Health and Wellbeing Board 2015 Annual Report 1

Draft Wiltshire Health and Wellbeing Board 2015 Annual Report

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POLICE

WILTSHIRE

England

Great Western HospitalsNHS Foundation Trust

SalisburyNHS Foundation Trust

Royal United Hospitals BathNHS Foundation Trust

Avon and WiltshireMental Health Partnership NHS Trust

Wiltshire Health and Wellbeing Board

South Western Ambulance ServiceNHS Foundation Trust

Health and Wellbeing Board 2015 Annual Report 3

ForewordWe are delighted to introduce this report, setting out some of our achievements over the last year, against the priorities in Wiltshire’s Joint Health and Wellbeing Strategy.

Together we are responsible for budgets of millions of pounds and for providing hundreds of different services. The services that Wiltshire Council, the NHS and our partners provide touch the lives of every single resident of Wiltshire.

Despite falling or constrained budgets, coupled with increased demand for services, we have continued to invest in a range of preventative schemes to keep people well. Critically, we have also introduced a range of schemes that have helped to reduce delayed transfers of care from hospitals, against a backdrop of national increases in this area. A particular focus for the Board is how health and social care can work more closely together – for the benefit of Wiltshire patients and service users. And we continue to look at what we do across the board to ensure it is innovative and effective.

Our vision is that our services should work seamlessly together to support and sustain healthy, independent living. This report highlights the progress we have made during 2015/16.

Baroness Scott OBE, Chair of Wiltshire Health and Wellbeing Board, Leader of Wiltshire Council

Debbie Fielding Chief Officer Wiltshire Clinical Commissioning Group

Carolyn Godfrey Corporate Director, children’s services, Wiltshire Council

Dr Peter Jenkins, Vice Chair of Wiltshire Health and Wellbeing Board, Chair of NHS Wiltshire Clinical Commissioning Group

Maggie Rae Corporate Director, adult social care and public health, Wiltshire Council

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Aim 1: Healthy livesOur first aim, healthy lives, means encouraging and supporting communities, families and individuals to take more responsibility for their own health and wellbeing through health promotion, protection and preventive activities.

Set out below are details of progress against the ongoing areas of delivery outlined in the Joint Health and Wellbeing Strategy for Wiltshire.

Children

Child poverty reduction planThis year marked a new phase of delivery of our work with children’s services. An action plan to deliver the Council’s Reducing Child Poverty Strategy 2015/20 was developed by the multi-agency Wiltshire Child Poverty Steering Group. Child poverty profiles have been produced for all of our 18 community areas in Wiltshire to help us work with local communities to address specific local issues that impact on levels of child poverty.

The Baby Steps programme for vulnerable parents was launched in 2015. Parental satisfaction is high among those who have attended and work continues on developing and implementing a robust evaluation framework and sharing learning.

Child Health Improvement Strategy Delivering the Council’s Child Health Improvement Strategy has involved work starting with pregnant women, through to support for parents and across the Healthy Child Programme 0-19.

The Healthy Child 0-5 services, including health visiting services and the Family Nurse Partnership, transitioned smoothly from the NHS to the Council in October 2015.

School Nurses and the Healthy School Programme continue to work with schools to promote the health of children while in education. The Food for Life Programme supports 25 schools in more deprived areas to maximise the benefits of school food and promote a healthy diet.

The Wiltshire Young and Safe Group was set up to provide a multi-agency approach to preventing and reducing unintentional and deliberate injuries in children and young people. In 2015 the group led a number of campaigns to promote safe cycling and scooting, water safety and on preventing sudden infant death syndrome.

Across 2013/14 and 2014/15 there were 190,201 attendances at free swimming sessions, enabling children and their families to be active and improve their health.

Children’s Community Health ServicesChildren’s Community Health Services were successfully re-tendered following a joint commissioning exercise between Wiltshire Council, NHS England and Wiltshire CCG. Development of the specification has been underpinned by effective engagement with professionals, parent carers and children and young people. The tender exercise saw 16 services previously provided by five separate service providers brought under one contract, starting from April 2016 with an initial term of five years. Safe transfer arrangements have been put in place to ensure the continuity and quality of care to be provided for children and young people.

Risky behaviours work with schools95% of service users who replied rated ‘No Worries!’ – our confidential sexual health service for young people aged 13-24 – as good or very good, and over 90% said it helped them find out what they want to know. The rate of teenage pregnancy in Wiltshire is the lowest it has ever been since 1998, down to 15.3 per 1000 women.

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Our MOTIV8 Children and Young People’s Substance Misuse Service offering harm reduction advice, support and specialist treatment services to any young person under 18 living in Wiltshire was expanded in 2015.

Using the cultural sector to engage young peopleThe Public Health team commissioned a series of theatre projects to engage young people in health related issues, including: This Secret Life which tackled the taboo subject of domestic violence and supported young people to understand the dangers of social media as well as the components of healthy and positive relationships; and Every Me Every You which helped young people in understanding the importance of mental health and raised the profile of some of the more common conditions such as schizophrenia.

Wiltshire Youth Arts Partnership (WYAP) has been undertaking music work with young people unable to attend mainstream schools for health reasons. A case study for this work can be found at www.wyap.org.uk. WYAP has also commenced a cultural programme to support LGBT young people and to deliver the countywide ZeeTee campaign.

The Ageas Salisbury International Arts Festival has been working with Action for Wiltshire to support young carers for the past five years. This work has focused upon developing creativity and self confidence as well as showcasing the talents of young people with few opportunities to take part in out of school activities. More information on the young carers showcase can be found here.

Families, adults and older people

Active travel planning and Air Quality ManagementWiltshire’s innovative air quality website and Know & Respond text and email service supports people who are particularly susceptible to changes in air quality. The Know & Respond Service is now helping schools, nursing and care homes ensure that pupils and patients have their medication to hand when they need it. Community air quality action plan groups across the county are working on projects to promote active travel within their towns to improve the air quality and reduce local car trips.

Stop Smoking StrategySince the national Tobacco Plan (2011) set out the government ambition to reduce smoking in pregnancy to 11% by the end of 2015, smoking in pregnancy rates in Wiltshire have dropped from 14.2% (2011/12) to 12.2% (2014/15) and more recently to 9.9% (Q2 2015/16).

Work with employers on workforce health strategiesThe stop smoking team have organised Health MOTs at workplaces across Wiltshire including Royal Mail Depots, waste depots and several MOD sites. This year Stop Smoking advisors have offered 704 health checks in workplaces and offered advice to staff. Progress toward Wiltshire Council achieving Workplace Health Charter status will culminate in accreditation assessment in April 2016. The groundwork has included a staff survey across all of the Charter themes followed by discussion at directorate level to explore what interventions may lead to the greatest impact upon staff health and well-being. Specific campaigns have subsequently targeted depression, musculoskeletal issues and sedentary behaviour amongst council employees. Mandatory online learning has been launched in respect of mental health issues and alcohol awareness. Personal health interventions will be a key component of future plans ensuring that all employees access information and events designed to encourage behaviour change in lifestyle choices.

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Campaigns and Health Checks The ‘Love your Lungs’ campaign was run in February 2015 with the British Lung Foundation in order to raise awareness of chronic obstructive pulmonary disease (COPD). The campaign reached over 62,000 people, specifically targeting 10,000 residents in higher risk communities. Thirteen community events took place with 1485 people screened for COPD. One in five of those screened were referred onto their GP for further assessment.

In May, Wiltshire’s Big Pledge ‘Make a Difference’ campaign was launched, encouraging Wiltshire residents to make a difference either personally or within the community in which they lived, by making one or more of 12 pledges. 12,761 local people got involved before the campaign closed in September. In July, a series of roadshows were run to help people to understand their risk of type 2 diabetes. Over 443 talked to the team and 261 were referred to their GP for further advice to help them reduce their risk of diabetes.

Wiltshire achieved 42.4% uptake in 2014/15 for the NHS Health Check Programme, which is delivered by GPs and provides a cardiovascular disease risk assessment every five years for all aged 40-74 resulting in a tailored package of healthy lifestyle interventions to improve health and wellbeing and reduce risk of cardiovascular disease. In 2016 the aim is to increase uptake by 10%.

Infection prevention and control and medicines managementTwo cases of anthrax detected in farm animals at a Westbury location in 2015 tested the resilience of our local system. The expertise of our emergency response and animal health teams enabled us to effectively contain and deal with the incident.

Wider work to prevent the spread of infection continued throughout the year with the promotion of the annual flu vaccine and partnership working with care homes. Work to effectively promote the better use of antibiotics to help protect their effectiveness saw a local task group established to help promote the issue in the local community.

Arts and cultural interventions in health and social care contextsOur successful programme of reading groups in libraries and community settings has been extended this year to include additional groups focussing on people with low level mental health issues such as anxiety or depression.

A new group is also being formed at Tidworth library which will focus on military families. Our libraries also offer ‘books on prescription’ for dementia, autism and mental health and this has been very well received

Salisbury Hospital has embedded creative practice within the operating of the Trust delivering physical improvements to the estate and developing an extensive programme of creative activity to support the health and well-being of patients across the wards. Examples of this work can be found here.

Healthwatch Wiltshire, alongside Elevate and the Wiltshire and Swindon Users Network, delivered a vintage tea party project that invited users of adult social care to reflect upon their experience of navigating the health and social care system. The tea parties took a creative approach to engaging people in a complex question and made use of live music to engender a relaxed and thoughtful environment that produced a more in-depth response to the question. A film of the project can be found here.

The Wiltshire and Swindon Users Network commissioned a playwright to develop a theatre intervention which enabled the neuro-typical majority to glimpse the world as seen through the eyes of people with Aspergers. More information about the project can be found here.

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Community centred approaches – action planning, volunteering, peer support groups, befriending initiatives, social prescribing. By increasing access and participation to arts and cultural activities we not only have an opportunity to improve wellbeing but to bring communities together, reducing social isolation. Following a positive evaluation of our Arts on Prescription initial programme, it has been extended to cover additional GP practices for 2015/16. The scheme is an ‘alternative/social prescribing intervention and offers primary care providers and professionals the option to refer patients for an 8-10 week art course which addresses health and wellbeing issues in potentially vulnerable or isolated groups.

Volunteering also improves wellbeing by helping people in our communities learn new skills; remain active, meet new friends and overcome isolation; develop confidence and give something back to their community. We know this from successful local projects such as the Lacock Unlocked project which engaged with over 100 community volunteers of all ages.

Encouraging people to be more responsible for their own healthAn ambitious community based project called Beat the Street was run in both Calne and Devizes. The project was designed to reduce the number of car journeys and improve air quality, as well as increase levels of physical activity. During the project over 24% of the local population in both towns took part, walking and cycling for six weeks instead of getting in their cars. Over 145,000 miles were walked and cycled.

Community health trainers have been based in all of our community areas to help people to eat more healthily, to attain a healthier weight, to stop smoking, to get more active, to drink less alcohol or to generally improve their wellbeing. Health trainers help clients to develop healthy habits that will improve their lives.

Community projects such as Get Wiltshire Walking have helped people across our county. There have been nearly 20,000 attendances on the walks organised in 2015, with approximately 1,200 registered participants. The activities are run by volunteer walk leaders and another three training courses have been delivered this year, generating an additional 45 new walk leaders to bring our active volunteer total to 120.

Health in all policies The public health implications of all of Wiltshire Council’s key policies are now taken into consideration before decisions are made. The public health team have engaged with academics and the spatial planning team through topic specific workshops to consider the delivery of best practice in planning for healthier environments. Wiltshire CCG is also developing quantifiable ambitions for improving public health through their work.

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Update the obesity strategyWiltshire’s Obesity Strategy is currently out for public consultation and the Health and Wellbeing Board will have final sign off prior to the strategy launch intended for summer 2016.

Update Children and Young People’s Plan The Children and Young People’s Plan has been refreshed for 2016 – 19 and builds on the previous plan. Whilst overall objectives remain the same, work on the ground will change. It is currently out for consultation until April 2016.

Delivery plan for Early Help Strategy The Early Help Strategy 2014-2017 defines the expectations for delivering effective early help to all vulnerable children and young people living in Wiltshire including children living in ‘troubled families’. Phase 2 of the ‘Troubled families’ programme started in January 2015 and saw additional funding received for at least one employment advisor working within Job Centre Plus with a specific remit on supporting parents in the programme to find work. Wiltshire Families First service was successfully transferred into the council following a Cabinet decision to approve a single family support service.

Update the Anti-Bullying Strategy (schools):Development of a county wide Anti-Bullying Agreement continues with partner agencies, schools and children and young people. This will set out how the Council and its partners will work together to identify and address all forms of bullying both in and out of school. The agreement will be launched in April 2016.

Develop a delivery Plan for the Emotional Wellbeing and Mental Health StrategyThe Emotional Wellbeing and Mental Health (EWMH) Commissioning Strategy Implementation plan contains the actions to implement the strategy which include improved access to schools counselling as well as clear information about the local offer of Child and Adolescent Mental Health Services. The transformation plan for Children and Young People’s Mental Health, developed by the Health and Wellbeing Board and wider partners, was endorsed by the Board in September 2015. The key objectives of the transformation build on local progress and are in keeping with our multi-agency Children’s Trust EWMH strategy.

Healthy Lives Strategy Development in 2015/16:

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Develop a housing strategyThe consultation period to establish an evidence base to underpin the development of the council’s housing strategy ran from July 2015 to December 2015. Data from both the field and desk research has been interrogated and analysed with the draft report and strategy themes and options going to sponsors in February 2016. The strategy is currently being drafted.

Update the Domestic Abuse strategyA Domestic Abuse Conference was hosted in Trowbridge to bring together the police and other key partners to more effectively reach out to people who need support. A new protocol has recently been launched to ensure children living in households where there is adult domestic abuse and/or substance and alcohol misuse, are effectively safeguarded. We have commissioned in collaboration with the Office for Police and Crime Commissioner specialist support services for people at all levels of risk of domestic abuse across the county. This service will provide easy to access support and advice.

As part of our commitment to tackle abuse we have also provided multi-agency training and awareness events for practitioners working across the field of domestic abuse, including a session on Honour Based Violence and Forced Marriage.

Update Alcohol Strategy and Delivery Plan:The Wiltshire Alcohol Strategy was approved in April 2015 and sets out four key themes of prevention, treatment, intervention and engagement. To move the strategy forward a multi-agency meeting took place in February 2016 to draft the implementation plan.

Update Volunteering Strategy:Work on updating Wiltshire’s Volunteering Strategy will take place during 2016.

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Aim 2: Empowered livesEmpowered Lives means care should be personalised and delivered in the most appropriate setting, wherever possible in the community and at, or closer to home.

Ongoing areas of delivery include:

Children

Services for looked after children, young people and care leaversA multi-agency group has met regularly to oversee the Improvement Plan for looked after children and young people and care leavers, to ensure we meet objectives outlined in the commissioning strategy. There has been a strong focus on improving the health of looked after children and young people (both physical and mental health) and on improving support for care leavers who often need additional help to ensure they can access education, employment or training. Care leavers who have received support from child and adolescent mental health services can now continue to receive this support beyond the age of 18 if they do not meet the criteria for support from adult mental health services.

Families, adults and older people Employment support for those with a long term conditionThe models in Wiltshire across all groups have now moved away from the previous models of preparing and training people to enter into work, and are now placing people with an employer, and then training them in the job. Mapping of available employment support for people has been undertaken to enable services to link up and avoid duplication.

Seven day servicesMore services are now available seven-days a week to support people discharged from hospital or to avoid a hospital admission (for example, HomeFirst and Urgent Care at Home). Hospitals still discharge fewer people at the weekend, which builds pressure for hospital capacity early the following week. More work is currently underway to understand what would make a difference.

Whole family support Our Troubled Families work has continued to be successful with 100% of families achieving change by the end of Phase 1 of the Troubled Families Programme. In Phase 2, there is now more focus on families with younger children and on helping parents to achieve sustained employment. There will be more work undertaken to ensure that health professionals are engaged in the Troubled Families initiative.

Joint health and social care assessments and plansThe integrated team sites, where teams are clustered around GP surgeries, are sharing information to reduce duplication in assessment. HomeFirst has also been developed to deliver a new pathway to support people at home after they have been discharged from hospital. HomeFirst is based on the principle of one assessment and one worker coordinating services around the patient/customer. Homefirst has been operating in the South to understand how it will be rolled out across the whole county.

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Urgent care at home and intermediate care in the communityUrgent care at home is now available 24/7 to prevent an inappropriate hospital admission. Since the service started in November 2013, nearly 1,500 people have been supported by the service and over 1,100 hospital admissions avoided. A specialist urgent care service was set up in December 2014, supporting people who are near to end of life and enabling more people to choose to die in their own homes rather than in hospital. Since the service started, 770 people have been supported at home. 70 intermediate care beds are also jointly commissioned and deliver enhanced rehabilitation and support for Wiltshire residents. We now have nine specialist ICT units in place delivering these services and they provide high standards of clinical input ensuring we transition a patient to independence as quickly as possible – usually within four weeks. This also helps to minimise admissions into hospital.

Personal budgets and personal health budgetsAs of December 2015, 95.8% or 2660 people with funded support from Wiltshire Council now have a personal budget in Wiltshire. The CCG currently offers direct payments for people with CHC and are developing their offer for personal health budgets. Work is progressing to enable integrated personal budgets to be available to people with health and social care needs.

TelecareTelecare provides an important part of the offer to help people remain independent at home. The council supports over 3,000 through the Telecare service made up of a mixture of people in sheltered accommodation or in their own homes. The service also supports 1,000 people who have bought the service privately.

Information portals – Your care your support and the Local Offer The new information and advice portal for adults went live in April 2015 – www.yourcareyoursupportwiltshire.org.uk. Over 100,000 visits were reported in the first six months. A refresh of the structure has taken place to improve the sites use – based on feedback from service users facilitated by Healthwatch Wiltshire. Increased functionality is planned for the next six months, including on-line forms, self-assessment, guides and videos. Similarly, the site for children related services www.wiltshirelocaloffer.org.uk has continued to develop.

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Strategy development:

Rollout integrated Education, Health and Care (EHC) plansThe Council’s SEND Service continues to work closely with health partners to ensure that existing Statements of Special Educational Need are converted into Education, Health and Care Plans which have a strong focus on understanding need, the child/young person’s wishes and feelings, and the level and type of support required to meet these.

Develop a Primary Care Strategy for Wiltshire The Wiltshire Primary Care offer has been developed as a three year programme 2016/19 to transform the commissioning, delivery and monitoring of the CCG commissioned enhanced services from GP Practices in Wiltshire, over and above core GP services to deliver: responsive, safe and sustainable services; to move towards “placed based commissioning” and the Wiltshire vision of integrated out of hospital services; to support the development of locality working to deliver primary care services at scale to support increased efficiencies, and to address issues of recruitment and retention of a competent, capable and resilient primary care workforce to deliver high quality primary care services.

Action Plan for the Wiltshire Mental Health and Wellbeing StrategyThe Mental Health and Wellbeing Strategy was approved in May 2015 and an implementation plan to deliver on its’ outcomes has been developed by the newly formed Mental Health and Wellbeing Partnership Board. The implementation plan covers a wide range of action to improve mental health and wellbeing in the county and is progressing well. This work has been influenced by the outcomes of engagement delivered by Healthwatch Wiltshire in collaboration with specialist local charities.

Implement whole family and joint health and social care assessments and plansWhole family assessment is an area still to be developed in order to comply with the new requirements set out in the Care Act. Family needs are always considered during an assessment but are completed largely on behalf of an individual still.

Review the Voluntary and Community Sector StrategyThrough the Better Care Plan Prevention work stream, work was undertaken last year with a number of voluntary organisations supporting older people. This culminated in an event last autumn, facilitated by Systems Leadership support, bringing organisations together to consider opportunities to work differently, reducing duplication and providing a more coordinated approach to support. Alongside this work, the Council and the CCG have been in discussion with the two Age UK organisations in Wiltshire and this has resulted in a merger of the two organisations, to provide a county-wide organisation and realise some benefits from economies of scale.

Elsewhere, a number of voluntary organisations have been meeting together, in discussions facilitated by Healthwatch. The focus of their discussions has been on working differently to support health and care, based on an understanding of increasing demand, diminishing resources and the overarching need to improve outcomes and reduce demand on statutory services.

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This group of organisations has agreed to continue to collaborate, initially in an informal way, but acknowledging that commissioning models may bring them together more formally to deliver specific services.

The VCS organisations and Healthwatch organised a workshop in February, along with commissioners (both CCG and Council) to share views, outline future intentions and start to flesh out a new approach in this vital area. Area Boards have also been active in appointing older people’s champions and are developing community-led proposals to take forward ideas for support and advice for vulnerable older people which was previously delivered through the Good Neighbours scheme.

In addition to this, the Joint Children’s Commissioning Team works closely with the Children and Families Voluntary Sector Forum and now has agreement that some of the organisations linked to the forum will provide placements for young apprentices (particularly care leavers) and will support our work in listening to and understanding the views of children and young people who are in contact with Children’s Social Care.

All the activity outlined above is expected to inform the update of Wiltshire’s Voluntary and Community Sector Strategy later in 2016.

Put Mental Health Crisis Action Plan in placeThe Wiltshire Mental Health Crisis Care Action Plan was endorsed by the Health and Wellbeing Board in March 2015 following an initial gap analysis. It recognises that a range of activity is already underway to address elements of the concordat and there was no need to replicate this within a separate plan. It focuses on additional activity necessary to meet concordat commitments so that no one experiencing mental health crisis is held in police custody unnecessarily and is updated and revisited regularly.

Update the Learning Disabilities Joint Commissioning StrategyThe joint strategy, and intentions document, is currently in the process of being refreshed. A consultation has just closed and a final draft is being prepared for presentation to the Mental Health and Learning Disabilities Joint Commissioning Board. The strategy focuses on four strategic aims:

Improving Choice and Control; Keeping Health and Staying Safe; Improving Choice and Access to the Places People Live; and Improving Quality and Value for Money. The strategy also include a Learning Disability and Dementia needs assessment and work has started on developing an action plan to progress this area of work.

Wiltshire’s ‘Winterbourne View’ project came to an end in December 2015 – some of the successes of the project have been:

• Introducing a Care Programme Approach within learning disability services

• The development of a Wiltshire Intensive Support Service to support people in a crisis and at risk of being admitted to hospital

• The development of two short stay beds for people to use in a crisis.

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Following this, a Transforming Care Partnership Plan has been developed to ensure Learning Disability and Autistic people receive improved care in the local community. National funding support has been requested over the next three years to deliver this plan.

Update the Autism Joint Commissioning StrategyNew statutory guidance was published in 2015 that detailed local authority and NHS responsibilities for people with autism; the Wiltshire commissioning strategy is currently being refreshed to reflect the new guidance; the Wiltshire Autism Partnership continues to be active in Wiltshire, for example, promoting awareness of autism within our communities.

Action plan for the Wiltshire Dementia StrategyThe main purpose of the strategy is to ensure that people with dementia and their carers and families are able to live well and are supported to do so through being able to access the right services and support at the right time, whether that be from organisations or their local community. A number of key areas were identified as priorities for the initial period of this strategy and since the launch of The Wiltshire Dementia Strategy in 2014 the following has been worked on: reducing risk, general Public Health initiatives, recognising memory problems, dementia friendly areas growing, learning its dementia, planning for the future, living well with dementia, managing at more difficult times and care at end of life.

Update the Carers StrategyThe Care Act and Children and Families Act brought in new rights for Carers, which meant they could ask for and be assessed in their own right. Consultation took place with Carers in the summer around what support carers needed during a Crisis. Further consultation has taken place during the autumn to produce a draft Carers Strategy. This will be presented to the HWB during 2016 before going out to formal consultation.

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Integrated WorkingDelivering our two key aims and the vision of supporting and sustaining healthy, empowered living will require increased integration and cooperation between public health and primary, secondary and specialist health services – together with social care and other council teams. Progress on this is set out below.

Our future health and social care modelWe have made major strides in the past year in setting the conditions for success in the realisation of our out of hospital future model of care, most notably with the successful Wiltshire CCG procurement and award of a new long term contract for Adult Community Health Services. This is fundamental to the successful implementation of our strategic vision, and working with the new providers in the future offers us a genuine opportunity to deliver our aspirations. The procurement represents the culmination of extensive and significant effort on behalf of Wiltshire CCG, and the outcome should provide the very bedrock foundation on which we can build the transformation of our system into our future vision. The contract was awarded to a new organisation called Wiltshire Health and Care, shared between the three major acute providers, and accordingly it is anticipated there will be close working using well established and robust relationships, in order to work together and make some fantastic changes which will deliver better services and outcomes for our population, while sustaining

the overall viability of our health system. We want to better exploit the clinical expertise that exists within our acute hospitals, shape it more closely around our population clusters, and thereby better utilise that expertise to support community and primary care. In short we want to provide a seamless service focussed on the

individual within their own home, closely tailored to local needs. The manner in which our future community services provider is able to deliver will be key in all of this. Accordingly, we have specified our requirement for an effective integrator and work is now underway on the mobilisation of the contract.

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Emergency acute admissions Hospital social work Planned surgery/care

Consultant led outpatients

Technology supported healthcare NHS 111 (mandatory)

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Enhanced urgent primary care Sat/Sun

Core seven day pharmacy

Patient advocacy and support

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Rollout of integrated care teams Following the successful introduction of the three demonstrator sites in December 2014; the remaining 17 integrated teams have now been established. These teams, operating in geographical clusters covering a population of approximately 20,000, bring together local GP Practices with community nurses and therapists, social care workers and mental health workers; alongside the voluntary and third sector to work jointly to better manage the care and support of these individuals. This enables better outcomes and more focus and care delivered in the community rather than in acute hospitals.

Primary care at scale Having taken responsibility for co-commissioning primary care alongside colleagues from NHS England, Wiltshire CCG aims to continue to build on the excellent foundations of primary care in the county, and strengthen that by encouraging networking across primary care practices. Funding provided under the Transforming Care of Older People programme has been used to encourage local innovation to improve support to the frail and elderly cohort of our population, and there is now a scheme live under this programme in every part of the county. There is evidence of local and clinically-led initiatives with some collaborative working across practices and engagement/alignment with the wider MDTs, reviewing and addressing the individual practice variation and learning from best practice. Learning from the

schemes to date has shown:

• Issues and challenges ofrecruitment of most groups ofhealth and social care staff

• Development of new roles suchas the Emergency ResponsePractitioner and new ways ofemployment (secondment, onepractice on behalf of others)

• Links and synergy betweenTCOP and the Better CarePlan schemes and integratedcommunity teams

• Focus on over 75s, but impact ofunder 75

• Release of GP capacity andimplications of this

• Implications for providingservices aligned to primary careat scale, which is a number ofpractices working together

• Links to other programmes andprojects such as work with carehomes, end of life, long termconditions, prevention andMusculo-Skeletal services (MSK)

• Impact of the social care modelas in the Leg Club schemes

• Impact of medications reviewson health outcomes and costs

Children’s centres and health visitors integration During the early part of 2015, considerable work was undertaken to re-design children’s centre services and consider how children’s centre staff could work more closely with health visitors to deliver the best start in life for young children. This work involved parents, organisations delivering children’s centre services, health professionals and early years providers. The need for closer joint working has now been written in the new service specification for children’s centre services to be delivered from July 2016 under new contracts.

Area board activity on health Local area boards have funded and supported numerous projects as a result of the Community Area Joint Strategic Assessments (CAJSA’s). In many community areas priorities in different thematic areas have been dealt with together to increase the impact of initiatives, such as in Salisbury where a desire to improve access to the arts has also been used as a means to improve health and wellbeing. Updated CAJSA’s will be developed to facilitate fresh community dialogue through the area boards.

Social care

Domiciliary

Integrated care teams

Mental health

GP

Practice nurse

Vountary

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Primary care co-commissioning In January 2015 Wiltshire CCG’s governing body agreed for the CCG to submit an expression of interest to pursue a joint commissioning arrangement for primary care with NHS England. This arrangement would align primary and secondary care commissioning with more efficiencies and greater consistencies of outcomes. After engagement events and a formal ballot the CCG was given clear mandate by member practices to jointly commission primary care with NHS England.

Enabling Integration

Workforce strategies

The initiatives include:

• Leadership Development –shared courses with a consistentcontent and open to health andsocial care staff.

• A shared coaching register – toenable coaches to coach peoplefrom other organisations on areciprocal arrangement.

• Pan Wiltshire Staff Passport –to avoid duplication of trainingwhen people move to workwithin different organisationswithin Wiltshire starting withselected statutory/mandatorytraining courses.

This was ratified by NHS England in March 2015 and a joint committee established which reports to both the CCG governing body and NHS England. Its first quarterly public meeting was held in June 2015. The Wiltshire Primary Care Joint Commissioning Operation Group meets monthly supported by a jointly developed framework and supplemented by a Memorandum of Understanding.

Wiltshire Community Safety Partnership substance misuse commissioning The Community Safety Partnership brings together expertise from Public Health, Wiltshire Police and the NHS for HM Erlestoke and in 2015 delivered a range of interventions on prevention (including work with licensing), treatment and rehabilitation. Wiltshire is currently best in the South West for opiate based recovery rates.

Development of a Wiltshire Health and Social Care workforce strategy is underway. In February 2015 an audit of all providers (excluding GP practices, who were not asked individually) was completed to give an understanding of workforce gaps. RiPfA (Research in Practice for Adults) were commissioned to review and evaluate what helps with integration and what we could learn to do better. The Workforce Group is developing collaborative solutions to capacity and development challenges. A Wiltshire Workforce Conference was held in autumn 2015 and the Wiltshire Workforce Action Group (Wilts WAG) has representation open to all adult health and social care providers to collaboratively work on solutions to common

issues and in so doing encourage a more system wide perspective. A post of Workforce and OD Lead for the Better Care Plan has been funded and that role also links with external agencies such as Health Education England to encourage a more integrated approach to workforce issues across health and social care. The development of a primary care development network across Wiltshire is planned for 2016/17 as a result of additional support from Health Education England and the local Academic Health Science Network. The Wilts WAG is presently looking at development across the following main areas, with a philosophy of starting small and allowing each to grow at an appropriate rate.

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• Care staff trained toundertake selected healthtasks – starting with wounddressings and now looking atblood glucose monitoring.

• Shared Wiltshire careerresources – to identify andinform about the plethora ofdifferent health and social careproviders within Wiltshire andthe potential roles and careerpathways available.

• Rotations and placements indifferent setting – developingsome innovative staff rotationsthrough different employersand different settings, probablystarting with newly qualifiedregistered professionals.

Single View Wiltshire Council is working with the CCG, the three acute hospitals, AWP and the Fire, Police and Ambulance services to develop a new approach for the electronic sharing of data. A test environment has been built to prove the high security requirements are met for the sharing of information across the partnership. Public focus groups are being engaged to ensure that information is shared for the right reasons and public concerns addressed. Information sharing in the first instance will be provided to support joint health and social care assessments and support plans and to enable seven day services by providing continuous access to information and support urgent care at home.

One of the first aspects of product implementation will be to provide access to specific adult social care information regarding care packages for care co-ordinators at GP practices. This will support better and quicker decision making, cut down phone calls between care co-ordinators and social care works, which in turn frees up time.

Market Position Statements Market position statements have been produced for each community area to reflect support for older people. These were shared with area boards during older people workshops earlier this year. Market position statements for learning disability and mental health have also been produced at a county level.

Shared plans for better use of estates and delivery of extra care housingWiltshire Council, Fire, Police and NHS partners successfully applied for £350k of funding to deliver a range of projects together under the One Public Estate programme. This will see increased co-location of GPs, community hospital provision, mental health care provision and social care teams together with emergency services across a range of sites.

This work builds on the Health and Wellbeing Community Centre programme (also known as campuses), which has already seen Springfield Health and Wellbeing Centre open in Corsham, bringing together the neighbourhood police team, library, leisure and social care and community health services. Centres in Salisbury (incorporating the Fire and Rescue Service HQ), Tisbury and Melksham (incorporating GPs) are set to open during the coming year.

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Five GP surgeries in Devizes have also agreed to work with the CCG to deliver a new Urgent Care Centre for Devizes within the next couple of years. It is anticipated that the centre will include access to urgent primary care services and all the services that are currently provided at Devizes Community Hospital. It will be next to the Devizes NHS Treatment Centre and have use of its x-ray machine. Funding for the centre will come from money raised by the sale of the old community hospital site and will ensure that vital primary care services can be delivered well into the future. The Urgent Primary Care Centre will be a centrally accessible service managing same day minor injuries and illnesses, with patients being directed following triage by GP practice. The centre will be staffed by GPs, nurse practitioners and emergency care practitioners with support from social care and mental health services.

A new Extra Care development has recently been completed in Royal Wootton Bassett by Housing and Care 21. The development is extremely vibrant and already has an excellent community feel with the bistro café. Work has started on a Wiltshire Council owned and managed scheme in Devizes and on developing proposals for sites in Amesbury and Salisbury. Existing sheltered schemes within the south of the county are also being reviewed which has resulted in the first Sheltered Housing remodelling at Nadder Close in Tisbury, with works due to complete in the spring 2017. In addition, Selwood Housing are remodelling a sheltered scheme in Westbury, to provide a new Extra Care facility at Bell Orchard. Opportunities for more Extra Care housing within Wiltshire’s community areas continue to be considered.

New commissioning models and system thinking An Intermediate Care system review which started in 2014 identified a disconnection and lack of strategy or information sharing between providers both from public and private sectors. A multi-agency, multi-disciplinary team spent six months compiling a picture of the system as it currently operates, with a report generated in March 15. As a result of this work, systems thinking methodology is supporting the implementation of other projects, such as HomeFirst.

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Cross Cutting Themes

OverallLife expectancy male 2012/14 80.9 years

ñLife expectancy for males has increased since last measured in 2011/13 when it was at 80.6

Life expectancy female 2012/14 84.1 yearsñ

Life expectancy for females has increased since last measured in 2011/13 when it was at 83.9

Healthy life expectancy 2011/13 67.6 yearsó

Average healthy life expectancy for males and females has remained broadly static since last measured in 2010/12.

Index of inequality, difference in life expectancy between most and least deprived areas

2012/14 2.5 years (f)

6 years (m)

ó Compared with 2.7 years 2011/13 and 5.2 years 2011/13

Indicators for success

Inequalities Equality is at the heart of decision making. Commissioning organisations have to consider equalities impact alongside others before a decision is made. Equality Impact Assessment training has been provided to both Wiltshire Council and the CCG staff in 2015/16 to ensure they understand the Public Sector Equality Duty (PSED). Over the last year we have also worked to reduce health inequalities further and improve health outcomes through targeted work with communities.

Involvement Healthwatch Wiltshire play a significant role in ensuring public engagement and involvement informs the delivery of health and care services in Wiltshire. Their 2014/15 annual report details the work they have already achieved and their 2015/16 Annual report is due to be considered by the Health and Wellbeing Board shortly.

Members of Wiltshire’s Health and Wellbeing Board have also engaged with a wide range of public, carer and patient groups throughout 2015/16 to inform specific proposals.

Safeguarding NHS and social care organisations have statutory obligations to provide safe, high quality care. As well as obligations on individual organisations, Wiltshire’s Safeguarding Children Board and Wiltshire’s Safeguarding Adult Board (which has also recently been given statutory powers) play an important role in delivering these aims through collaborative working. Wiltshire’s Health and Wellbeing Board have considered the implications of Wiltshire’s Safeguarding Boards’ annual reports and any particular investigations they have undertaken.

Healthy LivesAir pollution level in Wiltshire

March 2016 3 out of 10 In the UK most air pollution information services use the index and banding system approved by the Committee on Medical Effects of Air Pollution Episodes (COMEAP). The system uses one to ten rating with the lower the number the better. As of March 2016, Wiltshire can boast a low level rating of 3 out of 10 which is considered the top performing quartile in the scoring system. This data is measured at different five points across Wiltshire.

Early years development

As at Q2 15/16

66% ñ % of children achieving a good level of development in Foundation Stage Profile in 2015. This compares with a national average of 66% for 2014/15.

Numbers on protection plans

As at Dec 2015

347 ó This is a minor increase on this time last year which was 335.

Children in care As at Dec 2015

394 ó This is a decrease on this time last year which was at 416.

Achievement by vulnerable children

Academic Year 14/15

23% ó 23 % of children in care achieved 5 or more A*-C GCSEs incl English and maths. This is an increase from 17% the previous year and compares with 12% in UK.

Child obesity 2014/15 29.20% ò Excessive weight in 10-11 yr olds has dropped to 29.20% compared to last year’s average of 29.45% and well below the national average of 33.20%

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Empowered livesNumber of personal budgets – social care

As at Feb 20162737

(97%) ñ 97% of clients in adult social care have a personal budget.

Number of personal budgets – carers

As at Feb 2016545

(68%) ñ 68% of carers have a personal budget.

Number of personal health budgets – patients

As at Mar 2016 9 ñThis has increased from four patients. An expansion of the PHB offer from continuing health care to complex mental health and learning disabilities is planned.

Total permanent placements in care homes

As at Feb 2016 453 òOverall there is a decrease in permanent placements compared to this time last year. In Feb 2015 there was a total of 481 placements.

Admissions to hospitalAs at Jan 2016 (YTD)

35,372 òAs at Jan 2016, Wiltshire had 35,372 NEL hospital admissions for 2015/16, which is 5,000 less admissions than the same period last year.

Admissions to hospitals from care homes

As at Jan 2016 (YTD)

1478 òFor Non-LD care homes there has been a 14% reduction in admissions compared to last YTD, down 249 admissions.

Number of patients still at home 91 days after discharge

As at Sep 2015 (YTD)

86% ñ

The proportion of people at home 91 days post discharge from hospital for Q2 2015/16, discharges rose to 86.3% thanks in part to better streaming information from Intermediate Care beds. This takes the year to date figure to 86% which is the Better Care Plan target.

Average delayed transfers of care

As at Dec 2015 16

This refers to the 12 month average for the number of people delayed in hospital, for both health and social care reasons, per 100,000 population (over 18s). Generally, numbers of people delayed in hospital has reduced considerably in the last 12 months. Numbers of delays for social care reasons are now consistently better than targeted levels.

Dementia diagnosis rates

As at Feb 2016 65.6% ñIn February the rate increased by 0.9% and stands at 65.6% compared to the 66.7% target . 70 more diagnoses are needed to achieve the target.

Health based places of safety are available for those experiencing a mental health crisis, numbers held in police custody.

As at Dec 2015 (YTD)

27

27 individuals experiencing mental health crisis were taken to the custody suite at Melksham or Swindon Police station. This was 7% of all section 136 incidents across Wiltshire, as 383 incidents occurred during the year. The aim is to ensure that custody is avoided wherever possible and an appropriate health based place of safety is found, excepting cases where individuals are violent and pose a risk to staff. There are three places of safety in Wiltshire that are available for people who are held under the Mental Health Act.

Full details of performance against a range of indicators for children and adults are available in the Public Health Outcomes Framework. These show good progress across all four domains in Wiltshire. Similarly the Joint Strategic Assessment outlines more detail.

Progress with Integration

Horizontal Integration (multi disciplinary teams)

Three GP cluster sites acted as demonstrator sites ahead of rollout to other community areas in Wiltshire. Teams are now in place in all 20 cluster areas, although are at various stages of development.

Vertical Integration (pooled budgets)

The amount of money within pooled or transferred budgets between Wiltshire Council and Wiltshire CCG has grown from £15.9m in 2013/14 to £38.1m in 2015/16. This is inclusive of areas such as integrated community equipment and support services; as well as support for carers.

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