Health and wellbeing strategy engagement survey

1. Health and wellbeingstrategy engagementsurvey • Introduction • One of the first major tasks of the health and wellbeing board has been to develop priorities from evidence presented in the joint strategic needs assessment (JSNA) to form the basis of the joint health and wellbeing strategy. • The board has already translated the JSNA into a list of potential priority areas, below. This was completed by applying a range of filters to the potential areas. These filters included the potential added value by working together and whether the issue would become more severe in the future if nothing is done now. This process resulted in the following potential priority areas: • Children’s health and wellbeing • Strategic multi-agency safeguarding and child protection • Improve outcomes for children and young people with complex needs • Increasing physical activity: the Olympic legacy? • Reducing levels of obesity and its impact on other conditions • The prevention and management of diabetes • Reducing the harm of alcohol consumption • Review the pathways for stroke prevention and reduction • Review strategies in place for long term conditions • Adult mental health; review delivery, pathways and areas for joint working • Improving care for people with dementia and their families • Safeguarding vulnerable adults • Promoting independence • Improving end of life care and further promoting choice • The purpose of the engagement is to further refine these priority areas, build the evidence base for priorities and develop potential actions for the implementation plan. • The following survey is designed to capture the views of a range of stakeholders . It can be completed online at or, on paper and returned to post to Amanda Hubbard, G33 County Hall, Penryhn Road, Kingston Upon Thames, KT1 2DW, or completed online at . The survey is open until December 14th.

2. Health and wellbeingstrategy engagement: survey • Question 1 From the following priorities, which do you think are the three most important? • Children’s health and wellbeing • Strategic multi-agency safeguarding and child protection • Improve outcomes for children and young people with complex needs • Increasing physical activity: the Olympic legacy? • Reducing levels of obesity and its impact on other conditions • The prevention and management of diabetes • Reducing the harm of alcohol consumption • Review the pathways for stroke prevention and reduction • Review strategies in place for long term conditions • Adult mental health; review delivery, pathways and areas for joint working • Improving care for people with dementia and their families • Safeguarding vulnerable adults • Promoting independence • Adult mental health • Improving end of life care and further promoting choice • To help make this decision an appendix is attached with the evidence to support each priority. Please base you answers to questions 3-11 on your top three priority areas. • Please write your top three priorities here: • 1. • 2. • 3. • Question 2 • Is there anything missing from the priority areas?

3. Question 3 (1st priority) • Why is this your 1st priority? Question 4 (1st priority) • What opportunities are there for the health and wellbeing board to work on these priorities? • Which are relevant to your community? • What could we do to most make a difference in this priority area? Question 5 (1st priority) • What preventative measures could be taken to address this priority?

4. Question 6 (2nd priority) • Why is this your 2nd priority? Question 7 (2nd priority) • What opportunities are there for the health and wellbeing board to work on these priorities? • Which are relevant to your community? • What could we do to most make a difference in this priority area? Question 8 (2nd priority) • What preventative measures could be taken to address this priority?

5. Question 9 (3rd priority) • Why is this your 3rd priority? Question 10 (3rd priority) • What opportunities are there for the health and wellbeing board to work on these priorities? • Which are relevant to your community? • What could we do to most make a difference in this priority area? Question 11 (3rd priority) • What preventative measures could be taken to address this priority?

6. Question 12 • Any other comments

7. Appendix Priority Children's health and wellbeing (including support during maternity and in the early years; parents and carers support; improving outcomes for LAC and care leavers; safeguarding; supporting vulnerable children and young people; and support during the transition to adulthood) Evidence • A number of factors impact on wellbeing including educational attainment, family stability, and physical activity, which cut across a number of agencies including schools, local authority, and the NHS. • Despite a high proportion of women initiating breastfeeding in Surrey, six to eight week prevalence data suggests just 56% of women are still breastfeeding at six to eight weeks. Also in Surrey around 40% of mothers aged under 20 initiate breastfeeding. • Healthy Start uptake is poor in Surrey with only 25 out of a potential 5733 children’s vitamins being claimed (2008/09) and three out of a potential 498 women’s vitamins being claimed (2008/09). • The percentage uptake across all childhood immunisations for Surrey continues to be lower than the Strategic Health Authority and national figures. • Children and young people whose parents have poor mental health have a four to five fold increased rate in the onset of emotional/conduct disorder in childhood. • Latest figures show that in Surrey, one in four children in Year 6 in Local Authority schools was either overweight or obese. • The number of looked after children has risen (826 LAC as at August 2012) and there is an urgent need to ensure that any new service must be sustainable, fit for purpose and able to meet need and demand. • Looked After Children have poorer health and wellbeing outcomes compared to the majority of their peers. • Currently local young carers projects only support a small proportion of young carers estimated to be living in Surrey. Young carers are more likely to be living in a household where no adult care support is available, suffering social exclusion, or with unemployed parents or parents on low incomes who lack the means to pay for additional support. • Low levels of subjective wellbeing have been found to be associated with participation in risky behaviours in young people which can lead to, for example, teenage pregnancy, early alcohol consumption or STIs. Our responsibilities

8. Our responsibilities • The Early Years are a crucial time in a child’s life and the Health and Wellbeing Board can help ensure there is strong partnership working to support families to improve children’s outcomes, which will in turn improve outcomes later on in their childhood and adulthood. • The County Council has a statutory duty as a Corporate Parent and has identified supporting vulnerable children amongst its priorities. However, the current service is complex and delivered across a range of health providers. Now is a good time for change, as a significant portion of commissioning responsibilities will be inherited by Clinical Commissioning Groups from April 2013. Therefore a decision on commissioning an improved health assessment service for looked after children will help inform their priorities Our responsibilities

9. Priority Strategic multi-agency safeguarding and child protection (protect children through strong multi-agency safeguarding and child protection arrangements) Evidence • There is an upward trend of 40% (February 2010; 511, September 2011; 723) in the number of children on a Child Protection Plan. • Over half of children subject to a child protection plan were affected by domestic abuse and anecdotal evidence suggests incidence levels are rising. The number of referrals initiated into Children’s Services where there is a concern relating to domestic abuse from April-September 2011 was 428. • The number of vulnerable children requiring social care support as Children in Need has also risen by 20% over the same time period (February 2010; 2,725, September 2011; 3301). • If children in need are not identified and referred onto appropriate support they may be at risk of experiencing poor outcomes in health, development, behaviour and employment Our responsibilities • Safeguarding and promoting the welfare of children – and in particular protecting them from significant harm – depends on effective joint working between agencies and professionals that have different roles and expertise. • Munro states that Ofsted have made clear that early identification and early help are firmly within the scope of the new inspections and that the degree to which agencies work together to construct an effective local system are significant aspects of the new approach. • Early intervention and prevention are two key elements to improving outcomes for children and young people, which the Health and Wellbeing Board can help to embed. • The needs of vulnerable children are identified as a key part of the JSNA. • Changes in the health landscape provide an opportunity to strengthen both strategic and operational arrangements to ensure the effective safeguarding all children and young people in Surrey. • CSN Policy Briefing, Munro Review of Child Protection: Progress report

10. Priority Improve outcomes for children and young people with complex needs (by developing and implementing an integrated complex needs service across health, social care and education) Evidence • Forecast estimates of numbers of children with a long-term illness, disability or a medical condition affecting day-to-day activities show a slight increase from 8012 to 8148 (2010 to 2015). • In January 2011 Surrey County Council recorded and administered 5345 statements of SEN. This equates to 3.8% of the total number of pupils in Surrey and approximately 2% of the 0 to 19 population. • The proportion of pupils with statements of SEN in Surrey maintained schools was considerably higher than in England and the south east in 2009 and 2010. Furthermore, children and young people with statements of special educational needs have more complex needs than before. • The educational attainment gap between those with Special Educational Needs (SEN) and those without has remained high and pupils with some degree of Special Educational Needs (SEN) are three to four times more likely to become persistently absent from school than those pupils with no SEN. • Local authority and health resources could be used more efficiently and multi-agency working embedded. • To meet the new duties in the SEN and Disabilities Green Paper, service provision needs to be co-ordinated after diagnosis and assessment for children and young people with complex needs. Our responsibilities • Embedding multi-agency working is crucial to reduce duplication and make the system easier for parents/carers to navigate and put in place the right provision at the right time to ensure children are safe. • Early intervention and prevention are two key elements to improving outcomes for children and young people, which the Health and Wellbeing Board can help to embed across all partners.

11. Priority Increasing Physical activity Evidence • There is a strong evidence base that shows the benefits of achieving the recommended levels of physical activity to manage and prevent over 20 conditions and diseases. • A recent Lancet report suggests that an uncoordinated approach to physical activity has made physical inactivity as big a risk factor to ill-health as smoking and obesity. • One of the key recommendations in the JSNA is for Surrey to 'provide a co-ordinated approach to physical activity in Surrey' echoing Lancet's key message of 'a systems approach to physical activity beyond a resilience on behavioural science needs coordinated changes at the individual, social and cultural, environmental, and policy levels'. Outcomes for the whole family will only improve if agencies work together in a coordinated way. • Physical inactivity in England is estimated to cost £8.3 billion a year. This includes both the direct costs of treating major, lifestyle-related diseases and the indirect costs of sickness absence . • These costs are predicted to rise. Inactivity is estimated to cost NHS Surrey £12.8 million a year. Source .Department of Health (2009a). Be Active, Be Healthy: A Plan for Getting the Nation Moving. Available at: http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_094358 • For more information visit the JSNA chapter on physical activity Priority Reducing levels of obesity and its impact on other conditions Evidence • It currently costs Surrey taxpayers approximately £270 million a year to treat diseases related to weight and obesity. • However, the cost to society as a whole is far greater with rising sickness absence and reduced productivity. • In Surrey one fifth of four and five year olds and just over a quarter of ten and eleven year olds are overweight or obese. • The levels in the adult population are significantly worse with 61.3% being either overweight or obese and this figure is set to rise. • A multifaceted co-ordinated approach, which involves all partner organisations, is needed to tackle obesity.

12. Priority Reducing levels of obesity and its impact on other conditions Evidence • It currently costs Surrey taxpayers approximately £270 million a year to treat diseases related to weight and obesity. • However, the cost to society as a whole is far greater with rising sickness absence and reduced productivity. • In Surrey one fifth of four and five year olds and just over a quarter of ten and eleven year olds are overweight or obese. • The levels in the adult population are significantly worse with 61.3% being either overweight or obese and this figure is set to rise. • A multifaceted co-ordinated approach, which involves all partner organisations, is needed to tackle obesity. Priority The prevention and treatment of diabetes Evidence • Currently there are over 43,000 people in Surrey diagnosed with diabetes . • A further 17,000 people are estimated to have undiagnosed diabetes. • The prevalence of diabetes is increasing and is forecast to reach 7% of the population in Surrey by 2015 and 7.5% by 2020. Diabetes costs the NHS 10 percent of its annual resources - £9bn a year or £1m an hour • Effective primary care diabetes services, including identification and healthy lifestyle advice for people at risk and surveillance and treatment, are a priority for all CCGs in Surrey • Guidance and strategy are reflected in the JSNA, the National Service Framework for Diabetes and National Institute of Health Clinical Excellence (NICE) guidance • ..

13. Priority Reducing the harm of alcohol consumption Evidence • Alcohol-attributable hospital admissions, which were 18,890 in 2009-10, have been increasing year on year in Surrey and have almost doubled since 2002. • The estimated cost of alcohol harm to Surrey is £57.5 million a year.. • One in four of those aged over 16 who consume alcohol engage in 'increasing risk' drinking (JSNA, 2012). • Alcohol misuse /excess alcohol consumption affects all ages from unborn babies to the elderly. • Reducing alcohol-related harm requires a multi-faceted, multi-partnership approach. Early identification and brief advice on alcohol across a range of health and non-health settings is essential for reducing levels of 'increasing risk' drinking (NICE, 2010) Priority Review the pathways for stroke prevention and reduction Evidence • It is projected that by 2015 the number of persons aged 16 and over living after having had a stroke in Surrey will be just under 19,000 or 2.0% of the adult population. By 2020 this will rise to 20,500 or 2.1%. • There are many modifiable risk factors for stroke including many lifestyle factors such as smoking and alcohol use, and hypertension and atrial fibrillation. • Prevention strategies related to healthy lifestyles, depend on effective partnership working. NHS Health Checks can identify these risk factors and enable consideration of advice and treatment in line with NICE guidance. • A lot of work has been undertaken to support post-stroke but collective focus needs to shift to prevention

14. Priority Review strategies in place for long term conditions Evidence • The latest data from the 2010/11 Quality and Outcomes Framework (QOF) and the 2009 General Lifestyle Survey suggest that around 15m people in England have a long term condition. • The number of people with one long term condition is projected to be relatively stable over the next ten years. However, those with multiple LTCs is set to rise to 2.9 million in 2018 from 1.9 million in 2008. • A 2009 report for NHS Surrey shows that considerable savings could be made from better management of certain long term conditions. The report estimated that the spend on Coronary Heart Disease could be reduced by 5.1 million, Chronic Obstructive Pulmonary Disease (COPD) by 1.9 million and Heart Failure by 1.03 million per year. Priority Adult mental health; review delivery, pathways and areas for joint working Evidence • At any one time 1 in 4 Adults suffers from some form of mental ill health, accounting for over a third of all illnesses and 40% of all disability. • The World Health Organisation (WHO) have estimated that by 2030 unipolar depression will be the biggest disease burden in developed countries. • Mental health has been highlighted in Surrey County Council commissioning plans and the ongoing Public Value Review (PVR). • There are some areas in Surrey where mental health needs are greater than the England average – such as Merstham, Maybury and Sheerwater and the Friary and St Nicolas. • Demographic and prevalence trends suggest that the number of those with mental health conditions will increase in all age groups (JSNA).

15. Priority Improving care for people with dementia and their families Evidence • In Surrey, an estimated 15,100 people have dementia. 14,830 (one in 15) people are aged over 65 and 294 are aged under 65 (early onset dementia). There is an increasing number of people with learning disability who have early onset dementia. • Numbers are predicted to rise to 19,000 by 2020 and 25,000 by 2030. • 70% of all dementia costs relate to avoidable admissions to acute hospitals of which we have 5 in Surrey. • 70% of people with dementia are self-funders in terms of residential care options, but this increasing dependency on residential care as the only service option is not sustainable, both in terms of cost and quality. Our responsibilities • Services for older people with dementia and mental illnesses often suffer from a lack of fully integrated working between health and social care. Through implementing the joint Older people’s mental health and dementia strategy in Surrey, people and their carers will know where to go to receive information, advice and support and will find it easier to navigate to the services that they need. • The Health and Wellbeing Board can promote services and actions that are in accordance with the Joint Older People’s Mental Health and Dementia Strategy and support its implementation.

16. Priority Safeguarding vulnerable adults Evidence • Living a life that is free from harm and abuse is a fundamental right of every person. • All of us need to act as good neighbours and citizens in looking out for one another and seeking to prevent the isolation that can lead to abusive situations and put adults at risk of harm. That is one of the fundamental principles of a ‘Big Society’ that is caring, compassionate and fair. • Social care organisations play an important role in the protection of members of the public from harm and are responsible for ensuring that services and support are delivered in ways that are high quality and safe. Our responsibilities • The Government believes that safeguarding is everybody’s business with communities playing a part in preventing, detecting and reporting neglect and abuse. • According to the Statement of Government Policy on Adult Safeguarding 2011, “Measures need to be in place locally to protect those least able to protect themselves. Safeguards against poor practice, harm and abuse need to be an integral part of care and support.” • The draft Care and Support Bill (2012) proposes legislation that requires the local authority to establish a Safeguarding Adults Board (SAB) in their area to develop shared strategies for safeguarding and report to their local communities on progress. • The Health and Wellbeing Board can seek assurance that all key partners in the new health and social care partnership are appropriately involved in the safeguarding adults processes.

17. Priority Promoting independence Evidence • Projections suggest that the population aged 85 and over in Surrey will almost double from 30,000 people in 2010 to 59,000 by 2030. • 17.7% of Surrey’s population were aged 65 and over in 2011, in comparison to England estimates of 16.65%. • The ageing population raises specific challenges for the future of health and social care services, where limited resources will need to be allocated to support more people. This is because the ageing process brings increased risks to independence and wellbeing through disease, frailty, sensory impairments and other long term conditions. • The movement of large numbers of people into long stay hospitals in the county during the last century has artificially increased the proportion of people with a learning disability in the general population. Our responsibilities • Since 2003, the government and the other major political parties have embraced the personalisation of adult social care services through policies such as Putting People First (2007). • The Draft Social Care Bill (2012) proposes making personal budgets a legal entitlement. • Personal health budgets are currently being piloted in the NHS. In Oct 2011 the Secretary of State for Health announced that subject to evaluation of the pilot, by April 2014 everyone in receipt of NHS Continuing Healthcare will have the right to ask for a personal budget. • The Health and Wellbeing Board can support more personalised, preventative and community based services that meet with the priorities outlined by older people, their families and carers

18. Priority Improving end of life care and further promoting choice Evidence • In Surrey, there are about 9000 deaths each year, of which 200 are sudden. It is estimated around 1300 people require palliative care. • It is estimated that deaths will increase to between 9561 and 11,121 in 2020 and that those requiring care will increase to between 1434 and 1688 (JSNA). • People approaching end of their life often have complex care needs and require support from different agencies in different places (JSNA).