondon.ThevisionforthisStrategyprovidesaframeworktomakethebiggestdifferenceoverthenextfewyears.

Achievingtheprioritieswithinthisstrategywillrequireleadershipfromtheboardandactiveengagementfromtherangeofpartnersincludingcommissionersandprovidersofservices,communityandvoluntarysectorgroups,andthewiderangeoforganisationsthatcomeintocontactwithcitizensonadailybasisincludingemployersandschools.

Wewouldliketothankallthosewhohavecontributedtothedevelopmentofthisstrategyand,mostimportantly,allthoseworkingtocontinuetoimprovethehealthandwellbeingoflocalresidents,workersandroughsleepers.

Deputy Joyce Nash OBEChairman of the Health and Wellbeing Board

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2 Introduction

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TheHealthandSocialCareAct2012placeshealthandwellbeingboardsattheheartofplanningtotransformhealthandsocialcareandachievebetterstandardsofhealthandwellbeingforthepopulation.Healthandwellbeingboardshaveanumberofcoreresponsibilities.TheseincludeassessingthehealthandwellbeingneedsofthelocalpopulationthroughtheJointStrategicNeedsAssessment(JSNA)andpreparingajointhealthandwellbeingstrategy.

The aim of a joint health and wellbeing strategy is to jointly agree what the most important issues are for the local community based on evidence in JSNAs, what can be done to address them, and what outcomes are intended to be achieved.

(DepartmentofHealth,2012)

TheCityofLondoncontainsseveralpopulationsinoneplace(residents,workers,roughsleepersandotherpeoplewhovisittheCityeveryday),withdifferentneedsandhealthissues.Thisstrategythereforeconsidersthreedistinctpopulationswithdifferentneedsandmentalhealthissues:residents,Cityworkersandroughsleepers.

TheCityofLondon’sHealthandWellbeingBoard1 exists to improvethehealthandwellbeingofthesecommunitieswithintheCityofLondonandtoreducehealthinequalitiesacrosstheSquareMile.Itbringstogetherleadersacrossthehealthandcaresystemtoprovidecollectiveleadershiponarangeofcomplexandcross-cuttingchallengeswhichimpactonthehealthandwellbeingoflocalpeople.

Healthandwellbeingoutcomesandinequalitiesaredrivenbyarangeoffactors,someofwhichindividualshavelittlecontrolover.Othersaretheresultofbehaviourswhichinturnareheavilyinfluencedbypeople’scircumstancesandenvironment,suchasincome,employmentandlivingconditions.Thisstrategywilladdress those factors which affect the health of the population within the City of London.

1 Details of the Health and Wellbeing Board meetings, agendas and membership can be found here: http://democracy.cityoflondon.gov.uk/mgCommitteeDetails.aspx?ID=994

http://democracy.cityoflondon.gov.uk/mgCommitteeDetails.aspx?ID=994

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3 Background

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3.1 The CityTheCityofLondonhasthehighestdaytime population of any local authority area in the UK, with hundreds of thousands ofworkers,residents,studentsandvisitorspackedintojustoverasquaremileofdenselydevelopedspace.TheCityofLondonalsohasthesixthhighestnumberofroughsleepersinLondon.

The City Corporation is responsible for localgovernmentandpolicingwithintheSquareMile.ItalsohasarolebeyondtheSquareMile,asaporthealthauthority,asponsorofschools,andthemanagerofmanyhousingestatesandgreenspacesacross London.

TheCityandHackneyJointStrategicNeedsAssessmentpullstogetherdatafromarangeofsources.ItissupplementedbyaCityspecificdocumentwhichdescribes the health needs of the different communitiesintheCity,andmakesanumberofkeyrecommendationsforserviceprovisionbasedonlevelsofneed.Thesefindingsformtheevidencebaseforthisstrategyandenableustounderstandthe particular health problems faced by peopleintheSquareMile.

TheCityborderssevenLondonboroughsandresidentsoftenhavetoaccessservicesthataredeliveredoutsidetheSquareMile.ThecatchmentareaoftheCity’sonlyGPpracticedoesnotcoverthe whole City, so residents in the east

accessprimarycareservicesfromTowerHamletsGPs.Thismeanswemustalsoworkclosely with Tower Hamlets CCG to ensure residents’ needs are met.

Public Health in the City of London has astrongrelationshipwiththeLondonBoroughofHackney.CityandHackneyshare a Director of Public Health and aClinicalCommissioningGroup.Anumberofpublichealthservicesarealsocommissioned in partnership with the LondonBoroughofHackney.Whilemostpublichealthservicesarefocussedon the resident population, some public healthservicesarealsocommissionedforCityworkers.

Insurveys,theCityscoreshighlyasaplacetoliveandworkandithasexcellenttransportlinksandculturalservices.TheCity is an urban area, and suffers from poorairquality.Particulatematterandnitrogendioxidelevelsarebothveryhigh,andthereareahighnumberofnoisecomplaints. There are numerous open spaces in the City but they tend to be smallinsize.

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3.2 City residentsThe latest population estimates from the OfficeofNationalStatisticsplacestheCity’sresidentpopulationat8,760–afigurewhichisprojectedtoincrease.Thoseaged65andoverareprojectedtocontributethemosttothisgrowth,withtheirnumbersincreasingrapidlyinthenextdecade.Thisislikelytocreateincreaseddemand for health and social care servicesinthefuture.

Incontrast,therearerelativelyfewchildren in the City. The City’s children mainlyliveindensepocketsofhousingwithsomeareasexperiencinghighlevelsofdeprivation.TheCityofLondonhasadiverserangeofethnicitiesandreligiousfaiths.Around300childrenandyoungpeoplereceivesomeadditionalservicesthroughSEND(SpecialEducationalNeedsandDisability)supportbecausetheygotoschoolintheCity(281childreninJanuary2016)orbecausetheyliveintheCity.Anestimated78%oftheCityofLondonpopulationiswhiteBritish;however,approximately40%ofchildrenarefromblackorethnicminoritygroupscomparedto21%nationally,theBangladeshicommunityformthesecondlargestethnicgroupintheCityofLondon..

TherehasbeenimprovementintheCity’sdeprivationrankinginrecentyears,howeversignificantgapsremainbetweentheareasofPortsoken(40%mostdeprived)andBarbican(10%leastdeprived).

TheCityofLondonhasseveraleducational institutions so is also home tostudentswhoboardandtravelin duringtheday.

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3.3 City workersAround415,000peopleworkintheSquareMile,andthisisexpectedtogrowrapidlyoverthenextdecade.Cityworkersaremainlyagedbetween20and50,withahigherproportionofmen.Cityworkerstendtobehealthierthanthegeneralpopulationbecausetheyareyounger,althoughlifestylefactorssuchassmoking,alcoholconsumption,levelsofphysicalactivityanddiethaveanimpact.

3.4 Rough sleepersIn2015-16theCityhadthesixthhighestnumberofroughsleepersamongLondonlocalauthorities.Onaverage20-25peoplesleep on the streets of the City of London everynight.Thevastmajorityaremaleand include those new to the streets as wellaslongertermroughsleepers. Thosethatfindthemselveshomelessonthestreetsareespeciallyvulnerabletocrime,drugsandalcohol,andathighriskofphysicalandmentalillnessandprematuredeath.Manypeoplecome to the streets with complex issues, some havelimitedentitlementtoservicesand some are resistant to support and treatment. Homelessness can be both acauseandaconsequenceofmajorproblemsforanindividual’shealth,bothphysical and mental.

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4 How are we going to achieve our vision?

4.1Our visionThisstrategyisunderpinnedbythefollowingvision:

Working in partnership to achieve longer, happier, healthier lives in the City of London

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4.2How this strategy will deliver our visionThekeyroleofthisstrategywillbetoinformcommissioningandserviceplanning–toensuretheCity’sprioritiesaremet within wider partnership approaches andservicecommissioningfrom2017/18.We expect that both commissioners and serviceproviderswillseektoimplementthestrategyinthespecification,planninganddeliveryofservices.Wewillalsoexpectcontinuedintegrationwhereverthiscandeliverbetterhealthoutcomesand a better experience for patients and serviceusers.

Byimplementingourstrategywewanttoreduce the differences in health across the SquareMile,forthosewholiveandworkhere.Wewilluseevidenceofeffectivenesstoinformwhatwedoandwewillgetthebestvaluefromourresources.Wewillinvestinpreventionandearlyintervention.Wealsowantmorepeopletohaveapositiveexperienceofcareandsupport.Thismeansthataccesstoservicesshouldbefairandtransparent,provisionofservicesshouldbetimelyandthelocationshouldbeappropriate.Whereverpossible,people should be supported in the community, close to their homes, friends and families. Care and support should givepeoplethegreatestpossiblelevelofchoiceandcontrolovertheirlives and should be tailored to meet their individualneeds.

4.3 The role of our Health and Wellbeing BoardTheHealthandWellbeingBoard’srolewillbetochampionthevisionandprioritiesofthestrategyandtoholddeliverypartnerstoaccount.ThiswillrequiretheBoardtoproviderobustchallengetoworkbeingdeliveredacrossthesystemandshowaction-focusedleadershipifbarriersexistandarepreventingprogress.ThismayincludeBoardmembersworkingtoactivelydrivechangeintheirownorganisations,orlookingtogetherathow resources are used across different agenciesandpartnersformaximumimpact.Monitoringprogress,andseeinghowthestrategyisleadingtorealchangeforresidents,workersandroughsleepers,willenabletheBoardtomaketherightinterventionsattherighttime.Thedetailofthisactionisgivenbelowinsection9.

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5 Strategic context

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5.1National context TheNHSisfacinggrowingfinancialandservicepressuresduringatimeofrisingdemand.TheNHSFiveYearForwardView2, published in October 2014, is set in this context.ItsetsoutanewsharedvisionforthefutureoftheNHS,emphasisingtheneedtomovetoplacebasedsystemsofcarewhereorganisationsarecollaboratingandusingtheirresourcescollectivelytomeet the needs of the local population inthemostappropriateandeffectiveway.ItalsosetsoutthechallengestobeaddressedintheNHSaroundfinanceandefficiency,improvingthehealthofthepopulationandprovidingqualitycare.

5.2Local contextSincethelastJointHealthandWellbeingStrategypolicyourCorporatePlan(2015– 2019)hasbeenapproved.ThisistheCityCorporation’smainstrategicplanningdocumentandprovidesaframeworkforthedeliveryofservices.Itsetsaimsthatincludeacommitmenttomaintaininghighquality,accessibleandresponsiveservicesbenefitingitscommunities,neighbours,London and the nation3.ThisstrategysupportsthedeliveryoftheCorporatePlanandwillinturnprovidestrategicdirectionto

2 https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

otherstrategiesandactionplans,includingthoseonsocialcare,housing,transport,employmentandworkingwithbusinesses.4

ThestrategyisalsoinformedbytheCityandHackneyCCG’sFiveYearStrategicPlan(2014–2019)5, which outlines its strategicvisionas:

o patients in control of their health andwellbeing;

o ajoined-upsystemwhichissafe,affordable,ofhighquality,easytoaccess,savespatients’timeandimprovespatientexperience;

o everyoneworkingtogethertoreducehealthinequalitiesandprematuremortalityandimprovepatientoutcomes;

o gettingthebestoutcomesforeverypoundweinvestthroughanequitablebalancebetweengoodpreventativeservices,strongprimaryandcommunityservicesandeffectivehospitalandmentalhealthserviceswhicharewrapped around patient needs;

o servicesworkingefficientlyandeffectivelytogethertodeliverpatientandclinicaloutcomesandprovidersinfinancialbalance.

4 CCG Commissioning Strategy; Mental Health Strategy; Children and Young People’s Plan; Homelessness Strategy; Carers’ Strategy; Air quality Strategy; City of London Commissioning Prospectus – Services for Children and Young People; Noise Strategy; Suicide Prevention Action Plan, VAWG strategy.

5 http://www.cityandhackneyccg.nhs.uk/Downloads/About%20Us/Equality%20and%20diversity/5%20YEAR%20PLAN%20UPDATE%20final.pdf

https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

https://www.cityoflondon.gov.uk/about-the-city/how-we-make-decisions/Documents/corporate-plan-2015-19.pdf

http://www.cityandhackneyccg.nhs.uk/Downloads/About%20Us/Equality%20and%20diversity/5%20YEAR%20PLAN%20UPDATE%20final.pdf

http://www.cityandhackneyccg.nhs.uk/Downloads/About%20Us/Equality%20and%20diversity/5%20YEAR%20PLAN%20UPDATE%20final.pdf

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5.3Sustainability and Transformation PlansInDecember2015,NHSEnglandrequiredlocalareastoproducefiveyearSustainability and Transformation Plans (STP)tosetouthowlocalareasproposedtomeetthechallengessetoutintheFiveYearForwardView.TheCityCorporationis part of the North East London STP. This includeseightlocalauthorities,sevenCCGs and three acute hospital trusts (HomertonUniversityHospitalTrust,BartsNHSHealthTrustandBarking,HaveringandRedbridgeUniversityHospitalsTrust).

5.4Locality PlansCCGs and their partner local authorities aredevelopingtwotofiveyearlocalityplanstoaddresslocalissueshighlightedinlocalhealthandwellbeingstrategiesaswellascontributingtodeliveringthewiderSTP ambitions. This allows City of London specificprioritiesaroundsocialisolation,thehealthofworkersandcrossboundaryissues to be addressed in the locality plan.

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5.5Devolution pilot and integrated commissioningSeparatelytotheSTP,theLondonBoroughofHackneyandCity&HackneyCCGalongwithlocalhealthproviderswereapprovedasadevolutionpilot.Thisallowsthemtoexplorethedelegationofpowerstoalocalleveltobettersupporttheachievementofplans.Thisaimstoaccelerate the transformation of the local healthandcaresysteminHackneysothatitisfinanciallyandclinicallysustainableandprovidesimprovementsinhealth,careandwellbeingoutcomes.TheCityCorporationandtheCCGhavebeenworkingcloselytoensurethatdevolutionbringsadvantagesandimprovedoutcomes to the City, where its needs arespecific.

Thedevolutionproposalcommittedtoexploringjointcommissioningbetweenthe CCG and the local authority social careandpublichealthfunctions.Acommitment has been made to explore thisfortheLondonBoroughofHackney.AstheCityCorporationisnotpartofthedevolutionpilot,theCCGiskeentoestablishasimilararrangementwiththe City Corporation to mirror those in Hackneytoensureanequitableapproachacross the CCG area.

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6 Progress since the last strategy

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This is the second City of London Joint HealthandWellbeingStrategy,followingthefirstwhichcoveredtheperiodfrom2013-2016.TheHealthandWellbeingBoardhassuccessfullyoverseenthetransition of statutory powers from PCTs toLocalAuthoritiesandCCGsandhashelpedbothorganisationstoconsiderhowtomainstreamhealthandwellbeingconsiderationsthroughouttheirwork.

SincethelastHealthandWellbeingStrategy,wehaveworkedhardtodevelopapublichealthoffertoCityworkers.BusinessHealthy,acommunityand online resource for business leaders launchedinApril2014,aimstoengageandeducatebusinessesonawiderangeofhealthissuesthroughblogs,eventsandround table discussion. Business Healthy nowhas477members.Thisinitiativewasrecognisedasdemonstratingahighlevelof excellence by the Royal Society for Public Health, which awarded it the three yearHealthandWellbeingAwardfor 2014-2017.

WehaveworkedhardtoimprovementalwellbeingintheCity.Wehavedevelopedamentalhealthstrategyandaccompanyingactionplanwhichisbeingsuccessfullyimplemented.Wehavealsodevelopedasuicidepreventionactionplanandareworkingcloselywithpartnersto reduce suicide attempts in the City of London.ActionshaveincludedplacingsignstoencouragepeopletoseekhelponCityofLondonbridgesandtrainingfrontline staff and the members of the

publicinhowtorecogniseandhelpsomeonewhoisconsideringsuicide.

Wehavealsocommissionednewservicesaimedatpromotinghealthybehavioursincludinganewintegratedsmoking,alcoholandsubstancemisuseservice,SquareMileHealth,andahealthcheck,weightmanagementandphysicalactivityservicecalledCityLivingWise.

WithHackney,wehavejointlycommissionedpublichealthservicesforchildrenlivingintheCityofLondonincludingCHYPSPlus6, a holistic clinical andeducationservicefor5-19yearoldswith an emphasis on sexual health. Wehavealsotakenonresponsibilityfor0-5yearolds,andhavecommissionedanewhealthvisitingservicethatprovidesadditionalsupportformorevulnerablemothers.

TheHealthandWellbeingBoardhascontributedtothedevelopmentoftheCityofLondonairqualityandnoisestrategieswhichaimtocreateahealthierenvironmentforthosewholiveandworkinthe City of London.

6 City and Hackney Young People’s Service

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7 Developing this strategy

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WithintheCity,thesizeoftheresidentpopulation presents a number of challengestostrategicplanning.Itisoftendifficultforustogetmeaningfuldataabouthealthneeds,trendsandserviceprovision,givenverysmallsamplesizes.WealsohaveahugenumberofcommutersenteringtheCityeveryday,aboutwhomverylittleinformationiscollected.

Forthisreason,itisevenmorevitalthatweuseacombinationofquantitativeevidencefromtheJSNAandotherhealthneeds assessments, combined with local andcommunityintelligence,todetermineour priorities.

TheCityandHackneyJointStrategicNeedsAssessmentandtheJSNACitySupplementpulltogetherdatafromarangeofsourcestodescribethehealthneedsofthedifferentpopulationgroupsintheCity,andmakeanumberofkeyrecommendationsforserviceprovisionbasedonthelevelofneed.JSNAfindingsformtheevidencebaseforthisstrategyandenableustounderstandthe particular health problems faced by peopleintheSquareMile.

TheinformationfromtheJSNAhashelpedidentifyourprioritiesbylookingatthenumber of people affected, impact onhealthandwellbeing,scopeforimprovement,inequalities,deprivationanddisadvantageandunmetneed.

Therehasalsobeenengagementandconsultationwitharangeofstakeholders,includingaseriesoflocaleventsandformalengagementwithresidentsandworkersintheCityofLondon,whichhavebeen used to shape the priorities within thisstrategy.

Business Healthy members who represent businesseswithaninterestinworkplacehealthintheSquareMilehavealsobeenaskedfortheirviewsonthechallengestheyfaceinsupportingthementalhealthof their employees.

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8 Priorities

8.1 Guiding Principles

These are:

1.Supportparentsandlocalservicestogiveeverychildthebeststartinlife

2.Enableallchildren,youngpeopleandadults to maximise their capabilities and havecontrolovertheirlives

3.Encouragefairemploymentandgoodworkforall,includinghelpingpeopletomaintainawork-lifebalance

4.Encourageahealthystandardof livingforall

5.Createanddevelophealthyandsustainable places and communities

6.Strengthentheroleandimpactof ill-healthprevention

TheMarmotReviewin2010,‘FairSociety,HealthyLives’proposedevidencebasedstrategiesforreducinghealthinequalities,includingaddressingthesocialdeterminantsofhealthinEnglandfrom2010.TheMarmotReviewconcludedthatreducinghealthinequalitieswouldrequireactionfromgovernmentonsixpolicy areas. TheCity’sHealthandWellbeingBoardrecentlyrevisitedtheMarmotprinciples,inlightofdevelopmentsmadeinthepastsixyears,aswellasconsideringwhatwaswithinscopeforahealthandwellbeingboardandstrategytoachievealone.Where appropriate and within scope, thestrategywillstrengthenandsupportthedeliveryoftheMarmotprinciples.TheboardagreedthattheMarmotprincipleswouldbethestartingpointfortheirownset of six principles.

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Good mental health for all

Poor mental health is one the most significantandpervasiveissuesfacingour society. One in ten children and one in four adults will experience a mental health problem at some point in their life. Depression and anxiety, the most common and widespread mental health problems, arealsoknowntodisproportionatelyaffectmoredeprivedsectionsofsociety,contributingtolowerqualityoflife.Poormental health in the City of London affects each of the three main communities addressedwithinthisstrategy:residents,workersandroughsleepers.

Theincreasingnumberofolderresidents,particularlythoselivingalone,islikelytoresultinincreasedlevelsofsocialisolationanddepression.Itisalsoknownthatpeoplewithlong-termconditionsare2-3timesmorelikelytoexperiencemental health problems. Carers are also particularlyvulnerabletomentalhealthissues. Other issues such as unemployment andpoorhousingcancontributetomental ill health.

8.2Priority 1

8.2.1 Why this is a priority

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FormanyCityworkersthehighpressure,competitivenatureandlongworkinghoursofCityrolesmayalsotriggerstressandmentalhealthissuesincludinganxiety,depressionandrisk-takingbehaviours.Previously,periodsofsevereeconomicproblemsandjobinstabilityhavehadanadverseeffectonthementalhealthofworkerpopulations.

Around45%ofroughsleepersintheCityhave,orhavehad,amentalhealthproblem,makingthisgroupasignificantfocusformentalhealthservices.TheCity’slocationanddistinctiveinfrastructureincludingthehighrisebuildings,railandundergroundnetworksandtheRiverThamesprovidedifferentmeans for suicide. The City of London hasthreepopulationsatriskofsuicide:thosewholiveintheCity,thosewhoworkintheCityandthosewhotraveltothe Citywiththespecificintentionofcommittingsuicide.

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Our ambition is for more children, adults and older people in the City of London to havegoodmentalhealth

Weaspireforfewerpeopletodevelopmental health problems and for more people with mental health problems to beabletorecover,haveagoodqualityoflifeandapositiveexperienceofcareandsupport.Wewillkeeppeoplewellthroughpreventionandearlysupport.Peopleshouldbeequippedwiththetoolstomanagetheirconditions,withafocus onpreventingrelapseorescalationofexistingproblems.

We will better understand the needs ofCityworkersandimproveearlyidentificationofdepression,anxietyandsubstancemisuse.WeneedtoencourageallCitybusinessestobegreatemployerswho are committed to the health and wellbeingoftheirworkforceandprovidesupportforworkerswithmentalhealthproblems.

8.2.2 What we will achieve

We need to identify, assess and respond quicklytomentalhealthissuesamongstroughsleepersintheCity,providingthemwithservicesthatarecompatiblewithlifestyles that may be chaotic and hinder engagementwithstandardtreatmentmodels.

Wewillrespondeffectivelytopeopleincrisisandpreventsuicidewherepossible.

Good mental health for all

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TheCityCorporationwillworktogetherwith the City of London Police and City andHackneyCCGtodeliverthispriority.Actionplanstoincreasethefocusandstrengthenourcombinedeffortstoimprovementalhealthandwellbeingintheboroughwillbedevelopedinanumberofkeyareasincluding:

o Workwithcommissioningpartnersto improveservicesinordertocreateaparity of esteem between mental health andphysicalhealthservices

o Provideservicesandsupporttoresidentsintheircommunitiestoovercomeisolation, build resilience and increase social connections

o Promoteworkplacementalhealthandwellbeingandimproveemploymentoutcomes.

o Deliverpublicmentalhealthservicesthatsupportearlyidentificationofmentalhealthproblemsandimproveearlyidentificationboththroughhealthcarepathwaysandinourworkwiththecommunity.

8.2.3 What we will do

o Providetailoredsupportforpeople whoarehomelessorsleepingrough,takingintoaccountissuessuchasability to commit to treatment, chaotic lifestyles anddualdiagnosis.

o Improveourknowledgeofthementalhealthneedsofchildrenandyoungpeople in the City of London in order to improveourcommissioningandprovisionof child and adolescent emotional wellbeingandmentalhealthservices.

o Implement the actions on the Suicide PreventionActionPlaninpartnershipwith the City of London Police to reduce suicide and attempted suicide and to respondeffectivelytopeopleincrisis.

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A healthy urban environment

Thereisnowstrongevidencethattheenvironmentshapeshealthoutcomes. Awell-designedpublicrealmwithhigh qualitygreenopenspacewillencouragephysicalexercise,improvementalhealthandincreasebiodiversity.Spatialplanningpolicyshouldbeusedtodeliverimprovementstohealthandwellbeing.

Poorairqualitycontributestoshorteningthe life expectancy of all Londoners, disproportionatelyimpactingonthemostvulnerable.Poorairqualityexacerbatesheartandlungconditionssuchasasthmaandchronicobstructivepulmonarydisease.PublicHealthEnglandmeasuresshowthatthe City of London is the worst in the country forairqualitywith8.4%ofearlydeathsattributable to particulate matter in 2013. The CityofLondonAirQualityStrategyoutlinesourcommitmenttofulfilourobligationsforairqualitymanagementandhowwewillmonitortheeffectivenessofpoliciesandmeasuresthatareintroducedtoreducepollutionlevels.

8.3 Priority 2


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andupdatespoliciesandprogrammesthatarealreadyinplacetomanageandmitigatenoise.Italsoproposesadditionalmeasureswhichtogetherwithexistingonesshouldimprovemanagementofnoise in the City.

WhilstgatheringideasfromresidentsandworkersintheSquareMile,alackofgreenspace, community space and space to exercise came up repeatedly as a health andwellbeingissue.TheCityofLondonhasanetworkofgardens,churchyards,parks,plazasandhighwayplanting,whichare often smaller than 0.2 hectare but areintensivelyused.Greenspacescan

TheCityofLondoninevitablyexperiencesrelativelyhighlevelsofnoiseandtheCityCorporationnowreceivesaround1,100noisecomplaintsperyear(upfromaround750peryearin2011).ManagingnoiseintheCityisaconsiderablechallengeduetodensityofdevelopmentandthevasttransportnetwork.Highlevelsofnoisenot only cause disturbance to residents in their homes, but can also disrupt businessactivityintheCityandspoilthevisitorexperience.TheCityCorporationhasastatutoryresponsibilitytomanageandminimiseexposuretoexcessiveandsometimes unnecessary noise. The City ofLondonNoiseStrategybringstogether

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playaroleinpromotinghealthylifestyles,reducingstressandpreventingillnessand can also help with social inclusion by providingaspacetosocialise.

Thecondition,affordabilityandavailabilityoftheCityofLondon’sHousingStockisamajorinfluenceonthecapacitytoreduceinequalitywithintheLocalAuthority.Wherepeopleliveandthequalityoftheirhomehaveasubstantialimpactonhealth; a warm, dry and secure home is associatedwithbetterhealth.Thehousingin the City is different from in other areas: 90%offlatsare2-bedorsmallerandovercrowdingisanissue.

TheCityofLondonhasarelativelyhighnumberofthosekilledandseriouslyinjuredonEngland’sroads,(173peoplefrom2012-2014).ThisisasimilarratetootherinnerCityLondonLocalAuthoritieswhichhaveahighnumberofvisitorseachday.ElevatedCityHighWalkshaveplayedakeypartinpedestriansafety.

Poordietsandpoornutritionarekeycontributorstooverweight,obesity,andtoothdecay.Thelocalfoodenvironmentplays an important part, as it affects food andalcoholavailabilityandtheabilitytomakehealthychoices.Influencingtheavailability,presentation,andpricesofhealthieroptionscanencourageconsumers to reassess their preferences andmakealternativechoices.TheCityofLondonhasahighproportionoffoodoutletshoweverfoodpricesareoftenextremelyhigh,asretailersfocustheirbusinessonattractingdaytimeworkersratherthanaddressingtheneedsofresident families.

A healthy urban environment

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Our ambition is to create a healthy place forpeoplewholive,workinandvisittheCity of London.

We want health to be considered in all policyanddecisionmakingareaswithintheCityCorporation.HealthinAllPolicies(HiAP)isacollaborativeapproachtoimprovingthehealthofallpeoplebyincorporatinghealthconsiderationsintodecision-makingacrosssectorsandpolicyareas.HiAPisaresponsetoavarietyofcomplexandofteninextricablylinkedproblems, such as the increase in people livingwithchronicillnessandlong-termillnesslinkedtoourageingsociety,growinginequalityandhealthinequalities,climatechangeandtheneedforeffectiveandefficientstrategiesforachievingsociety’sgoalswithshrinkingresources.

Wewillcreateahealthierenvironmentwithhealthyfoodanddrinkoptions,particularly in those areas in which residentsliveandthataremoredeprivedareas. We want to enable our residents andworkerstomakechoicesthatwillimprovetheirhealth.

o Ensurehealthandwellbeingissuesareembedded into the Local Plan and majorplanningapplications

o Tackleunhealthyenvironmentsbydeliveringimprovedinfrastructureforsafeactivetravelandbyprovidingeasyaccess to healthy and affordable food in the local area

o Encourageretailersofhealthyfoodinunder-served,low-incomeneighbourhoodsand/ortoencourageexistingretailerstooffermorehealthyproducts

o Introducevoluntarysmokingbans inareaswheremorevulnerable peoplecongregateforexample outside schools

o Overseetheimplementationof theairqualitystrategyandsupport the implementation of low emission neighbourhoods.

o Overseetheimplementationofthe noisestrategy.

8.3.2 What we will achieve

8.3.3 What we will do

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Effective health and social care integration

Theintegrationofhealthandsocialcareservicesisawell-establishedprincipleasitprovidesabetterpatientandserviceuserexperience,moreeffectiveservicesandcancontributetofinancialsavings.

TheCityCorporationalreadyworksinanintegratedwayacrossthehealthandsocialcaresystembuttherehavebeenlimitationstothisintermsoforganisationalboundariesandlegalframeworks.

Withgrowingfinancialandservicepressuresatatimeofrisingdemandinhealthservices,NHSEnglandpublishedafiveyearplantoaddresssomeofthechallengesarisingfromthisandencouragedhealthandsocialcareorganisationstoworkmorecloselytogethertoaddressthem.Thisisset out in further detail in the local Sustainability and Transformation Plan andforCityandHackneyandintheemerginglocalityplan.

Workingmorecloselytogethercaninvolvehealthandsocialcareservicescommissioningordeliveringservicesinnew ways.

8.4 Priority 3


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8.4.3What we will do o WorkwithCityandHackneyandTower

Hamlets CCGs to promote City resident needs and ensure access to any emergingintegratedservicemodels for City residents

o Utilise opportunities such as the Better CareFundtodevelopschemeswhichfacilitateintegrationacrosshealthandsocial care for City of London residents

o Exploredifferentandinnovativewaysofcommissioninganddeliveringservicesinanintegratedway.

8.4.2 What we will achieve Our ambition is to ensure that the further developmentofintegratedhealthandsocialcareservicesreflectandmeetCityresidentneedseffectively.

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All children have the best start in life


8.5 Priority 4

GivingeverychildthebeststartinlifewashighlightedintheMarmotReviewasthehighestrecommendationforreducinghealthinequalities.Preventionandearlyinterventioninthefirstyearsofachild’slifehasasignificantpositiveimpactforachild’soutcomes.Itcanbreakthelinksbetweenearlydisadvantageand poor outcomes later in life such as emotionalandbehaviouraldifficulties,under-attainmentatschool,truancyandexclusion,criminalbehaviour,drugandalcoholmisuse,teenagepregnancyandthe need for statutory social care. Early years are often called the foundation yearsbecausethisiswhenbehavioursareestablished that last well into adolescence andadulthood–theseincludeoralhealth(e.g.toothbrushinghabitsareestablishedbytheagefiveyears),dietaryhabitsanddisposition to physical exercise.

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BabiesgenerallyreceiveagoodstartinlifeintheCityofLondon:thereisgoodbreastfeedinguptake,lownumbersofunderweightbabies’bornandlownumbersofwomenwhoaresmokersatthetimeofbirth.However,thereisstill roomforimprovement.NationalindicatorsshowthatchildpovertyintheCityofLondon is still present and persistent in partsoftheCity.Officialfiguresshow 10.3percentofCitychildren(under16)werelivinginpovertyin2013.DataforCityandHackneyshowsthatvaccinationratesforMMRarebelowaveragecomparedtobothregionalandnationalrates.

Nationallyoralhealthhasbeenidentifiedas an issue for children’s health. Public HealthEngland’soralhealthsurveyshowsthatalmostaquarterofchildreninCityandHackneyaged5yearssufferfromtooth decay and tooth decay accounts forahugecosttohealthservices.

TheCityofLondonChildrenandYoungPeople’s Plan includes the priority to improvephysicalandemotionalhealthandwellbeingfromconceptionto birthandthroughoutlifewhichthis strategysupports.

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8.5.2 What we will achieve Ourambitionisforeverychildtorealisetheirfullpotential,helpingthemto preparefromanearlyagetobeself-sufficientandhaveanetworkofsupportthatwillenablethemtoliveindependentandhealthylives.

EveryCityofLondonbabywillhavethebestpossiblehealthatbirth,havegoodnutritionandmaintainahealthyweight,beprotectedfromillhealth,injuriesandphysical and mental health problems and haveapositiverelationshipwith their parents.

Wewillimprovetheenvironmentinwhichchildrenandyoungpeoplelive,learn,workandplaysothatouryoungpeoplegrowupinenvironmentsthataresupportivetotheirhealthandwellbeing.Thisincludesworkingwithfamiliestoaddressandimprovewhole-familywellbeing.WewantfewerchildrenintheCityofLondontogrowupinpoverty.

8.5.3 What we will do Wewillactwithpartnerstogiveallchildren and families the best start in life.Thiswillincludeofferingearlyhelptohavehealthylifestylesandgoodphysicalandmentalhealth,integratinghealthybehavioursintoeverydayroutinestopreventproblemsatalaterstage,andprovidinganongoingandroundedofferofsupportoncechildrenleaveschool.Supportisprovidedatthisstageoflifefrommaternityservices,healthvisitors,GPs,children’s centres and many others.

All children have the best start in life

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We will o Evaluateourcurrentparentingprogrammeswithafocusonlearningfrom best practice to inform the use of resources and promote to increase uptake

o Promotegoodoralhealth,particularlyfor those under 5 years old

o WorkwiththeLondonBoroughofHackneytoreviewourapproachtochildhoodobesityandagreearevisedstrategy

o Ensurefrontlinestaff(healthvisitors,GPs,housingandchildren’sservicesstaff)areworkingtogethertosupportparentsandto help parents to access employment, educationandtrainingopportunities(Makeeverycontactcount)

o Usetheinfluencewehavetoincreasetheuptakeofchildhoodimmunisationstoachieveherdimmunity

o Involvechildrenandyoungpeopleinco-designingmentalandphysicalhealthservicestoensuretheyarerelevant,convenient,acceptableandaccessiblefor them

o Enablechildrenandyoungpeopletomonitorandfindsourcesofsupporttoimproveandmaintaintheirownhealth

o Developanintegratedhealthpromotionoffer for children and families focused onbreastfeedingandgoodnutrition,oralhealth,playandphysicalactivity,immunisation and tobacco free homes

o Closethegapinoutcomesforchildrenandyoungpeopleinvulnerablegroups.

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Promoting healthy behaviours

8.6 Priority 5

8.6.1Why this is a priority

SmokingGuidance from the National Institute for HealthandCareExcellence(NICE)statesthattobaccouseisthesinglegreatestcauseofpreventabledeathsinEngland–killingover80,000peopleperyear.

The2016CityofLondonHealthProfileshowsthatadultsmokingisslightlybetter(lower)thantheEnglandaverageforresidents;althoughitisknownthatsmokinglevelsarehigherinPortsokenwardthantherestoftheCity.AmongstCityworkerssmokinglevelsareknowntobehigherthanthegeneralpopulationduetothestressfulnatureoftheirjobsandthepredominanceofwhitemales.AsurveyofCityworkersin2012reportedthat24.7%ofrespondentsweresmokers,representingapproximately 91,000 people. This was abovetheaverageforbothLondon(17%)andEngland(20%).

AlcoholNICEadvisesthatalcoholconsumptionis associated with many chronic health problemsincludingpsychiatric,liver,neurological,gastrointestinalandcardiovascularconditionsandseveraltypesofcancer.Alcoholisalsolinked to a number of social problems, includingrecordedcrimeassaultsanddomesticviolence.

The2016CityofLondonHealthProfileshows that hospital admissions for alcohol relatedharmarebetter(fewer)thantheEnglandaverage.The2012report‘insightintoCitydrinkers’foundthatnationallyaroundoneinfourpeople(24.2%)drinkatincreasingorhigherrisklevels.Amongstthesampleof740Cityworkersthefigurewasclosertooneintwo(47.6%).

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DrugsBeingdependentonadrugcanleadtophysical illness, mental health problems, relationshipproblemsandfinancialdifficulties.TheageprofileandstressfulnatureofjobsputsCityworkersathigherriskofdrugmisuse.RoughsleepersintheCityofLondonalsohavehighneedsrelatingtoalcoholanddrugsalthough it should be noted that this is based on small numbers.

Sexual healthHIVprevalenceintheCityofLondonisthethirdhighestofallLondonlocalauthorities,(afterLambethandSouthwark)at12.78per1,000ofthepopulationage15-59.Thisismuchhigherthantheregional(5.85)andnational(2.22)averages.GenitourinaryMedicine(GUM)attendances by those recorded as City of LondonresidentsareamongstthehighestinLondonandthecountry,withover2,100attendancesin2015/16.TherehavebeenincreasesindiagnosesofSexuallyTransmitted Infections in the City of London overthelastfivetosixyearsforallofthe5majorSTIs.ItislikelythatsomeoftheseattendancesandSTIdiagnosesareattributabletoCityworkerswhoareusing

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a business postcode for extra anonymity whenaccessingsexualhealthservices.

The transformation of sexual health servicesinLondonpresentsanopportunitytoreducecostsandimproveoutcomesforusersofsexualhealthservices.Akeystrandof this transformation is the establishment ofanewsexualhealthe-healthcareservicethatallowsserviceuserstoordertestingkitsonlineandreceiveresultsbytextmessage,emailorpost.TheCityofLondonhasacceptedaformalrequestfrom the leader of the London Sexual HealthTransformationProgramme,onbehalfoftheparticipatingLondonboroughs,totaketheLeadAuthorityroleforthisnewserviceforLondon.

Promoting healthy behaviours

8.6.2 What we will achieve Ourambitionisforpartnerstoworktogethertoreduceharmfulbehavioursamongsttheresident,workingandroughsleeper populations in the City of London with a reduction in the associated health inequalities,crimeanddisorder.

We intend for fewer people in the City ofLondontostartsmokingorbecomedependentondrugsandalcohol.Wewillhelpmorepeopletoquitsmoking,leadingtofewerpeoplewithsmoking-relatedhealthconditionsandfewersmoking-related hospital admissions.

We want to see a reduction in the numberofCityworkerswhosmokeoraredependentonalcoholordrugs.Positivemessagesaboutthebenefitsofnotsmokingandreducingalcoholwillbe communicated by all Health and WellbeingBoardpartners.Employerswillbeengagedtobreakthecultureofrisktakingbehavioursamongsttheiremployees.

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8.6.3 What we will doAddressingalcoholanddrugmisuse,particularlyamongtheworking populationisachallengingissuefortheCity of London.

o Raise awareness of the harms caused byalcohol,promotelowerriskdrinkingandencourageahealthyapproach to alcohol

o Raise awareness of the harms caused byapoordietsandlackofphysicalactiviy,promotehealthierlifestyles andencourageahealthyapproach to food

o ImplementsmokefreepoliciesacrosstheestatesofHealthandWellbeingBoardmemberorganisations

o Extendsmokefreezonestomoreparksand public areas

o Identifyandsupportpreventionprojectsaimedatfamiliesandyoungpeople

o Supportsmokerstoquitusingthefullrangeofnewtechnologiesavailable

o WorkwithBusinessHealthytoengageemployerstobreakthecultureofrisktakingbehavioursamongsttheiremployees

o Participateincross-boroughactivitytobetterunderstanduseofillegaltobaccoand reduce its supply

o Expandourpreventionworkwithstudentsinschools,includingindependent schools within the City boundariesandworkmoreextensivelywithvoluntaryandcommunitygroups

o Workwithourcommissionedservicetoensureworkerswithdrugoralcoholissuesarereferredtoservicesintheirhomeboroughs

o IncreaseaccesstoSTItestingusing newtechnologies.

o Supportroughsleeperstoengagewithappropriateservicestodealwithdrugand alcohol issues.

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9 Delivering the strategyWearecommittedtoachievingouraimsforhealthandwellbeingintheCityoverthenextthreeyears.Wewillfocusonstrongpartnershipworkingtojoinuphealthandsocialcare,evidence-basedcommissioningtodelivereffectiveservicesandlisteningtotheviewsofserviceuserstoensurethattheyarebeingsupportedtoachievethebestoutcomes.

Thestrategywillbesupportedbyadeliveryplanandaccompanyingindicators that will be refreshed annually. ThiswillbegovernedbytheCityofLondonHealthandWellbeingBoard,whowillmeasureandmonitorprogress.ProgressontheindicatorswillbeboughttotheHealthandWellbeingBoardevery6months.

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TosupportthedeliveryoftheprioritiestheHealthandWellbeingBoardwill:

o Bringpartnerstogethertoensuremorejoinedupworking,leadingtoimprovedaccess and better outcomes for residents

o Ensuretheskillsneededtoidentify,referand support people with mental health needs are embedded in Board members organisationsandacrossthehealthandcare system

o Monitorandholdtoaccountpartnersacrossthehealthandwellbeingsystemforimprovementsintimelyaccesstoeffectivehelpandsupport,withafocusonrecovery

o Useitsinfluencetoadvocatechangeintheperception,understandingandresponse to mental health conditions, addressingstigmaanddiscrimination

o Leadandchampionthesechanges,identifyingnewwaysandopportunitiestodrivepositivechangesinoutcomesand experience across partner organisations,withakeyfocusonaddressinginequalities

o Championearlyidentificationofthosewhoareaffectedbydrugandalcoholproblems,byconnectingpeopletotherightsupportattherighttime

o LeadbyexampleofamajoremployerintheCityofLondonthroughaworkplaceofhealthandwellbeingamongststaff

o ActivelyengagebusinessesandotherorganisationsintheCitytobecomehealthy employers

o Engageseniorleadersacrossthehealthand social care system and champion the importance of early help and supportduringthestartofachild’s life and its contribution to outcomes later in life

o AgreeBetterCareFundPlansandmonitor their impact

o Consideranyplansforintegration which could potentially impact on City residents to ensure that their needs are met

o Considertheintegrationofhealthandsocialcareservicesintheirassuranceofotherplansandstrategies.

9.1The Role of the Health and Wellbeing Board

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Joint Health and Wellbeing Strategy2017-2020

City of London CorporationMay 2017