Devon Health and Wellbeing Sandbox

A range of evidence-based interventions have been invested in including: early years (2-5 years) and adult weight management programmes; the Food For Life Partnership supporting healthy eating and growing food in schools, Walking for Health– delivering free walks across Devon, the Get Active Devon online physical activity finder tool and a programme promoting Naturally Healthy ways to access the countryside, nature and wildlife.

Evidence-based alcohol harm reduction interventions are targeted in multiple settings in a range of ways to impact on different drinking contexts and populations. These include:  alcohol brief interventions as part of the NHS Health Checks programme; alcohol awareness and harm reduction programmes as part of community probation order; computer-aided therapy in multiple settings including targeted work in Community Pharmacies. The voluntary sector organisation Addaction has recently received lottery funding to work specifically with over 55s.

An analysis has been completed as part of the Joint Strategic Needs Assessment work programme which identifies the impact of lifestyle behaviours contributing to a range of long-term health conditions. This has also helped to identify groups of people who are more likely to have multiple long-term health conditions. This will be used to influence decision-makers about effective services and advice to prevent worsening ill health, for example the ICE (Integrated Care in Exeter) project.

Health and wellbeing will be considered as a planning consideration in DCC consultation responses; a framework and protocol for planning responses is being developed. Also work with alcohol licensing teams is in place, for example the licensing team in Torridge District Council has a voluntary project with to remove high-strength alcohol from licensed premises (“Stop the Strength”). The Food for Life Partnership project is an example of an evidence-based programme which is based in schools to enable children to grow, cook and eat healthy food.

Programmes to support positive social relationships have been supported and sustained through public health and wider partners including a new Walking for Health grant to sustain and develop the programme in Devon and support for Neighbourhood Health Watch to assist in its development going forward. Both programmes support social connections but also have a strong volunteer base.

The Devon Early Help Strategy and Implementation Plan have been completed and a cross-organisation programme of work to address the recommendations is underway.

Local Specialist Stop Smoking Midwife posts have been commissioned in the Royal Devon & Exeter hospital and the North Devon District Hospital.  Pregnant women are now screened for carbon monoxide at various stages in their pregnancy and supported to quit smoking.

A specification is being written to outline the evaluation requirements for our services.  A mini-competition between preferred providers on the evaluation framework will take place and a provider will be appointed Spring 2015.

Work is underway to co-commission and co-design with schools an Emotional Health and Wellbeing Service for School Age Children which has included extensive needs analysis, review of the evidence base and the engagement of stakeholders including children, young people and families.  The commissioning and procurement schedule is on target for services to be in place by September 2015.

The main providers of these health improvement programmes are the Public Health Nursing Service (Health Visitors and School Nurses), Children’s Centres and schools. An asset-based approach to intensive home visiting is currently being implemented by Public Health Nursing; plus the development of asset-based approaches in perinatal mental health, attachment support and as part of Universal Partnership care planning.  Principles have been adopted by Children’s Centres and the wider children and families workforce as part of Early Help. The asset-based approach will also underpin the commissioning of the Emotional Health and Wellbeing Services for school-age children (see R4.4)

An “eye health” needs assessment is being developed to inform future decision-making on eye health. Falls prevention is a priority in locality public health plans across the County and there are examples of local projects to provide advice and support on preventing slips and trips. The Safe at Home service provides preventative slips and trips advice and support. There is also a pilot programme providing evidence-based strength and balance classes in priority groups.

Devon County Council has a well-established and well regarded Carers Support Service which includes carers’ health and wellbeing checks.

A scoping report has been completed by Public Health Devon looking at the barriers and motivators for accessing and being active in outdoor spaces. A workshop has been held to facilitate the application of these insights to the work of providers delivering opportunities in outdoor spaces. A Naturally Healthy week is being promoted by the Devon Local nature Partnership in 2015.

A review in underway on the evidence of effective interventions that individuals can use to prevent ill health or help to manage the illness at an early stage. This will be used to effectively reach those most in need and reduce health inequalities.  Devon County Council has supported the development of a volunteer snow warden scheme in local communities.

Public Health Devon has worked with both National Parks (Dartmoor National Park and with Somerset County Council for Exmoor National Park) to develop projects to explore the delivery of health outcomes though engagement with the natural environment.  Insights from the scoping report (see R4.8) were applied to these project specifications. Learning from these projects will be shared through the Naturally Healthy working group of the Local Nature Partnership.

The promotion of a healthy diet is a key component of new adult healthy weight service.

A range of programmes are in place through public health and wider stakeholders, the new Devon County Council Operating Model and resilience mapping and new commissioning approach will involve communities in discussions and decisions about how to build community capacity and social capital (see also R3.5).

Immunisation uptake increased for all antigens between 2011-12 and 2012-13, most notably for Measles, Mumps and Rubella (MMR), where MMR1 uptake at 2 years of age increased by 1.7% to 93.8% and MMR2 at 5 years of age by 2.5% to 87.8%.  New immunisation programmes for Shingles and Rotavirus were also introduced in 2013, both have been well accepted, and there has been a visible impact on cases of Rotavirus. The childhood nasal ‘flu vaccination programme has begun, although uptake to date has been slow both locally and nationally.  Breast screening continues to have about 80% uptake and cervical screening uptake, having declined slightly, has now stabilised at 80%.

Public Health Devon collaborated with Public Health England, NHS England, local authorities and primary care to improve ‘flu immunisation uptake rates across the Peninsula. Activity included practice interviews, development of a “best practice” toolkit, a patient survey, data analysis and communications.

With other organisations, Devon County Council participated in Exercise Cygnus – the national pandemic influenza exercise – with the result that business continuity processes have been improved and updated across the organisation.

Public Health Devon works with commissioners in the local authority and with both Clinical Commissioning Groups to identify the impact of their decisions, and specifically, the impact on health inequality. This includes ensuring that services and interventions are targeted to those groups most at risk of experiencing poor health.

Devon County Council and Public Health Devon have worked in on issues such as fuel poverty and home safety via the Private Sector Housing Group and Devon Strategic Housing Group.

This has been slow to develop but links have been made through the Economy Team to work more closely with the LEP to ensure health and wellbeing becomes an important element of the LEP’s strategic approach.