Agenda item

This paper provides an overview of the progress in the delivery of the Health and Wellbeing Strategy (HWB Strategy) as of 28 May 2024.

Witnesses:

Karen Brimacombe, Chief Executive, Mole Valley District Council (Surrey Chief Executives’ Group) (Priority 1 Sponsor)

Emma Jones, Public Health Lead, SCC

Kate Barker, Joint Strategic Commissioning Convener (Priority 2 Co-Sponsor)

Jack Smith, Prevention and Communities Manager, SCC

Mari Roberts-Wood, Managing Director, Reigate and Banstead Borough Council (Priority 3 Sponsor)

Julia Groom, Public Health Consultant, SCC

Key points raised in the discussion:

Priority 1

1.    The Priority 1 Sponsor noted that findings from the work on encouraging young people to maintain a healthy weight revealed a gap in support for children aged between 5 and 17 years old and Active Surrey was awarded a contract for Be Your Best to deliver a programme of work to that cohort. Two outreach workers from the Surrey Bridge the Gap programme spoke to representatives from various government departments to promote how Surrey was delivering cost effective system outcomes. Changing Futures alongside the Alliance for Better Care presented their work at a national conference and received an award for supporting individuals with lived experience to get back into meaningful employment. Several agencies were working in partnership with community and faith organisations in Key Neighbourhoods to address the lower levels of referrals and uptake of NHS health checks. A Macmillan researcher had started work on cancer inequalities. There was training to raise awareness around hoarding and there was a SharePoint site for professionals to seek information. Training was being developed around preventing falls. A new Carers Partnership Group was operational and three quarters of its membership are non-paid carers.

2.    The Public Health Lead (SCC) detailed the spotlight item: Surrey Tobacco Control:

·         smoking continued to be the significant contributor to health inequalities and cost Surrey £950 million per year. Under 12% of the population smoke and the highest prevalence is in routine and manual workers, people in treatment for substance misuse, Gypsy, Roma, Traveller Communities and those who face homelessness.

·         the Surrey Tobacco Control Strategy was launched in October 2023 and that same month the Government announced its plans to create a smokefree generation through the Tobacco and Vapes Bill. Whilst not enacted before the General Election, using the additional grant allocation of £1.1 million for the next five years work was underway in Surrey to support an additional 15,000 smokers to set a quit date. A partnership action plan was in place.

·         the evidence showed that only 6% of smokers would use local stop smoking services, so the programme has sought to increase demand through local mass media campaigns using behaviour change approaches and building on the tobacco programme in acute trusts and across maternity services. The training provision would be increased for all frontline staff. Performance would be tracked through a Combating Drugs Partnership sub-group.

3.    The Chair asked how long the additional funding was for. The Public Health Lead (SCC) explained that it was an annual grant committed to for five years.

Priority 2

4.      The Priority 2 Co-Sponsor noted that consultation on the revision of the Surrey Suicide Prevention Strategy was underway with input sought from the relevant board chairs and groups. Progress was underway on creating a universal Wellbeing Plan for Children and Young People in Surrey prior to Feeling Good Week in early October. The First Steps to Support pilot areas had been extended to Waverley and Woking, and to care homes. The launch of the Chatbox pilot meant Surrey-wide access to it. The Mental Health Investment Fund (MHIF) team was close to agreeing an evaluation framework to support impact analysis of the funded programmes, a workshop is to take place in early autumn and there were monthly communications across the Council and Surrey Heartlands highlighting the impact. A round table workshop on 12 June involved representatives from across the system and work was underway to allocate the remaining funds.

5.      The Prevention and Communities Manager (SCC) detailed the spotlight item: Green Health & Wellbeing Programme: Dose of Nature:

·         Dose of Nature is a charity established to promote mental health benefits of engaging with the natural world, there was a hub in Richmond. The Council paid £100,000 to commission them to set up a second hub in Guildford. There was a ten-week Social Prescription Programme and group therapies.

·         commissioned by the Council in 2022 as part of the Green Social Prescribing (GSP) programme, Guildford was chosen as a hub (Dapdune Wharf)focused on providing services in north Guildford. In the first year there were 80 referrals and high engagement levels, there was an average seven point reduction in measures of anxiety and depression. There was relief in demand to GP Integrated Mental Health Service (GPimhs) and qualitative improvements. 

·         results from a study at the Richmond hub showed that there were 40% fewer GP contacts post-nature intervention at a six-month follow up.

·         Dose of Nature would likely receive limited funding from the Department for Environment, Food and Rural Affairsin phase two of the national GSP programme for a year, other funding sources were being reviewed.

·         whilst having a large network of local stakeholders such as voluntary sector organisations, making a clear contribution to the Health and Well-Being Strategy with positive quantitative outcomes, the programme struggled to attract long-term system funding. Strategic support was needed to identify financial resource to align green health with the health system priorities.

6.    A Board member highlighted the correlation between mental health and anxiety with neurodiversity and alcohol and substance dependency, and asked whether the service was open to those people. Hoped that the presenter was linked into the Voluntary, Community and Social Enterprise (VCSE) Alliance and noted the development of greater integration and funding relationships with the NHS. The Prevention and Communities Manager (SCC) believed that Dose of Nature would take referrals from those people, he was in contact with the VCSE Alliance and would follow up the offer of support.

7.    A Board member noted that the £100,000 for 150 people was around £700 per person per programme and that there were several providers of NHS Talking Therapies (formerly IAPT) services in Surrey. If the programme of work was reducing anxiety and depression, queried whether there was a different way of approaching the funding of such services for a more sustainable model rather than relying upon green funding. The Chair agreed noting the evidence of such interventions having a larger and longer impact, and queried if the Better Care Fund (BCF) should be funding these.

8.    A Board member noted that the Public Health team was working to align such projects into the strategic conversations at every level, considering how to invest the money collectively and how to create the best integrated prevention and early intervention model. The Chair noted that many initiatives were short-lived often funded as a pilot for one year. She stressed that impacts must be assessed cross-agency and that sample representatives of service users must be tracked. She welcomed the individual projects however they should not be looked at in the current piecemeal approach, they could replace expensive business as usual initiatives and should be committed to long-term. A Board member noted that it was important that all the initiatives are looked at collectively and have robust impact on population health and financial return. That was happening as part of the transformation programme and Surrey Heartlands ICS’s One System Plan. 

9.    A Board member explained that the funding dictates the projects and pilots. Work was underway to look at the overall picture and benefits and how to bring those together. The Chair queried whether the benefits for residents was known from the pilots as opposed to them repeatedly accessing business as usual interventions. Of those who accessed Dose of Nature coming out better than when they entered, she asked how it was known where they might have ended up otherwise. The Board member noted the work underway that sought to create a strategy through business cases and modelling to see the outcomes if intervention or prevention was not done and to understand the value for money for residents.

10.  The Vice-Chair noted that many of the projects supported through the MHIF had robust outcome measures, to be followed up over a longitudinal study cross-agency, over the last six years the system did not have the maturity to do what the Chair had previously requested, it was developing. There was a six-month follow-up on the outcomes from the one-year Dose of Nature programme. The MHIF supported programmes had funding for several years as a year’s pilot was insufficient. The same interventions could have very different outcomes for people.

11.  A Board member noted that some of the activities by Dose of Nature were the same as those from Community Connections, she offered her support in addressing the challenge of duplication. She welcomed the work to ensure cohesive support through the Commissioning Collaborative, addressing that lack of funding through partnership working would be beneficial. The Prevention and Communities Manager (SCC) acknowledged that there was duplication across the county with an overlap in similar provision and that impeded the coordinated approach needed to target populations; that could be provided by Dose of Nature.

12.  A Board member noted that they had been involved in the early trials of GSP two decades ago. He noted the need to take advantage of that duplication, many organisations needed volunteers to do green activities, it would be beneficial to link the Prevention and Communities Manager (SCC) with the voluntary sector organisations doing similar activities. He had worked with Dr William Bird MBE who had researched the issue over thirty years, and he suggested that people like him be involved to talk about the benefits of those interventions.

13.  A Board member presumed that the programmes or projects were accessible to people with physical disabilities. The Prevention and Communities Manager (SCC) noted that several of those were accessible to people with disabilities, the therapy gardens for children and young people had a wheelchair accessible path.

Priority 3

14.  The Priority 3 Sponsor noted that the Council’s Warm Welcome scheme launched in November 2023 and had over 40,000 residents attending the sessions across winter compared to 16,000 visitors the year before. Over 1,100 fuel vouchers and 9,000 Winter essentials were distributed to residents, energy advice and support was given to 5,000 attendees. The feedback was positive and providing those additional services was vital to the prevention and early intervention agenda. Surrey Community Action was successful in its funding bid submission to the Fuel Poverty programme and would continue to provide energy support to residents for another year, engaging with key demographics at risk of fuel poverty. The In Our Own Words peer research project for neurodiverse young people was in its implementation phase and training had been delivered. The Council’s Work Wise programme was accepting referrals, it is a free employment service available to any person with a mental or physical health condition, disability or neurodiversity who wants to work. The Sanctuary Scheme offered people the choice of remaining in their homes where suitable, for example where their domestic abuse perpetrator has left. As at March 2024 the scheme fitted nearly 300 security measures in the homes of survivors across Surrey.

15.  The Public Health Consultant (SCC) detailed the spotlight item: Surrey Sexual Health Programme:

·         the vision for Surrey was for positive sexual wellbeing for all, providing access to high quality sexual health services when needed and reducing sexual health inequalities so that no one is left behind. Three services provided by Surrey Sexual Health were outlined.

·         Chlamydia: the most common bacterial sexually transmitted infection in England, the priority was on testing young women as they were at the most risk of reproductive harm through untreated infection. The 2023 data on the chlamydia detection rate for women between 15-24 years old had increased and was at its highest level since 2012. Need to continue to test the right people and to reach more people, targeting the 21 Key Neighbourhoods, promoting pharmacy access and working with organisations that work with young people to ensure effective communication through social media.

·         Teenage pregnancy: it was important to work as a whole system to address the range of reasons that influenced the pregnancy, linking to the wider determinants of health such as education and a young person's early life experiences. The national rates had increased, Surrey’s rates had plateaued, and the ambition was to see a continued decline. A prevention action plan had been developed working in partnership, focusing on: leadership support, understanding data, targeted communications and prevention work, expanding contraception support in non-clinical settings and focusing on relationship and sex education in schools. Training had been delivered for workers in residential homes and children's social workers, for young people to be confident to talk about relationships and sexual wellbeing.

·         HIV: there was an action plan in Surrey which reflects the Government's national action plan and focuses on four areas: prevent, test, treat and live well and reduce stigma around HIV. A pilot had been undertaken for point of care testing that provides instant results, a wider roll out was the aim across organisations to increase access; staff had been trained. Surrey’s prevalence rate of HIV was lower than England’s, yet the challenge was that 60% of HIV diagnoses were late diagnoses against the national ambition of 25%.

16.  A Board member asked how people with lived experience or those from target cohorts had been involved with communications and social media, was there co-design to ensure the messages reach the intended audiences. The Public Health Consultant (SCC) noted that there were several areas where people had been engaged to co-design services. For example, through the joint sexual health outreach plan where feedback was collected from service users and there was targeted work around chlamydia testing using targeted social media messages to girls aged 15 to 24 years old, she could provide further details on request.

17.  A Board member noted their visit to Guildford's Sexual Health Clinic and was impressed to see many young people there being sensible about their own health, the messaging was reaching them. He noted that much of the work had been designed with the help of the Surrey School of Acting to make sure it is focused on the younger cohort. It was a joint responsibility to make sure such topics are not taboo and can be openly discussed across ages.

18.  The Chair noted feedback from residents that for some young adults living at home, there were parts of Surrey where sexual health clinics were far away and they do not want testing kits sent to their home address where their parents are. Noted the loss of wages for time spent travelling to and at the clinics for those on zero-hour contracts. The Vice-Chair clarified that test kits were in discreet packaging. The Public Health Consultant (SCC) added that there was access to some testing from pharmacies, she stressed the need to reduce the stigma about discussing sex and relationships for example through education at schools. She noted that since Covid-19 there had been a change in accessing online services and was keen to promote that more widely, the service had expanded access through teen Tuesday clinic drop-ins.

19.  The Vice-Chair noted that she was not surprised that Surrey’s pregnancy rates had plateaued when they should be decreasing, a sexual health clinic at St Peter's Hospital which was well-attended had closed. To effectively target, she noted the need to cross reference gaps in access looking at geographical data around chlamydia and pregnancy rates. The Public Health Consultant (SCC) noted that unlike previous data where there were geographical hotspots of teenage conceptions, the latest data did not reflect that. The focus was on groups at a higher risk such as young people excluded or missing from school and care experienced young people.

20.  A Board member commended the work of the Public Health team which had reached out to primary care and had run a webinar for World AIDS Day with a sexual health consultant and someone with lived experience highlighting the late presentations for HIV, linked conditions and destigmatising HIV testing particularly for those from South Asian and Black communities. Work was underway with Surrey Minority Ethnic Forum to support those communities around HIV testing. The Public Health Consultant (SCC) welcomed the support provided during National HIV Testing Week which this year focused on stigma.

21.  The Chair referred to the new Work Wise programme noting that the employment statistics for vulnerable groups was low and the impact was dreadful. She asked how many people had taken up the service and how much capacity was available to communicate it across Surrey; were employers being engaged with. The P3 Sponsor would obtain those take up figures, it was a free service and referrals were from many partners. She noted that the economic prosperity teams within the district and borough councils had advertised the scheme but recognised that more could be done in terms of the communication and reach.

RESOLVED:

1.    Would use the Highlight Reports and Engagement Slides to increase awareness of delivery against the HWB Strategy and recently published / upcoming JSNA chapters through their organisations.

2.     Noted the opportunities/challenges including:

-       The sharing and use of the updated HWB Strategy Index.

-       The increased focus being seen on health inequalities through Key Neighbourhoods and Priority Populations.

-       The doubling of funding for local stop smoking services for the next 5 years.

-       EOIs being requested for organisations to benefit from workplace wellbeing programme.

-       Workshops to inform topics for the Health Determinants Research Collaboration (HDRC) programme that will boost research capacity and capability within Surrey.

-       The beneficiaries being supported by Bridge the Gap are at significant risk without securing sustained funding from April 2025.

-       The funding for Serious Violence programme finishes on 31 March 2025 and there is currently no indication of a future funding settlement.

Actions/further information to be provided:

1.    The Prevention and Communities Manager (SCC)/Public Health team will look into ensuring the evidence base such as from Dr William Bird MBE is involved and built into GSP interventions.

2.    The P3 Sponsor will obtain the take up figures for the Work Wise programme, sharing those with the Chair.