Tameside Strategic Partnership

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2. Improving the wider determinants of health

2.1 Children in poverty

Outcomes framework:

Public Health 1.1

Implications for the population’s health and well-being:

Child Poverty is currently defined by the national child poverty measure: the percentage of children who live in families in receipt of out-of-work benefits or in working families with income less than 60% of the median national income. The wider determinants of poverty include a range of social and economic factors and are currently being reviewed under the banner of ‘life chances’ and ‘social mobility’. The consequences of allowing a child to grow up in poverty are severe, not only for the child but for the family, for society and for the wider economy. For a child, consequences can be wide ranging and can affect Health, Education, Employment, Behaviour, Finance, Relationships and well-being.

A child growing up in poverty has a greater likelihood of experiencing health problems from birth and of accumulating physical and mental health problems throughout life. Poverty and inequalities proportionately increase the chances that someone will develop a disability or life limiting illness and ultimately decrease their life expectancy.

Programme spend:

Spend on tackling child poverty is difficult to quantify due to the cross-cutting nature of the poverty agenda and can be considered integral to the core work of children’s and adult services, health and economic development. As such the policy responses to tackling child poverty will be embedded at a strategic level within a number of service areas including the Economic Strategy, Children and Young People’s Plan and Local Health and Well-being Plans.

At risk or vulnerable groups:

Though poverty can affect anyone, a number of groups are more at risk than others. These include, children in care, teenage parents, asylum seekers, single parents and particular ethnic groups.

Benchmarking:

Levels of Child Poverty in Tameside are higher than both the North West and England (national Child Poverty Data from 2007). Local data indicates that levels of child poverty in Tameside have continued to climb over the past four years and now stand at an estimated 29%.

Figure 3: Percentage of children living in poverty, Greater Manchester local authorities 2009.

Graph showing child poverty in Manchester

Source: Tameside MBC, 2011

Figure 4: Percentage of children living in poverty, England and Tameside, 2009.

Graph showing child poverty in Tameside

Source: HM Revenue and Customs 2012

Policy Context:

The approach to tackling child poverty has shifted emphasis in-line with reductions in public spending and changes to public services and is increasingly being considered within the wider scope of the life-cycle under ‘life chances’ and ‘Social Mobility’. In 2011 the Government released its new child poverty strategy ‘A New Approach to Child Poverty: Tackling the Causes of Disadvantage and Transforming Families’ Lives’ and its social mobility strategy ‘Opening Doors, Breaking Barriers: A Strategy for Social Mobility’.

What interventions work?

The Government’s child poverty strategy places less emphasis on solely income instead focusing on ‘strengthening families, encouraging responsibility, promoting work, guaranteeing fairness and providing support to the most vulnerable’. It is this approach combined with welfare reform, the work programme and the complex families and community budgets programme which now encapsulates the child poverty agenda.

What are we doing now?

An assessment of child poverty in the borough was carried out in 2011 looking at the characteristics and needs within the borough. Tackling poverty is integral to the ‘people’ work strand of the economic strategy and action plan as well as the work of the Children’s Trust and Health and Well-being Board.

What needs to happen next and by whom?

The Prosperous Tameside Board will drive forward the ‘people’ action plan within the borough in order to tackle poverty and improve life chances of residents in the borough.

2.2 School readiness

Outcomes framework:

Public Health 1.2

Implications for the population’s health and well-being:

School readiness focuses on whether a child is ready for school based on a range of skills including literacy, numeracy, physical health, social and emotional adjustment, the child’s approach to learning and their level of language, cognition and general knowledge. Young children’s earliest experiences and environments set the stage for future development and success and can influence their life chances.

At risk or vulnerable groups include:

  • Looked after children
  • Children who receive Free school meals
  • Children with SEND (Special Educational Needs and Disabilities)
  • Children for whom English is an additional language

Benchmarking:

This is a new indicator which needs further development; however, it was previously based on the ‘good level of development measure in the current Early Years Foundation Stage (EYFS) Profile. A ‘Good level of development’ measure was defined as achievement of at least 78 points across the EYFS, with at least 6 points in each of the scales in Personal, Social and Emotional Development and Communication, Language and Literacy.

Table 1: EYFS Good Level of Development achievement, Tameside and National, 2009 to 2011.

2009 Good level of development - EYFS

2010 Good level of development - EYFS

2011 Good level of development - EYFS

National

Tameside

National

Tameside

National

Tameside

52.0

48.5

56

53.9

59

56.8

Source: Department for Education/Tameside MBC, 2012.

Over the last three years the number of children who have achieved a good level of development in the EYFS in Tameside has increased.

Policy context:

What interventions work?

High quality home visits by trusted professionals, a menu of provision for families requesting additional support and parenting programmes.

What are we doing now?

In Denton South a project has been initiated to identify and improve the readiness for school of all children under 5 by working closely with midwifery and other partners to identify vulnerable parents at the 18 week booking session. This is now identified as the ’18 week offer’. Early intervention packages of support offered include:

  • Smoking cessation
  • Breast feeding advice and support
  • Housing and debt advice
  • Signposting to services i.e. Children Centres and Homestart

Within the wider context, Sure Start Children’s Centres are part of the local system of universal and targeted children’s services, providing easy access to a range of community health services such (as speech and language, healthy child promotion agenda), parenting and family support (such as 1-1 and evidence based group parenting), integrated early education and childcare to include the free two year places and Free Entitlement Funding (FEF) funding for all three year olds in quality provision Effective Provision of Pre-school Training (EPPE research) and links to training and employment opportunities for families with children under the age of five. Children’s Centres are a key mechanism for improving outcomes for young children, promoting and supporting the parent in developing sound skills for positive interactions and raising family aspirations, while reducing inequalities between the poorest children and their peers, all of these approaches contribute to making sure children are ready for school as well as addressing child poverty.

What happens next and by whom?

The evidence base about early development and attachment continues to grow and recently we have learnt a lot about the development of the brain during pregnancy and the foundation years; this evidence base will inform our work in the early years sector.

The revised EYFS Profile document will be available from September 2012 and training will be provided by the EYFS Profile Moderation Manager in the autumn and spring terms for all schools/settings who will be involved in completing the EYFS Profile. A profile moderation plan will be put into place by the EYFS Profile Moderation Manager as soon as guidance is received from the Standards and Testing Agency, relating to implementation and moderation of the profile. Tameside will continue to have a duty to collect and submit to the Department of Education all profile data in the summer 2013 term and also provide good start in life for health.

The Health and Well-Being Children’s Trust Board needs to take forward recommendations from Association of Greater Manchester Authorities (AGMA) Early Years Steering Group to implement evidence based proposals to achieve an increase in the number of children who are learning ready when they begin school.

2.3 Absence from school

Outcomes framework:

Public Health 1.3

Implications for the population’s health and well-being:

Poor school attendance impacts on pupil’s attainment, future life opportunities and earnings as an adult as well as being an indicator of possible safeguarding concerns. The clear correlation between attendance and attainment is shown in the Attendance Strategy where local data shows that 62% of pupils whose attendance was more than 97% achieved 5+ A*-C compared to just 3% of pupils whose attendance was less than 60%.

Absence from school is measured by the percentage of half days missed by pupils due to overall absence, which includes both authorised and unauthorised absence. An alternative measure is the percentage of children who are persistent absentees i.e. they miss more than 15% of school time.

At risk or vulnerable groups:

The statistics also show that children on free school meals (FSM), or those with special educational needs (SEN), were around three times more likely to be persistently absent. In Tameside at the end of the school year 2010/2011, 18% of the secondary school population was eligible for FSM yet 41% of the pupils with persistent absence were eligible for FSM.

Benchmarking:

The statistics for the end of the 2010/2011 school year show that almost 400,000 children in England were persistent absentees and of these, 1,680 were from Tameside. There has been a downward trend in absence both locally and nationally over recent years however the children who are persistently absent from school remain at a considerable disadvantage. As can be seen from the chart below, the most recent data shows that Tameside, at 5.5% absence compares well with its statistical neighbours and with the National figure of 5.8%.

Figure 5: Overall absence in school 2010/11 – Tameside in comparison with statistical neighbours

Graph showing school absence

Source: Tameside MBC, 2012

Policy context:

What interventions work?

Ensuring Children’s Right to Education determines that early intervention and use of CAF (Common Assessment Framework) provide an appropriate framework for identifying and resolving attendance issues. Locally the Attendance Strategy sets out the multi agency framework for action which has supported a year on year reduction in absence.

What are we doing now?

  • Education Welfare Officers are working within the Youth and Family Service and as well as participating in direct work, they raise awareness and contribute to the skill base in other agencies.
  • Traded Services are being developed to ensure that schools who wish to enhance their attendance work with additional resources are able to do so.
  • Central and Statutory Services are being developed to ensure that the Local Authority is able to maintain an overview and to identify any schools or areas where additional support is required.
  • School Nurses support parents and school to maximise school attendance.

What needs to happen next, and by whom?

  • In the context of the changing role of the LA, schools should ensure that their systems for early intervention and action are in place and effective.
  • The Attendance Strategy and the Children Missing Strategy need to be reviewed to reflect the changing roles and responsibilities of the range of agencies which have an impact on school attendance.
  • Early access to data needs to be available in order to identify emerging issues and trend changes which may require remedial action.

2.4 First-time entrance to the youth justice system

Outcomes framework:

Public Health 1.4

Implications for the population’s health and well-being:

Children in, or close to, the Youth Justice System (YJS) have far more unmet health needs than other children of their age and face a range of other difficulties including school exclusion, substance misuse, speech and language difficulties, fragmented family relationships and unstable living conditions. In addition, organisational and attitude problems can be barriers to progress.

An offence is defined as a first offence if it results in the offender receiving their first reprimand, warning, caution or conviction – i.e. they have no previous criminal history recorded on the Police National Computer (PNC). Offences resulting in further reprimands, warnings, cautions or convictions are known as further offences since the offender already has a recorded criminal history.

Programme spend:

The overall monies given to the Youth Offending Team (YOT) from Local Authority, NHS and Police and Probation Funding are £1,200,000. Early intervention is embedded within this overall budget. A proportion of this budget (substance misuse grant £39,633) has been given to the Police and Crime Commissioner and is currently being reclaimed for YOT funding.

At risk or vulnerable groups:

Research findings describe common characteristics of offenders:

  • Personal: usually male; often of low intelligence; is addicted to drugs or alcohol, frequently from an early age.
  • Background: experience of poverty, poor housing, instability, association with delinquent peers and unemployment.
  • Family: parental conflict and separation; a lack of parental supervision; harsh or erratic discipline; and evidence of emotional, physical or sexual abuse.
  • School: no qualifications attained; will probably have been aggressive and troublesome, often leading to his expulsion or to truancy.

Contact with the YJS can bring extra problems for some children and young people, including those with learning difficulties, communication needs and mental health problems.

The sexual health of young people who are supported by the YOT needs to be addressed through its interventions. There are also a disproportionate numbers of young people that offend sexually within the geographical area, with a number of young victims.

Benchmarking:

Nationally, the number of first time entrants (FTE) has fallen by 50 per cent from 90,180 in 2000/01 to 45,519 in 2010/11. The number of first time entrants has fallen by 59 per cent, since the peak of 110,815 in 2006/07. In the last year the number of first time entrants has fallen by 27 per cent from 62,504 in 2009/10 to 45,519 in 2010/11. Locally, Tameside’s rate is the 5th highest/5th lowest in Greater Manchester, and has been reducing in line with other Greater Manchester areas.

Figure 6: Rates of young people aged 10 – 17 receiving their first reprimand, warning or conviction per 100,000 of the population by Local Authority, 2010/11.

Graph showing youth crime

Source: Tameside MBC 2012 and Ministry of Justice 2012

Policy context:

What interventions work?

The task is to intervene more effectively, providing the right help at the right time and in the right place. When diversion from the YJS has failed, we need to use the opportunity of young people’s contact with it to give them better support. However, the YJS itself is different to the adult criminal justice system in many respects and this has implications for how diversion for children and young people should best be approached. Effective interventions have the potential to impact immediate offending and re-offending rates, but also to influence children and young people away from an adulthood of offending.

There is a clear causal link between youth offending and substance misuse whether by offending whilst under the influence or through acquisitive crimes to maintain habits. Dual diagnosis has shown that children and young people use alcohol and drugs to mask mental health issues, however, once weaned the ‘merry go round’ begins of coming off and going back to substance misuse.

A number of factors have contributed to the downward trend in FTEs, although it is not possible to attribute specific gains, or scale of gain, to any specific intervention. Nevertheless, it is thought the main factor is the Offences Bought to Justice Target (OBTJ), which created targets for the police around the number of offences reported to them that should be “brought to justice”, i.e. resolved and an offender given a caution/conviction. The number of FTEs peaked in 2007 and the subsequent large fall in offending coincides with the replacement of the target in April 2008 with one that placed more emphasis on bringing more serious crimes to justice. In December 2010 it was dropped entirely. It is also possible that work by YOT and other partners to divert young people into alternatives, such as restorative justice disposals and Triage schemes has also contributed to the fall.

What are we doing now?

Under the former Government’s “Youth Crime Action Plan” the YOT established, with colleagues in Greater Manchester Police (GMP), a triage service to provide alternatives interventions that diverted young people from being charged. This has been extended by YOT and has attracted funding from the Department of Health to undertake Health Triage (Youth Justice and Liaison Diversion). This extended the health services provided to young offenders (Speech and Language Therapy; Mental Health and Generic Health). GMP has introduced Restorative Justice and again this has diverted young people away from the criminal justice system by mediating between the young person and the victim to find an alternative to charge.

What needs to happen next and by whom?

  • Intervene early to address emerging health and well-being needs to preventing offending, with clear pathways into health provisions.
  • Underpin interventions with specialist health assessments.
  • Engage the Police and Crime Commissioner re: Commissioning of Youth Offending early intervention programmes.
  • Ensure that young offenders’ health needs are known, enabling the Police and Courts to make informed decisions to divert children and young people from the YJS.
  • Introduce Multi Systemic Therapy (MST) to provide intensive family based interventions to young people primarily at the edge of care and custody and include those that are also displaying anti-social behaviour.
  • Ensure referral routes from the Neighbourhood Resolution Panels.

2.5 16-18 Year Olds Not in Education, Employment or Training (NEETs)

Outcomes framework:

Public Health 1.5

Implications for the population’s health and well-being:

It is generally accepted that young people in Education, Employment and Training (EET) are less susceptible to poor health, effects of poverty, involvement in crime and negative measures of well-being. Evidence shows that long term NEET membership can cause a life-time ‘scar’ – with consequential impact on health indicators, lower income earning potential and less positive participation in community life.

Programme spend:

  • The Local Authority commissions the Connexions Service to work with young people (especially vulnerable groups) to promote EET (generally) and address NEET (specifically). Programme spend for 2012-13 = £916,000
  • A European Social Fund (ESF) NEET contract, held by Rathbone UK, directly benefits residents with Tameside postcodes. A proportion of the total spend is dedicated to reducing 16-18 NEET. Programme spend is £930k across 2011-14
  • Tameside 50/50 Apprenticeship scheme – apprenticeship entry for 16-18 year old NEETs. £50,000
  • Other programmes (e.g. Early Intervention Foundation Learning, Looked After Children) contribute indirectly to NEET reduction

At risk or vulnerable groups:

  • Those young people in areas of high multiple deprivation (Smallshaw Hurst, Hattersley, Denton South, St Peter’s)
  • Vulnerable groups designated as LLDD (Learner with Learning Difficulties or Disabilities), Teenage Parents, Looked After Children and Care Leavers, Special Educational Needs (SEN), Youth Offenders, those with mental health problems.

Benchmarking:

Tameside’s Area Agreement uses local residency information as a measure which is felt to be more accurate that the national descriptor. Information is provided by the Connexions CCIS (Client Caseload Information System) with quarterly updates and an annual validation. NEET performance tends to be cyclical – for example, higher figures in September, October until the system ‘tracks’ where post 16 learners are registered.

NEET has been reducing since 2006 (8.6%) to a static 7.1% (2009/10 and 2010/11). The current economic situation is directly affecting NEET and a deterioration might be expected in the Quarter 3 data. Unemployment evidence (Department of Work and Pensions) appears to indicate, however, that the greatest impact is on the 18-24 age group rather than 16-18.

Table 2: % of NEET population in Tameside from 2009/10 to 2011/12

Tameside

Q1 - %

Q2 - %

Q3 - %

Q4 - %

NEET (based on residency)

Apr - Jun

Jul - Sept

Oct - Nov

Dec - Mar

2099-10

9.3

9.5

7.2

8.1

2010-11

9.1

9.2

7.2

7.1

2011-12

8.5

8.6

-

-

England (2010/11)

15.4

15.4

15.4

15.4

North West (2010/11)

17.7

17.7

17.7

17.7

Source: Tameside MBC 2012.

Figure 7: Percentage of NEET population in Tameside from 2009/10 to 2011/12

Graph showing NEET figures in Tameside

Source: Tameside MBC 2012 & Department of Education 2012

N.B The National Data on the proportion of 16-18 year olds NEET is published annually by Department of Education, but are not directly comparable with LA figures due to differences in definitions used.

Policy context:

Positive Participation and Youth Unemployment are high on the national policy and governmental agenda. Various local, regional and national support programmes are available to support NEET reduction: Youth Contract, Youth Commitment, Apprenticeship grants and incentives for employers. The Council’s Leader, Chief Executive and senior management are committed to TMBC being instrumental in supporting measures to reduce youth unemployment through increasing apprenticeship opportunities and improved post 16 educational participation.

What interventions work?

  • Increasing apprenticeship opportunities (16-18 apprenticeships in learning currently 20.4% (2011) against a baseline of 13.8% (2008))
  • Increasing post 16 education participation (currently 86% (2011) against a baseline of 74% (2005). Overall EET stands at 90% (2011)
  • Bespoke programmes for re-engagement in learning, personal development programmes, pre-vocational learning, supported employment for LLDD (Learner with Learning Difficulties or Disabilities).
  • Bespoke cohort programmes for designated vulnerable groups (e.g. LAC EET (69% (2011) compared to 43% (2009)

What are we doing now?

  • Employer engagement in apprenticeship provision - supported work experience, financial incentives, brokerage, awareness raising etc.
  • Revised Connexions and TMBC service unit focus on designated vulnerable groups (see above)
  • Strategic focus on locality based interventions in a holistic context – Family Intervention teams, Local Integrated Service Pilots, Youth and Family teams

What needs to happen next, and by whom?

  • Continuation of the above
  • Increased focus on Tameside post 16 retention in education
  • Increased focus on small and medium employers to engage in apprenticeships
  • Direct intervention work with vulnerable groups
  • Reduction in teenage pregnancy
  • Reduction in alcohol and drug misuse

2.6 People with mental illness and/ or learning disability in settled accommodation

Outcomes framework:

  • Public Health 1.6i: Percentage of adults with learning disabilities known to social services who were in settled accommodation at the time of their latest assessment.
  • Adult Social Care 1G: Proportion of adults with learning disabilities who live in their own home or with their family
  • Public Health 1.6ii: Percentage of adults receiving secondary mental health services known to be in settled accommodation.
  • Adult Social Care 1H: Proportion of adults in contact with secondary mental health services living independently, with or without support

Implications for the population’s health and well-being:

The measure is intended to enhance the quality of life for people with care and support needs, by ensuring people are able to find employment when they want, maintain a family and social life and contribute to community life, and avoid loneliness or isolation. The aim is to improve outcomes for adults with mental illness/ learning disabilities and by demonstrating the proportion in stable and appropriate accommodation. The nature of accommodation for people with mental illness/learning disabilities has a strong impact on their safety and overall quality of life and the risk of social exclusion.

Settled accommodation refers to accommodation arrangements where the occupier has security of tenure or appropriate stability of residence in their usual accommodation in the medium to long-term, or is part of a household with tenure/residency. The accommodation types that represent settled accommodation for the purpose of this indicator are:

  • Owner occupier/shared ownership scheme (where tenant purchases percentage of home value from landlord).
  • Tenant – Local Authority/Arms Length Management Organisation/Registered Social Landlord/Housing Association.
  • Tenant – private landlord.
  • Settled mainstream housing with family/friends (including flat-sharing).
  • Supported accommodation/Supported lodgings/Supported group home (accommodation supported by staff or resident caretaker).
  • Approved premises for offenders released from prison or under probation supervision (e.g. Probation Hostel).
  • Sheltered Housing/Extra care sheltered housing/Other sheltered housing.
  • Mobile accommodation for Gypsy/Roma and Traveller community.
  • Adult placement scheme.

Non-settled accommodation refers to accommodation arrangements that are precarious, or where the person has no or low security of tenure/residence in their usual accommodation and so may be required to leave at very short notice. The accommodation types that represent non-settled accommodation for the purpose of this indicator are:

  • Rough sleeper/squatting.
  • Night shelter/emergency hostel/direct access hostel (temporary accommodation accepting self referrals).
  • Refuge.
  • Placed in temporary accommodation by Local Authority (including Homelessness resettlement) – e.g. Bed and Breakfast.
  • Staying with family/friends as a short term guest.
  • Acute/long stay healthcare residential facility or hospital (e.g. NHS or Independent general hospitals/clinics, Long stay hospitals, specialist rehabilitation/recovery hospitals).
  • Registered Care Home.
  • Registered Nursing Home.
  • Prison/Young Offenders Institution/Detention Centre.
  • Other temporary accommodation.

At risk or vulnerable groups:

Those with metal health problems: Adults aged 18 – 69 who are receiving secondary mental health services and who are on the Care Programme Approach (CPA) – it is recognised that this definition may limit the scope of the measure by potentially excluding individuals who have been supported to maintain paid employment but are not on the CPA.

Therefore the definition of this indicator is subject to review and development work, with a view to agreeing a revised definition for “in contact with secondary mental health services”. This also applies to adults with learning disabilities, particularly those that are not in contact with the council.

Adults with a primary client group of Learning Disability who have been assessed or reviewed by the council during the year, irrespective of whether or not they receive a service, or who should have been reviewed but were not.

It is also important to recognise that there will be a proportion of adults with mental illness / learning disability who are not accessing mainstream support services.

Benchmarking:

In Tameside, the proportion of people with learning disabilities living in settled accommodation is higher than the North West (60%) and England (59%) average.

Amongst people with mental health problems, there has been a recent increase in those in settled accommodation. Local figures are now much higher than the average across the North West (75%) and England (67%).

Table 3: The Proportion of adults with learning disabilities and mental health problems, in settled accommodation, (with or without support), 2009/10 to 2010/11.

People with:

Learning Disabilities

Mental Health Problems

2099/10

74.9%

63.4%

2010/11

65.2%

91.8%

Source: Pennine Mental Health Trust and Tameside MBC

Policy context:

Supported Living – Making the Move: Developing Supported Living options for people with learning disabilities

What interventions work?

  • Re-ablement
  • Routes to Work for pre-employment training
  • Housing Strategy for appropriate housing
  • Telecare systems to promote independent living.
  • A mixed economy of housing options including Extra Care Housing
  • Shared Lives scheme
  • Aids, Adaptations and equipment.

What are we doing now?

  • We are refreshing the Learning Disabilities (LD) and Mental Health (MH) housing strategy to ensure that future housing is accessible for the MH and LD population.
  • All new builds are being designed with future planning in mind.
  • Promotion of personal budgets to offer increased choice and control.
  • Expansion of Re-ablement services, including the use of technology to promote independent living skills and ensure people are safe.
  • Development of Extra Care Housing schemes for people with LD and MH problems.
  • Applying for accreditation by National Autistic Society to enable us to provide better support for people with Autism within their own homes.
  • Programme of resettlement for people living out of borough.

What needs to happen next, and by whom?

  • Continue to prioritise and expand the programmes above to meet the increasing demographics within these client groups.
  • Continue to engage and involve clients groups in the commissioning and delivery of services.
  • The Health and Well-being Board should drive and govern programmes of joint commissioning and integrated service delivery for Health and Social care Services.

2.7 Proportion of adults with learning disabilities, mental ill health or long term conditions in employment

Outcomes framework:

  • Adult Social Care 1F: Proportion of adults in contact with secondary mental health services in paid employment.
  • NHS 2.5: Employment of people with mental illness
  • Adult Social Care 1E: Proportion of adults with learning disabilities in paid employment
  • Public Health 1.8: Employment for those with a long term condition (LTC) including those with a learning difficulty/disability or mental illness
  • NHS 2.2 Employment of people with LTC

Implications for the population’s health and well-being:

The measure is intended to enhance the quality of life for people with care and support needs, by ensuring people are able to find employment when they want, maintain a family and social life and contribute to community life, and avoid loneliness, isolation, and risk of social exclusion and discrimination. Employment outcomes demonstrate quality of life and are indicative that social care support is personalised. Employment is a wider determinant of health and social inequalities.

The measure is focussed on “paid” employment, voluntary work is excluded.

At risk or vulnerable groups:

  • Adults aged 18 – 69 who are receiving secondary mental health services and who are on the Care Programme Approach (CPA). However, this definition may potentially exclude individuals who have been supported to maintain paid employment but are not on the CPA. Therefore the definition of this indicator is subject to review and development work with a view to agreeing a revised definition for “in contact with secondary mental health services”.
  • Adults with a primary client group of Learning Disability who have been assessed or reviewed by the council during the year, irrespective of whether or not they receive a service, or who should have been reviewed but were not.
  • Those with long term conditions (LTC) (see more information about LTC in LTC indicator reviews).

Benchmarking:

In Tameside, the proportion of local people in employment has fallen for those with mental ill-health with performance lower than the regional and national averages, (4.9% and 6.6% respectively). Conversely, the proportion has increased for those with learning disabilities and is now higher than regional (9.6%) and national averages (9.5%).

Figure 8: Proportion of adults in contact with secondary mental health services in paid employment.

Graph showing adults in contact with mental health services

Source: Pennine Mental Health Trust

Figure 9: Proportion of adults with learning disabilities in paid employment 2008/09 to 2010/11

Graph showing adults iwith learning disabilities

Source: Pennine Mental Health Trust

Policy context:

What interventions work?

  • Routes to Work pre-employment training
  • Strong links with local employers and job centres
  • Considerable investment in supporting individuals into employment

What are we doing now?

The Mental Health Local Implementation group have met and produced an action plan in relation to “No Health without Mental Health” to inform future commissioning decisions. Progress to date includes:

  • Joint pilot with probation services to increase the access to psychological therapies for offenders and promote joint working.
  • Increasing Access to Psychological Therapy (IAPT) - for the last 3 quarters the recovery rate has been over 50%. Targets include getting people back into work.
  • Plans in place to increase the uptake of primary care mental health services for older people and people from Black and Minority Ethnic (BME) groups. The range of referrers has been increased from GP’s to a wider number of professionals, e.g. health visitors/district nurses, and the range of therapies has increased to include Interpersonal Psychotherapy (IPT), Eye Movement Desensitization and Reprocessing (EMDR) and mindfulness.
  • Everyone on the Care Programme Approach (CPA) has an annual health check.
  • Access to psychological services: The NHS Clinical Commissioning Group (CCG) supported Pennine Care MH Trust to submit a successful bid to join the Children and Young People’s IAPT. A number of local staff are being trained and service redesign will follow.
  • Development of an employment pathway for all client groups which includes a qualification framework for students to assist in securing paid/unpaid employment.
  • Link with the Work Programme to support long term unemployment into work.

What needs to happen next, and by whom?

  • Development of an older people’s pathway
  • Development of an offender health pathway
  • A single point of entry will be developed from April 2012 which encompasses primary and secondary care and will streamline access to services
  • Develop further links with the Health Improvement team in relation to the BME networks to increase the uptake of psychological services for this minority group.
  • Increase the range of therapies on offer to include Cognitive Analytical Therapy (CAT) therapy.
  • A general psychological therapy pathway will be developed.
  • The Local Enhanced Service (LES) component of the Primary care Mental Health service will be refreshed and re-launched.
  • Continue with the pilot to increase access to psychological therapies for offenders.
  • Evaluate effectiveness of pathways into early intervention for Looked After Children
  • Implementation of the employment project plan which includes good practice interventions that work and is led by Adults Service Management Team
  • .
  • The Local Authority will redesign the employment pathway for people with mental health, learning disabilities, autism and physical disabilities to ensure that they have access to pre employment training/support/qualifications to help access employment. This will be overseen by Routes to Work support in employment scheme.

2.8 Enhancing quality of life for people with dementia

Outcomes framework:

Public Health 4.16; NHS 2.6.

Implication for the population’s health and well-being:

Dementia may result in:

  • Premature death, life expectancy is usually between 5 – 10 years post diagnosis
  • Loss of independent living (resulting in the need for costly care package)
  • Loss of physical ability to keep mobile increases social isolation and increases ill health
  • A greater risk of mental health ill health; particularly depression
  • Burden on carers that can manifest in decline in the carer’s mental and/or physical well-being.

Programme spend:

Care home placement of people with dementia costs the UK £7billion per year with two thirds paid by social services and one third by older people and their families themselves. The National Audit Office has estimated the excess cost to be more than £6 million per year in an average general hospital.

At risk or vulnerable groups:

  • Older people (65 and over) - The proportion of people with dementia doubles for every 5 year age group, with one third of people over 95 having dementia
  • People with learning disabilities
  • People with a history of significant alcohol misuse

Benchmarking:

The Office of National Statistics (ONS) estimated that in 2006 the population of Tameside was 214,400 and projected a rise to 230,000 by 2019. It is estimated that in 2008 there were 2,384 (763 males and 1,621 females) over the age of 65 with dementia in Tameside. By the year 2025 this total is expected to rise by 40.6% to reach 3,351 people. Males over 65 with dementia are projected to rise by 60.3% to reach 1,223 and females by 31.3% to reach 2,128 in 2025.

The figure below shows the percentage of dementia patients that received a review of their care within the preceding 15 months to March 2011. Within NHS Tameside and Glossop 80.5% of dementia patients received a care review within this 15 month period, which is marginally higher than that of the North-West and England averages.

Figure 10: Percentage of dementia patients whose care has been reviewed in the previous 15 months, 2010/11

Graph showing dementia

Source: NHS Information Centre 2012

Policy context:

The National Dementia Strategy was published in 2009 and has been adapted locally to reflect to the needs and priorities for the population of Tameside and Glossop.

The Operating Framework for the NHS in England 2012/13: For the first time to support local accountability in 2011/12, PCTs were asked to work with their local authorities and publish dementia plans which set out locally the progress they were making on the National Dementia Strategy. That requirement will also apply for 2012/13 with the additional expectation that any local or national CQUIN goals should be included.

In February 2012 David Cameron launched the PM’s Challenge on Dementia, a high profile pledge to improve, awareness of dementia, quality of care for patients with dementia and research into the condition over the next three years.

What interventions work?

  • Raising awareness and understanding of dementia
  • Early diagnosis and a range of support mechanisms for patients and their carers to live well with dementia
  • Good quality care for people with dementia with acute illness in a dementia friendly environment

What are we doing now?

NHS Tameside and Glossop is committed to working in partnership with both Tameside Metropolitan Borough Council (TMBC) and Derbyshire County Council (DCC) to raise standards of care for people with dementia, and their carers. A local strategy, reflecting the domains of the National Dementia Strategy, has been developed and a challenging Action Plan agreed with key stakeholders. A multi professional – multi agency Local Implementation Group (LIG) was established in 2011/12 and will oversee the implementation of six key work streams focusing on the following national dementia priorities:

  • Good quality early diagnosis and intervention for all and easy access to care, support and advice following diagnosis
  • Improved quality of care for people with dementia during episodes of acute illness, including in General Hospitals
  • Living well with Dementia in Care Homes
  • Good quality End of Life services for people with dementia
  • An informed and effective workforce for people with dementia
  • Effective use of anti psychotic drugs

Partnership working and engagement is critical to the success of this programme. Constituent members of the group include, Tameside MBC, Derbyshire County Council/High Peak Borough Council, Pennine Care Mental Health Foundation Trust, Tameside Hospitals Foundation Trust (THFT), The Alzheimer’s Society, Age UK and Tameside and Glossop Community Healthcare (T&GCH).

In 2011/12 a Commissioning for quality and Innovation (CQUIN) indicator was developed with Pennine Care to develop personal profiles for all patients admitted to Older Peoples’ inpatients wards with dementia and to audit anti-psychotic prescribing.

What needs to happen next, and by whom?

NHS Tameside and Glossop will continue to engage with partners to pursue the national dementia agenda through its local strategy and the use of existing and emerging national guidance such as the Department of Health Commissioning Pack, NICE Quality Standards, SCIE guidelines, and the Department of Health Quality Outcomes Framework for people with Dementia, outlined in the local action plan which is jointly owned by Tameside MBC, Derbyshire CC and NHS Tameside and Glossop.

Plans for 2012-13 include:

  • Response to national audits
  • Membership of Greater Manchester (GM) Lead Dementia Commissioners forum
  • Demonstrator site within GM in 2012/13 to showcase an innovative approach to End of Life Care (EoL Care) for people with dementia
  • Local providers have signed up to participate in the AQuA Dementia Challenge throughout 2012/13 which will focus on improving the care of people with dementia in General Hospitals
  • Compliance with the NICE Quality Standard for all provider organisations

Using the leverage of the acute care CQUINs we will:

  • Improve diagnosis rates through screening and onward referral ,
  • Support Tameside Hospital Foundation Trust (THFT) to improve the experience of patients with dementia and their carers through better identification of their condition and needs on admission,
  • Support THFT to reduce Length of Stay (LOS) for patients with dementia and reduce readmission rates for patients with dementia:
  • Support THFT to reduce Anti Psychotic prescribing rates in secondary care where appropriate,
  • Work with THFT and partners to develop pathways for patients with dementia,
  • Support THFT to deliver care in a dementia friendly environment and continue to comply with mixed sexed accommodation mandates.
  • Develop proxy measures to monitor our progress against reducing non elective inpatient admissions for patients with dementia
  • Ensure we have responsive community alternatives to admission. This will include working with General Practitioners, Care Homes and community based staff to reduce the variation in confidence and competence to deal with patients with dementia through training and awareness raising
  • Primary Care will be enrolled to support the drive to improve diagnosis rates against expected prevalence of dementia locally (as per the NHS Atlas of Variation) and we will support patients and their carers by providing good quality information and signposting to support following diagnosis
  • We will commit to review Memory Assessment Services in 2012/13 to support better access

NHS Tameside and Glossop has been proactive in working with providers to reduce anti psychotic prescribing and will continue to look to improve with the support of the NHS Institute’s ‘Call to Action’.

2.9 Sickness absence rate

Outcomes framework:

Public Health 1.9

Implications for the population’s health and well-being:

It is well recognised that a healthy workforce is a productive workforce. This has wider benefits for the community and the local and national economy. As good health is good business, it is vital for employers to embrace this during the current economically uncertain environment.

Every year 140 million working days are lost to sickness absence, much of which ends in a swift return to work. However, a significant number of absences last longer than they need to and each year over 300,000 people fall out of work onto health-related state benefits. Before reaching this point, many have been long-term sick off work. They have become increasingly distanced from the labour market and suffer from the reduced economic, social and health status that come with being out of work. We know that the longer someone is off sick or out of work, the harder it is to get back to work, and worklessness comes at great personal and financial cost. Much absence and inactivity is due to comparatively mild illness which is compatible with work – and may indeed be improved by work. Work sickness absence is a significant cost to the UK economy in terms or working days lost.

The most common reason given for sickness in 2011 was minor illnesses such as coughs, colds and flu. This type of illness tends to have short durations and the greatest number of days lost were actually due to musculoskeletal problems. This accounted for just over a quarter of all days lost or 35 million days. Around 27.4 million days were lost due to minor illnesses and 13.3 million days were lost to stress, depression and anxiety.

At risk or vulnerable groups:

  • Routine and manual workers
  • Health and social care workers
  • Public sector workers
  • Workers with long term conditions
  • Women and older workers
  • Largest workforces (500+) report highest sickness levels

Benchmarking:

There is no local data for this indicator. The number of days lost through national sickness absences remained constant through the 1990’s until 2003 and has fallen since then. Over the same period, the percentage of people having a spell of sickness and hence the percentage of working hours lost has been falling. The reason the number of days lost remained constant between 1993 and 2003, when the percentage of hours lost were falling over this period, was because there were more people entering employment during this time.

Looking at the number of days lost per worker, in 1993, around 7.2 days were lost (or around a week and a half based on a 5 day week). By 2011 this had fallen to less than a week (or 4.5 days). Women have consistently higher sickness absence rates than men but both sexes have seen a fall over the past 20 years. People are generally more likely to develop health problems at older ages and sickness absence rates also increase with age.

The percentage of hours lost to sickness in the private sector is lower than in the public sector, 1.6 per cent and 2.6 per cent respectively. According to data produced by the Health and Safety Executive, the risk of work-related stress, depression and anxiety is highest in the public sector, with those working in health and social work are almost twice as likely as the average worker to suffer.

Figure 11: Sickness absence rates, annual averages 2011, UK.

Graph showing sickness absence rates

Source: Labour Force Survey - Office for National Statistics

Figure 12: Percentage working hours lost to sickness absence

Graph showing sickness absence rates

Source: Labour Force Survey - Office for National Statistics

Policy context:

What interventions work?

  • Healthy workforce policies and standards
  • Training for employers on the importance of workplace health
  • Mental health/preventative stress management interventions e.g. massage, reflexology, yoga, or stress management groups
  • Supportive interventions focusing on personal support, training in individual coping skills on health and work outcomes
  • Alcohol/smoking - employee assistance programmes, referral to cessation services, and smoke-free workplaces
  • Diet - programmes aimed at improving nutrition behaviour e.g. in-house weight watchers/ healthy eating programmes
  • Physical activity e.g. lunch time/ after work exercise classes and shower facilities or having a bike rack to encourage cycling to the place of work
  • Screening - providing in-house screening services or signposting staff to NHS Health Checks, Chlamydia Screening, as well as raising awareness of screening programmes (e.g. cervical screening, breast screening etc.) will encourage the uptake of screening
  • Promotion of social marketing campaigns including national campaigns such as National No Smoking day, World Health Day, World Asthma Day, World Mental Health Day etc
  • Access to local high quality accredited occupational health services

What are we doing now?

  • The Health and Well-being Board, through the Joint Strategic Needs Assessment (JSNA) and emerging Health and Well-being Strategy stress the importance of the wider determinants of health as a key priority and that ‘work is good for your health’.
  • Working with Manchester New Economy to implement the ‘Good Work: Good Health’ Charter in Tameside
  • Developing training ‘Well-being Champions’ in the workplace
  • The Council and NHS have jointly appointed a dedicated Workplace Health Lead for the Borough to promote health improvement
  • The Mindful Employer initiative has been commissioned for employers and employees of Tameside workplaces
  • The Five Ways 2 Well-being campaign
  • Community model for delivering NHS Health Checks developed to support the ongoing GP led service, targeting people in full time work particularly those in routine and manual occupations
  • Health Improvement Services deliver interventions in the workplace setting and link into the Work Programme
  • Targeted campaigns for smoking cessation

What needs to happen next, and by whom?

  • Continue to prioritise and deliver the actions above, driving the work through the Tameside Economic Strategy and Prosperous Tameside Board.
  • Local organisations, whether public or private sector, must put staff health and well-being at the heart of their work.
  • Workplace health and well-being initiatives need to be backed with strong leadership and visible support at a senior level.
  • Continue to promote training and awareness in health and well-being as an integral part of management training and leadership development.
  • Build the capacity and capability of management and support at all levels to improve the health and well-being of staff.
  • People should be encouraged to improve their own health through education, encouragement and support from local Health Improvement Services.

2.10 Killed or seriously injured casualties on England’s roads

Outcomes framework:

Public Health 1.10

Implications for the population’s health and well-being:

In 2011, over 7,100 people were injured in accidents on Greater Manchester’s roads 746 of whom were either killed or seriously injured (KSI). Within Tameside during 2011 there were 57 KSI’s.

Road accidents impose a wide range of human and financial costs on people and organisations, estimated to be £225 million in Greater Manchester in 2009. Therefore, reducing the number and severity of accidents has significant human and financial benefits and Greater Manchester’s approach to reducing road casualties is set out within the third Greater Manchester Local Transport Plan (GMLTP3).

Programme spend:

Within Greater Manchester transport schemes, including road safety, are funded through Department for Transport monies allocated to Transport for Greater Manchester (TfGM). Road safety is also improved by the effective maintenance of roads, footpaths, structures and highway equipment and improvements to public transport.

Table 4: Tameside’s annual capital funding is set out within the Highways Capital Programme which is set below for the financial years 2011/12 to 2014/15.

Budget (£000s)

2011/12 Provisional Outturn

2012/13 Provisional Budget

2013/14 Budget

2014/15 Budget

Integrated Transport Block – TfGM funding (Local safety traffic management and other schemes)

0

0

0

475

Prudential Borrowing – Tameside MBC funding (Local safety traffic management and other scheme)

647

476

360

0

Maintenance – TfGM funding (Structures & Carriageway maintenance and Street Lighting)

2,103

2,579

1,820

1,867

Other – Non specific funding – Tameside MBC and other funding(including Street Lighting, Major schemes and Developers contributions)

11,276

2,556

 

 

Total

13,377

5,611

 

 

Source: Tameside MBC 2012

In addition, road safety and maintenance measures are also funded through the Council’s revenue budgets.

At risk or vulnerable groups:

Research has shown that vulnerable groups (in terms of their accident risk) include:

  • children and older people (particularly as pedestrians);
  • pedestrians;
  • cyclists;
  • motorcyclists; and
  • young males are also relatively vulnerable as drivers.

There is also a strong link between deprivation and road accidents, children from social class V (unskilled) are five times more likely to be involved in a fatal road accident than those from social class I (professional).

Benchmarking:

As part of GMLTP3, 16 Key Performance Indicators (KPIs) have been developed, grouped into 4 categories based upon the GMLTP3 objectives, including:

  • KPI 10 – Total KSI on Roads: Number of people killed or seriously injured on local (non – motorway) roads.

Table 5: Illustration of KSI casualty trends and forecast casualty reductions for both Greater Manchester and Tameside, for the period up to 2020.

KSI Casualty Trend 2000 – September 2011 and Projection to 2020

Year

KSI Casualty Totals

Index

Actual

Projection

Actual

Projection

GM

TMBC

GM

TMBC

GM

TMBC

GM

TMBC

2005-2009 Baseline
916
64
 
 
100
100
 
 
2010
743
58
810
56
81
91
88
88
2011
746
57
777
54
81
89
85
85
2012
 
 
746
52
 
 
81
81
2013
 
 
716
50
 
 
78
78
2014
 
 
687
48
 
 
75
75
2015
 
 
660
46
 
 
72
72
2016
 
 
634
44
 
 
69
69
2017
 
 
608
42
 
 
66
66
2018
 
 
584
41
 
 
64
64
2019
 
 
560
39
 
 
61
61
2020
 
 
551
38
 
 
60
60

Source: Tameside MBC 2012

  • KPI 11 – Casualty Rates – Head of Population: Number of people killed or seriously injured on Greater Manchester roads/Greater Manchester resident population.

The overall Greater Manchester casualty rate/resident population trend from 2010 to 2016 is for a forecast reduction of 18% and a 45% reduction to 2020 (based on the 2005-09 annual average baseline of 375 casualties/million population).

Policy context:

What interventions work?

The types of interventions that have been successful to date include:-

  • Local safety schemes, including 20 mph zones
  • Road safety training in schools, i.e. cycle training
  • Safety camera operation and policing activities
  • Education and training
  • Publicity information and safety campaigns
  • Other highway works such as carriageway maintenance and street lighting works

What are we doing now?

A local safety scheme programme for 2011/12 has been identified for highway locations/junctions which have poor accident records. In addition, traffic management, maintenance and, street lighting programmes have been identified for 2012/13 which will also contribute to accident reduction.

At the wider Greater Manchester level the Greater Manchester Casualty Reduction Partnership has continued to target casualty reduction activities at high risk behaviours and locations and in support of the most vulnerable people.

What needs to happen next, and by whom?

The low level of casualties in Greater Manchester makes it harder to achieve further reductions. However, there are still many highway locations where the potential for accidents is still high, and the Council will continue to implement local safety, traffic management schemes, maintenance and, street lighting programmes to help reduce the number of accidents.

In order to continue the recent positive accident trend, the TfGM Joint Road Safety Group proposes to target casualty reduction activities for example introduction of 20mph zones, at high risk behaviours and locations and in support of the most vulnerable people, through the Greater Manchester Casualty Reduction Partnership.

2.11 Violent Crime, including domestic violence and sexual violence

Outcomes framework:

Public Health 1.11 and 1.12

Implications for the population’s health and well-being:

Domestic Abuse is linked to:

  • alcohol and increased risk due to alcohol use
  • A&E attendances
  • Maternity Services due to increased risk of domestic violence during pregnancy
  • Increased risk due to substance misuse (e.g. steroid rage)

Violence is linked to:

  • Night Time Economy and alcohol related crime
  • Forced Marriage
  • Honour Based Violence
  • Female Genital Mutilation –a clear health risk for women and girls and also a crime

Programme spend:

£100,000 per annum for IDAAS (adult drugs & crime and disorder funding)

At risk or vulnerable groups:

Women, young males and females, same sex relationships

Benchmarking:

There are no local statistics around Domestic Abuse (DA) on iQuanta (Home office database for police performance) other than the number of incidents for the Force as a whole. Comparison to other areas is not possible.

Violent Crime: To fall in line with HMIC rationale there are two indicators ‘Violence with Injury’ and ‘Violence without Injury’.

Table 6: Violent Crime rates for Tameside (with and without injury)

Type of Crime

Rank

Rate

Group Average

Violent Crime with Injury

10/15

7.32 / 1,000 residents

6.8 / 1,000 residents

Violent Crime without Injury

13/15

6.62 / 1,000 residents

5.8 / 1,000 residents

Source: Tameside MBC, 2012

Table 7: Sexual Crime rates for Tameside.

Type of Crime

Rank

Rate

Group Average

Source:

Rape

8/15

0.32 / 1,000 residents

0.3 / 1,000 residents

iQuanta Charts\rape.pdf

Other Sexual Offences

9/15

0.72 / 1,000 residents

0.7 / 1,000 residents

iQuanta Charts\Sexual Offences.pdf

Source: Tameside MBC, 2012

Policy context:

  • Government launch of 'Ending gangs/violence report’- key themes are support, prevention, punishment, complex families
  • Development of a local violent crime strategy- delivery plan with 4 themes; domestic abuse, sexual violence, night time economy and young people
  • Greater Manchester Policing Priority for 2012-2013 includes ‘Help keep people safe: We will work with our partners to reduce and prevent crime, pursue the most persistent offenders and reduce the harm they cause.’

What are we doing now?

  • Greater Manchester Police (GMP) currently piloting domestic violence protection orders
  • Current interventions- IDVA (Independent Domestic Violence Advisors) service, Sanctuary housing
  • New Statutory duty of domestic homicide reviews
  • GMP centralised rape unit in 2012
  • Development of a local top ten premises scheme
  • New strategy- look at what are the gaps locally and what can be planned for the next 12 months that is cost free?

What needs to happen next, and by whom?

  • Investigate potential to commission Independent Sexual Violence Advocacy Service (ISVA) locally.
  • Realignment of counselling services for both domestic violence and sexual violence victims.
  • Support available for male domestic abuse victims.
  • Holistic approach to identify and manage victims across all organisations with access to support services
  • Improve data collection particularly in A&E

2.12 Reducing re-offending

Outcomes framework:

Public Health 1.13

Implications for the population’s health and well-being:

High rates of reoffending are a particular problem for short-sentence prisoners, many of whom have a prolific offending history. Nationally, around 61% of prisoners released from custody after less than 12 months are reconvicted within a year. This compares with a reconviction rate of 49% for the total population released from custody (Ministry of Justice, 2010).

Many offenders have poor life and coping skills, often experience long term disengagement from services, and have histories of poor relationships with those who might help them. This group can struggle to access appropriate care and all too often have to reach crisis point to do so. They are also more likely to have mental health problems, drug and alcohol problems, smoke, be HIV positive, have tooth decay, long standing illness or disability, and not be registered with a GP.

Turning round the lives of offenders should have a significant impact on the overall levels of dependency and demand for services, as offenders consume a disproportionately high volume of expensive, targeted services, and are much less likely to contribute productively to the economy. Reducing levels of offending and reoffending should enable a range of agencies to make cashable savings, particularly if greater reductions can be made. In addition, the reductions on crime levels and victimisation are also part of the rationale.

In addition, children of offenders typically experience a great many risk factors besides their mothers' incarceration, including poverty, drug and alcohol problems in their families, community violence, and multiple changes in caregivers. Children of incarcerated mothers experience internalizing (fear, withdrawal, depression, emotional disturbance) and externalizing (anger, fighting, stealing, substance abuse) problems, as well as heightened rates of school failure and eventual criminal activity and incarceration.

At risk or vulnerable groups:

Offenders, including those on probation and their families represent one of the most socially excluded groups in our society, with considerable and complex physical and mental health needs compared to the general population, particularly young offenders. In a consultation document entitled “Improving Health, Supporting Justice” Ivan Lewis, the then Parliamentary under Secretary for Care Services, stated:

“Many offenders, particularly those with a history of persistent re-offending have health and social care needs which may be causally linked to their offending behaviour."

Baroness Jean Corston's report called for a greater focus on women in the criminal justice system and highlighted the need to take a radical new approach to address the complex and multiple needs of women who offend and those at risk of offending. Many women in the criminal justice system suffer poor physical and mental health or substance abuse, or both. Large numbers have endured violent or sexual abuse or had chaotic childhoods. Many have been in care.

The poor experience of people with a Learning Disability in the Criminal Justice and the Health systems has been well documented. There is a much larger group of offenders and potential offenders that have difficulty in learning – but no diagnosis as having a Learning Disability.

Benchmarking:

Currently, it is not possible to accurately ascertain a true rate of reoffending in Greater Manchester due to existing recording processes, but the overarching crime has dropped by almost half during the past 10 years, and between April 2011 and March 2012 there has been a 9% drop in total crime.

Locally, amongst adult offenders supervised by probation, there has been:

  • Reduction of reconviction rates from 8% to 5%
  • Reduction of reconviction rates for prolific and priority offenders (PPOs) from 20% to 15%

Nevertheless, the crime rate for Greater Manchester per 1000 population (Jan 2010-December 2011) remains higher than the England and Wales average: 82.5 compared to 73.4.

Policy context and what interventions work:

The Social Exclusion Unit Report “Reducing Re-offending by Ex-prisoners” identified Physical and Mental Health, and Drugs and Alcohol as two of the 7 pathways to reducing re-offending. The recently published Bradley Report concerning people with mental health problems or learning disabilities in the Criminal Justice system, further highlighted the need for criminal justice and health care systems to work in partnership.

Greater Manchester Probation identified the following Health specific priorities in April 2011:

  • Improve access for offenders to mainstream health services
  • Improve the commissioning and delivery of services related to alcohol, drugs and mental health
  • Improved joint management of health across the pathway

High levels of health needs among offenders are recognized in the Government’s Delivery Plan, Improving Health, Supporting Justice and the report Reducing Reoffending by Ex-Prisoners emphasises the extent to which people with chaotic lives and those from deprived backgrounds fall into crime as a consequence of unemployment and a lack of skills and qualifications. The National Offender Management Service’s (NOMS’s) National Reducing Re-offending Action Plan (Home Office, 2004) identifies improving health as one pathway out of reoffending.

What are we doing now?

The NHS Clinical Commissioning Group (CCG) and Tameside MBC is a pathfinder for the Youth Justice Liaison and Diversion project. This went live in January 2012.

Health Trainer pilot - 3 month small scale pilot to improve offender health and well-well-being against key indicators. An early evaluation of the Rochdale, Bury and Oldham service demonstrated that the service was effective in reducing alcohol intake and smoking amongst those on the caseload. Individual case studies described offenders who had increased levels of physical activity, reduced alcohol intake and raised self esteem as a direct result of the Probation Health Trainer interventions. Furthermore, some clients were shown to have entered employment after these improvements in health.

What needs to happen next, and by whom?

  • Acknowledgement that targeting improvement at this group will have a significant impact on overall health improvement and will bring savings to the NHS through prevention.
  • Development of offender health trainer services.
  • Development of a multi-disciplinary Mental Health Diversion service.
  • Promote the integration of health and social care services with criminal justice services, education and housing. This will help join up services around individuals’ needs and improve health and well-being outcomes for the local population.
  • Probation representation on the new Health and Well-being Boards.
  • Engage with the Police and Crime Commissioner. PCCs will have a remit to cut crime and anti-social behaviour and will have commissioning powers and funding to enable them to do this with partners. They will need to work collaboratively with other local leaders – including establishing strong links with Health and Well-being Boards, NHS Clinical Commissioning Groups (CCGs) and local authorities – to develop common causes with partners on a range of crime and health issues and achieve the most effective community safety and criminal justice outcomes for communities.
  • Local areas should ensure commissioning for drugs and alcohol services has the right representation, accountability and engagement to deliver on offender health.
  • Continue with the pilot to increase access to psychological therapies (IAPT) for offenders.
  • NHS Commissioning Boards will become responsible for managing the health of detained people, including for example, custody suites, immigration centres, probation etc, They will need to work collaboratively across agencies and with local primary care services to ensure offenders are able to effectively access the health care they need.

2.13 The Percentage of the population affected by noise

Outcomes framework:

Public Health 1.14

Implications for the population’s health and well-being:

The significance of noise pollution has been recognised for some time. Noise can disrupt human activities and make the environment unpleasant for large numbers of people. The effect of noise on human health both physically and psychologically is undoubted. Noise damages hearing and is the greatest single cause of preventable sensorineural loss in the world. Noise, unlike other forms of pollution, has prompted members of the public to commit acts of violence against each other, against enforcement officers and has, unfortunately, also led to the suicide of those unwillingly exposed to it.

At risk or vulnerable groups:

No data is available to correlate environmental noise with socio-economic status as we do not have an overlay of socio-economic and noise maps. However, inspection of the noise map for Tameside would suggests that areas of higher noise levels coincide with areas of socio-economic need.

Benchmarking:

The Environmental Noise Directive (END) requires Member States to develop and adopt action plans 'designed to manage noise issues and effects, including noise reduction if necessary'. The action plans will be developed following a consultation process involving Local Authorities, other Government Departments and other interested bodies and members of the general public.

The END has set out requirements for action plans. These include:

  • a description of the agglomeration, the major roads, the major railways or major airports and other noise sources being taken into account in the plan
  • a summary of the results of the noise mapping
  • an evaluation of the estimated number of people exposed to noise, and identification of problems that need to be improved
  • any noise reduction measures already in force and any projects in preparation
  • actions to be taken in the next five years
  • a long term strategy

It is envisaged that action plans will identify relevant measures (both existing and new) to manage environmental noise from the sources mapped. Such measures could range from over-arching national strategies which take noise into account, to local targeted measures designed primarily to address a specific noise issue. The plans will also include some form of cost-benefit assessment of measures, to ensure their sustainability, and estimates of the reduction of the number of people affected by excessive noise as a result of the proposed measures. The END makes specific reference to paying attention to 'quiet areas' in agglomerations that may be discernible from the noise maps, and requires us to identify and where possible protect quiet areas. The Department for Environment, Food and Rural Affairs (Defra) commissioned a research project to assist in the process of defining quiet areas in urban areas.

Policy context:

The World Health Organisation reports that in the European Union countries about 40 % of the population are exposed to road traffic noise with an equivalent sound pressure level exceeding 55 dB(A) daytime and 20 % are exposed to levels exceeding 65 dB(A). Taking all exposure to transportation noise together about half of the European Union citizens are estimated to live in zones which do not ensure acoustical comfort to residents. More than 30 % are exposed at night to equivalent sound pressure levels exceeding 55 dB(A) which are disturbing to sleep. Additionally the Environmental Noise (England) Regulations 2006, and are intended to inform the production of noise action plans for large urban areas, major transport sources, and significant industrial sites in England. The aims of the regulations are:

  • the determination of exposure to environmental noise, through noise mapping;
  • provision of information on environmental noise and its effects on the public;
  • adoption of action plans, based upon noise mapping results, which should be designed to manage noise issues and effects, including noise reduction if necessary;
  • preservation by the member states of environmental noise quality where it is good.

Population exposure figures are calculated by firstly statistically assigning census output area data to buildings in the mapped area (rather than precisely determining the number of people living in each building). A count is then made of number of people falling in each noise band calculated. All population exposure figures are rounded to the nearest 100 people, in accordance with the requirements of the END.

What interventions work?

The Association of Greater Manchester Authorities (AGMA) local authorities have agreed joint policies with respect to dealing with neighbourhood noise including response times and standardised responses. Analysis of the response time data and the number of repeat complaints shows that neighbourhood noise complaints are being resolved more quickly with fewer repeat requests for service.

What are we doing now?

Tameside has adopted the AGMA standardised approach to dealing with neighbourhood noise.

What needs to happen next, and who needs to do it?

Noise action plans need to be completed and be built into planning guidance regarding areas for development. Action plans will cover the Greater Manchester conurbation. Local Authorities are to continue to liaise with Defra in respect of local data and in particular quiet area.

2.14 Statutory homelessness

Outcomes framework:

Public Health 1.15

Implications for the population’s health and well-being:

Homelessness is the most extreme form of social exclusion and is a strong indicator of social injustice in any society. Individuals become excluded when various factors prevent or limit their ability and opportunity to participate in mainstream society. It is when individuals are prevented from participating in social, economic, political and cultural life placing them at a disadvantage in terms of life chances.

Preventing homelessness is a priority for housing services. The target for number of Preventions for 2011-2012 is 537.

At risk or vulnerable groups:

Housing need cuts across all of the protected characteristics set out by the Equalities Act 2010. If the council is unable to increase its housing targets this will have a serious impact on a range of vulnerable groups.

Most household growth is actually amongst older person households. Of the anticipated growth of 20,000 households (800 each year) the number of households with a Household Reference Person over 65 is projected to increase by 15,000 (or 600 each year). Older people will increasingly require a wide range of support at home.

Shortage of good quality affordable housing has also impacted on homelessness, leading to increasing numbers of homeless families people having to access temporary accommodation.

Benchmarking:

The North West Regional Spatial Strategy (RSS) set out the housing requirement for Tameside at 750 dwelling units per year net of clearance over the period 2003 to 2021. However, with the exception of 2007/08, Tameside has not met this target.

The result is that at 31st March 2010 Tameside has accumulated a deficit of 1,411 dwellings over the period 2003 to 2010.

Figure 13: Net dwelling completions in Tameside 2003/04 – 2009/10

Graph showing net dwelling completions

Source: Tameside MBC 2012

The Greater Manchester Forecasting Model (GMFM) estimates that the rate of household growth and dwelling stock provision will increase to an average annual household growth of 857 and a dwelling stock increase of 874.

Table 8: Adopted and emerging housing targets in Greater Manchester.

 

GMFM 2006-21 (2006 based)*

CLG 2003-26 (2003 based)

DRAFT RSS 2003-2021

ADOPTED RSS 2003-2021

 

Annual Average Growth

% of GM

Annual Average Growth

% of GM

Annual Average Growth

% of GM

Annual Average Growth

% of GM

Bolton
1329
9.8
957
11.5
510
5.3
578
6.0
Bury
885
6.5
652
7.8
600
6.3
500
5.2
Manchester
4149
3.6
2000
24.0
3500
36.7
3500
36.4
Oldham
820
6.0
435
5.2
400
4.2
289
3.0
Rochdale
927
6.8
696
8.3
400
4.2
400
4.2
Salford
900
6.6
435
5.2
1600
16.8
1600
16.6
Stockport
1110
8.2
565
6.8
450
4.7
450
4.7
Tameside
1060
7.8
696
8.3
750
7.9
750
7.8
Trafford
951
7.0
783
9.4
430
4.5
578
6.0
Wigan
1434
10.6
1130
13.5
900
9.4
978
10.2
Greater Manchester
13,565
100
8,349
100
9,540
100
9,623
100

CLG – Department of Communities and Local Government;

RSS – Regional Spatial Strategies

Source: Association of Greater Manchester Authorities (AGMA) Planning and Housing Commission, 2011.

Policy context:

What interventions work?

  • Communication and engagement with Registered providers and owners of empty homes
  • Front line homelessness prevention activity

What are we doing now?

  • Working with partners both internally and externally to deliver new affordable homes through Registered Providers and the Homes and Communities Agency and additional market stock by encouraging development
  • Developing an empty property strategy to increase supply of and access to affordable homes
  • Working with Housing Association Partners to develop a Social Lettings Agency to increase well managed accommodation in the private rented sector
  • Local Authority Mortgage Scheme (LAMS). The Council is looking to offer a Local Authority Mortgage Scheme in partnership with Sector Treasury Management Services and a lender to provide a mortgage indemnity to the lender so that they can offer 95% mortgages at a competitive interest rate to first time buyers who meet the lender’s borrowing criteria. This scheme is now operating in a number of authorities nationally and is proving very popular and effective in that it creates further housing market moves beyond the first time buyer purchases delivering a broader stimulus to the local market.
  • Homelessness prevention - receiving upstream support e.g. welfare / debt advice, Drugs Intervention Programme

What needs to happen next, and by whom?

Regional Strategies have been removed by the current Government and with the agreed housing targets; the target in the Unitary Development Plan was 370 dwelling units per year net of clearance for the same period. A new target now needs to be set.

Tameside MBC needs to -

  • Adopt empty homes strategy
  • Identify a pipeline of empty homes
  • Adopt core strategy and Local Development Framework
  • Access to appropriate housing for people who are homeless, particular focus on children and families

2.15 Utilisation of green space for exercise/health reasons

Outcomes framework:

Public Health 1.16

Implications for the population’s health and well-being:

For the purposes of this paper, green space is defined as the green open spaces in and around towns, including parks and the wider countryside. Access to good-quality and well maintained green spaces promote physical activity, positive mental well-being and healthy childhood development. Ninety one per cent of people report using parks and countryside to some extent. In England, 42 per cent of people use these spaces at least once a week.

The value of green space for exercise is unquestionable. Good quality spaces will encourage people to make short journeys on foot or by bike. Regular physical activity contributes to the prevention and management of over 20 conditions including coronary heart disease, diabetes, certain types of cancer and obesity. For example, strokes cost the NHS £2.8 billion a year and physical activity reduces the risk of having a stroke by a third.

Access to green space positively impacts on mental health. Responses to nature have a calming and restorative effect helping to improve mental well-being. Moderate activity in a green environment can be as successful at treating depression as medication.

Children with access to safe green space are more likely to be physically active and less likely to be overweight. Outdoor play encourages healthy brain development and promotion of healthy well being through adulthood.

At risk or vulnerable groups:

People from the most deprived areas are much more likely to visit urban destinations and places closer to home with 46% of visits (DE social grades) being within one mile of their starting point. This is a significantly larger proportion than recorded amongst the more affluent AB social grades (38 %).

Respondents from Black and Minority Ethnic (BME) communities were twice as likely to visit green space within two miles of their starting point compared to respondents from white communities.

Benchmarking:

It is estimated that between March 2010 and February 2011, the 41.7 million adult residents in England took a total of 2.49 billion visits to the natural environment. Just over half of these visits (53 per cent or 1.31 billion) were to places in the countryside and just over a third (37 per cent or 0.92 billion) were taken to green spaces within a town or city.

Across England, the use of green spaces for exercise or health reasons was given as the main reason for the visit by 36% of people surveyed, while in Greater Manchester the figure was 31%.

Figure 14: Percentage of people using green space for exercise/health reasons (England and Greater Manchester)

Graph showing use of green space

Source: Tameside MBC, 2012

Figure 15: Percentage of people’s reasons for not using green space (England and Greater Manchester)

Graph showing reasons for not using green space

Source: Tameside MBC, 2012

Policy context:

What interventions work?

  • Accessibility to good, well managed green space close to where people live.
  • British Trust for Conservation Volunteers (BTCV) Green Gym
  • Activities led by volunteers/local community as part of locally led initiatives.
  • Walking for Health initiative
  • Initiatives and activities that involve whole intergenerational family groups.

What are we doing now?

  • Provision of network of freely accessible parks, countryside and green spaces for informal grass root sports/fitness/well-being activities.
  • Annual countryside events and activities programme.
  • Opportunities for active countryside volunteering.
  • Stamford Park restoration scheme
  • Supporting groups/volunteers wishing to use parks and countryside sites.
  • Promotion of parks and countryside to targeted underrepresented groups.
  • Provision of opportunities for exercise such as allotments, play areas, football pitches, bowling greens, outdoor adult gyms.

What do we need to do now?

  • Development of an effective mechanism to link GP referrals to existing Greenspace health improvement opportunities such as Wild Work Outs, events and activities programme, volunteering opportunities and park activities.
  • Identify and secure further investment in the Parks, Countryside and Green spaces close to where people live.
  • Development of the ‘Green pathways’ project, linking Parks and Countryside sites through investment in footpaths, bridleways and cycle paths.
  • Work more closely with planning to deliver health and well-being benefits from every development.
  • Ensure that the value of green space is represented on health and well being boards.
  • Further promotion of parks and countryside to targeted groups such as those with heart conditions, older people and Black and Minority Ethnic (BME) groups.

2.16 Fuel poverty and Excess winter deaths

Outcomes framework:

Public Health 1.17 and 4.15

Implications for the population’s health and well-being:

Fuel Poverty is currently defined as a household who has to spend more than 10% of their income to adequately heat their home. The main drivers for this are low income, poor household energy efficiency and energy prices. Due to rising energy prices in recent years an increasing number of households are falling into fuel poverty.

Living in poorly heated housing is associated with increased morbidity and mortality. For example, living in cold housing has shown to be associated with respiratory and cardiovascular diseases, which are also the main causes of excess winter deaths. In England and Wales there are approximately 26,000 excess winter deaths every year. Excess Winter Deaths (EWD) can be a good indicator of the impact of fuel poverty and a conservative estimate of the number of excess winter deaths directly caused by fuel poverty is 10% which nationally equates to over 2,700 people per year.

Programme spend:

This can be variable, depending on the opportunities available at the time. A proportion of external funding is secured from sources such as the Department of Health and the National Energy Action (NEA) on a bespoke basis. There have also been a number of recent capital schemes such as the Domestic Retrofit Programme which has been offering free basic measures (insulation) to private households and a Boiler Scrappage Scheme run for vulnerable residents with low incomes.

The bulk of the consistent spend is allocated to staffing as there is a dedicated officer working in support of affordable warmth initiatives.

Table 9 Approximate spend on all initiatives and work related to reducing fuel poverty throughout 2011/12.

Program / Resource

Funding from:

2011/12 Spend

Affordable Warmth Officer
TMBC Revenue (Env. Services)
Grade H (Approx 0.5-0.7 FTE)
Boiler Scrappage Scheme
TMBC Housing Capital
£250,000
Domestic Retrofit Programme
TMBC Housing Capital
£158,000
Warm Homes Health People
Department of Health
£83,000
AWARM
TMBC Health & Well-being
£6,000
Marketing
TMBC Health & Well-being
£5,000
Warm Homes Campaign
NEA
£500
Total
 
Approx £521,000

Source: Tameside MBC 2012

At risk and vulnerable groups:

This indicator mainly relates to the over-60’s category of vulnerable groups affected by fuel poverty. It is also linked to people with existing conditions such as circulatory or respiratory diseases; people aged over 65 years, and particularly those aged over 85 years; people living on low incomes; people living in fuel poverty.

Benchmarking:

The number of households living in fuel poverty has been increasing steadily in recent years due to rising energy prices. This is a trend that has been seen across England but in Tameside the level of fuel poverty has been rising faster than the national average. Across the region and Greater Manchester, levels of fuel poverty are significantly higher than the national average.

Figure 16: Fuel Poverty in Greater Manchester and the North West by Local Authority, 2010

Graph showing fuel poverty

Source: Department of Energy and Climate Change 2012 and poverty.org.uk (2012)

In 2010/11 there were 146 excess winter deaths in Tameside and Glossop. This is an increase from 81 excess winter deaths in 2009/10 and comparable to a five year peak of 165 in 2008/09.

The figure below compares the Tameside and Glossop, North West and England indexes over a five year period. The Tameside and Glossop index fluctuates substantially compared to the North West and England, due the relatively smaller population being susceptible to variations in the number of deaths. However, the most recent figures give a local index of 19.7, compared to 16.0 in the North West and 16.4 in England.

Figure 17: Comparison of Excess Winter Mortality Index for Tameside and Glossop, the North West and England

Graph showing the excess winter mortality index

Source: Office for National Statistics (ONS) 2012

However, the fluctuations that appear in Tameside and Glossop’s index is also seen in other Greater Manchester PCTs, particularly across smaller PCTs who are affected more extremely by changes in the annual number of deaths.

Figure 18: Excess Winter Mortality (EWM) Index across Greater Manchester 2009/10Source: Office of National Statistics 2012

Graph showing the excess winter mortality index

Source: Office of National Statistics 2012

Policy context:

Nationally Fuel Poverty has been recognised as a distinct problem in the recent Hills Fuel Poverty Review and there are also considerations for vulnerable and fuel poor individuals as part of the Energy Company Obligation (ECO) which is to accompany the forthcoming Green Deal. There is general concern however that these proposed measures will not be adequate in preventing the growth of fuel poverty and do not meet current levels of provision.

Healthy Lives; Healthy People: Our Strategy for Public Health in England describes many of the excess winter deaths as avoidable. Fair Society; Healthy Lives (Marmot Review) makes the connection between fuel poverty levels and poor health, with the inevitable impact on excess winter deaths. 2009 Annual Report of the Chief Medical Officer highlights the importance of improving the energy efficiency of housing in England and Wales to reduce fuel poverty and its impact poor health and excess winter deaths. The report also promotes investment to reduce fuel poverty and healthcare spending. On a local level there is an active Affordable Warmth Strategy that is co-ordinated by the Tameside Council.

What interventions work?

What are we doing now?

  • Domestic Retrofit (Insulation): until 29/02/12 there had been 2,931 referrals for free insulation in Tameside.
  • AWARM: is a referral management and advice service, which supports vulnerable people to access support and advice to limit the impact of fuel poverty. A total of 230 referrals since project began in 2009.
  • Priority Outreach: (as of 01/04/12) has assisted 61 residents in fuel poverty.
  • Warm Front: this programme will continue until 31/12/12 with anticipated annual spend in Tameside of over £800k.
  • “Kill the Chill” marketing campaign aimed at raising awareness of the importance of staying warm in the winter months, as well as providing information on advice and support services available.
  • Expansion of Citizen’s Advice Bureau (CAB) Role: to increase CAB opening times; enable home visits; and marketing of fuel poverty reduction schemes.
  • Home Energy Assessment Scheme: commissioned from Age UK offers emergency heaters, access to hardship funds for vulnerable people not able to pay for heating, as well as home hamper delivery service and home visit service.
  • Minority groups are targeted access: Tameside Third Sector Coalition (T3SC) has been commissioned to target minority groups to help offer support to access fuel poverty reduction advice and support.

What needs to happen next, and who needs to do it?

A refresh of the Affordable Warmth Strategy for Tameside is due in 2012 which will coincide with the Green Deal. Until the final details of the Green Deal and ECO are announced and we know what role Local Authorities will take in this, it is difficult to say what interventions will be possible in the future. As ECO is the main replacement for the Warm Front scheme and CERT in terms of helping vulnerable people, this will be the key to what we can deliver to local residents. As well as this, the intention is for some of the current work such as AWARM and the Priority Outreach to continue subject to funding. One of the key actions going forward is to seek resource for more joint working between the Local Authority and the health sector around the health impacts and health inequalities associated with fuel poverty. CQUIN for NHS services is in place.

NHS and Tameside MBC need to increase health and social care referral rates to fuel poverty reduction schemes.

The ‘Kill the Chill’ branding will be used as an umbrella banner to launch the expansion of current initiatives in fuel poverty reduction, with a particular focus on improving access by hard to reach groups.

2.17 Social connectedness

Outcomes framework:

Public Health 1.18

Implications for the population’s health and well-being:

Social connectedness refers to the relationships people have with others and the benefits these relationships can bring to the individual as well as to society. Social connectedness is vital for health and well-being.

Recently, several studies have demonstrated links between social connectedness and positive outcomes for individual health and well-being. People with a wider circle of friends are generally happier, healthier and better off than those that have limited interaction with others. Evidence has also proven that a strong sense of well-being and happiness spreads through social networks. However, as well as having a positive influence on health and well-being, social networks can also have a negative influence on health behaviours depending on the ‘culture’ of the group; for example, starting and stopping smoking.

Membership in groups is essential to our mental and physical health and well-being. As individuals, a large part of our sense of self is driven by group membership and social identity. Membership of groups gives us a sense of social identity whether it be sporting clubs, volunteering groups or local common-interest community groups.

Our ability to access and be part of local groups is part of who we are as individuals and communities.

Linked to social connectedness is a strong sense of community cohesion and good community relations. Feelings of difference can influence individual choices around which services people feel comfortable accessing. For example, perceptions that a service is specifically targeted at one group over another can leave people feeling isolated and unwilling to seek support.

Programme spend:

Locally, Tameside MBC spends around £150,000 a year on delivering targeted intervention work to build community cohesion. In addition to this funding, support is allocated to increase volunteering, reduce hate crime, build resilience to violent extremism and increase social justice.

At risk or vulnerable groups:

A lack of social connectedness is most prevalent amongst groups that are at risk of social exclusion e.g. Black and minority Ethnic (BME) communities; ex-offenders; Lesbian, Gay, Bisexual and Transgender (LGBT) communities; migrant communities; refugees and asylum seekers, people with learning disabilities and mental health needs.

Benchmarking:

All questions are asked annually in the Tameside Citizens Panel, and therefore no comparison data is available.

Table 10: The most comparable indicators are as follows

Indicator

Latest available data (2011)

% of residents who volunteer
40.6% of respondents had given either 'unpaid help to any group, club or organisation' or 'unpaid help as an individual only and not through groups, clubs or orgnaisations'
% of residents who are satisfied with their area as a place to live
69.8% of people are satisfied with their local area as a place to live (unchanged since 2009)
% of residents who feel they belong to their local area
66.6% agree (performance is down two-thirds based on trend data from 2009 which shows 73.8% of people agreed with the statement)
% of residents who feel people from differnt backgrounds get on well together
55.5% agree (with the lowest performing area being Hyde with just 43.9% of people agreeing with the statement - Hyde is the only area to score below 50%)
% of residents who regularly meet and talk with people from different backgrounds
(Hyde has the highest % of people who never meet and talk with people from different backgrounds, 18.6%)

Source: Tameside MBC 2012

Policy context:

What interventions work?

Social connectedness is fostered when family relationships are positive, and when people have the skills and opportunities to make friends and to interact constructively with others. Good health, employment, and feeling safe and secure all increase people’s chances of developing positive social networks that help improve their lives.

What are we doing now?

Delivering cultural activity to bring people together and increase their sense of belonging.

  • Providing access to networks and groups that create social connectedness (through the faith, community and voluntary sectors)
  • Targeted work to build community cohesion in Hyde.
  • Implementing Tameside Race Equality Framework.
  • Awareness raising campaign around hate crime.
  • Strengthening Communities work to reduce vulnerabilities around violent extremism.
  • 5 ways to well-being promotion and community grants

What needs to happen next, and by whom?

  • Benchmarking with an agreed measure of social connectedness to begin analysing gaps and planning future work streams
  • Develop understanding locally of the link between social connectedness and health and well-being
  • Awareness raising campaign to encourage people to get involved in their community (either through volunteering or through membership in a group/network) led by T3SC and the Volunteer Centre
  • Targeted work to build intergenerational cohesion led by the Supportive Communities Delivery Board

2.18 Permanent admissions to residential and nursing care homes and Delayed transfers of care from hospital

Outcomes framework:

Adult Social Care 2A and 2C

Implications for the population’s health and well-being:

Avoiding permanent placements in residential and nursing care homes is a good indication of delaying and reducing dependency and the need for care and support. In addition, research suggests where possible people prefer to stay in their own home rather than move into residential care. Conversely, people should be receiving the care and support they need in the most appropriate setting, in order to regain their independence. This means that people should not be delayed in hospital awaiting discharge to social services.

Programme spend:

Net spend on Residential and Nursing in 2010/2011 was £17,035,000.

At risk or vulnerable groups:

Any adult with additional health and social care needs.

Benchmarking:

2011/2012 will be the first year of reporting against this indicator so previous data collected around this is not comparable. The year end figure for 2011/2012 will be available in May 2012. With regard to delayed transfers, Tameside compares favourably to other North West local authorities.

Figure 19: No of bed days - delayed transfers of care aged 18+ per 100,000 population. Jan12 Bed Days

Graph showing number of bed days

Source: Tameside MBC, 2012

Policy context:

What interventions work?

There needs to be effective joint working between local health and social care services partners to reduce avoidable admissions and/or delayed discharge.

  • Re-ablement
  • Assistive Technology
  • Personal Budgets
  • Aids, Equipment and Adaptations
  • Investment in Well-being, Early Intervention and Prevention
  • Carers services
  • Intermediate Care
  • Integrated Hospital Transfer Team
  • Partnership Working

What are we doing now?

  • Expansion of the Re-ablement service, with increased promotion of Assistive Technology.
  • Redesign of Intermediate Care services resulting from the Intermediate Care Strategy action plan.
  • Increased delivery of Personal Budgets offering greater choice and control.
  • Implementation of the Halfway Homes policy.
  • Redesign of the Well being and Prevention Service
  • Redesign of the Assessment and Care Management Service
  • Working on an Integrated Discharge Pathway with partners.
  • Increasing resource within the Moving and Handling Service.

What needs to happen next, and by whom?

Continue to develop and expand the programmes above in response to the increasing demographics.

The Health and Well-being Board should drive and govern the development of programmes of joint commissioning and integrated service delivery for Health and Social care Services.

2.19 Older People’s perception of community safety

Outcomes framework:

Public Health 1.19

This indicator is currently not defined in the framework and there is no existing indicator which specifically considers Older People’s perception.

Implications for the population’s health and well-being:

Feeling and being unsafe or 'at risk' has a significant negative impact on older people's health and can leave them isolated and unable to participate socially and economically in their community.

Home Office Research Study 269 (June 2003) considered the impact of distraction burglary amongst older adults and minority ethnic communities:

  • An increased level of trauma above the cut off for PTSD
  • Poor mobility is a significant vulnerability factor in older people being targeted
  • In some cases a worsening of health status over three months post incident of crime
  • Significant impact on quality of life
  • Increased concern about crime in general

At risk or vulnerable groups:

Focus on...Fear of Crime, (CARDI, 2010) highlighted that:

  • Fear of crime has been shown to be significantly higher amongst older people
  • The fear of crime can reduce the level of participation of older people in physical activity and social interaction. This can lead to further isolation and social exclusion.

Benchmarking:

Limited benchmarking data is available, but age categories in the Tameside ROS and Citizen’s Panel questionnaires have been considered to develop a proxy indicator for this:

  • ROS 2010-11: Question related to level of satisfaction with community safety measures (e.g. CCTV, Patrollers). Baseline – 30% (age 65+) fairly or very satisfied compared to 32% all ages.
  • Citizens Panel: Question – how safe do you feel when you are out in your neighbourhood during the day? Baseline – 97.4% (65+) very of fairly safe compared to 97.5% all ages.

Policy context:

Older people are a national priority across a range of agendas, however within crime and disorder there is nothing specifically relating to older people. Vulnerability seems to be the overarching category.

What interventions work?

Home Office Research Study 269 suggests that work to raise awareness within communities and amongst older people can impact on reducing the risk of becoming a victim of crime. The Home Office Research Study also suggests that when a crime does occur, appropriate referral and support to health provision should be a protective factor in reducing the risk of the crime being repeated:

“The findings from the study with older adults highlighted the importance of assessing and treating victims of distraction burglary as individuals, rather than developing a standard response to distraction burglary victims. For victims, the assessment and prolonged intervention for physical and mental health problems should concentrate on the relatively small proportion of victims and repellers experiencing serious trauma as a result of the distraction burglary incident.”

What are we doing now?

There is extensive awareness amongst front line staff groups of the importance of reducing the risk of crimes occurring. There is a need to ensure that this is part of ongoing training and induction with appropriate front-line services. We undertake awareness raising work within communities that are at risk and try to build up social awareness and support where possible.

What needs to happen next, and by whom?

  • There needs to be a whole system approach to prevention of vulnerability that should be part of an integrated programme rather than only considering crime and fear of crime.
  • Programme focussing on prevention needs to be developed which includes health professionals and frontline services.
  • Health professionals and frontline services need to be more aware of the impact of crime and fear of crime on Physical and Mental health.
  • Joint referral
  • Homes for life

2.20 Social care related quality of life

Outcomes framework:

Adult Social Care 1A

Implications for the population’s health and well-being:

Enhancing the quality of life for people with care and support needs. This indicator gives an overarching view of the quality of users of social care. The overall quality of life measure brings together peoples experiences of eight outcomes related to social care, into a single measure: being clean and presentable, getting the right amount of food and drink, having a clean and comfortable home, feeling safe, having control over daily life, having social contact with people, the way people are treated and spending time doing enjoyable things that are valued or enjoyed.

At risk or vulnerable groups:

All adult social care users.

Benchmarking:

This is the first year this data has been collected via a survey method. Tameside is slightly below the North West and England average.

Figure 20: Social care related quality of life for Tameside, England and North West Averages 2010/11

Graph showing social care quality of life

Source: NHS Information Centre 2012

Figure 21: Social care related quality of life across Greater Manchester 2010/11

Graph showing social care quality of life

Source: NHS Information Centre 2012

Policy context:

Social Care related quality of life is an overarching measure within the “Enhancing quality of life for people with care and support needs” outcome domain in the 2012 - 2013 Adult Social Care Outcomes Framework. Our health, our care, our say: a new direction for community services

What interventions work?

  • Contract Monitoring to improve quality and outcomes within commissioned services
  • Regulated Services that meet national minimum standards
  • Inspections by regulators to ensure compliance and quality standards
  • Assessments / Reassessments and Support Planning
  • Care Management
  • Personal Budgets to promote choice, control and independence
  • Person Centred Planning
  • Re-ablement – support to optimise capabilities
  • Assistive Technology
  • Tele Health
  • Safeguarding
  • Well being, Early Intervention and Prevention Services to improve quality of life Service User engagement and consultation.

What are we doing now?

  • Drive and monitor improvements via the Tameside Adults Transformation Programme Board.
  • Continue to restructure and transform services to ensure alignment with policy drivers.
  • Produce an annual Local Account for citizens to demonstrate accountability and transparency.
  • Continue to engage and involve service users and carers in the commissioning and development of local services.
  • Continue to engage with and promote shared learning with partners with regards to Dignity in Care.

2.21 Quality of life for carers

Outcomes framework:

  • Adult Social Care 1D: Carer reported quality of life
  • NHS 2.4: Health related quality of life for carers

Implications for the population’s health and well-being

Carers play a key role in effective functioning of families and communities as a whole. With people living longer there will be greater prevalence in long term conditions.

As a result of this, more and more people find themselves taking on the role of a carer to support their family or friends, to help maintain a level of independence and control over their lives. Carers provide care and support that is often the responsibility of health or social care professionals. Therefore they need support and skills required for caring, considering the safety and well-being of the person they care for. The support from carers also helps in delaying the need for home care or residential care and often care is solely provided by the Carer at home instead of accessing residential care.

There are nearly six million carers in the UK, with one in 10 people taking on the role of a carer. There are approximately 22,240 carers in Tameside. 10.4 % of the population of Tameside take on the role of carers, with many providing care for over 50 hours a week. Unpaid carers who care for sick or disabled family members and friends are twice as likely to suffer ill health compared to people who do not have caring responsibilities.

Programme spend:

The total PCT spend on Carers for 2012/13 is £1million and £60,000. Tameside MBC in 2012/13 allocated budget equivalent to the former Carer’s grant, £1.2 million which funds the Carers Centre, Carers Support staff, sitting and support, emergency and alternate respite, advocacy, Carer’s breaks and direct payments.

At risk or vulnerable groups:

  • Young carers
  • Black and Minority Ethnic (BME) carers
  • Hidden carers (these are carers that are not known as carers to any agencies, services or to local authorities)
  • Carers not registered with GPs
  • Carers in employment
  • Carers who look after people with long term conditions
  • Lesbian, Gay, Bisexual & Transgender Carers
  • Lone Parents that are Carers
  • Carers that are in poverty
  • Carers with learning disabilities

Benchmarking:

The Carers survey, which will include questions about career’s reported quality of life, will be biennial, although there is scope to move to an annual survey subject to the agreement of local government. In the meantime, GP Survey Results 2012 (Question 34) asks about people’s health status based on the five dimensions of EQ 5D.

Figure 22: The level of support provided by carers as a result of long term physical or mental health/disability or problems related to old age.

Graph showing level of carer support

Source: GP Survey Results 2012

Policy context:

The local Joint Strategy for Carers 2011-14 has adopted its vision in line with the national strategy. A key theme throughout the strategy is for carers to have access to a wide range of advice and information, to support them to carry out their caring role and having a greater choice and control over their own health needs.

What interventions work?

  • Adopting an ‘early intervention and prevention’ approach is beneficial for people to stay healthy and independent.
  • Considering carer support in relation to the development and implementation of pathways such as hospital discharge, falls, dementia, stroke and end of life could lead to a systems-wide efficiencies
  • Access to information and support for carers that is locally available at the earliest time e.g. carer’s information, helpline and website
  • Access to education, training, work and leisure for carers
  • Appropriate and improved support from a lead health professional to be offered to carers to ensure early intervention when circumstances for carers change
  • Support for carers from GP’s, by providing appointments that are tailored around their caring responsibilities
  • Health checks for carers
  • Improving emotional support offered to carers by 3rd sector organisations

What are we doing now?

A Joint Strategy for Carers 2011-14 was launched in March 2012 and was developed by the NHS, Local Authorities, Carers and Service Users. It sets out how services for carers will be delivered over the next 4 years by Tameside MBC, Derbyshire CC and NHS Tameside and Glossop. The main aim is to work together in partnership with carers and local organisations to implement local actions set out in the annual action plan which identifies addresses priorities for carers locally and to meet requirements of Department of Health.

It has been identified that respite services and regular breaks from caring are a priority for Carers. It has been agreed by NHS Tameside and Glossop and Tameside MBC that the allocation for carers’ breaks will be managed via pooled budget arrangements.

Some of the actions currently delivered include:

  • Commissioned to develop a GP identification tool to help GPs identify ‘hidden carers’.
  • Tameside Carers Centre and the Young Carers service support Young Carers in transition (aged 17+) to the adult Carers service ensuring think family principles are used where a child carer is identified within a family
  • Engaging Carers in developing stronger communities by using the information ambassador network (IAN) to identify and support more hidden Carers. Engage with Carers Action Group (Tameside), NHS Tameside and Glossop consumer advisory panel, Tameside local involvement network (LINK) and in the future Healthwatch.
  • Providing holistic Carers assessments by adult social care and the health and well-being service where education, training, work, leisure, home, community, health and well-being, daily living , managing money, contingency arrangements, emergency respite and young carers needs are taken into consideration
  • Tameside Carers Centre hosts a weekly welfare rights clinic providing benefit checks to maximise the Carers income whilst ensuring Carers are not financially disadvantaged
  • Tameside’s ‘Having a break’ scheme provides a one-off grant, available from the Carers’ Centre, to offset the cost for a break or activity
  • TMBC carry out various activities with young carers giving them time away from their caring responsibilities and safeguarding them from inappropriate caring
  • TMBC facilitate 11 monthly Carer support groups, these include 2 specifically for BME Carers and 1 for younger adult carers
  • Decaf in Tameside and Glossop – this is a social support group for carers and the people they care for (who have a dementia).

What needs to happen next, and by whom?

It is important to ensure carers needs are highlighted within the responsibilities and plans of the NHS Clinical Commissioning Groups (CCGs).

The NHS will continue collaborative working with Derbyshire County Council (DCC) and Derbyshire Carers Association to commission carers’ support for Glossop.

One of the most important priorities is to identify new/more carers and offer carers assessment and develop personalised support.

The local action plan will be monitored via the Joint Commissioning Executive Board (JCEB) and Carers Strategy Group (CSG), and issues are prioritised in future partnership arrangements with the emerging Health and Well-being Boards.

Some of the key actions include:

  • Begin to organise carer awareness sessions for health and social care staff, community groups, faith groups, voluntary organisations and local employers, and work with schools identify, recognise and signpost young Carers
  • Identify carers within primary care settings, acute trust and community settings including staffs that are carers. This also includes carers within military families.
  • Involve GP’s at an early stage of the formation of the clinic commissioning group
  • Ensure carers have access to relevant information, advice and interventions at the right time, including Expert Patient Programme, Carer’s breaks
  • Involve carers including young carers in service planning, development/changes
  • Work with local employers to identify and support carers and ensure employers are aware of the Equality Act 2010
  • Ensure carers are not financially disadvantaged
  • Increase choice and control over the resources used to secure the services needed
  • Reducing the time waiting for assessments both for carers and the people they support
  • Continue to develop flexibility of support services and emergency short term situations
  • Continue to work with relevant professionals/organisations to identify young carers and protect them from inappropriate caring and give them the right to be children
  • Ensure that the link between the Carer's Strategy and Dementia Strategy is supported, in practical terms

2.22 Quality of life for people with long term conditions

Outcomes framework:

  • NHS 2: Health related quality of life for people with long term conditions
  • NHS 2.1: Proportion of people feeling supported to manage their long term condition
  • Operating Framework PHQ14: People with long term conditions feeling independent and in control of their condition

Implications for the population’s health and well-being:

Long-term conditions (LTC) are chronic illnesses that can limit lifestyle, such as diabetes, heart disease, and chronic obstructive pulmonary disease (COPD) and those living with HIV. There are 15.4 million people living with a long-term condition in England. Numbers are expected to rise due to an aging population and unhealthy lifestyle choices.

People with LTC are significant users of NHS and social care services. NHS services are measured by:

  • the proportion of people feeling supported to manage their condition;
  • early and appropriate diagnoses of the LTC.
  • unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) (see the corresponding indicator review regarding this issue)
  • Unplanned hospitalisation for asthma, diabetes and epilepsy (in under 19s) (see the corresponding indicator review regarding this issue)

At risk or vulnerable groups:

Patients with a diagnosed long term condition.

Policy context:

What interventions work?

People with LTC want greater control of their lives, to be treated sooner before their condition causes more serious problems and to enjoy a good quality of life. This means transforming the lives of people with long-term conditions to move away from the reactive care based in acute settings toward a more systematic patient-centred approach, where care is rooted in primary and community settings and underpinned by early diagnosis, strong partnerships across the whole health and social care spectrum. This also includes delivering appropriate and targeted interventions to increase early diagnosis within high prevalence groups.

What are we doing now?

NHS Tameside and Glossop are participating in the Department of Health’s LTC Quality, Innovation, Productivity and Prevention (QIPP) programme. We have a local LTC commissioning network, with membership from the Local Authority (Social Care), Primary Care, Community services, our local Foundation Trust, and patient representatives. This is under the leadership of the nominated NHS Clinical Commissioning Group (CCG) lead for LTC. During 2011-12 we have:

  • Delivered PCT wide telemedicine service for ECGs
  • Redesigned our anti-coagulation pathways to deliver more care in General Practice
  • Commissioned GP direct access B-type Natriuretic Peptide testing (BNP and NT-proBNP) in line with NICE guidance on chronic heart failure
  • Worked with our GPs and main secondary care provider trust to identify patients who are appropriate for management and care in the community and primary care, and facilitated this transfer of care (for diabetes and cardiology/heart failure)
  • Developed local pathways and services for pulmonary rehabilitation
  • Expanded provision of self care programmes for patients with long term conditions by increased investment in the “Expert Patient Programme”
  • Successfully implemented Telehealth for patients with COPD and Heart Failure.
  • Redesigned our community based “Long Term Conditions” team, to focus on the provision of specialist clinical management and care co-ordination for patients with LTC.

What needs to happen next and by whom?

The NHS Clinical Commissioning Group (CCG) plans for 2012-13 centre on the Department of Health’s key drivers for the management of long term conditions:

  • Risk profiling
  • Integrated care teams
  • Self care and self management
  • Ensure people are on disease registers to target effective disease management

Specific projects for 12-13 include:

  • Development of local risk profiling tools and clinical dashboard
  • Primary care management of long term conditions and work with primary care to increase the number of patients on disease registers, increasing confidence within primary care to offer HIV testing where appropriate, continue the delivery of the NHS Health Checks, and ensure delivery of LTC related QOF indicators for 12-13
  • Cardiology: Implementation of primary care referral pathways, further development of primary care based diagnostics, and potentially GPwSI role
  • Development of local primary care based service / expertise (GPwSI) for neurological conditions
  • Redesign of local diabetes services – with support from NHS Diabetes – to deliver care in line with the principles outlined in “Diabetes without Walls” (2009)
  • Further development and uptake of formal self care / management programmes
  • Redesign of local COPD and respiratory pathways in line with the national strategy and the NW Respiratory QIPP
  • Ongoing improvement of the management and prevention of AF, delivery of TIA services, and acute stroke care (in line with Greater Manchester & Cheshire Cardiac & Stroke Network guidance)
  • Evaluation and potential expansion of telehealth

2.23 Children and adults with autism

Implications for the population’s health and well-being:

The Autism Act 2009 and subsequent statutory guidance was created in response to increasing evidence that a significant proportion of adults with autism, across the whole spectrum are being excluded from society both socially and economically. Prevalence within Tameside is difficult to establish as there is a gap in provision in relation to a clear diagnostic pathway. Based on a national formula of 1:100 have a Autistic Spectrum Disorder (ASD), we estimate at this time 21,500 people have ASD in Tameside, this increases to 24,500 when including Glossop.

At risk or vulnerable groups:

Adults and children who have an Autistic Spectrum Disorder (ASD). It is estimated that 50% of people with ASD also have a learning disability.

Benchmarking:

There is currently very little comparative data available to benchmark against in terms of national and regional performance.

Policy context:

This area is fundamentally driven by the Autism Act 2009 and subsequent statutory guidance ‘Fulfilling and Rewarding Lives’ Statutory Guidance for Local Authorities and NHS Organisations to Support the Implementation of the Autism Strategy (2010).

The Autism Act (2009) was created in response to increasing evidence that a significant proportion of adults with autism, across the whole spectrum, one excluded both socially and economically. The Autism Act 2009 was the first ever piece of legislation designed to address the needs of one specific impairment group: adults with autism. The Autism Act 2009 Section 1 (1) required the Secretary of State to prepare and publish a document setting out a strategy for meeting the needs of adults in England with Autistic Spectrum conditions by improving the provision of relevant services to such adults by Local Authorities, NHS bodies and NHS Foundation Trusts. This guidance ‘Fulfilling and Rewarding Lives: The Strategy for Adults with Autism in England’ was published on the 3rd March 2010. The Department of Health has released statutory guidance to provide guidance on the Act and subsequent strategy. The guidance is required by law and is “Statutory” guidance. It is to be treated as if it were guidance issued under Section 7 of the Local Authority Social Services Act 1970.

Fulfilling and Rewarding Lives (2010) does include a list of policies that apply to adults with autism. These provide a useful context for how the strategy was developed. Some key policies such as valuing people now the Government’s Strategy for people with learning disabilities, recognised that adults with autism are some of the most excluded and least heard people in society and that service providers, commissioners and policy makers were not specifically addressing their needs.

The Autism Act 2009 states that local arrangements for leadership in relation to the provision of relevant services to adults with such conditions. This strategy document addresses the local priorities in relation to services to people with autism and in Tameside and offers a local framework.

As around 50% of people with ASD are also thought to have a learning disability, the objectives set out in the statutory guidance closely link to objectives set out in Valuing People Now: A new three year strategy for people with learning disabilities (2009).

What interventions work?

Key interventions as identified in the statutory guidance, North West Action Plan and Tameside strategy PATH include:

  • Increase awareness of autism with front line professionals
  • Development of a clear and consistent pathway for diagnosis
  • Improving access to services and assistance with living independently in the community
  • Assistance with access to employment
  • To work with key partners to develop and improve access to services

What are we doing now?

The North West Joint Investment Partnership (JIP) produced a regional action plan to address issues across the region in terms of meeting the statutory guidance. Following this work a North West group has been formed to provide a strategically co-ordinated approach to achieving better outcomes for Adults with Autism through supported integrated working across the North West. The focus is to develop 5 Autism Networks across the North West which will be aligned to the 5 PCT Clusters. One of the key four stages identified is the identification of key priorities within each network and action planning to achieve identified priorities. This arrangement will allow greater comparative information sharing upon which benchmarking and performance management can be monitored against.

  • We are currently working with the National Autistic Society, Autism Specialist Nurse, NHS, Local Authority(LA), Parents / Carers, Education and Children’s Services to develop a Joint Autism Strategy for Tameside
  • We are working with Pennine Care NHS Trust in progressing a CQUIN to develop a diagnostic pathway for people with autism
  • We have established user and carer peer support groups
  • We have identified a local GP who represents the autism agenda on the NHS Clinical Commissioning Group (CCG)
  • We have identified Senior Managers within the LA and NHS Tameside and Glossop, and local politicians who are responsible for ensuring the Autism Strategy objectives are achieved
  • We have an Autism Network website to assist in providing good quality information and advice. www.tameside.gov.uk/autismnetwork
  • We are redesigning pre employment services to include access to services by people who have autism
  • We have a multi-agency assessment team for children.
  • Applying for accreditation by National Autistic Society to enable us to provide better support for people with Autism within their own homes.

What needs to happen next, and by whom?

  • The Autism Strategy needs to be finalised and agreed and progress needs to be made with key objectives set out in the strategy (Autism Strategy Group)
  • A performance management framework needs putting in place to aid performance management of progress to achieve the Autism Strategy objectives (Autism Strategy Group)
  • A clear action plan and commissioning plan needs developing as part of the strategy that links with NHS North West, ADASS and the National Autistic Society (LA, NHS Tameside and Glossop Autism Leads)
  • The NHS Clinical Commissioning Group (CCG), Health and Well-being Board and the Local Authority Public Health need to be engaged in driving forward the objectives of the Autism Strategy and ensure that good quality information, advice and support is available (LA & NHS Tameside and Glossop Autism Leads)
  • The CQUIN needs to be progressed to develop a diagnostic pathway (NHS Tameside and Glossop Lead)
  • Better information systems need to be developed to enable evidence based prevalence rates and forecasting to inform future service planning (Autism Strategy Group)
  • A link needs to be made to the Mentally Disordered Pathway that includes individuals with ASD (LA Autism Lead)
 
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