Health Improvement Programme RESOURCE PACK 1999-2000 EAST SUSSEX, BRIGHTON AND HOVE HEALTH
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Health Improvement Programme RESOURCE PACK 1999-2000 EAST SUSSEX, BRIGHTON AND HOVE HEALTH
AUTHORITY |
Back to Brighton and Hove Rocks |
Contents
|
Appendix |
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1. Introduction
Welcome to the East Sussex, Brighton and Hove Health Improvement Programme Resource Pack for 1999/2000.
Every health authority is responsible for developing, with local organisations, a Health Improvement Programme (HImP). The purpose of the Health Improvement Programme is to co-ordinate action to improve health and reduce the health inequalities within the local population.
This is not an easy task. It can only succeed if there are practical, effective and measurable programmes of action agreed jointly between agencies, organisations and the community.
This in turn requires a clear understanding of:
East Sussex, Brighton and Hove Health Authority (ESBHHA) has produced this document as a resource for local organisations and communities to help in the process of agreeing a fully fledged Health Improvement Programme over the coming years.
This is not a final blueprint for action. It is a starting point, from a health perspective, so that everyone can contribute to the discussion and the debate. Just as we must act together to improve the health of the local population, so we must discuss and agree our priorities together.
We have prepared this pack to be used by people in statutory organisations (e.g. the NHS and local authorities), by voluntary organisations, regeneration partnership boards and the private sector, by local communities and users of services. It should be read in conjunction with the recent Annual Report of the Director of Public Health, with the Service and Financial Framework 1999/2000 and with the Joint Investment Plans. More details on these are given later in this document.
In this resource pack we set out:
This document is available on our web site at www.esbhhealth.cix.co.uk. We will also publish summary versions of this document later in the year.
We hope you find this information useful. Details of how to be involved in the HImP process are given in section 7.
We look forward to working with you.
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2. Improving health - the policy context
This section looks at the national policy context for the development of the Health Improvement Programme. It explains why we have produced this document now.
Over the last ten years the gap in health status between rich and poor has become wider and wider. Recognising this, the government has launched a range of initiatives. These set out a whole new approach to social regeneration and put particular emphasis on the government’s will to tackle social exclusion.
As part of this approach, the government is committed to improving the health of the whole population and understanding the causes of health inequalities. All agencies and communities are being encouraged and enabled to work together to improve health.
The government has set two key aims:
The publication of the Green Paper "Our Healthier Nation" (OHN) and the recent report on health inequalities are part of this significant policy change. OHN recognised that many factors operate together to cause ill-health, for example:
"Our Healthier Nation" accepts that on its own, exhorting people to change their behaviour will not improve the health of our population. Instead, it proposes a national contract for better health, in which government, local communities and individuals are seen as having key roles to play in improving the health of our communities. If we accept that the factors described above are those which determine people’s health, it is clear that many organisations and individuals can contribute to meeting OHN’s aims.
The government has told the NHS and other public organisations to work with each other and with their communities on the national priorities set out in Our Healthier Nation, and on locally agreed priorities. The national priorities are:
OHN also proposes three settings to focus the drive against health inequalities and improve health overall. These are healthy schools, healthy workplaces and healthy neighbourhoods.
Our Healthier Nation must be read as only one of the policy statements from the government designed to improve health and social conditions and to reduce the problems caused by factors such as poverty, the environment, or social exclusion.
Within the health sector other policy statements include:
Other national strategies and action plans that will influence the health of the population include:
There are also programmes to help children, young people, the long-term unemployed and communities at large. Tackling crime and disorder are seen as major contributors to improving the health of communities.
All these policies have common themes:
Local partnerships between health authorities, other public agencies and voluntary organisations have, of course, existed for many years. We have recognised that people’s health is affected by factors outside the direct control of the NHS. We have worked together in different forums and on different issues to make the best use of our mutual resources and to ensure that our policies align rather than clash.
Now the government has given this work a new focus. It has placed the health and well-being of the population centre-stage for both the NHS and other public organisations.
The Health Improvement Programme is seen as the vehicle for delivering these local improvements in health through such local partnerships, as well as through the NHS's own internal workings. The next section of this document explores in more detail the role and function of a Health Improvement Programme.
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3. What is a Health Improvement Programme?
This section describes the role and purpose of a Health Improvement Programme. It sets out how we suggest the local Health Improvement Programme is developed.
Every health authority is charged with developing, with partners, a Health Improvement Programme. The purpose of the Health Improvement Programme is to co-ordinate action to achieve the aims of "Our Healthier Nation" of improving health and reducing health inequalities.
In reality the programme will be much more than a document or bits of a paper. Its hallmark will be the way in which partners work together to deliver improvements in health. It is the commitment to pursue an agreed course, and turn it into tangible results, that really matters.
A Health Improvement Programme is:
Our Health Improvement Programme in East Sussex, Brighton and Hove will have three main strands:
Health authorities have been given lead responsibility for developing a process for health improvement. It is not for the Health Authority on our own, or even for the NHS in East Sussex, Brighton and Hove, to set the agenda before reaching agreement with our partners on the broad content.
In December 1998, East Sussex, Brighton and Hove Health Authority began the local process. We issued a discussion document on the principles of how the HImP might be developed.
We suggested that the development of the Health Improvement Programme would:
We discussed these suggestions with a wide range of stakeholders including local councils, CHCs, PCGs, groups in the local authority/NHS joint planning structures and voluntary organisations. We received a very favourable response to the suggested Health Improvement Programme development process. On the whole people preferred local processes for agreeing local priorities and action, focused around district and borough council boundaries, with a strategic county-wide forum and a standing conference that is open to all. Section 7 explores in more detail how the HImP will be developed over the coming months.
The NHS as a whole - health authorities, PCGs and NHS trusts - is expected to work with local authorities (central to achieving the aims of "Our Healthier Nation"), voluntary organisations and with local businesses, economic organisations and social entrepreneurs, local communities and users of services. The thrust of national policy is that we need to harness the energy and enthusiasm of local people, of businesses and the statutory sector to deliver health improvement.
So far in East Sussex, Brighton and Hove, there is agreement that we must develop local processes for agreeing local priorities and action. As part of that process, local partners need to decide themselves who should be involved.
We will need to develop appropriate mechanisms to involve users of services and the general public. We are talking to local councils and other organisations on working together to involve communities and users to avoid duplication and over-consulting the public. These mechanisms must suit the task, rather than be consultation for the sake of it.
One of the key elements of a Health Improvement Programme is needs assessment. Clearly, we cannot decide what we want to do to improve the health of the local community without having a view of what the health needs are in that community.
However, there is a real difficulty. The words "needs assessment" mean different things to different people. Before we can proceed, we need to develop a shared understanding of the concept of needs assessment and then to turn this into some agreed practical actions. Appendix C explores this issue in more detail.
Background
The 1999/00 total revenue funding for this Health Authority is £513.6m, including £7m for AIDS/HIV special allocation yet to be notified to us. This includes Hospital and Community Health Services (HCHS) of £425m, prescribing costs of £75.4m and cash-limited General Medical Services of £13.2m. In 1996/97 the Health Authority was considered to be 5.21% under its assessed target (based on a national formula which takes into account the cost of care by age group, for relative need and for unavoidable geographic variations in the cost of providing services). However, changes to this formula have moved the authority to 2.15% over target for 1999/00 (£10.6m). This may have an adverse impact on the levels of growth that we receive in future years.
For the financial year 1999/00, we received uplifts of £11.1m for general growth and £7.2m for the Health Authority’s share of the Modernisation Fund, excluding inflation. This is the largest settlement that the local health economy has ever received. However, pressures, particularly around the Pay Review Body awards, have meant that we are unable to fund all the services we would like. Please refer to the summary of the draft Service and Financial Framework 1999/2000 at Appendix G for further details.
Allocating resources to PCGs
To prepare for the introduction of PCGs and to help establish their budgets, the Health Authority has been working to attribute what it currently spends to individual PCGs. This task has been approached collaboratively by a working group that includes representatives of local Trusts, PCGs, the Local Medical Committee (LMC) and the Authority.
As part of this process, the Authority has been charged with calculating a ‘fair share’ of local financial resources for PCGs, based on a national formula similar to the one used to calculate the Health Authority’s share of national financial resources. This formula takes into account the age structure of the population, and other indicators of need for health services. Over the next few years, the Authority will be expected to move PCGs’ budgets towards this "fair share", over an appropriate period of time.
This process will begin in 2000/01, and will help set the context of the available resources for PCGs in which to deliver the local Health Improvement Programme.
Where differentials exist (and we know from initial analysis that some areas have a higher historical level of expenditure than the national formula suggests is appropriate) we will not reduce their share in absolute terms without the agreement of all areas. However, we will be able to target any new monies in ways that favour those areas that appear to have fewer resources for their population profile, depending on our existing commitments and local pressures. In addition, all areas, but particularly those that appear to be over target, will be encouraged to use their resources in ways that address agreed priorities.
We will be talking to our partners about those differentials in the coming months.
Capital infrastructure
The Health Improvement Programme has to provide the strategic context for the capital development programme for the local NHS. We need to work together to ensure that the health needs identified through the HImP process are adequately met through long term capital programmes and that these are aimed at modernising hospital and community services.
This section provides information on the frameworks and strategies that will underpin our future Health Improvement Programme.
Service and Financial Framework for the NHS
A full Health Improvement Programme includes a Service and Financial Framework (SAFF) for the local NHS. We have already produced the SAFF for 1999/00 and it is given in summary form at Appendix G. It is currently in draft form but final versions will be available from the Health Authority later in the year.
The SAFF sets out the local NHS commissioning intentions for the following year. It gives Health Authority and PCG plans for investment in national and our local priority areas, as well as our joint working with Social Services and other partners. It contains plans for the location, investment in and configuration of services to meet local needs. It builds on previous strategic work to improve services for cancer, coronary heart disease and stroke, mental health, sexual health and substance misuse, as well as primary care. It gives a framework within which the Health Authority and PCGs commission services from NHS Trusts and other health care providers.
Until now, we have produced a SAFF annually, as required by the NHS Executive. Next year, for 2000/01, we will ensure that the SAFF is produced after the Health Improvement Programme, to ensure consistency of approach.
Joint Investment Plans
Our future HImP will include the local Joint Investment Plans for older people and older people with mental illnesses. These set out the way in which the local NHS and social services departments intend to allocate existing and new resources to ensure that services meet the needs of older people.
For more details please see section 6.4. Alternatively, please contact the Health Authority for a copy of current Joint Investment Plans.
Allocating Resources to Primary Care Groups
As part of the process of preparing for the introduction of Primary Care Groups (PCGS), and particularly to help establish their budgets, the Authority has had to attribute what it currently spends to individual PCGs. This task has been approached collaboratively by a working group which includes representatives of local Trusts, PCGs, the LMC and the Authority. In addition, the Authority has been charged with calculating a ‘fair share’ of local financial resources for PCGs based on a national formula similar to the one used to calculate the Health Authority’s ‘fair share’ of national financial resources. This formula takes into account the age structure of the population, and other indicators of need for health services. Over the next few years, the Authority will be expected to move the PCG’s budgets towards this fair share. This process will begin in 2000/01, and will help set the ‘context’ of the money available to PCGs to deliver the local Health Improvement Programme.
Capital Infrastructure in the NHS
The Health Improvement Programme will need to provide the strategic context within which the additional capital resources from improving the capital stock within the NHS is used. The NHS to work together to ensure that the health needs identified through the HImP process are adequately me through a long term capital programmes aimed at modernising hospital and community services
Human Resources
In order to be able to successfully produce and implement the objectives for change set out in a future HImP a comprehensive and coherent human resources and organisational development strategy will need to be in place. The key elements in the strategy will be workforce planning across the health economy, ensuring quality recruitment practices, individual, team and organisation performance management processes, integrating development opportunities for all staff and ensuring people are treated fairly and involved and that family friendly policies are in place.
Information for Health
To achieve the aims and objectives of the future HImP, we need to put plans in place to implement improvements in information, for clinicians, staff and patients across all sectors, not just the NHS. Appendix E explores the Health Authority commitment to this national strategy.
Primary Care Investment Plans
These plans outline the local priorities of Primary Care Groups, drawn up in the context of "Our Healthier Nation" and the local Public Health Report for 1998. For this year, local PCGs have already compiled their draft Primary Care Investment Plans (PCIPs) and the sections that relate to health improvement are shown at Appendix F. In future years, PCIPs will be more closely informed by the overall HImP.
The development of a fully fledged HImP for East Sussex, Brighton and Hove has a three year timescale.
As part of our discussions over the last few months, partners agreed it would be useful to have a document setting out what the NHS knew about health needs, reflecting existing local partnerships to address these issues.
The document aims to achieve that. It is a meant to be a useful starting point to discuss how we go about agreeing local priorities. The Resource Pack does not set out the local priorities, as these still have to be agreed, thought it offers ideas and observations on what they might be.
The next section summarises some of the factors that determine health.
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4. The social and economic determinants of health
This chapter draws on a World Health Organisation publication ‘The Solid Facts’. It summarises what we know about the social and economic determinants of health; that is the complex ways in which how we live influence our health. It considers ten interlinked determinants of health.
Understanding the relationship between social and economic factors and the health of the population is important because:
The scientific evidence on the social and economic determinants of health has been gathering pace over the last few decades. People's lifestyles and the conditions in which they live and work influence their health and longevity. Medical care can prolong survival after a period of illness but social and economic conditions affect whether people become ill are important for health gain in the population as a whole.
People's social and economic circumstances strongly affect their health throughout life
People further down the social ladder usually run at least twice the risk of serious illness and premature death of those near the top. The social gradient of health reflects material disadvantage and the effects of insecurity, anxiety and lack of social integration. Disadvantage has many forms, for example, less income, poor housing, becoming stuck in a dead-end job.
Stress harms health
Social and psychological circumstances can cause long term stress, which can have powerful effects on health. Such effects can accumulate during life, leading to poor mental health and physical health, as well as premature death.
A good start in life means supporting mothers and young children
Slow growth and lack of emotional support during pre-natal and early life raise the life-time risk of poor physical health and reduce ultimately physical, cognitive and emotional functioning in adulthood.
Social exclusion creates misery and costs lives
Poverty, unemployment, homelessness all contribute to social exclusion which in turn has a major impact on health. The harm to health not only comes from material deprivation but also from the social and psychological problems of living in poverty. Those excluded from citizenship or work, or who are marginalised by society due to their race, sexuality or disability are more likely to suffer ill-health than those who are not.
Stress in the workplace increases the risk of disease
The work environment contributes to greater differences in health that are related to social status. Inadequate rewards for work and lack of self-control over work can contribute to poor health.
Job security increases health, well-being and job satisfaction
The health effects of unemployment are linked to its psychological consequences and financial problems, especially debt.
Friendship, good relations and strong supportive networks improve health at home, at work and in the community
Support operates at the levels of both the individual and society. Social isolation and exclusion are associated with an increased risk of early death and poorer chances of survival, after a heart attack for example. People who get less support from others experience less well-being, more depression, and higher levels of disability from chronic disease.
Individuals turn to alcohol, drugs and tobaccos and suffer from their use, but use is influenced by the wider social setting
Alcohol dependence, illicit drug use and cigarette smoking are all closely associated with markers of social and economic disadvantage. The causal path runs both ways. People turn to alcohol to numb the pain of harsh economic and social conditions, and alcohol dependence leads to social and economic decline.
Healthy food is a political issue
A good diet and adequate food supply are central for promoting health and well-being. Access to good, affordable food makes more difference to what people eat than health education. Social and economic conditions result in a social gradient in diet that contribute to the worst off in society having the worst diet and the poorest health.
Healthy transport means reducing driving, and encouraging more walking and cycling, backed up by better public transport
Safe walking, cycling and the use of public transport provide exercise, reduce fatal accidents, increase social contact and reduce air pollution.
We now recognise that individual good health depends upon our ability to:
Whether tackling national priorities (coronary heart disease, mental health, cancer and accidents) or local ones, East Sussex, Brighton and Hove Health Authority has to work with other organisations who can all contribute to health improvement in their own particular way.
In the next section we build on this understanding of the determinants of health to describe our perspective on the health needs of local people in East Sussex, Brighton and Hove.
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5. East Sussex, Brighton and Hove: the health status of local people
This section briefly describes the main health issues within East Sussex, Brighton and Hove. The information is drawn from two main sources:
Both of these are available from the Health Authority.
In presenting such brief accounts, it is important to recognise that they are not comprehensive. Issues that are included cover those where the impact on the health of the population is greatest, such as coronary heart disease and mental health; or those where the figure (for the Health Authority or part of it) is significantly different from the national or local picture.
There are two broad approaches. Firstly, we describe the important issues for each local authority area. In doing so, we cover the important social and demographic factors, as well as more specific health issues. Secondly, we look at several topics both at a local council level and across the authority. These include the four "Our Healthier Nation" priorities; cancer, coronary heart disease, mental health and accidents; as well as children’s health, sexual health and substance misuse.
Socio-demographic issues
Brighton and Hove has a younger population than the rest of East Sussex, Brighton and Hove (ESBH): 46% of the population is aged less than 45 years compared with 39% of the total population of ESBH. The biggest population growth is therefore predicted to be in the 45 - 64 year age group while the population aged over 75 years is actually predicted to decrease by 7%. In recent years there has been an increase in the proportion of residents from ethnic minority backgrounds, however overall the proportion of the population from ethnic minority groups remains small at just 3%.
Brighton and Hove is a diverse area with much variation in the socio-economic status of its residents although in recent years its overall socio-economic status has deteriorated. The Department of Environment Index of local conditions - a measure of social deprivation - ranks the area at 21st nationally, out of 62 local authorities considered to be seriously deprived. Within East Sussex the four wards that score worst are all in Brighton and Hove; they are Regency, Vallance, Brunswick and Adelaide, and Marine.
Unemployment is high: 7.8%, compared to 5.7% in East Sussex, Brighton and Hove, and levels are particularly high in Moulsecoomb and Marine wards. Street homelessness is a particular problem with the highest recorded levels (per capita) in the country. Compared to rural parts of East Sussex, rates of drug-related offences, criminal damage and burglary are high.
Specific health issues
Accidents
The rate of accidents in the under 5s and 5 - 14 year olds is higher in Brighton and Hove compared with the population of East Sussex, Brighton and Hove. The death rate from hip fractures in those aged over 85 years is significantly higher than both the national rate and the rate in the rest of the Health Authority.
Mental illness
Mental illness, as measured by both the mental illness needs index (MINI) and the psychiatric needs index (PNI), occurs more commonly in Brighton and Hove than in East Sussex (Hastings excepted).
Suicide rates, including deaths from undetermined intent, have been very high in Brighton and Hove compared to East Sussex, Brighton and Hove as a whole and the country as a whole for many years. There was a further increase in 1997, particularly among women, although rates are highest amongst men.
Cancer
Lung cancer and large bowel occur more frequently than nationally or elsewhere in East Sussex, Brighton and Hove since 1992. Deaths from skin cancer, although small in number have continued to increase in recent years.
Coronary heart disease
In Brighton and Hove, deaths from heart disease in men aged 35 - 64 years are particularly high compared to the rest of East Sussex, Brighton and Hove. Deaths as a result of increased blood pressure in women have increased in the last three years.
Child health
Child health represents an area of concern. Measures of need (defined in the 1989 Children’s Act as children who require the support of services from health, social services or education in order to attain a reasonable standard of health or development), suggest that Moulescoomb, Queen’s Park, Hanover, Kings Cliff and Marine wards have more than 15% of children in need (22% in Moulescoomb and Queen’s Park). This compares to around 3% in other rural and suburban parts of East Sussex, Brighton and Hove.
Sexual health
The 1990s have seen an increase in the teenage conception rate in East Sussex, Brighton and Hove. The teenage conception rate for Brighton, whilst lower than in Hastings, is still higher than the national rate. With its large gay community, HIV infection represents a significant health issue in Brighton and Hove.
Substance misuse
Accurate information on substance misuse is notoriously difficult to obtain. Nevertheless, local sources all indicate that there is substantially problematic use of alcohol and other drugs in Brighton and Hove.
Socio-demographic issues
Over the last 25 years, Lewes has been one of the slowest growing populations nationally. In common with all the districts in the county of East Sussex, it has a high proportion of residents above pensionable age. Although the proportion of pensionable age has fallen in the other districts, in Lewes it has remained steady at around 26%.
Lewes is relatively affluent but it contains smaller pockets with above-average levels of deprivation, particularly in parts of Newhaven and Peacehaven.
Despite having a relatively low unemployment rate (3.2%), Lewes has the highest proportion of long term unemployed in East Sussex. Lewes also has a higher percentage of unskilled men than East Sussex, Brighton and Hove generally, but in Newhaven Valley there are over three times more.
Specific health issues
Accidents
Between 1995 and 1997 11 children under 15 years died in East Sussex, Brighton and Hove as a result of accidents. Five of these of the 11 children were from the Lewes area.
Cancer
The death rate for breast cancer is high, with the exception of 1997, deaths over the past five years have been higher than the national average . Lewes has a relatively high rate of lung cancer. Between 1994 and 1996 it was 23% greater than in East Sussex, Brighton and Hove as a whole. For the same period, the number of new cases of cancer of the large bowel was above the East Sussex, Brighton and Hove rate. In particular, Lewes has the highest death rate in people aged 65-74 years.
Coronary heart disease and stroke
Although death rates from stroke among under 65 year olds have been significantly lower than the East Sussex, Brighton and Hove rate, deaths from stroke among 65-74 year olds have increased significantly over the last three years.
Mental health
Of particular importance for Lewes is the recent increase in the number of suicides and deaths from injuries of undetermined intent. This figure rose from an average of 11 over the previous 10 years to 18 in 1997.
Child health
Within Newhaven there are wards where substantial numbers of children are classified as "in need" (i.e. require health, social services and educational support). In Newhaven, Meeching and Newhaven Valley wards, 22% of children are classified as "in need" and in Newhaven Denton ward the figure is 18%.
Socio-demographic issues
Overall, Wealden is a relatively affluent area with a stable population, which is reflected in its overall health status. It has the lowest unemployment rate and the highest proportion of households (40%) with two or more cars in East Sussex, Brighton and Hove. However, there are pockets of deprivation, particularly in Hailsham East ward; for example:
Specific health issues
Accidents
The death rate due to road traffic accidents is 50% higher than the national figure. This is likely to be a reflection of high car ownership. The mortality rate among young adults (15-24) due to accidents is also high. Many of these deaths will be due to road traffic accidents. This age group includes vulnerable road users, particularly cyclists and motorcyclists. Nationally motorcycling casualties are highest in this age group and the 25-34 age group.
Cancer
The death rate for all cancers in Wealden residents under 65 years is well below the national average and one of the lowest in East Sussex, Brighton and Hove. For lung cancer Wealden has relatively low numbers of new cases for lung cancer and a relatively low mortality rate. However, the population of the deprived ward in Hailsham East had the highest ward mortality rate from lung cancer in women aged 65-74 years.
The death rate from skin cancer (malignant melanoma) is substantially greater than the national figure. We must be cautious when interpreting this, since the actual number of deaths annually is small and fluctuates. Exposure to sunlight is the main risk factor for malignant melanoma, particularly if exposure is sufficient to cause sunburn. In a relatively affluent area like Wealden, it is likely that there will be an increased risk of malignant melanoma due to episodic exposure to strong sunlight, for example, holidays to hot destinations.
Coronary heart disease and stroke
The affluence of Wealden is reflected in the coronary heart disease rates that are 13% below the national rates.
Mental health
Wealden has a relatively low score for mental health need and the overall suicide rate is near to the national average. However, there were 16 male suicides, including deaths from injuries of undetermined intent in 1997, double the annual average for the previous 10 years.
Socio-demographic issues
Eastbourne has a high proportion of elderly people. Over 25% of people are aged over 65 years. However, recent population projections suggest that by 2003 the number of children will increase by 8% and adults below 65 years by 12%. As a result, Eastbourne is projected to have the fastest population growth in East Sussex.
Overall, Eastbourne is relatively less deprived than other areas in East Sussex, Brighton and Hove. However, this masks pockets of need, as there are wards in Eastbourne where levels of deprivation are very high. Devonshire and Upperton wards in particular have high levels of deprivation with associated high levels of unemployment.
Specific health issues
Accidents
The rate of hospital admissions due to accidents among old people is the highest locally, at 739 per 100,000 compared to 683 for East Sussex, Brighton and Hove.
Cancer
Mortality from malignant melanoma is higher than the national rate. We must be cautious when interpreting this, since the actual number of deaths annually is small and fluctuates. This may reflect Eastbourne’s position on the South coast but also the relative affluence of most of the population and the likelihood that they will take holidays abroad.
Mental health
Devonshire and Upperton wards score highly on mental health needs as measured by the Mental Illness Needs Index (MINI) and the Psychiatric Needs Index (PNI). Eastbourne has a relatively high death rate from suicides and undetermined injuries, higher than the rate for England and Wales and for South Thames - the former region. For adults, hospital admissions for schizophrenia and neuroses are the highest in East Sussex, Brighton and Hove and considerably higher than the national rate. However, this may reflect the local availability of beds.
Socio-demographic issues
Hastings has high levels of deprivation. A number of wards show some of the highest levels of deprivation in the country. In particular:
This high level of socio-economic deprivation is reflected in the amount of reported limiting long term illness in Hastings, which is 18% greater than expected for the age structure of the population. It is also reflected in the health indicators shown below.
Specific health issues
Accidents
The rate of falls in the elderly is high.
Cancer
The standardised mortality ratio (SMR) for all cancers is high. The death rate for breast cancer in three years between 1994 and 1996 was the highest of all 358 local authority areas in England and Wales. In addition, the number of new cases of cancers of the lung and breast is high. The number of new cases of colorectal cancer is the highest in ESBHHA
Coronary heart disease and stroke
Coronary heart disease rates are high in the 65 - 74 age group. Deaths from stroke are much higher than the national rate or the rate for East Sussex, Brighton and Hove.
Mental health
Mental health indicators show high levels of need in Hastings and the suicide rate is one of the highest in the country. Castle ward and Central St Leonard’s ward have a particularly high suicide rate.
Sexual health
Hastings has one of the highest teenage pregnancy rates in the country (double the rate elsewhere in East Sussex, Brighton and Hove) and one third of all births are to mothers under 25 years old.
Child health
There is a high level of oral disease in children living in Hastings and Rother compared to the rest of East Sussex, Brighton and Hove, although levels are below the average for the former South Thames region.
Substance misuse
There is a recognised substance misuse problem in the Hastings area.
Socio-demographic issues
Although overall Rother district is affluent when compared to other areas of East Sussex, Brighton and Hove, this conceals marked variations in social and economic conditions locally. Parts of Bexhill have some of the highest levels of deprivation in East Sussex, Brighton and Hove. In Sidley and Old Town wards there are significantly more residents living in unsatisfactory accommodation, lacking or sharing bathrooms and inside toilet facilities, or without central heating. In Camber there are a large number of people living in overcrowded conditions.
The demographic profile of the district shows a very high proportion of the population to be of pensionable age, almost one third. This is one of the largest elderly populations in the country. This has significant implications for both health and social care needs.
Specific health issues
Accidents
Rother has, relative to other areas in East Sussex, Brighton and Hove, low levels of admission to hospital for accidents in children. However, admissions to hospitals for those over 65 years is relatively high, along with Hastings, Eastbourne and Wealden.
Cancer
Mortality from malignant melanoma in Rother is higher than the national rate although absolute numbers are low. In addition the death rate for prostate cancer has been greater than the national rate for 9 of the past 10 years.
Coronary heart disease and stroke
The death rate for coronary heart disease is low in Rother. It is the lowest in East Sussex, Brighton and Hove and considerably lower than the national average.
Mental health
Mental health indicators show particularly high levels of health need in Bexhill Central and neighbouring Sackville wards.
In addition to those specific local problems identified above, there are a number of issues that are relevant to the whole Health Authority area.
Accidents
Looking at the Health Authority as a whole, accident rates are similar to the national picture but there is significant variation within the Authority.
Rates in Brighton and Hove are particularly high in children, although Eastbourne and Hastings have the highest rates for people aged over 65. There is considerable potential for decreasing accidents amongst pre-school children by creating better access to home safety devices, combined with injury prevention in primary care. Accidents for school children could be targeted by introducing traffic calming and other measures that protect pedestrians and cyclists. Accidents by older people could be reduced by balance training and home assessments by primary care teams. All of these require a multi-agency approach.
Coronary heart disease
Overall, mortality rates are lower than the national figure. However, the most deprived parts of the Health Authority have higher mortality rates. There appear to be inequalities in access to surgical interventions that are not related to the need for these interventions in the population.
In terms of lifestyle, smoking is increasing in young people (particularly young women), the amount of exercise the population is taken is decreasing and obesity is increasing. Despite our generally good performance, the potential for improvements in primary prevention and secondary prevention rehabilitation is considerable.
Cancer
Most measures of the amount of cancer in our population show that we are better than the national picture. Nonetheless, the frequency of cancer is greater in socially deprived electoral wards.
Despite improvements in breast cancer death rates (associated with better treatment and the National Screening Programme) there are worrying underlying issues. Smoking rates in the population are decreasing more slowly than we would like and rates are increasing in young people. Large parts of the population do not eat enough fresh fruit and vegetables. As with other priority areas, we have to balance improvements in screening and treatment with effective preventive action based on partnership work.
Mental Health
There are major differences in mental health needs across the Health Authority, with parts of central Brighton and Central St. Leonard’s having particularly high levels of need. Social isolation, the breakdown of families and fear of crime all contribute to poorer mental health. Suicide rates have remained consistently high in the Health Authority area. Consequently, tackling the problems of isolation, loneliness and mental distress must be a priority in plans to improve the quality of life of the population.
Children
All measures of health show inequalities in child health across the Health Authority. Oral health is better than England in general, but high levels of oral disease are found in Hastings and Brighton. Fewer teenagers in the Health Authority have been offered drugs than nationally, but a greater focus needs to be made in services for the vulnerable, socially excluded and for young people. Poor parenting skills consistently emerge as the factor most frequently associated with the need for registration for child protection.
It is clear that a child’s chance of a long and healthy life is influenced by how well off his or her parents are, where they live and their ethnic background. Children who grow up in conditions of socio-economic - economic deprivation experience poorer health than their more affluent peers. In recognition of this we must provide solutions that include the reduction of poverty, improve access to high quality education, housing and social services as well as health care.
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6. Improving health, reducing health inequalities
This section looks at some actions that can be or could be taken to improve the health of our local population and to reduce health inequalities. It describes examples of current partnerships in East Sussex, Brighton and Hove and looks at areas for further development.
Previous chapters explored the underlying causes of ill-health and the inter-relationships between them. We have also provided a pen portrait of the health of the local population.
We present information about the "evidence based" actions that can make a difference to the health of the population. These actions or interventions can be implemented at a population level and an individual level. For example, at a population level, organisations can work together to develop policies to prevent people smoking in public places. At an individual level the NHS can also support those who want to give up smoking through smoking cessation clinics.
This section also gives examples of where actions are already being taken in East Sussex, Brighton and Hove. Whilst we know that these actions bring results for health, they are included here because the action is not always implemented or agreed consistently across the area.
We also outline the existing partnership arrangements and existing strategic work throughout East Sussex, Brighton and Hove. There is no easy way to map all this activity. There are already several cross-agency partnerships tackling the root causes of ill-health by working to bring about social regeneration. The health service is currently involved with many, but not all, of these.
The Health Authority has worked closely with partner agencies, with service users and with community representatives to develop and agree strategies for heart disease, cancer, mental health, sexual health, substance misuse and accident prevention. This chapter aims to show that these strategies are complementary to the wider effort to improve health and reduce health inequalities.
We have therefore chosen to present the information in three parts, reflecting the different levels of activity and the variety of approaches:
The following pages should not be read as a complete picture of the entire work in all parts of East Sussex, Brighton and Hove. We do not rewrite the strategies but give examples and highlight areas where the we suggest other initiatives might be valuable.
These are some examples of good practice in partnerships involving East Sussex Brighton and Hove Health Authority that aim to influence the social and economic factors determining our health.
It is important to note that we do not include partnerships where the NHS is not directly involved, for example, joint work between local councils and housing associations to tackle homelessness or to improve housing conditions for local people. Nor do we include any of the important policies implemented by local authorities to improve the health of the population.
Regeneration partnership boards
These are partnerships between local business, local authority, Health Authority and the voluntary sector. Boards exist in Brighton and Hove, Hailsham, Hastings and Bexhill. There are also partnership boards in Battle and Rye, with Rye seeking Single Regeneration Budget (SRB) funding this year.
East Sussex, Brighton and Hove Health Authority, and the health service generally, is a partner on both the Brighton and Hove and the Hastings boards. The priorities for these boards are:
Education Action Zones
East Brighton is an Education Action Zone. This is a partnership between business, education, police, the Health Authority, social services, the youth service, independent schools and the universities. It aims to provide East Brighton with a modern education service of the highest standard and to raise standards in core skills of literacy, numeracy, information and communication technology. Education Action Zones seek to improve motivation, enthusiasm, reduce truancy and poor examination results.
New Deal for Communities
This programme aims to involve local communities in deciding how to address some of the issues that cause poor health. A proposal is being developed in East Brighton to take this forward.
Local Agenda 21
The 1992 United Nations Earth Summit in Rio de Janeiro agreed an international plan of action for "sustainable development" into the 21st century. The plan is known as Agenda 21. It includes an expectation that local authorities throughout the world will work with their communities to formulate their own plans to help achieve sustainable development. Local authorities have therefore been charged with developing their own plans, in conjunction with local residents, businesses and council representatives to consider and take action on quality of life issues within local communities. The Health Authority has not consistently played an active role in these forums. In future we would like to participate in these groups and help to ensure that creating a sustainable environment is linked with action on the social determinants of health.
Responsible Authorities Groups
Every local authority has a "Responsible Authorities" Group or Partnership to oversee the implementation of the Crime and Disorder Act. These groups oversee all work on community safety.
As an example, the Health Authority, through Eastbourne Downs Primary Care Group, is a member of the Eastbourne Responsible Authorities Partnership. This group involved the local community in devising a "Community Safety Plan". This identified priorities for action including fear of crime, drug and alcohol misuse, poverty, housing and social exclusion, anti-social behaviour, youth issues, domestic abuse and car and traffic issues.
Healthy living centres
This new Government initiative is intended to enable local communities to address the causes of ill health by promoting good health in its widest context. Through the National Lottery, funds will be available to develop healthy living centres across the country. The Government is particularly interested in targeting area and groups that represent the most disadvantaged sectors of the population to help improve the health of the worst off in society.
In East Sussex, Brighton and Hove, the Health Authority’s health promotion department is helping to develop local networks, one in East Sussex and the other in Brighton and Hove. These will support local organisations and groups in working together on bidding proposals.
Community development initiatives
There are many examples of work involving partnerships between local communities and agencies. The common theme is that the communities identify their own needs and ways of addressing these needs, thus empowering their communities and developing social capital.
Ore Valley project
This project is funded jointly by social services, the Health Authority and by primary care. It is managed by Hastings and Rother NHS Trust and Hastings Trust, a local voluntary organisation. Whilst many organisations and residents contribute to the project, the two main posts funded are the centre co-ordinator and community health worker. Working with the community and other organisations, many different projects have been established and services including parenting groups, exercise classes for older people, mother and toddler groups, a baby clinic and health advice services and health advice services for men.
Brighton and Hove community needs audit project
This project was established by the Brighton Local Planning Team. It uses skilled workers to help communities describe their own needs, concentrating on the most vulnerable within a geographical community. It has involved communities from Brunswick, Regency, Kemp Town and the Whitehawk and Clarendon estates. The results of the audits have been used to make successful bids for further projects, for example the Brunswick neighbourhood project, URBAN and New Deal for communities.
Other similar community partnerships include initiatives in Rye and the Sussex Rural Community Council’s work with village elders.
Sure Start
This government-funded strategy aims to improve services for children aged under four years and their families in areas of need. It is part of the wider policy to prevent social exclusion, raise educational standards, reduce health inequalities, regenerate communities and promote opportunity. Sure Start aims to build on local good practice to:
Sure Start programmes are meant to dovetail with other government initiatives, such as Early Years Development and Childcare Partnerships, Children’s Services Plans and Health Improvement Programmes, NHS and social services national priorities and the New Deal for Communities.
In East Sussex, Brighton and Hove, the Health Authority is involved in three bids for Sure Start funds - in Hastings (Ore Valley), Wealden (Hailsham) and Brighton and Hove (central sea front). These funds will, if the bids are accepted, support extra services, capital investment and new ways of working.
In this section we provide examples from East Sussex, Brighton and Hove of evidence-based action around the national priorities of cancer, coronary heart disease, mental health and accidents. We have included examples of current partnership arrangements and we have identified what we see as some of the areas for further development.
We have worked closely - and we think effectively - with partners to develop local strategies for cancer, mental health and heart disease. We believe this has been valuable and has laid the foundations for our approach to the HImP process. These strategies are listed in our appendix of useful reading (Appendix A) and are available from the Health Authority.
The examples we give are not specific to individual towns or areas unlike the examples given earlier in this chapter. Until now the Health Authority has structured itself to address health and health service issues across the whole of East Sussex, Brighton and Hove (such as mental health and cancer). The new agenda now prompts us to examine inequalities in health at a local level.
The examples in this section, and the possible areas we identify for further work, are a starting point for discussion with our partners. As with the previous section, the examples are not meant to be a comprehensive list.
In each of these areas we show some of the things we could do together to address the problems. In some cases we are already working together on them. For some issues the NHS needs to work with local councils, local communities and voluntary organisations. For others, action needs to be taken by different parts of the NHS working collaboratively between the different health sectors and with users of service.
Accidents
Examples of action
Working together we can:
Examples of current partnership arrangements
We chair a multi agency group, "East Sussex, Brighton and Hove Injury Reduction Steering Group", whose role is to oversee the implementation of these interventions through three local Accident Prevention Working Groups. The Sussex Road Strategy Group, which includes local authorities and health authorities from West and East Sussex and Sussex Police amongst others, acts as a campaigning forum to address road safety.
Development work required
We have started discussions with local authorities on how to ensure a more integrated and strategic approach to accident prevention. We hope to continue this over the coming months.
Cancer
Examples of action
Working together we can:
In the NHS we can:
Examples of current partnership arrangements
Over the last three years, the Health Promotion department of East Sussex Brighton and Hove Health Authority has been working with Brighton and Hove Council, Brighton Health Care NHS Trust, Lewes District Council and local communities to develop food and low income projects. These aim to create opportunities for all sections of the community to acquire basic cooking skills and information on nutrition, food hygiene and safety in the kitchen. The focus of this work has been with communities who are particularly in need. In the future, we will develop a broader remit, recognising the interrelated issue of access to reasonably priced fruit and vegetables for people on low incomes .
Interventions to improve the uptake of breast and cervical screening are led by the Health Promotion Department, in partnership with NHS trusts, primary care practitioners, local authorities and local communities.
Cancer services are being improved through the Sussex Cancer Network, a multi organisational, multi disciplinary network facilitated by East and West Sussex Health Authorities who all work together to implement the Calman/Hine report.
Development work required
The food and low income projects need to be developed in other wards across East Sussex. However these projects alone will not tackle the broader issue of improved access to cheap fresh fruit and vegetables in deprived areas. We need to implement more strategic population based interventions to tackle smoking across the county.
Coronary heart disease and stroke
We will implement the National Service Framework on Coronary Heart Disease, alongside our own Coronary Heart Disease Strategy "Straight to the Heart", our emerging local service framework for stroke services and the White Paper on tobacco as appropriate. The actions below are contained within these reports. It is not intended to reiterate these strategies. However, we have emphasised the key actions that require a wider partnership and summarised, very broadly, the issues that are fully in the domain of the NHS "family".
Examples of action
Working together we can:
In the NHS we can:
Examples of current partnership arrangements
There has been significant progress towards meeting some of these objectives across the area, but it is patchy. For example, the 20 small food and low income projects in Brighton, Hove and Newhaven have no counterparts in the eastern part of the authority. Most local authorities have developed cycle lanes, usually on highways but some segregated from motorised traffic. There are voluntary "Smoke Free" schemes in public areas in most local authorities but take-up in the licensed, catering & leisure trades is incomplete.
The Health Promotion department, GPs, local authorities and community organisations have worked in partnership with others to promote physical activity through walking schemes and Referral-For-Exercise programmes. This work has focused on changing behaviour at an individual level. Whilst this continues to be valid for those at high individual risk, the policy shift we are now engaged in demands a different approach that can influence the whole community, for instance by focusing on how communities interact with their environments and how this affects health.
A programme of improvement in health care services, set out in the 1997 Cardiovascular disease strategy "Straight To The Heart" is being taken forward with the support of a multi professional working group. These partnerships within the NHS (between primary care, secondary care and the Health Authority) are central to achieving evidence-based best practice. The forthcoming National Service Framework for Coronary Heart Disease will set an expanded agenda for the NHS that we shall have to respond to.
Impetus to develop a Health Authority-led Stroke Strategy was given by a stakeholder conference in 1998 where significant agreement was reached on the priorities for action. Stakeholders at this event are now engaged in following it through. These include carers’ organisations, community workers and social services, as well as primary care professionals, PCGs and trusts.
Development work required
In our partnership work until now we have not adequately addressed the prevention issues on a population basis and have been focused on treatment and care. However, Health Promotion advisors have worked to develop prevention programmes with other stakeholders.
We now have an opportunity to develop a more strategic approach with our partners. We expect to continue to discuss with local authorities and other organisations the possibility of agreeing priorities in these areas. At the same time, we must review the way we plan cardiovascular health in the NHS to the work addressed the wider health agenda as well as improving treatment and care.
Mental Health
Examples of action
Working together we can:
The NHS and Social Services working together with other providers of care can:
Examples of current partnership arrangements
The action is derived from the local strategy on mental health developed jointly by health and social services. The positive mental health agenda and the broader promotion and prevention issues have been developed with our many partners in local authorities, user groups, health promotion and voluntary organisations.
For example, the work on destigmatisation of mental illness in the community has involved a wide range of stakeholders, NHS trusts, user groups, voluntary organisations, health promotion, borough and district council and social services. This particularly focused on the way that media shapes the public perception of mental illness. From this partnership a media pack was produced which is used by trainee journalists to provide accurate information on illness and good practice guidelines on how stories are presented.
Developing social capital in communities is carried out through work in partnership with local councils, criminal justice agencies, voluntary organisations, primary care groups, social services to develop a multi-agency social and economic regeneration programme. The main arenas for collaboration are community development, social regeneration partnerships and community safety fora.
Development work required
We need to discuss with PCGs the objectives and interventions on appropriate issues. We will be progressing this over the coming months. We also need to engage local councils in addressing issues such as reducing social exclusion, suicide reduction and promotion of mental well being. This is not to say that these organisations have not worked on these issues but that we would like to discuss with partners how to make the work more coherent and strategic.
This Health Authority considers sexual health, substance misuse, children's health and older people to be four important areas for the health of our local population. As in the previous section, we look at actions we could take in the current partnership arrangements and at areas for development.
Sexual Health
Examples of current action
The Health Authority has been developing a Sexual Health Strategy over the past year to formulate a co-ordinated approach across the county with partners in statutory and voluntary agencies. We do not reproduce the draft Strategy here, but give some examples of what we might do to tackle the problems facing the population.
Examples of current partnership arrangements
We have worked with:
Development work required
We need to discuss with all partners including PCGs the objectives and action contained within the Sexual Health Strategy in order to co-ordinate any developments targeting the priority areas. We would like to develop the Healthy Schools initiative, particularly in Hastings.
Substance Misuse
Examples of current action and partnership
Local communities are affected by drug and alcohol related anti-social and criminal behaviour. In addition, the prevention of communicable diseases in injecting drug users remains a priority. Public services spend significant amounts of time responding to these problems that do not occur in isolation, but are often tied in with other social problems.
Partnership working is the key to tackling drugs. The East Sussex, Brighton and Hove Drug Action Team (DAT) meets regularly to address these issues. It is made up of senior officers from the Health Authority, local authorities, the Police, Probation and Prison services and representatives from other organisations. It has four main aims:
The DAT agrees a range of specific actions every year and reports these to the UK Anti Drug Co-ordinator. These are described in the DAT Action Plan, which is freely available from the Health Authority.
Children’s Health
Examples of action and current partnership arrangements
The Health Authority is working in partnership with a variety of different agencies to improve the health status of our children.
Working with our social services departments we are:
These are national strategies to improve interagency co-operation to improve services for vulnerable children. We are also working to improve access to child and adolescent mental health services through the use of the Mental Illness Specific Grant.
With a range of partners we are:
Development work required
It is clear that a child’s chance of a long and healthy life is influenced by how well off his or her parents are, where they live and their ethnic background. Children who grow up in conditions of socio-economic deprivation experience poorer health than their more affluent peers. In recognition of this we must provide solutions that include the reduction of poverty, improve access to high quality education, housing and social services as well as health care.
The Health Authority has more work to do across the broad child agenda by working with different agencies to develop programmes that tackle such issues as:
working with children, their parents and schools to prevent smoking
In addition, we need to develop our partnership work to address the following health issues (amongst others) child and adolescent mental health, oral health and a review of health visiting.
Older People
Examples of Action
There are many issues affecting older people in our community, including isolation, depression, osteoporosis, stroke, disabilities and accidents. Some of these are addressed in previous sections. In the context of the government’s expressed desire to improve services for older people and our own high percentage of elderly people, this section looks at how we can improve the health and social care services for older people in East Sussex, Brighton and Hove.
Health Authorities and Local Authorities must work together to deliver appropriate services which result in older people having more opportunity to continue living independently in the community, thus reducing the need for long term care in hospitals, nursing homes or care homes.
We are expected to produce with our two Social Services a Joint Investment Plan (JIP). The focus of the first plan is services at the interface between health and social care for older people (aged 65 and over) and older people with mental illness who reside in East Sussex. JIPs for other client groups, under the broad umbrella of ‘vulnerable people’, will be written in 1999/2000 for consultation the following year.
The JIPs set out a joint view of:
The final draft of this JIP will be available in March for consultation and involvement of other stakeholders throughout 1999/2000. It is anticipated that the JIP will evolve considerably throughout the consultation prior to its final agreement.
In order to ensure that the local population can be involved in the plans for joint investment, Consultation Steering Groups have been established in both Brighton and Hove, and East Sussex. The aim of these groups is to ensure maximum contribution from all interested parties, using a range of consultation methods. We anticipate that the consultation will be completed in August in order to agree recommendations in time to inform the commissioning process for 2000/2001.
Initially agreed priorities for future joint investment
The local statutory agencies in Brighton and Hove and in East Sussex have compiled initial lists of priorities as a baseline for discussion. These are summarised below.
Brighton & Hove initial priorities
East Sussex initial priorities
The next chapter considers the next steps in developing the local HImP.
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7. Next steps
This chapter summarises the full document, recaps on the purpose of the Health Improvement Programme and sets out some next steps for its development, building on how we have worked in the past.
As explained earlier, this document is the first step towards a Health Improvement Programme. However, we are expected to produce a more comprehensive HImP during 1999/2000 for 2000/2001 that will demonstrate:
This means that, by 1 April 2000, all partners will have developed and agreed:
From discussions so far it seems clear that, given the complexity of the task in East Sussex, Brighton and Hove we need to work at two levels. First strategic action across East Sussex, Brighton and Hove; and second, at a local council level. This process will help build strategic and local ownership of both the Health Improvement Programme process and content as the work develops. This process must also involve all staff in the health care sector, so that it is clear how each of us can contribute.
We are not starting with a blank sheet of paper. We have worked together to develop and implement many jointly owned strategies and many existing mechanisms for joint work. These have already achieved a great deal. The task facing us now is how we develop a programme of action that complements this work.
As shown in earlier chapters we have worked collaboratively with our partners on local strategies for (among others); carers, mental health, cancer, coronary heart disease (CHD), accidents, sexual health and, substance misuse. We are also working in partnership to improve the broader determinants of health with local councils and in particular with Regeneration Partnership Boards. All this has involved a range of stakeholders including clinicians, users, local communities, local councils, business partners, GPs and NHS primary care groups. All these, as well as the work on the major strategies, give us a starting point for agreeing the joint priorities we all want to work on together.
Many of the priorities we would wish to tackle have already been set out for us. For example Our Healthier Nation enables all parties to tackle cancer, CHD, mental health and accidents that are all real issues in East Sussex, Brighton and Hove. There is joint guidance issued to both health and social services requiring us to address a range of issues including children's services, older people, and inequalities in health. The NHS is required to implement the National Service Frameworks for mental health and coronary heart disease, and Social Services departments are required to implement "Quality Protects" (See glossary).
The Health Authority and primary care groups will work in partnership with other organisations to deliver these frameworks. Sometimes the different elements within the NHS will need to work together. Sometimes the co-operation of other organisations, such as local councils, will be required.
In East Sussex, Brighton and Hove Health Authority, we believe the first version of the Health Improvement Programme should reflect this work. However we should also seize this opportunity to create a more strategic approach to working together, and agree joint priorities in local areas. Through this process we will be able to clarify the different roles we play in delivering health improvement in those local areas.
To start this discussion, we offer this statement about the Health Authority’s commitment to the Health Improvement Programme process, and to the priorities within it. We then outline some mechanisms for development of the HImP over the coming year.
We are committed to developing a HImP process in line with the principles we have discussed and agreed with our local partners (see section 3).
From the discussions with key partners we suggest that two different levels of process need to be developed:
So far we have agreed that local processes need to be developed to agree shared or aligned priorities for the HImP, and to involve the community. Various local events are being planned to take this forward.
We will also develop a Standing Conference on Health Improvement which enables all those involved, at whatever level across the county, to come together to review progress so far, and exchange information. Generally partners support this idea. We will facilitate this event in May 1999 to launch the discussion process, and to consolidate the work done so far.
The milestones for developing the Health Improvement Programme for East Sussex, Brighton and Hove are detailed below.
Establish East Sussex, Brighton and Hove Steering group |
By the end of May 1999 |
Hold Standing Conference |
End of July 1999 |
Agree local priorities and |
End of September 1999 |
Agree local action plans |
End of December 1999 |
Publish draft 2000/2001 HImP |
March 2000 |
We would like to involve groups, agencies and other local representatives from across East Sussex, Brighton and Hove in developing our Health Improvement Programme. If you would like to be involved - in local discussions or at a county wide level - please contact Zoë Nicholson at East Sussex, Brighton and Hove Health Authority 36-38 Friars Walk, Lewes, BN7 2PB (telephone 01273 403533) for more details.
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Other useful reading
East Sussex, Brighton and Hove Health Authority: Inequalities in Health. Annual report of the Director of Public Health, 1998
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