MERTHYR TYDFIL HEALTH SOCIAL CARE & WELLBEING STRATEGY

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1 MERTHYR TYDFIL HEALTH SOCIAL CARE & WELLBEING STRATEGY

2 Table of Contents FOREWORD...3 INTRODUCTION...5 OUR VISION FOR THE FUTURE...6 OUR VALUES...8 OUR APPROACH...9 RELATIONSHIP WITH OTHER PARTNERS. 9 ENGAGEMENT WITH STAKEHOLDERS.13 ACHIEVEMENTS SO FAR...14 OUR THEMES FOR THEME 1 - PROMOTING HEALTHY LIFESTYLES AND PREVENTING ILL HEALTH 18 THEME 2 - PROMOTING INDEPENDENCE AND PROTECTING THE VULNERABLE 29 THEME 3 - IMPROVING SERVICES AND JOINT WORKING 43 USEFUL DOCUMENTS 47 IMPLEMENTATION AND DELIVERY..48 2

3 FOREWORD Welcome to the third Health Social Care and Wellbeing (HSCWB) Strategy for Merthyr Tydfil covering the period The Health Social Care & Wellbeing (HSCWB) Strategy is a statutory plan written by Merthyr Tydfil Local Authority and Cwm Taf Local Health Board. The purpose of the Strategy is to ensure that Merthyr County Borough Council and Cwm Taf Local Health Board work together alongside partners including the Third Sector, Private Sectors and Public Health Wales to improve the Health, Social Care & Wellbeing of our communities. It is closely linked to the Community Plan, Children & Young People s Plan, Local Development Plan and the Community Safety Strategy. By identifying the issues, and focusing on the priorities relating to the social determinants of health such as our lifestyles, our living conditions and employment, we will reduce health inequalities and deliver an improved quality of life for people in Merthyr Tydfil. We will aim to address the underlying causes of ill health and rebalance care towards local provision, which focuses on promoting good health and independence. We will involve the communities in how we do this and provide an effective communication plan to ensure that the involvement is ongoing. We will also communicate across organisations, to ensure that information is shared and the provision of services is not duplicated. The plan identifies that: 1. We need to: prevent ill health; protect the most vulnerable; promote independence and encourage self care; ensure that we empower people to take responsibility for their own health; integrate services and avoid duplication; and deliver a customer led approach. 2. We have made good progress since the first Health Social Care & Wellbeing Strategy and built a strong foundation to improve the issues that have the potential to affect the health and wellbeing of the population of Merthyr Tydfil. Issues identified include worklessness, poor mental health, substance misuse, housing and poor lifestyle choices. 3. We will build on the previous 2 strategies by continuing to work together to ensure that we make the most effective use of health and social care resources. We will also promote healthy lifestyles and support people to live an independent life for as long as possible. 3

4 By remaining focused on the priorities, working together, and encouraging people to take responsibility for their own wellbeing, we will provide services which are accessible and citizen centred, providing clear tangible outcomes. Our aim is to fulfil the Health Social Care & Wellbeing requirements of the Community Plan thereby ensuring a healthy, safe and fair society. We will review what we have done so far against the agreed measurable targets which will be determined with individual action plans for implementation and ensure that what needs to be done over the next three years is achieved. We will do this by ensuring that health, social care and the voluntary sector work collaboratively. We will ensure robust mechanisms for accountability and performance are in place which will lead to demonstrable improvements. We will look at age groups through the life course and work towards ensuring that people stay healthier and independent for longer and that that services are sustainable. Joint working, delivery of integrated services and joint commissioning will be key issues in ensuring that the Strategy is delivered effectively. We would like to thank everybody for taking the time to tell us your views on the issues which are important to you and your families. We have taken account of all the comments made as part of the consultation exercise in the development of the Strategy. We will continue to keep you informed of progress in implementing the new plan which will only be a success, as many of you pointed out, if we all work together and communicate effectively. We look forward to a Brighter Merthyr Tydfil. Giovanni Isingrini Director of Social Services and Social Regeneration Merthyr Tydfil County Borough Council Joint Chair HSCWB Partnership Samia Saeed Assistant Director Partnerships, Cwm Taf Local Health Board Joint Chair HSCWB Partnership 4

5 INTRODUCTION Welsh Assembly Government Guidance states that it is a statutory duty for the Local Authority and the Local Health Board to produce a Health Social Care & Wellbeing (HSCWB) Strategy under Section 40 of the National Health Service Wales Act The Guidance focuses on two important areas where the ability of the Local Health Board and the Local Authority together have a major opportunity to improve the health and well being of their local population. These are reducing inequalities in health and improving the provision, quality, integration and sustainability of overlapping services. This involves the NHS, local government and their partners jointly providing a range of interlocking services to identifiable groups within their population. The HSCWB Strategy focuses on priorities to improve the health & wellbeing of our communities, thereby encouraging healthy, fulfilled lives. We particularly need to improve wellbeing for those who are disadvantaged and vulnerable. The HSCWB Strategy is about planning effectively to promote healthy lifestyles, prevent ill health and reduce health inequalities, as well as ensuring that our health and social services are accessible to everyone in the community. Priorities featured in the Children & Young People s Plan are identified in the HSCWB Strategy to ensure that there is a clear alignment across both plans. We need to ensure that transitional arrangements for children moving from childhood to adulthood are effective. This ensures a more holistic approach focusing on family issues, ensuring that the most vulnerable and harder to reach families are prioritised. The HSCWB Strategy outlines our achievements since the HSCWB Strategy , highlighting where we are now and identifies what we need to focus on in the next three years. Joint commissioning will be encouraged to stop duplication of services. We will disinvest in services which prove to be unsustainable and reinvest in new, more effective health and social care services. We will ensure that our communities are engaged in the planning process acknowledging that people in the community have important views and opinions. We will ensure that there is a golden thread between the five statutory plans (Community Plan, Children & Young People Plan, Local Development Plan, HSCWB and Community Safety Strategy) by working together on the plans and reporting mechanisms. By communicating effectively across, and within, partner organisations, we will ensure that the Local Authority Business Plans, the Local Health Board Service Workforce Financial Framework (SWaFF) and Communities First Plans are aligned and that all involved are working towards a common goal. 5

6 THE CONSULTATION PROCESS A formal 12 week consultation period was required to consult on the draft strategy. However, it was also expected that there would be ongoing engagement with the public, staff and stakeholder organisations throughout the whole process and in a range of ways. Engagement to help inform the drafting of the consultation was undertaken in the latter part of The Stakeholder Reference Group and a wide range of partnership groups were involved and also a health event for staff was held at Prince Charles Hospital. The formal consultation process took place between January 4 th and March 29 th The draft Strategy document was made available electronically in both English and Welsh, and was distributed widely using the databases of partner organisations and other stakeholders to reach as many groups and individuals as possible. It was made available on the Local Authority website and Facebook, the Local Health Board website and partner websites. It was also publicised in the media. Presentations were given at meetings and to various groups including public groups such as the Older People s Forum and local church groups. Specific events and workshop discussions were held and a variety of other methods were used to communicate as widely as possible including the use of partner organisation newsletters, and FREEPOST questionnaires. 2 workshops were also held with a wide range of both primary and secondary schools. Where appropriate, events were held jointly across Merthyr Tydfil and Rhondda Cynon Taff (RCT). These included a joint Communities First workshop and a joint workshop for the Third Sector which was organised by VAMT and Interlink. All responses received were considered by the Core Group and a number of common themes and key messages were taken into account when finalising the Strategy. Specific comments/suggestions will also be fed into action plans for the HSCWB Strategy and to other partnerships and operational groups where appropriate. We are grateful to all those individuals and groups who responded. The final Strategy was agreed by the Core Group at the end of March 2011 and then formally approved by Merthyr Tydfil Local Authority and Cwm Taf Health Board. OUR VISION The HSCWB Strategy is a high level plan which sets the framework and direction for all other health, social care and wellbeing policies. Our vision for the next three years recognises the importance of people being able to participate fully in life and remain as independent as possible for as long as possible. However, it also requires that if people do become ill or vulnerable, their needs are met effectively. We have created a high level aspirational vision and will identify clear outcomes that reflect what we want to achieve: 6

7 WHAT YOU TOLD US There was broad support for the general direction of the Strategy and the Vision itself. Some respondents commented that joint working would be key in achieving the aspirational vision. Joint working needs to be part of the vision Need focused partnership working to deliver on theme 3 It s how we achieve it and how we support people to achieve it. Partnerships need to provide the added value to service delivery through joint working and joint service delivery It was also highlighted that it is important to make information available in key areas for all to access and that key workers are essential links and require appropriate signposting. As many comments stressed the importance of partnership working we have reflected this important aspect by prefacing the Vision with an additional statement: BY WORKING TOGETHER MERTHYR TYDFIL WILL BECOME A PLACE WHERE All people in Merthyr Tydfil live longer, healthier and happier lives with fairer outcomes for all. All people in Merthyr Tydfil live their lives to the full and are enabled to maintain their independence for as long as possible. All people in Merthyr who become ill, frail or vulnerable receive the care and support they need at the right time and in the right place. All individuals and communities in Merthyr Tydfil recognise the need to take more responsibility for their own health and wellbeing and are supported to do this. 7

8 OUR VALUES Building on the developments of the first two HSCWB Strategies, our plans will be underpinned by the following key values: Equity Tackling the unfair and avoidable differences in health by improving people s social and economic prospects and reducing inequalities in access to services. Empowerment Supporting individuals and communities to take increasing control over their own lives and health. Engagement Involving all stakeholders including service users and the wider public in the development and delivery of plans. Effectiveness Making health and social care as safe, sustainable and careful of resources as possible, minimising harm, waste and variation which means the best is not provided everywhere. Empathy Service users and carers should be treated with dignity, respect and integrity. 8

9 OUR APPROACH In developing the Strategy, we have placed great emphasis on the following: 1. Needs Based Planning The HSCWB Strategy is based on an assessment of needs which has given us an understanding of the key challenges we face. The needs assessment analyses a range of statistical data and evidence as well as taking account of other softer information based on what people have told us is important to them, their families and their communities. The main findings are listed below and other specific issues are included in the relevant sections of this document. The full needs assessment will be available as an online resource which can be accessed early in 2011 by any professional or member of the public on both the Local Authority and the Local Health Board websites. The level of deprivation in Merthyr is greater than in the rest of Wales which results in poorer health for our residents and lower life expectancy. Compared with the rest of Wales, people in Merthyr have fewer years of healthy life expectancy which is the estimate of how long people can be expected to live in good or fairly good health. We have a growing elderly population which is likely to cause a rise in chronic conditions and in dementia. There is also likely to be an increase in economic dependency and in-care dependency. 2. Relationship with other Partnerships and Plans In the same way that health and wellbeing cannot be improved by the NHS and Council alone and is a shared goal for a wide range of stakeholders, so too the HSCWB Strategy must not be developed and delivered in isolation from the other key plans that affect our population. We must work together to ensure we achieve the maximum impact in improving outcomes for our residents, that we avoid gaps or duplications and manage overlaps effectively. The current partnership review will allow us to work more holistically across the partnerships by bringing together a partnership support team from Health Social Care & Wellbeing, Children & Young People and Community Safety and also by establishing a Partnership Board which will support the need to work together on key priorities. There will be a consistent approach to performance management for the detailed action plans which will include timescales and measurable outcomes. 9

10 WHAT YOU TOLD US: In addition to the many comments stressing the importance of partnership working, it was highlighted that training and effective communication would be essential in the delivery of the Strategy. In particular, we need to align our Strategy with the following: Merthyr Tydfil Local Service Board The Local Service Board is where the Leaders of local public sector organisations and voluntary organisations come together as partners to improve the delivery of services. The Local Service Board was introduced quite recently in It has set out a common set of community priorities in the Community Plan and appropriate priorities are set out in each of the partner organisations plans. It provides the overarching context for all plans. The Local Service Board will ensure that the Community Plan is delivered through effective partnerships and effective partnership working, and it provides regular progress reports on key areas, one of which is Health Social Care & Wellbeing. It addresses issues that individual organisations or partnerships cannot successfully tackle alone and ensures that the key partnerships are able to deliver their part of this plan and that they do so cost-effectively. The Local Service Board has developed the Merthyr Tydfil Community Plan for which provides the overarching context for all plans in Merthyr Tydfil. The Local Service Board will be a key driver in the development of the HSCWB Strategy. It will implement systems to improve the joint commissioning and delivery of services and support projects to integrate local service delivery across all public service sectors ensuring that resources are used effectively to tackle local issues. The development of a joint web based needs assessment and other media channels such as digital television, will increase knowledge and skills not only for the people in the community, but also for professionals and partners providing and sharing key information for the improvement of service delivery. Merthyr Tydfil Community Plan The Community Plan provides the overarching context for all plans in Merthyr Tydfil. The Plan aims to deliver: A Prosperous, Cultural and Diverse Merthyr Tydfil. A Healthy Safe and Fair Society. A Sustainable Living Environment. Learning For Life. The HSCWB Strategy will have a particular role in delivering the ambitions identified for a Healthy Safe and Fair Society. We have listened to what you told us in the consultation for the Community Plan and will aim to ensure that our County Borough s people live healthier lives for longer. We will ensure that 10

11 action plans identify cross cutting issues and that partners work together to achieve results. Merthyr Tydfil Children and Young People s Plan This plan is the defining statement of strategic planning intent and priorities for all children and young people s services in Merthyr Tydfil. It is essential that this plan is closely aligned with the HSCWB Strategy as: good health in the early years and adolescence makes a vital contribution to maintaining good health through life; the health and wellbeing of children is intimately connected with that of their families; children use other services besides those specifically designed for them; children will go on to use services designed for adults and we must have good transitional arrangements in place; and we need to tackle Child Poverty. There are nine key priorities for the Children & Young People s Plan and seven core aims addressing all aspects of young people s lives. We will work alongside the C&YPP to promote healthy lifestyles and tackle child poverty. There will be areas of overlap between the two plans and we will work to ensure that there is synergy. The HSCWB Partnership and the CYPP will take a key role in agreeing and delivering a work plan to radically re-engineer the way we deliver public services. We will also work with other partners on family issues and common priorities such as substance misuse, worklessness and mental health to improve outcomes for parents and children. Multi agency planning will be essential. Community Safety Partnership Many of the issues being addressed by the Community Safety Partnership to ensure Safer Communities will also have an impact on health and wellbeing. In particular we have common interests in seeking to reduce the impact of alcohol and drug misuse, domestic abuse and anti social behaviour. These are key cross cutting issues which need to be addressed in mental health and substance misuse action plans. Our two Strategies must work together to tackle these problems to promote wellbeing and improve community confidence. Local Safeguarding Children s Board Safeguarding is everyone s responsibility. It is important therefore that the HSCWB Partnership has a key role to play in safeguarding children and promoting their welfare. The main functions of the HSCWB Partnership in relation to safeguarding children are: Safety in health settings. Health promotion. Access to preventative health services. Access to primary health services. Healthy eating. 11

12 Links between HSCWB and the Local Safeguarding Children s Board are in place and will continue to be strengthened in the future to ensure that safeguarding children is a priority. Communities First Partnerships There are 7 Communities First areas in Merthyr Tydfil, recognising the significant levels of deprivation experienced in many parts of the County Borough. It is important that the local plans developed by the Partnerships covering these areas are not only informed by the HSCWB Strategy, but also influence its priorities and contribute to it s delivery as vibrant, sustainable communities are essential to achieving our vision. There are many excellent Communities First programmes which are already being delivered in Merthyr Tydfil which will play an influential role in improving healthy lifestyles. The programmes deliver community centred health enhancing activities and volunteering opportunities in areas of Merthyr Tydfil experiencing acute deprivation and low levels of health and wellbeing. Other Merthyr Tydfil Planning Groups There are also a range of other strategic and operational partnerships with which there are already close links and ongoing opportunities for continued alignment of plans and priorities as well as joint working on specific programmes. Examples of these planning groups are: Families First Steering Group Social Landlords Forum Economic Regeneration Partnership Adult Community Learning Merthyr Tydfil Environment Partnership Open Spaces Strategy Project Group Merthyr Tydfil Biodiversity Partnership Supporting People Operational Group Local Authority Partnership Agreement Group (LAPA) Financial Inclusion Group Area Adult Protection Committee HSCWB Third Sector Forum We will ensure that plans align with the HSCWB plans and work together to encourage health improved lifestyles. Rhondda Cynon Taff HSCWB Partnership Whilst our separate strategies identify local issues, there are a number of common issues faced by the populations in Merthyr Tydfil and Rhondda Cynon Taff. We have already worked together across the two County Boroughs on a range of health and social care initiatives and will continue to do so where appropriate in order to improve outcomes for our residents, share best practice and make the best use of resources. We will use a common needs assessment, strategy development and consultation process. 12

13 3. Engagement with Stakeholders The development of the Strategy for Merthyr Tydfil has involved a wide range of partners including statutory, voluntary and independent sector organisations. We have held joint planning group meetings/workshops and have also consulted with members of the public and staff. Consultation response has told us how important effective communication is and we will continue to provide regular feedback on progress in a variety of ways with all our stakeholders. Our detailed Engagement Plan identifies what we need to do for the twelve week period of formal consultation and also the ongoing engagement. We have a variety of methods by which we want to consult. We will carry out joint consultation with partners from the Children & Young People s Partnership and have also arranged joint consultation events between Merthyr Tydfil Communities First Coordinators and Rhondda Cynon Taff Communities First Coordinators and also between Voluntary Action Merthyr Tydfil (VAMT) and Interlink (RCT) Health Social Care & Wellbeing Forums. Our intention is to consult as closely as possible to the local communities to ensure that their voices are heard. 13

14 ACHIEVEMENTS SO FAR Our HSCWB Strategy for focused on the delivery of real improvements and following consultation with you we addressed the following priorities: Worklessness. Mental Health. Older People. Substance Misuse. Chronic Conditions. Healthy Lifestyles. Partners have worked collaboratively on the priorities addressed to tackle the issues facing the population and the following are examples of successes: Supporting people back into work The Worklessness Sub-group which is the HSCWB delivery mechanism for the worklessness priority, has made substantial progress in driving forward the worklessness agenda. The Worklessness Sub Group oversees Aim 1 of the Adult Community Learning Strategy Skills for Work and has been actively trying to widen the knowledge of partners by encouraging the delivery of presentations of new initiatives etc. To date the group have been privileged to learn about support available from Jobmatch, the Condition Management Programme (CMP) and others such as: Working Links and the new award of the Flexible New Deal Contract which commenced in October Voluntary Action Merthyr Tydfil have successfully marketed the Engagement Gateway to ensure maximum take up of the grant available. Merthyr Tydfil County Borough Council (MTCBC) introduced the Future Jobs Fund initiative to encourage partners to create job opportunities for local people. The Worklessness Steering Group facilitated a collaboration event which saw 60 agencies with 140 delegates attending to share information. Research projects have identified evidence/best practice to continually improve the way in which we work with the worklessness agenda. The Condition Management Programme (CMP) and Jobmatch also facilitated production of a digital story for a client who has progressed back into work. The DVD is available on request. Support for people with mental health conditions As part of the worklessness agenda, Job Centre Plus has introduced a new post of Mental Health Coordinator to ensure clear identification of claimants requiring additional support. This is especially pertinent with the ongoing changes in the welfare reforms which will undoubtedly impact on people in the local communities. 14

15 Additionally, close links have been made with Communities First Coordinators in developing training to support people with mental health conditions. Mental health first aid courses for the Youth Offending Team and Youth Inclusion Programme workers have been one of many delivered providing mental health awareness and, reducing stigma. Raising the profile in this way has ensured that the main local partnership groups, who traditionally would not have been involved - such as Merthyr Tydfil Housing Association, are included in the awareness raising programme. The Mentro Allan programme in Merthyr Tydfil has increased outdoor physical activity for 552 service users with mental health conditions since the project commenced in March The programme has supported 60 service users to progress into the Bridges into Work and other community learning activities and 13 people have progressed into employment. The project has strengthened partnership working across health, social care and education sectors through engaging secondary care service users with meaningful opportunities that offer progression to community based learning, where appropriate. Telecare The Merthyr Tydfil Integrated Demonstration Education Centre (MIDEC) was developed by the Local Authority in partnership with Rhondda Cynon Taff CBC and Cwm Taf Local Health Board. It was officially opened in December The Centre supports vulnerable individuals, mainly the elderly, who may require assistive technology (Telecare) in order to maintain their independence and remain in their own home. Telecare can also provide assistance to people who have a physical or learning disability, frailty, dementia, are prone to falls, and people who suffer from epilepsy and the chronically sick young and old. 154 households in Merthyr Tydfil now have Telecare installed including detectors for smoke, carbon monoxide, floods, falls, heat, gas and wandering and security devices. The scheme is proving particularly popular with carers who now feel reassured about leaving loved ones whilst they go out to work. Extra Care The development of extra care housing in Merthyr Tydfil will play a key role in the delivery of the aims of the Council s Homes for Life Strategy and Housing Strategy. The scheme will contribute to neighbourhood renewal and help to improve overall quality of housing in the area, especially serving the needs of the older population. It will create a further means of delivering independence and inclusion for vulnerable people, enabling older people with care and support needs to live independently and have choice and control over their lives. Seasonal vaccinations In 2009/10 the uptake of the seasonal influenza vaccination amongst the over 65s in Cwm Taf increased to 62.2% (from 52.3% the previous year). Falls & Fractures A Falls & Fractures Prevention Strategy for Merthyr Tydfil and Rhondda Cynon Taff was launched in 2009 and is gradually being implemented. 15

16 The Integrated Community Equipment Service This service has brought together the LHB and the Local Authorities across Merthyr Tydfil and RCT to pool their resources to support the management and delivery of a joint equipment service. This has enabled the development of facilities for the storage, decontamination, demonstration and management of Community Equipment. Alcohol and Drugs Social marketing campaigns, development of work place policies and the delivery of initiatives such as Strengthening Families have promoted the safe use of alcohol and sought to reduce the impact of its misuse and the Community Safety Partnership has continued its work to tackle crime and anti social behaviour associated with alcohol misuse by targeting inappropriate and underage drinking in public places. Improvements in delivery service can be clearly seen. In 2006/07 individuals identified as misusing substances in Merthyr Tydfil were waiting in excess of 12 months for substitute prescribing services; highlighting this area as having the longest waiting times in Wales. All local substance misuse services are now consistently meeting the target to access within 10 working days of referral, thus ensuring that opportunities are maximized to engage individuals in services and provide support they need. Managing patients with a chronic condition In 2008 a joint Chronic Conditions Strategy was developed for Merthyr Tydfil and Rhondda Cynon Taff, which has resulted in several improvements to the way we manage patients with a chronic condition. Some examples are: The Chronic Obstructive Pulmonary Disease (COPD) Health Forecasting Service can now be used to help people manage their own health conditions more effectively. The Service provides COPD patients with information on how to proactively manage their condition and identifies individuals at risk of becoming ill due to the weather conditions. Community based home oxygen service. Expert Patient Programme a self help programme to manage long term conditions. Additional services provided by community pharmacies. Stroke Services Acute stroke services have improved thanks to additional funding from the Welsh Assembly Government (WAG) which has enabled the Local Health Board (LHB) to appoint stroke nurse co-ordinators and additional therapists. Exercise Referral Scheme The WAG funded Pathways to Health scheme provides an opportunity for clients to access a high quality supervised 16 week programme with the aim of encouraging long term adherence to physical activity. Longer term support is offered via a number of exit strategies such as reduced cost gym membership or linking to local walking groups. There are many positive outcomes for the patient ranging from reports of increased activity and improved confidence and quality of life through to reductions in weight, BMI, blood pressure readings and levels of 16

17 medication. GP visits have also reduced. There is now currently a waiting list for this programme. Merthyr Tydfil Physical Activity Partnership Agreement (LAPA) This agreement combines all the existing agreements that Sports Wales had with the Local Authority to improve sport and physical activities in the community into one overarching agreement and plan. It also provides the opportunity for the Local Authority to engage more fully with all local organisations that could potentially have a role in the physical activity agenda. The partnership is now into its second year and has developed a number of new activities via an annual plan using the five key themes: active young people; active adults; developing people; developing places; and successful sport. The Sports Development Team have coordinated and supported this process with a number of new projects successfully implemented such as the development of trampolining at Merthyr Tydfil Leisure Centre. New orienteering courses and competitions for primary and Secondary Schools linked to Physical Education Secondary Schools (PESS) and the Active Young People (AYP) initiatives and the development of two multi activity club for children with disabilities via the Tri County Play Association. The planning process for 2011 and beyond is currently under way with a new vision and aspirational goals for being developed. Commissioning Policy Development Project (Voluntary Action Merthyr Tydfil) A two year Commissioning Policy Development Project has been established to produce a Funding, Commissioning and Procurement Code of Practice for public and third sector organisations in Merthyr Tydfil and Rhondda Cynon Taff. Its outputs are a Joint Public Services Policy and Project implementation - including training. This will mean better informed and supported public and third sector organisations in relation to commissioning and a more citizen centred service developed on who does what basis. 17

18 OUR THEMES FOR In working to achieve our vision, we will group our priorities for action around 3 key themes: Theme 1: Theme 2: Theme 3: Promoting healthy lifestyles and preventing ill health. Promoting independence and protecting the vulnerable. Improving services and joint working. WHAT YOU TOLD US: All three themes were supported by respondents. Comments have been linked to each theme and the areas for action on which we want to focus. THEME 1 PROMOTING HEALTHY LIFESTYLES AND PREVENTING ILL HEALTH Our population has the poorest health in Wales, and healthy life expectancy for both males and females in the Cwm Taf (Merthyr Tydfil and Rhondda Cynon Taff) area is the lowest of any of the new Local Health Board areas in Wales. It is important to recognise that in addition to modifiable factors, such as smoking and diet, we need to tackle the underlying causes of poor health such as worklessness and poor educational achievement if we are to reduce inequalities in the long term. As a partnership we will continue to work with our partners to influence and support action that can impact positively on the wider determinants of health. This HSCWB Strategy will address the issues identified in Our Healthy Future, the Welsh Assembly Government s strategic framework for Public Health. The framework is incorporated into the NHS planning system through the Annual Operating Framework for and is part of the Prospectus for Local Authority Outcome Agreements. It provides long term direction until 2020 and sets out two overarching aims supported by 6 key themes. The framework identifies ten priority outcomes which have been shown to be the biggest causes of preventable ill health. By tackling these we will also be able to help those experiencing the greatest disadvantage. It should be noted that statistics have been taken from the Welsh Health Survey. 18

19 WHAT YOU TOLD US: Whilst the theme was supported, the point was made that taking responsibility for their own health and wellbeing would be difficult for some individuals and groups. It was also recognised that self worth is important and that the role of the voluntary sector in supporting people back into work is huge. Respondents comments: Target resources in areas of high need Healthy eating in schools but what about home? Health starts with the individual There needs to be more facilities available to small villages in Merthyr Need more parent/child activities Need more clubs play/fun Need more local facilities in evenings Drugs and alcohol too readily available Need to raise awareness on key issues with parents Employability was considered very important and needs to be considered in relation to child poverty and financial inclusion especially in the present economic climate. The new welfare reforms will have a huge impact on society and planning will be essential to ensure that we protect the most vulnerable. We need to develop coordinated action plans looking at cross cutting issues with measurable outcomes and review the roles of the various delivery groups across agencies and partnerships to work more effectively together. The priorities and how they relate to our local population are outlined on the following pages: Priority 1 - Reduce the levels of smoking Our ambition is to: Reduce the harm caused by smoking Where are we now? 30% of adults in Merthyr Tydfil smoke; this is well above the Welsh average of 24%. We have the highest rates of smoking for all local authorities in Wales. Why does this matter? Smoking is the biggest cause of disease and early death in Wales. Smoking is linked to many diseases including cancer, stroke, heart and lung disease. Our priorities will be: Helping smokers who wish to quit. 19

20 Preventing young people from starting smoking. Protect non smokers from the effects of environmental tobacco smoke. Who will take this forward? The multiagency Merthyr Tydfil Tobacco Control Forum. Priority 2 - Improving people s emotional wellbeing Our ambition is to: Improve the emotional health and wellbeing of people living in Merthyr Tydfil. Where are we now? People in Merthyr Tydfil have poorer emotional health and well being than the rest of Wales. Unemployed people and those on low incomes are more likely to have poor mental health. It is likely that mental health in Merthyr Tydfil will get worse as a result of the current economic climate. Why does this matter? Emotional wellbeing is essential to good health. It helps people to cope with daily challenges, reach their full potential and support others. Poor emotional health and mental ill health is a major cause of death and disability. It reduces people s quality of life and can harm their families and the wider community. What do we need to do about this? Make sure that organisations, communities and partnerships make the most of the opportunities they have to improve emotional health. Improve everyone s knowledge of emotional health and help them to develop the skills they need to stay healthy, while focussing on the people most at risk of having poor emotional and mental health. Continue to work with volunteers to provide them with the confidence and self esteem to support them back into the workplace and to be socially included. Encourage the establishment of self help groups and local projects. Ensure that we work alongside the Children & Young People s Plan, reducing stigma and creating opportunities to develop family projects with Families First. Work with the Community Safety Partnership to reduce the use of drugs and alcohol. We will work with people to provide early interventions, preventing mental ill health and promoting wellbeing. Who will take this forward? The multi agency Cwm Taf Emotional Health and Wellbeing working group led by the Local Public Health Team. Other partners such as Communities First and the Third Sector will be involved in the delivery of programmes. Further information on mental health services is also included under Theme Two. 20

21 3 - Employability and Well-being at Work Our ambition is to: Support people back into the workplace and sustain employment. Where are we now? Within Merthyr Tydfil 26.7% of the population aged 16 to 64 is economically inactive, compared with 27.3% for Wales. Merthyr has 15.2% of its working age population in receipt of employment support allowance and incapacity benefits compared with Wales at 9.8%. The number of unemployed people claiming Jobseekers Allowance is 5.6% in Merthyr Tydfil compared with Wales at 3.6%. Why does this matter? Research indicates that; Having sustainable employment and promotional prospects is critical in tackling the poverty agenda. Individuals who are economically inactive for a long period of time are more likely to suffer from ill health. Lack of employment increases poverty and also increases the risk of mental health illness National data indicates that mental ill-health is one of the most common reasons for claiming health-related benefits. What will we do about this? The Health Social Care and Well Being Partnership will continue to build on the success of the Worklessness Steering Group and ensure activities are developed to support the following priorities - Developing skills for work - Supporting people into employment - Supporting people whilst in employment Increasing the numbers of agencies by at least 2 annually, who contribute to the joint targets detailed within the Steering Group s action plan. Develop an Individual Placement and Support (IPS) model within the centre of Merthyr Tydfil that will help at least 20 individuals (annually) with a mental health illness to access training and employment opportunities. Increase the number of residents who are engaged and supported through employment focused activities. Increase the number of residents who gain level 2 work related qualifications. Undertake research to establish a greater understanding on the impact of the welfare reform on worklessness families in Merthyr Tydfil. For those individuals who present themselves to an employment focused initiative, ensure that they are assessed and receive personalised plans tailored to their needs which have a clear outcome to support them into work Promote the benefits of work to key stakeholders that come into contact with unemployed individuals such as Family Support, Social Services, Health Increase the number of young people supported to gain work experience and accredited learning through employment focused programmes 21

22 Developing a range of co-ordinated interventions which provide support and training from soft skills to hard skills. Establish an effective web based information facility that provides access to personal support through specialist agencies. The partnership will promote the Corporate Health Standard within all member organisations and to local businesses. This will include working with local employers to retain people in work and provide a fairer, healthier workplace for all employees in Merthyr Tydfil. Who will take this forward? The employability multi agency steering group will take these actions forward. Priority 4 - Increasing participation rates in physical activity Our ambition is to: Encourage our population to become more active more often throughout life. Reduce levels of obesity. Where are we now? In % of adults in Merthyr Tydfil met the physical activity guidelines of 30 minutes x 5 weekly; this compares to the Wales average of 29%. In % of adults in Merthyr Tydfil described themselves as overweight or obese, compared to a Wales average of 57%. Why does this matter? Low levels of physical activity along with an unhealthy diet are leading to an increase in obesity. Regular physical activity has many benefits to health including mental health and wellbeing. People who are physically active will live longer and have up to a 50% reduced risk of developing major diseases such as heart, stroke, diabetes and some cancers. Our priority will be: To develop and implement a local Creating an Active Wales Plan engaging a wide range of partners. To continue to develop the work undertaken by the Merthyr Tydfil Physical activity local Partnership Agreement (LAPA). To support projects situated in community and voluntary sectors. Who will take this forward? The LAPA strategic and steering groups will lead this area. Priority 5 - Reducing unhealthy eating Our ambition will be to: Reduce unhealthy eating amongst our population. Reduce levels of obesity. 22

23 Work more closely with CYPP to further promote healthy eating Where are we now? In , 60% of adults in Merthyr Tydfil described themselves as overweight or obese, compared to a Wales average of 57%. In , 32% of adults in Merthyr Tydfil said they ate at least five portions of fruit or vegetables a day, compared to the Wales average of 36%. Why does this matter? Being overweight or obese increases the risk of developing diseases such as diabetes, cancers and coronary heart disease (CHD). A balanced diet helps promote good health and prevent disease. Diets high in fat and salt and low in fruit and vegetables and whole grain cereals are linked to an increased risk of heart disease and cancers. Our priorities will be: To utilise the recent Cwm Taf obesity mapping process to develop an action plan to develop current provision across all levels. Improve access to healthy food through initiatives such as Food Co-ops and the Healthy Options Award Scheme. Ensure people in health and social care settings receive and are able to eat nutritious meals that are appropriate to their individual needs. Who will take this forward? The Director of Public Health and the Director of Therapies will work with other agencies to reduce obesity. Priority 6 Alcohol and Drugs Our ambition is to: Prevent the harm caused by alcohol and drugs. Where are we now? A comparison of deaths from alcoholic liver disease compared to shows a 63% increase in the number of deaths in Cwm Taf. There has been a 60% increase in alcohol related diseases over the last 5 years. Referrals into substance misuse services are higher in the Cwm Taf area than anywhere else in Wales. Why does this matter? People who misuse drugs or alcohol can cause considerable harm to themselves, their families and their community. Substance misuse is often likely to be a factor in domestic violence and school absenteeism. What do we need to do about this? Our priorities are to: prevent harm through a co-ordinated approach to education; 23

24 provide support for those misusing drugs and alcohol to aid and maintain recovery; support and protect families and communities; tackle availability; work in partnership with the Peer Mentor Scheme to help and support drug and alcohol users to make positive, sustainable lifestyle changes. We will enable individuals with a history of drug and/or alcohol use to become economically independent by entering employment. The peer mentoring scheme is a brand new European Social Fund (ESF) initiative and an integral part of the Welsh Assembly Government s strategy to help and support drug and alcohol users; work with vulnerable families to ensure that they have the necessary support where appropriate to reduce the use of drugs and alcohol. Eg The Integrated Family Support Team (IFST) will work with children and families who are affected by parents/carers, drug and/or alcohol misuse Who will take this forward? We will work with the Substance Misuse Action Team, Substance Misuse Area Planning Board, Community Safety Partnership and CYPP to take this forward. Priority 7 Reducing Teenage Pregnancies and Improving Sexual health Our ambition is to: Reduce conception rates in young people. Reduce rates of sexually transmitted infections in young people. Improve our services to pregnant teenagers and young parents. Where are we now? Under 18 conception rates in Merthyr Tydfil are amongst the highest in Wales at 59.2 per 1,000 women against the Wales average of The rates of sexually transmitted infections such as Chlamydia are rising across Wales. Cwm Taf has the highest percentage of births to mothers aged under 20 in Wales, at just over 10% (2009). There were 85 conceptions to girls aged yrs in Merthyr Tydfil in This is a rate 73.5 per 1,000 girls, 1 in every 14, the highest in England and Wales. 52 of these conceptions led to live birth, 33 were terminated. Why does this matter? Sexual health is an important part of everyone s physical, mental and emotional well-being. The consequences of poor sexual health can be both serious and life changing, particularly for young people. Sexually transmitted infections affect people of all ages in Wales, although young people are more at risk. What do we need to do about this? Reduce teenage pregnancy rates. Reduce the rate of sexually transmitted infections. 24

25 Support young people to look after their sexual health through education and appropriate service provision. Undertake a series of projects with young people to help us establish the facts about issues such as teenage pregnancy and young people s attitude towards sex and relationships. Develop and implement consultation events with young people to explore their views on sexual health and sexual behaviour. Develop and implement a County Borough-wide Young People s Sexual Health Strategy. Who will take this forward? Merthyr Tydfil Children and Young People s Partnership Priority 8 Reducing Accidents and Injuries Our ambition is to: Reduce the number of individuals killed or injured in accidents. Where are we now? In % of adults in Merthyr Tydfil reported having an accident, injury or poisoning needing hospital treatment or a visit to casualty in the past three months. Accidental falls are the main cause of serious injury in older people. Falls accounted for 745 hospital admissions in Merthyr Tydfil between 2004 and Why does this matter? Injury is one of the main causes of death and disability in Merthyr Tydfil. Vulnerable groups such as older people and children, particularly those in poorer families, are more likely to be injured in an accident. Serious injuries can have a long term impact on people s quality of life, independence and well being. In addition to the very real human cost, the social and financial costs of injuries are high. What do we need to do about this? Our priorities are to: Develop a coordinated approach to the prevention and treatment of falls in older people. Reduce the number of injuries to Children and Young People. Who will take this forward? The Cwm Taf Falls Prevention Group will take forward the implementation of actions within the Cwm Taf Falls Prevention Strategy. The C&YPP is responsible for taking forward the prevention of childhood injury through the Children and Young People's Plan. 25