Healthand Wellbeing Strategy

Health andWellbeingStrategy2018 - 2022

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Hertsmere Health and Wellbeing Strategy 2018 -2022 1

Page

Foreword ...................................................................................... 2

Introduction.................................................................................. 3

Strategic Context ........................................................................ 4

Defining health ............................................................................ 6

How healthy is Hertsmere?........................................................ 8

Our priorities.............................................................................. 11

Our Public Health role .............................................................. 12

Implementing the Health and Wellbeing Strategy .............. 16

Contents

Hertsmere Health and Wellbeing Strategy 2018 - 20222

ForewordI’m delighted to introduce the refreshed Health and Wellbeing Strategy for Hertsmere2018-2022. Overall, Hertsmere is a healthy place in which to live, work or visit.Being healthy is more than the absence of disease; it is the ability for everyone to fulfiltheir potential, make a contribution and be resilient to life’s challenges.

In Hertsmere we have a strong culture of working together to create a healthy, safeand fulfilling place to live, work or visit. Hertsmere Borough Council workssuccessfully with our partners through the Local Strategic Partnership, Community

Safety Partnership and Health and Wellbeing Partnership. This strategy will focus our collective energiesto improve the health of the community and address the health inequalities. The review of the previousstrategy has enabled the partnership to refocus and take account of new health policies.

We recognise the importance of growing our understanding of where different departments in the councilcan have the most impact on improving health and this is reflected throughout this strategy.

The borough benefits from beautiful open spaces, a vibrant leisure offer and cultural heritage. We alsomaintain responsibility for healthy living including improving air quality, sanitation, housing standards andfood hygiene.

However, there is more that we can do. There has been greater focus nationally on health issues such asobesity, mental health and adequate housing conditions. This strategy provides a significant opportunityto enhance opportunities for our community to prevent, promote and improve health.

Cllr Caroline Clapper, Portfolio Holder for Leisure, Culture and Health

This Hertsmere Health and Wellbeing Strategy recognises the important role that thedistrict council and their partners have on impacting upon the health of residents. Thevision, priorities and principles that are referenced in this strategy align well with thecountywide Public Health Strategy. I have no doubt this strategy will help make animpact on the health and wellbeing of people in Hertsmere.

Hertsmere Council and its many partners, of which I am proud to be one, arecommitted to the health and wellbeing agenda, actively trying to improving the health

of the people living in the borough. It’s great to work with such committed people, and it’s great to see astrategy which has carefully thought through the needs and priorities for the borough. We all need towork in partnership to achieve this strategy, from the district and county councils, to the NHS, localcommunities, voluntary sector and businesses.

I hope this strategy is very successful.

Professor Jim McManus, Health Foundation

The purpose of this strategy is to set out thevision for health and wellbeing in Hertsmere.This strategy recognises Hertsmere BoroughCouncil’s corporate goals, the aims of the LocalStrategic Partnership and other local andnational priorities. The priorities have beenagreed by Hertsmere Borough Council andorganisations that make up the Health andWellbeing Partnership. The focus of thepartnership is on improving health and wellbeingso that individuals and communities are able tolive healthier lives.

Health and wellbeing is more than the absenceof disease; it is the ability for everyone to fulfiltheir potential, make a contribution and to beresilient to life’s challenges. Health and wellbeingaffects each and every one of us. We each havea responsibility to ensure that good health andwellbeing is promoted in our families,workplaces and communities.

Health systems are complex with many differentorganisations responsible for different parts ofcare. This strategy recognises that primaryresponsibility for supporting the health of

Hertsmere residents lies with Herts ValleysClinical Commissioning Group, WestHertfordshire Hospitals NHS Trust, HertfordshirePartnership University NHS Foundation Trustand Hertfordshire Community NHS Trust. Thelead role in public health, family services, adultand social care is held by Hertfordshire CountyCouncil. At a local level, district councils have nostatutory duty to provide primary or secondarycare. However, district councils and theirpartners are well placed to collaboratively createan environment that empowers people andcommunities to take responsibility for their ownhealth.

This document is a refresh of the Health andWellbeing Strategy that was published in 2013.The strategy will be monitored by theHertsmere Health and Wellbeing Partnership. Anaction plan will be produced, reviewed andreported to the board annually.

The priorities for the Health and WellbeingPartnership will focus on where we can makethe biggest difference by working togethertowards the key issues for our community.

3Hertsmere Health and Wellbeing Strategy 2018 - 2022

Introduction


Hertsmere Borough Council understands theimportance of partnership working and we havedesigned our approach with the strategic plansof our partners in mind:

NHS Five Year Forward View (2014)

The NHS Five Year Forward View it is publishedby NHS England outlines how NHS services mustchange to move towards the care modelsrequired for the future. Many services arecommissioned to treat diseases, illnesses andinjury after they occur. The NHS Five YearForward view recognises that a shift towardspreventing illness and long-term healthconditions will avoid improvements in healthylife expectancy being reversed. The HertsmereHealth & Wellbeing Strategy will consider howour approaches can contribute to preventingillness and long-term health conditions.

A Healthier Future: Sustainability andTransformation Plan (STP) forHertfordshire and West Essex(2016 - 2021)

The population is growing with greater healthneeds but the resources available are reducing.This means that organisations have got to bemore efficient to have the biggest impact.Across Hertfordshire and West Essex, currently£3.1 billion is spent on health and social care.The funding gap is forecast to reach more than£550 million a year by 2020 if changes aren’tmade to the way services are delivered.

There are four priorities outlined in the plan:

1. Living well and preventing ill-health

2. Transforming primary and communityservices

3. Improving urgent and hospital services

4. Providing health and care more efficientlyand effectively1

The Hertsmere Health and Wellbeing strategyclosely aligns to the ‘Living well and preventingill-health’ priority; by championing communitybased approaches that influence the health andsocio-economic behaviours of the localcommunity to prevent ill-health.

Hertfordshire Health and WellbeingStrategy (2016 - 2020)

The strategy has been developed by theHertfordshire Health and Wellbeing Board whichincludes a wide range of partners, includingthose from health, local government, voluntaryand community sectors. Each sector contributestowards the delivery of this strategy through itsown strategic aims.

Strategic Context

1 A Healthier Future https://www.healthierfuture.org.uk/sites/default/files/publications/2016/December/A-Healthier-Future-Final.pdf

Hertsmere Health and Wellbeing Strategy 2018 - 2022 5

The strategy is underpinned by the vision for allpartners to work collaboratively to reducehealth inequalities and improve the health andwellbeing of residents in Hertfordshire.

The strategy recognises that factors whichaffect our health and wellbeing vary over thecourse of our lifetime. This strategy sets highlevel priorities, based on four significant stagesof the life course:

• Starting well• Developing well• Living and working well• Ageing well

The Hertsmere Health and Wellbeing strategywill consider the four stages of the life coursewhen planning and delivering services.

Hertfordshire Public Health Strategy(2017 - 2021)

The strategy outlines the aims for the PublicHealth Service as part of the vision forHertfordshire. It sets out how the work of publichealth ensures all Hertfordshire residents will

have an opportunity to be as healthy as possibleand to live safely in their communities. It isintended to support and complement the publichealth aims of partner organisations such asdistrict councils.

Hertsmere Borough Council 2020 Vision

Hertsmere’s 2020 Vision is the council’scorporate plan that sets out three themes:

1. Being an enterprising council

2. Planning for the future

3. Supporting our communities

These priority areas have been identified inresponse to the challenges faced by the Councilduring the life of the plan. Particularly relevantto this strategy is the changing nature of thelocal population. The number of people living inHertsmere is growing which along with healthissues like obesity and an ageing population,means additional pressure on local services. The2020 Vision is supported by an annual actionplan which identifies key projects underwaywithin the Council which support the prioritythemes.


What is Health and Wellbeing?

The World Health Organisation defines health as‘a state of complete physical, mental and socialwellbeing, not merely the absence of disease orinfirmity’. Many Hertsmere residents enjoy goodhealth and wellbeing. The average lifeexpectancy in Hertfordshire has increasedconsiderably over the past 10 years, and this isreflected in Hertsmere. However, there are stillsignificant problems, such as the low level ofphysical activity in children and young people,prevalence of smoking and people beingseriously injured or killed in road accidents.

What is Public Health?

Public Health is about helping people to stayhealthy and protecting them from threats totheir health. Smoking, alcohol, sexual health,obesity and physical inactivity continue to belifestyle indicators for individuals andcommunities. However, health is personal to theindividual and without suitable support to takepeople forward, encourage achievement ofhealth goals and help with the right tools forbehavioural change, people can often losemotivation and revert back to their previous,unhealthy lifestyle choices.

The Public Health Outcomes Frameworkconcentrates on:

• increased healthy life expectancy• reduced differences in life expectancy• healthy life expectancy betweencommunities

The outcomes reflect a focus not only on howlong people live but on how well they live at allstages of life. Life expectancy is higher whichmeans people are living longer but theproportion of life spent in good health is falling.The outcomes also address health inequalitiesbetween people, communities and areas.

A set of public health indicators helps focusunderstanding of progress and are grouped intofour domains which include:

• improving the wider determinants of health• health improvement• health protection• healthcare and preventing prematuremortality

Defining health

There are many factors that determine ourhealth and wellbeing. We need to considerDahlgren and Whitehead’s model2 to understandthe wider determinants of health.

The model maps the relationship betweenindividuals, their environment and disease. Itshows the complexity of factors that caninfluence an individual’s health and quality of life.

The Marmot Review stresses the importance oftaking a life course perspective and recognisingthat disadvantage accumulates throughout life.3

Our aim is to deliver services for children andyoung people, working age adults and olderpeople.


2 Dahlgren, G. and Whitehead, M. (1993) Tackling inequalities in health: what can we learn from what has been tried?3 ‘Fair Society, Healthy Lives’ The Marmot Review

Figure 1: Dahlgren and Whitehead (1993) Determinants of health


Understanding the make-up of individuals,communities and the resources they haveaccess to, are vital in achieving improved healthoutcomes for all. With greater understanding ofthese variables and the influences they have, amore informed public health approach can be

taken to help people and the places they live into be healthier. A variety of different datasources and evidence has helped us to identifythe main health concerns and challenges inHertsmere.

How healthy isHertsmere?

4 Hertsmere Health Profile 2017 www.healthprofiles.info (Public Health England)

Health in HertsmereA snapshot (2018)

20.5%

2,620

25.3%

62.4%

of children starting primaryschool overweight or obese.*

children are living in low incomefamilies.

of adults aren’t doing enoughphysical activity.

Life Expectancy in men differs by9.7 years depending on whereyou live.

of adults in Hertsmere carryexcessive weight.

Benchmark Trend

9.7 yearsLeast

deprived

Most

deprived

Benchmark - against the England average. Trend - Movement from 2013. Key: Green - Better, Orange - Similar, Red - Worse *NHS Digital

Hertsmere’s Health Profile - ASnapshot

Hertsmere has a population ofapproximately 103,700 residents.According to the Hertsmere Public HealthProfile4 2017 and Public HealthOutcome Framework, the health ofpeople living in Hertsmere is generallybetter than the England average.

The number of children classified asobese in Year 6 is better than the Englandaverage, 18.0% of children are classifiedas obese. However this is an increasefrom 15.4% in 2016. GCSE attainment,rates of newly diagnosed sexuallytransmitted infections (excludingchlamydia), levels of teenage pregnancy,hospital stays for alcohol related harmand smoking in pregnancy are better thanthe England average.

Hertsmere is a very diverse borough withvarying levels of deprivation. The 2015Index of Multiple Deprivation shows thatBorehamwood Cowley Hill ward is in thetop 25% of the most deprived areas in

the country. Other areas of deprivation alsoexist in parts of Bushey North, Potters BarOakmere, Borehamwood Brookmeadow,Borehamwood Hillside and BorehamwoodKenilworth wards. This deprivation contrastssharply with the equally concentrated areas ofaffluence that characterise other areas of the

borough, particularly Radlett and Aldenham. Thiscontrast is demonstrated by the gap of 9.7years in male life expectancy between the mostand least deprived wards.

The following map shows the differences indeprivation across Hertsmere:


There are different circumstances that influencehealth across the wards. It is important toacknowledge that the relationship betweenhealth and deprivation is a complex one.However, Hertsmere’s health deprivation

correlates closely with income deprivation andmainly affects areas that are less affluent.

The following indicators have been identifiedwhere Hertsmere is similar or worse than theHertfordshire average and require improvement.


Diabetesdiagnosisrates

* Hertsmere is a major road network hub with the M1, A1 (M) and M25 connecting with the borough.

Indicatorswhere

Hertsmere is similaror worse than theHertfordshire

average

Percentageof physicallyactive adults

Killedor seriouslyinjured onroads*

Hipfractures in

people aged 65and over

Dementiadiagnosis

Smokingprevalence in

adults

Excesswinterdeaths Hospital

stays foralcohol specificconditions(under 18)

Overweightchildren inreception

Excessweight inadults


Our priorities

Overarching principles

The following principles will underpin the workneeded to deliver this strategy. The fourprinciples of this strategy are:

Whole systems approach - An personl’s healthis influenced by factors that can be addressedby services offered by the wider council andlocal partners. Therefore the contributions of allpartners must be considered when planning anddelivering local health and wellbeing services.

Partnership working - Different skills,relationships and approaches generated by ourpartners must be pooled together to address

the needs of the local community and deliverthis strategy.

Prevention - Projects and services aimed atreducing the development and severity ofchronic diseases and other morbidities bychanging the behaviour of individuals to positivehealth-related behaviours.

Person Centred Approach - Treat everyone asan individual by considering their personalneeds, wants and goals so that they becomecentral to the services they are offered. This canmean putting the person’s needs, as they definethem, above those identified as priorities byprofessionals.

The following priorities have been identified as a result of gathering local intelligence through theJoint Strategic Needs Assessment and Public Health England Health Profiles as well as consultationwith partner organisations and local residents.

VisionSupport our residents to live longer; happily, healthily and independently.

Priorities

PrinciplesWhole systems

approach

Promotehealthy weightand increase

physical activity

Improvemental healthand emotionalwellbeing

Supportthe reduction ofsmoking, drug and

alchoholmisuse

Enhanceour

environments andincrease use ofgreen space

Partnershipworking

PreventionPerson centred

approach


In order to tackle health inequalities alldepartments and partner organisations mustwork together to address environmental,economic and social factors when planning,designing and delivering services. Many of thesefactors could be influenced by the statutoryservices that Hertsmere Borough Councilprovides for local communities. It is importantthat residents take responsibility and feel able tomake healthy choices in life, whilst HertsmereBorough Council and community groups providesupport and deliver services when they areneeded. The following section outlines thepractical ways that Hertsmere BoroughCouncil’s services impact upon health andwellbeing.

Street Scene

A clean environment is essential for humanhealth and well-being. Street Scene improvesand promotes a healthy living environment by:

• Keeping the streets of Hertsmere clean byundertaking waste and recycling collections,street sweeping, removing fly-tipped itemsand abandoned vehicles.

• Administering the management of car parksand controlled parking.

•Maintaining the borough’s parks and openspaces. Our parks are maintained to anexcellent standard this is reflected by theborough having five Green Flag awardedparks.

• Developing the green spaces in the boroughto offer residents an opportunity to behealthy and active, such as the outdoorgyms, play equipment and cycle routes.

• Providing walking and cycling trails throughthe borough’s parks to encourage activetravel.

Community Safety

The Hertsmere Community Safety Partnership(CSP) brings together key partners within theborough with the aim of reducing crime anddisorder and making Hertsmere a safer place tolive, work and visit.

Community Safety plays a major role in thehealth and wellbeing of the community throughdealing with causes of domestic abuse, tacklingmodern slavery, reducing anti-social behaviour,responding to mental health crises, drug andalcohol safety.

The impact of Community Safety on health isperceived as important for Hertsmere Borough

12

Our Public Health role

Council. Our Community Strategy, HertsmereTogether, includes healthier communities as akey priority. This link is strengthened by the CSPand Health and Wellbeing Partnership jointlyfunding initiatives which influence both areas.The Safer Streets, project co-ordinated by theCommunity Safety Partnership, visits residentsin their home. Representatives from differentagencies provide crime prevention advice, firerisk assessments, information on voluntaryservices and advice on giving up smoking andhealthy living.

Environmental Health & Licensing

Environmental Health and Licensing plays anessential part in health protection and inimproving public health through its advice and,where necessary, regulation and enforcement.Environmental Health influences health by:

• Ensuring food hygiene standards aremaintained in commercial kitchens.

• Dealing with a particular nuisance orproblem in a specific area that is detrimentalto the local community’s quality of life.

• Assessing, monitoring and working toimprove air quality across the borough.

• Offering facilities grants to adapt homes tobe more appropriate for individuals with adisability to live in, independently.

• Protecting the health and safety of thosewho live, work and visit the borough atevents, in work environments and leisurepremises.

• Issuing licences relating to alcohol, animals,entertainments, gambling and taxis.

Environmental Health participates with otherpartner agencies to provide an effectiveresponse to a wide range of emergenciesincluding natural hazards (e.g. flooding/droughtetc) major incidents, outbreaks of widespreadinfectious disease (e.g. Flu Pandemic) andterrorist incidents.

The main purpose of Environmental Health isensuring public safety and they work closelywith our Community Safety team to reduceincidents of public nuisance.


Housing

Housing is an essential element to health andwellbeing of individuals and families. Living inpoor housing can lead to an increased risk ofcardiovascular and respiratory disease as well asanxiety and depression. Problems such as damp,mould, excess cold, overcrowding and structuraldefects which increase the risk of an accidentcan impact on a person’s health.

We can improve health in many different ways,for example, by:

• Taking action to deal with poor housing byencouraging landlords to improve livingconditions.

• Licensing larger private rented properties toensure they meet suitable standards.

• Educating landlords on changes toregulations and laws that may affect them.

• Providing energy advice and fundedimprovements as part of Warmer Homes, toreduce fuel poverty and excess winterdeaths.

• Intervening to prevent individuals andfamilies becoming homeless at the earliestopportunity.

• Support vulnerable people to avoid orprevent homelessness.

• Considering health and wellbeing needs ofall people we interact with.

Planning

Health is influenced by how surroundings makepeople feel and the opportunities they provide.

To foster health-promoting environments, it isessential that planners, urban designers,developers and health professionals collaborateto ensure that health is considered at alldevelopment stages. Well-designed places,spaces and buildings enable people to be morephysically active, feel safe and secure, usefacilities and services, and socialise and play.5

Hertsmere Borough Council is starting work on anew Local Plan that identifies potential areas ofgrowth across the borough. The Issues andOptions report issued by the council recognisesthat local infrastructure needs to be providedalongside new homes and jobs; this includesopen spaces, sport and recreation facilities andplay areas, as well as provision for new orexpanded GP/health facilities. The Plan strivesto make it easier for people to get out into thecountryside and green spaces.

The National Planning Policy Frameworkencourages planning authorities to shiftbehaviour from private car use to more


5 The Health Foundation (2018) What makes us healthy? An introduction to the social determinants of health

sustainable forms of transport. Well-designedstreets, limitations on parking and accessiblepublic services can encourage active travel andreduce harmful emissions. The new Plan willneed to manage off-street parking levels withinnew strategic development sites, including theproposed Garden Village.

The Site Allocation and DevelopmentManagement Policies Plan (SADM48)recognises the impact of hot food takeaways onthe health of residents, particularly secondaryschool students. Proposals to locate new hotfood takeaways within a 400 metre walkingdistance of a school site will be assessed morerigorously for their impact on the accessibility ofunhealthy food.

The Community Infrastructure Fund uses moneypaid by developers of properties in the boroughto improve facilities and services in Hertsmere.Organisations can apply for contributions toaddress shortfalls in delivering health andwellbeing infrastructure improvements.

Sports, Leisure and Culture

The Partnerships and Community Engagementunit has the responsibility to ensure there are

cultural, leisure and sporting offers across theborough. Hertsmere Borough Council providesdirect functions in sports development andhealth and wellbeing, working together withpartners to deliver sport and health initiativesacross the borough. In addition a range of otherservices are delivered by Hertsmere LeisureTrust, on behalf of the council, that seek toimprove opportunities for residents to take partin their community; for example, parks events,theatre shows, activities and trips for ‘fifty plus’.

Hertsmere Heritage Forum was set up to bringtogether, celebrate, develop and promote thewide variety of local community groups whoplay a significant role in developing arts andculture across the borough. It is supported bythe local museums from Borehamwood andElstree, Bushey, Potters Bar and Radlett.

Hertsmere Borough Council supports a range oforganisations in the voluntary sector with grantfunding to provide specific services across theborough. For example, Citizens AdviceHertsmere is funded to provide free, impartialand confidential advice to residents on a rangeof issues from debt and money to legal advice.



Hertsmere Borough Council recognises that wecannot achieve the priorities in this strategyalone. This strategy sets a vision for HertsmereBorough Council and partners. We will need towork in partnership with a number oforganisations; statutory, voluntary and privatesector to provide opportunities for everyone inthe borough to improve their health andwellbeing.

This Health and Wellbeing Strategy will beowned and implemented by the HertsmereHealth and Wellbeing Partnership which isrepresented by Hertsmere Borough Council,Hertsmere Leisure, Community Hertsmere,Citizens Advice Hertsmere, Health Watch, HertsMind Network, Hertfordshire County Council,Aldenham Parish Council, Elstree andBorehamwood Town Council, Herts ValleysClinical Commissioning Group, Watford FC CSETrust, Children’s Centres and Groundwork.

Each year an action plan will be produced andreviewed by the Health and Wellbeing

partnership to demonstrate how we deliver ourpriorities. It is important to note that thestrategy and action plan will continue to evolveto reflect local needs based on evidence andchanging aspirations.

Hertsmere Health and Wellbeing Partnership willimplement the key priorities outlined in thisstrategy by:

•Working together towards a shared vision• Combining resources, skills and expertise todeliver impactful initiatives

• Delivering or commissioning projects thatrespond to need

• Championing health and wellbeing in theborough and promoting positive health-related behaviours

• Responding to consultations both at localand national level to improve health inHertsmere.

Implementing theHealth and WellbeingStrategy

Documents

Healthand Wellbeing Strategy