Agenda Item No: Part 1 X Part 2 NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 25.4.17 Title of Report Purpose of the Report Public Health Update This report provides an update to the Clinical Commissioning Group Governing Body of NHS Trafford. This report provides information and progress on key Public Health programmes and activities locally and references links to Greater Manchester and Public Health England. Actions Requested Decision Discussion Information X Strategic Objectives Supported by the Report 1. Consistently achieving local and national quality standards. 2. Delivering an increasing proportion of services from primary care and community services from primary care and community services in an integrated way. 3. Reduce the gap in health outcomes between the most and least deprived communities in Trafford. 4. To be a financial sustainable economy. Recommendations The Clinical Commissioning Group Governing Body is asked to note the update on the key Public Health activities and contents of the paper. Discussion history prior to the Governing Body Financial Implications Risk Implications Impact Assessment Communications Issues Public Engagement Summary Prepared by and Responsible Director Eleanor Roaf, Interim Director of Public Health
1. Purpose of the Update The purpose of the report is to update the Clinical Commissioning Group (CCG) Governing Body on key Public Health activity 2. Improving Healthy Life Expectancy in Trafford: Health and Well Being Board (HWBB) Priorities In order to progress the health and wellbeing board priorities more effectively, we have identified leads for each programme area, are reviewing the evidence and putting together multiagency action plans. This work is ongoing and the draft action plans were presented meeting of the April Health and Wellbeing Board. The Governing Body will remember that the HWBB has chosen its five priorities based on the impact that these areas have on healthy life expectancy and premature mortality in Trafford. Taking concerted, co-ordinated action at a population level on alcohol, smoking, physical inactivity, the impact of mental illness, and cancer screening and early diagnosis rates will deliver measurable results within a reasonable timescale. i. Reducing the Impact of Alcohol Tendering for the new Joint Substance Misuse Service has started with the call for bids going out on 18 April 17. How this service relates to the new One You lifestyle service will be crucial to ensuring there are no gaps for people who are drinking too much, but not dependent. The most effective of options for prevention of alcoholrelated harm are also difficult politically, e.g. minimum unit pricing and reducing availability. We are exploring what might be achieved at GM level. ii. Reducing the Impact of Tobacco The Tobacco Control Action Plan is focusing on protecting children from harm, and we are pleased to announce that our first Smoke-free School gates school, The Firs in Sale West has held a competition for the design of the signs and the signs will be going up soon. On the same note the Council has agreed that as signs on sports fields and facilities are replaced they will include a smoke-free message. Public Health England are now pushing strongly that tobacco smokers should switch to vaping (using electronic cigarettes), as in that way 95% of the harm that is associated with smoking tobacco is prevented. We are looking to get this message widely disseminated in the local NHS, including GPs, community health services and very importantly Mental Health services so as many people suffering poor mental health as possible are supported to give up smoking or to vape. iii. iv. Reducing the Impact of Mental Illness The multiagency group to address the issues arising from poor mental health in Trafford is meeting for the first time on 28 th April 2017. However work has started on the evidence review and action planning. Reducing Physical Inactivity The CCG is continuing to show great leadership through the work underway between GPs and Trafford Leisure. 1
The Partnerships team in all four neighbourhoods of Trafford has been identifying an interest in increasing physical activity in every area, and this interest is leading to local plans and engagement with a range of organisations and individuals. This work is overseen by the Sport and Physical Activity Partnership Board. v. Increasing Cancer early diagnosis and screening uptake Trafford Cancer Local Implementation Group (LIG) is hosted by the CCG and oversees existing cancer activity in Trafford and the links with the Greater Manchester Cancer Vanguard Project. It considers all elements of the cancer pathway including prevention, screening, early diagnosis, treatment, living with and beyond and end of life with a focus on performance and financial management. The LIG has also developed a performance monitoring framework. Benchmarking and targets are currently being agreed for each performance measure. A local delivery plan and performance monitoring framework has been agreed by the LIG with a focus on local intelligence to ensure the outcomes of the LIG meet the needs of our population. The local delivery plan has captured elements from the learning gained from the successful 2014, cervical screening improvement programme. The LIG has a number of subgroups, including one on Prevention and Early Intervention, which leads on the public health elements of the delivery plan. Key activity from the sub-group includes: Priority Practice Support Eleven Trafford practices that have been identified to receive free specialist support. This is a voluntary improvement initiative, and practices have been chosen for a number of reasons ranging from current screening uptake rates to population need or difficulty in engaging the community in health and wellbeing activities. Practices will be contacted in April and offered a range of free, specialist support, and they can choose one or more or all of the interventions listed. Primary Care Practice Cancer Champions Fifteen practices have one or more Primary Care Practice Cancer Champion. This scheme aims to support practices to improve the outcomes of their patients through non-clinical practice such as coding, invite and recall processes, knowledge of cancer systems, and campaign promotion. The practice champions meet regularly to review progress, with feedback being very positive. Work is ongoing to recruit champions from the remaining 17 practices. Talk Cancer Embracing people s roles as advocates supports behaviour change and early intervention. A programme of work has been developed to engage local elected members in improving the health and wellbeing of their residents. This includes Prevention Matters training in May, and to complement this, members of the CCG Governing Body, Trafford s Partnership Board and local Councillors have been offered the opportunity to complete Talk Cancer training, also scheduled for May. Beating Bowel Cancer Practice Volunteers Trafford s current bowel screening uptake rate is 58.1%, similar compared to the national rate of 58.5% (2015/16), but we have considerable variation across the 2
borough, with a range of 36.9% 66.2%. The LIG has an aspiration target of 61.2% by 2018. Beating Bowel Cancer are training volunteers to go in to primary care practices in Trafford to talk on the phone with people who have recently been invited to take part in bowel screening, but have not done so. Volunteers have an informative, nonpressured conversation with the bowel screening non-responders about the importance of bowel screening and how to take part. If consent is given, they arrange for a new kit to be sent to them to complete. Practices are offered volunteer support based on levels of need. Four Trafford practices are currently participating and another 5 volunteers have been trained and will be working in practices shortly. To date, in Trafford, our volunteers have spoken with 149 people and 92 of these (62%) have decided to opt in to bowel screening. Co-ordinated Communication A Cancer Communications Plan, part of a wider Public Health Communications Plan is being developed. This will ensure that appropriate cancer messages are shared across partners and the borough. For example, practices will soon receive information about the Breast Screening Programme and the timetable for when their patients will be invited. It is hoped that this will support practices to encourage their eligible women to be screened. Voice of BME Saving Lives Programme This programme has focussed on improving screening rates in the North locality. The main emphasis has been on encouraging behaviour change through community engagement, which was a significant element of the cervical screening quality premium work. The programme is due to come to an end in March with an evaluation report available in April. Engaging Partington A plan is being developed to improve community engagement in Partington with the aim of increasing screening uptake. Cross cutting work is being explored with the Alcohol and Tobacco Steering Groups, as it is recognised the impact these factors have on cancer risk. 3 Children and Young People the 2016/17 Public Health Annual Report We have focused on the five priorities (above) in relation to outcomes for children. Many health and social care outcomes are rooted in childhood experiences. We are now finalising our Public Health Annual Report, in which we are looking at population health through the prism of the experiences of children both across Trafford and in our neighbourhoods; identifying areas of good and poor performance, assessing the implications of these, and of the internal variation in the borough, in order to make the slogan No one held back, no one left behind a reality. 4 Health Protection The Health Protection Forum now meets quarterly, and we have good engagement with all partners. The Annual Report for 2016/17 will be presented to the next meeting of the group, and is showing good progress against infection control 3
objectives. For example, the targets for MRSA bacteraemia (zero tolerance) and for C.difficile were met last year. The Infection Control Team remains under capacity, with one member of staff on maternity leave, but the Modern Matron returned from sick leave in December and has been able to resume the programme of visits to GP practices and care homes. Results from these are proving to be excellent and we are seeing year on year improvements against the standards. The full report will be presented to the next CCG Governing Body and the July s Health and Wellbeing Board. Immunisation uptake rates in Trafford continue to be good, although we have had some problems with the recording of, for example, rotavirus vaccination. This is now being addressed. We are about to start the review of this year s flu programme and the planning for next, which will be informed by our local experience and the PHE (North) review session set for June. Initial areas identified for further work are the strengthening of the offer to health and social care staff, including those working in the care home sector; and a review of the offer to children, including those in special schools. 5 The National Diabetes Prevention Programme The National Diabetes Prevention Programme (NDPP) will be rolling out in Trafford in May, and detailed preparations are underway. The Greater Manchester steering group has agreed to use HbA1c values in the range 42 48 mmol/mol as the thresholds for eligibility, and we will be working with practices to identify the prevalent cohort, i.e. those already known to be in the pre-diabetic range. The education programme will be delivered by Reed Momenta, who delivered the programme last year in Cumbria. There is a current concern regarding local programme management capacity. 6 Weight Management A review of the Adult Specialist Weight Management Service (SWMS) and the Children s Weight Management Service (CWMS) is underway and is due to conclude in May 2017. The overall aims of the review are as follows: To review the current CWMS and SWMS provision available to children and adults in Trafford; To review how each component part of the SWMS service is working and its impact during its first year of operation To gain a better understanding of current performance of the CWMS and SWMS including any issues in reporting To investigate how the services could work together in a more holistic way to support families To take account of best practice and evidence based interventions including NICE guidance on weight management; and o take account of any feedback from service users and other stakeholders 4
The SWMS offers programmes designed to educate and promote behaviour change for adults with a BMI of 30 or over (27.5 for BME adults). The service commenced operation of a number of new pathways from January 2016, these pathways are: Healthy Lifestyle Programme; Disordered Eating Pathway; Maternal Obesity Pathway Home visiting Pathway and Bariatric Education Pathway The CWMS started to operate in September 2015, the service supports overweight and obese children who are on or above the 91 st centile and their families to reach and maintain a healthier BMI. It is an integral part of Trafford s Healthy Weight Pathway for children and young people. The review will seek to establish how well the obesity care pathway and training for health professionals is responding to identified local need. Once the data, service user feedback and literature review are completed a full report of the review findings will be completed. In addition to this, the Community Nutrition and Dietetic Service is currently working with Medicines Management in the CCG to re-write the Oral Nutritional Supplement Policy for Trafford which will be communicated with GPs on completion. A local CQUIN has also been devised as part of this work and will include the prescribing of ONS directly by the service. Work is also ongoing with the service to look at capacity challenges in relation to increasing workload involving the following cohorts: patients with Learning Disabilities, Children, Nursing and Residential Homes. 7 Greater Manchester Population Health Plan The Population Health Plan lists 20 specific programmes aimed at improving health and wellbeing at scale. As the plan moves into its implementation phase areas of key benefit to Trafford are being identified. The Plan as a whole has an excellent match to work already underway in the borough, and should provide additional support and impetus to this. The Get Manchester Moving programme is one example of this match We are pleased to see the Baby Clear initiative aiming to protect our youngest residents from the effects of tobacco is being rolled out in all GM maternity units under this programme. 7. Increasing Public Health capacity We are pleased to announce that a Public Health Analyst is starting with the team in May. This should enable the Council to access mortality data which has been unavailable in Trafford for some years, and allow the sort of detailed analysis essential to identify specific local areas for further investigation and action. 5
8 MIAA Public Health Audit There are some outstanding actions from the MIAA Public Health Audit, in the main relating to the agreement of the workplans and the MoU. Discussions on these are now underway and it is expected that these will be finalised in May. 9 Recommendations To note; and to consider the capacity issues that may arise in the implementation of the activity outlined above. Eleanor Roaf Interim Director of Public Health 12.4.17 6