By:	Roger Gough

Cabinet Member for Education and Health Reform

To:	Kent Health and Wellbeing Board

Date:	18th November 2015

Subject:	Assurance Framework

Classification:	Unrestricted

Summary: This paper provides exception reporting on areas requiring further attention by the Board. There are a number of areas that the Board may wish to seek in-depth assurance on; some of these such as mental health and dementia will be addressed as part of the scheduled work plan for the Board. Therefore it would be useful to undertake in-depth exploration of indicators that are not in the scheduled work plan such as obesity. Recommendations: The Health and Wellbeing Board is asked to: Agree for local Health and Wellbeing Boards to undertake a review of local action plans for addressing obesity and improving population outcomes (for children and adults) and report back on progress in delivery and outcomes at the Board meeting in May 2016.

1.	Introduction

The purpose of the Assurance Framework is to provide assurance on delivery of five outcomes of the Kent Health and Wellbeing Strategy along with additional care system stress indicators. In previous months the report has covered information on all indicators with detailed information on one outcome. To make the assurance process more effective this paper provides exception reporting on areas requiring further attention by the Board. Based on most recent available data the report also makes recommendation for the indicators that requires further in depth analysis and review of local actions to address these.

Exception Reporting

An overview analysis was undertaken of the data to identify areas for exception reporting. These indicators are highlighted in Table 1 along with a brief update and next steps.

Table 1

Indicator description	Update and next steps
Reducing the number of pregnant women with a smoking status at time of delivery	Work has commenced to address this indicator by Kent Public Health team in partnership with other colleagues
Increasing breast feeding initiation and continuation rates (variance across Trusts and local district level and poor completion rates)	Initiation and continuation needs cross sector action. Initiation rates at each Trust need further scrutiny and continuation completion rates to be re-evaluated following the change of data source from GPs to Health Visitors from October 2015.
Improving MMR vaccination uptake of two doses for five year olds	Director of Public Health is working with NHS England and Public Health England to gain assurance.
Reducing proportion of 4-5 year olds and 10-11year olds with excess weight (variance at local district level)	Needs cross sector action across Kent.
Reducing the proportion of adults with excess weight (variance at local district level)	Needs cross sector action across Kent.
CAMHS related indicators: some of the sub-indicators are improving	Children and Young People’s Emotional Health and Wellbeing strategy and delivery plan has been signed off by the Board. Ongoing work continues in partnership with KCC and CCGs to progress transformation plan and commission new pathways.
Indicators related to mental health and learning disability	These will be addressed in mental health related report to the Board as part of scheduled work plan
Indicators related to dementia	These should be addressed as part of scheduled work plan
Increasing the early diagnosis of diabetes – Recorded Diabetes (registered GP Practice aged 17+)	Obesity related type 2 diabetes requires cross sector action
Reducing the number of hip fractures for people aged 65 and over (rate per 100,000).	This is a BCF indicator and KCC and CCG are working jointly to progress this.
Increasing the population flu vaccination coverage for those aged 65+ and for those at risk individuals.	Director of Public Health seeking ongoing assurance from NHS England and Public Health England for improved uptake. 2015/16 campaign recently launched
Urgent care stress indicators Bed Occupancy Rates in acute hospitals – Overnight, A&E attendances within four hours (all) from arrival to admission, transfer or discharge, and Number of delayed days by acute/non acute setting	In September the Board received a report from NHS England on winter preparedness. Further action is taking place at a Local level across sectors to address these issues.

Conclusion

The report highlights areas that the Board Members may wish to seek in depth assurance on, some of these such as mental health and dementia will be addressed as part of the scheduled work plan for the Board. Therefore it would be useful to undertake in-depth exploration of indicators that are not in the scheduled work plan such as obesity.

3.1 Obesity (adult and childhood)

Obesity is one of the most significant and complex health challenges affecting individual’s health and wellbeing. It contributes significantly towards costs associated with health, social care and a wide range of other services. The Health and Wellbeing Board is in a uniquely influential position to champion transformational change for addressing obesity across all sectors.

Although Kent shows a decreasing excess weight in four-five year olds in 2013/14 (20.8%), and a lower proportion than nationally (22.5%) there is variance across the districts, with the lowest proportion of excess weight in Maidstone at 16.4% through to the highest in Gravesham at 24.6%. Gravesham has also been increasing in the proportion of excess weight since 2011/12. Some districts have seen an increase into 2013/14, these are Ashford (21.5%), Dartford (22.2%) and Swale (23.7%).

As with excess weight in four- five year olds, excess weight in ten-eleven year olds is also showing as having a slightly lower proportion than nationally at 32.7% to 33.5%. Kent has maintained this rate since 2011/12. Across the districts the rate of excess weight in ten-eleven year olds ranges from 27.5% in both Sevenoaks and Tunbridge Wells to 37.5% in Dartford.

Dartford is also one of the districts with increasing excess weight along with Ashford (35.4%), Canterbury (32.9%), Maidstone (31.9%), Swale (34.7%) and Thanet (34.4%).

The data suggests that excess weight in adults for Kent is slightly above the national figure at 64.6% (national 63.8%) with variation between the districts of 54.2% in Canterbury to 68.8% in Swale.

Recommendations:

The Board are asked to note the contents of this report and agree the following recommendation:

Agree for local Health and Wellbeing Boards to undertake a review of local action plans for addressing obesity and improving population outcomes (for children and adults) and report back on progress in delivery and outcomes at the Board meeting in May 2016.

Report Prepared by

Malti Varshney, Consultant in Public Health Malti.varshney@kent.gov.uk

Helen Groombridge, Performance Officer, Public Health Helen.groombridge@kent.gov.uk

Mark Gilbert, Commissioning and Performance Manager, Public Health Mark.gilbert@kent.gov.uk