This meeting was to consider a variety of reports about the health and wellbeing of the people of North Northamptonshire. The meeting was scheduled to include the adoption of the new North Northamptonshire Health and Wellbeing Strategy and consider the progress that has been made on each of its 5 key priorities: Smoking and Vaping, Keeping Active, Mental Health and Wellbeing, Children and Young People, and Financial Resilience. The meeting was also scheduled to consider a report about the Better Care Fund, and receive the annual reports of the Northamptonshire Integrated Care Board and the Director of Public Health, Jane Bethea.

It is important to note that this article is based only on the documents that were prepared in advance of the meeting. It is therefore possible that some of the topics listed below were not actually discussed, and it is certain that this summary does not contain any information about what decisions were taken.

Adoption of the new North Northamptonshire Health and Wellbeing Strategy

The main item on the agenda was to be the adoption of the new North Northamptonshire Health and Wellbeing Strategy. The supporting report describes how the Health and Care Act 2022 requires all Health and Wellbeing Boards to develop and deliver a Joint Local Health and Wellbeing Strategy.

The report says that this new strategy “forms a fundamental pillar of the overall Integrated Care System 10-year strategy Live Your Best Life” adopted by the Northamptonshire Integrated Care Board in December 2022. The report explains how the new strategy “shifts away from a deficit or treatment lens towards an asset based one” and “purposefully goes beyond the health care to place more focus on ‘the causes of ill health’”. This echoes the findings of the 2010 Marmot Review, which explained how health inequalities result from social inequality. The review's author, Professor Sir Michael Marmot, found that these social inequalities are the biggest influence on health and wellbeing and argued that “actions must be universal, rather than being focused solely on the most disadvantaged”. This approach, known as proportionate universalism, has been adopted in the new strategy.

The new strategy proposes to use Local Area Partnerships (LAPs) and Place Based Partnerships to deliver its 5 key priorities which have emerged from the Joint Strategic Needs Assessments, stakeholder views, and other relevant strategic plans:

Smoking and Vaping

The North Northamptonshire Health and Wellbeing Strategy describes how:

Although real progress has been made in reducing smoking prevalence, 14.6% of North Northamptonshire residents still smoke and this rises to 25-30% in some areas

The report describes how these “smoking and the impacts of smoking are closely linked to inequalities, with smoking responsible for 50% of the difference in life expectancy between the most deprived and least deprived populations in England”. It describes smoking as a financial burden, saying “spend is similar to the average annual energy spend”, and says that it “can increase the risk of children growing up in poverty”.

The strategy seeks:

to reduce the overall prevalence of smoking and reduce inequalities in smoking prevalence between population groups in North Northamptonshire

It proposes to achieve this by:

1. Increase the number of people receiving support to stop smoking.
2. Provide targeted support to population groups with higher levels of smoking.
3. Implement prevention activities focused on smoking and vaping in children and young people.
4. Disrupt the sale of illegal tobacco and e-cigarette products and reduce underage sales of tobacco and e-cigarette products.

The strategy document lists some examples of how this will be achieved. These include:

expanding the Local Authority Stop Smoking Service team and strengthen NHS Tobacco Dependency Advisor Service, increasing capacity to deliver more stop smoking sessions and a wider range of engagement events

strengthening the capacity of a wide range of services to deliver stop smoking brief interventions and improve referrals to stop smoking services

initially prioritising our routine and manual workforce, women in pregnancy, and people with severe mental illness

developing guidance and assessing training needs for schools and other settings to ensure everyone has the resources and skills to address smoking and vaping in children and young people

working with children and young people to co-develop and co-deliver campaigns and interventions

raising awareness of the risks of illegal products and underage sales and how to report concerns, delivering a public facing campaign

delivering training to stakeholders across the system

strengthening the joint working approach between key partners such as Trading Standards, Public Health, Licensing and the Police

Keeping Active

The report pack includes an update on the Keeping Active strand of the emerging North Northamptonshire Health and Wellbeing Strategy. It describes how the 2020-2021 Sport England Active Lives survey showed that North Northamptonshire “has a significantly higher number of INACTIVE adults (31.4%) and children (33.5%) and has significantly lower numbers of ACTIVE adults (56.1%) and children (40.9%) than National/Regional/County levels”.

The report says that “the North Northamptonshire Active Communities Framework is currently in its final draft stage”. This incorporates the following strategies:

• Active Communities
• Leisure Facilities
• Playing Pitches

The report says that these strategies will form “the key documents underpinning the implementation of the Keeping Active action plan”.

The report says that “the North Northamptonshire Active Communities Strategy is the over-arching document that gives direction and vision to wider organisations, plus it sets the basis for future prioritisation and collaboration regarding increasing physical activity”, and explains that it has 4 themes:

• Healthy Communities
• Connected Communities
• Thriving Communities
• Green Communities

The report says that “each of the themes will have priorities and actions to address issues and barriers to participation” and that they “will support increased levels of activity targeting areas of identified need, health inequalities and social deprivation”, and explains that:

The North Northamptonshire Active Communities Strategic Partnership group has been established to oversee and monitor this work with the first meeting and workshop held in November 2024 to begin a collaborative approach to developing the action plan forming a workstream of activities

The strategy document lists some examples of the key activities the group is working on. These include:

Healthy Communities: Aging Well - Increasing participation in recreation, movement and physical activity as a tool for improving Health and Wellbeing, to reduce demands on health services in future years

Connecting Communities: Delivering targeted active wellbeing programmes in the areas of most need.

Thriving Communities: Upskilling the adult Active Communities workforce, including employees, coaches, volunteers and hard to reach groups to deliver wellbeing programmes within their communities.

Green Communities: Developing the Council’s leisure services to be more energy efficient, environmentally sustainable and carbon neutral where possible.

Mental Health and Wellbeing

The North Northamptonshire Health and Wellbeing Strategy describes how people living with severe mental illness have a life expectancy “15–20 years shorter than that for the general population”. It says that this is “largely due to preventable physical illnesses”, and that “an estimated 50% of deaths in people living with SMI are attributable to smoking”. The strategy says that people with existing mental health problems are more likely to have a physical health condition, and less likely to access preventative healthcare such as screening and vaccination programmes. It also says that these people are more likely to be digitally excluded, and that:

People in contact with secondary mental health services are significantly less likely to be in employment. Experiencing social inequalities increases the risk of poor mental health; housing insecurity is associated with poor mental health.

It says that “access to support is also not equally distributed across the population”, and that “groups who are more likely to experience poor mental health often experience the greatest difficulty in accessing services and have poorer outcomes and experiences”.

The strategy says that the Integrated Care Northamptonshire (ICN) Mental Health Prevention Concordat “sets out the strategic, preventive, population health approach to mental health and wellbeing in the area”. It explains how the concordat “recognises the social, economic, and environmental determinants of both positive wellbeing and mental ill-health”, and says that it “focuses on five key domains for local action”:

• Understanding local needs and assets
• Working in partnership and alignment for co-ordinated approach
• Taking action on prevention/promotion of good mental health, and reducing inequalities associated with poor mental health.
• Defining success/measuring outcomes
• Strong Leadership and Direction

The strategy says that it “will enhance and not duplicate the work” of the Mental Health Learning Disabilities and Autism Collaborative and the Population Health and Prevention Pillar that leads on the delivery of the Prevention Concordat Action Plan. It says that “taking a North Northamptonshire focus, the mental health theme will illustrate how all organisations represented on the Health and Wellbeing Board can contribute to improving population mental health”.

The strategy lists 3 key objectives for the coming period:

• Refining and strengthening our current work to reduce self-harm and suicide prevention
• Increasing the focus on reducing smoking in people with SMI and opportunities to improve the physical health of people with SMI
• Reducing mental health related inequities in access, outcomes and experience

The strategy document says that the ICB will “establish a cross-agency group to consider mental health and wellbeing priorities taking a flexible and agile approach, which can adapt in response to emerging population mental health needs” and says that “echoing other Health and Wellbeing Board themes, all actions will include a focus on reducing health inequalities”, explaining that:

In developing the mental health themed action plan, the group will consider the promotion of positive mental health and wellbeing, prevention actions that can improve mental health and support for people who experience mental health problems.

Children and Young People

The report pack includes a progress report on the Children and Young People strand of the emerging North Northamptonshire Health and Wellbeing Strategy. It explains how a “small cross-agency group met to consider the health and wellbeing priorities for children, young people and families in North Northamptonshire” and that the group “identified family resilience, behaviour change, low income, ‘start well and thrive’, parent family and carer support and healthy weight and healthy diet as emerging themes”.

The report says that the 2 main issues the group is working on are family resilience, and supporting children and their families “to eat a healthy diet, be physically active and maintain a healthy weight”.

The report says that the 2023-2024 National Childhood Measurement Programme (NCMP) found that 23.4% of reception age children and 36.9% of year 6 children in North Northamptonshire were overweight or obese.

The report describes how “childhood obesity is strongly associated with socioeconomic deprivation , sex and ethnicity ”, and says that in North Northamptonshire:

children aged 4-5 years living in the most deprived areas of North Northamptonshire were 1.3 times more likely to be overweight or obese than those living in the least deprived areas. In the same period, children aged 10-11 years living in the most deprived areas of North Northamptonshire were 1.6 times more likely to be overweight or obese than those living in the least deprived areas.

The report quotes from a 2019 Public Health England (PHE) report, which said that:

“Obesity is a complex problem with multiple causes and significant implications for health and beyond. We know that there is no one single solution. Tackling such an ingrained problem requires a long-term, system-wide approach that makes obesity everybody’s business, is tailored to local needs and works across the life course”

The report says that the group is working to reduce the overall prevalence of childhood obesity and reduce inequalities in childhood obesity between different population groups in North Northamptonshire.

To achieve this, the group has 4 objectives:

1. Using existing assets such as Family Hubs and the Healthy Schools Programme, implement primary prevention activities focused on increasing the proportion of children who maintain a healthy weight by eating a balanced diet and enjoying physical activity.
2. Working as a system, explore opportunities for school and community-based family weight management approaches as part of a system-wide approach to address childhood obesity. The effective use of NCMP data will ensure system partners can target interventions towards those with the most capacity to benefit.
3. Recognising the association between childhood obesity, poor oral health and deprivation (PHE, 2019 ), ensure that professionals working with children and families communicate consistent messages regarding infant feeding, healthy weaning and healthy family diets to reduce dental caries and admissions to hospital for tooth extractions with a proportionate universal approach.
4. Dovetailing with the 'Keeping Active' priority, work with partners to increase the proportion of children and young people who participate in movement and physical activity, setting the foundation for long-term participation that enhances their physical and mental health and wellbeing ensuring there is a focus on those who experience barriers to participation.

The strategy document lists some examples of how this will be achieved. These include:

reviewing and enhancing our existing primary prevention approaches drawing on the expertise of system partners including Family Hubs and the Healthy Schools Programme.

ensuring that families and professionals have access to consistent, evidence-based information regarding infant feeding, ‘healthy weaning’, eating healthily on a budget and associated topics using existing mediums such as the Family Hubs North Northants website and Northamptonshire Healthcare NHS Trust’s iDiscover.

tailoring our primary prevention approaches to increase acceptability in different communities including families who are experiencing financial hardship and thus find it harder to eat a healthy diet.

building on existing work, further developing food policies in schools, expanding the approach early years settings, Family Hubs and other locations children regularly use.

exploring opportunities for school and community-based family weight management approaches

working with geographical communities and communities of identity to explore the barriers to healthy eating including whether financial vulnerability impacts on access to fruit and vegetables and cooking confidence

reviewing the current interventions for children who are overweight and obese, exploring opportunities to jointly commission weight management interventions for children

ensuring children and families are actively involved in developing local interventions for children who are overweight and obese to ensure acceptability and increase the likelihood of embedding behaviour change in the long-term

effectively using NCMP data to ensure the interventions are targeted to those who have the most capacity to benefit

ensuring that professionals working with children and families communicate consistent messages regarding infant feeding, healthy weaning and healthy family diets using a proportionate universal approach

developing a local food policy to reduce sugar intake in children’s settings throughout North Northamptonshire

exploring opportunities to extend the ‘Supervised Toothbrushing’ scheme ‘My New Baby Tooth’ Programme, focusing on areas with high deprivation and high levels of tooth decay

continuing to provide oral health training

increasing the proportion of children and young people who participate in physical activity that enhances their physical and mental health and wellbeing

ensuring there is a focus on the children and young people who experience barriers to participating in physical activity, adapting service offers in response to their feedback

clearly communicating the local physical activity opportunities including those that are free or low cost such as parks and open spaces, recognising that children and young people living in areas of deprivation are less likely to be physically active.

Financial Resilience

This is a new strand of work for the North Northamptonshire Health and Wellbeing Strategy. The supporting report describes how:

strong financial resilience has a wide-reaching positive effect on the individual, their friends and families, local communities, businesses, and the wider economy.

It says that when people “are unemployed, have low-income jobs or are reliant on benefits, have unstable or unsuitable housing, have low skills and qualifications, [or] lead chaotic lifestyles due to multi-exclusion”, it “severely” compromises “their mental health and physical health and wellbeing and their ability to fulfil their potential”, arguing that it can also “lead to missed opportunities, exclusion and even stigma and discrimination”.

The strategy says that:

Financial Resilience relates to feeling confident and empowered to make the most of your money and assets from day to day; the ability to deal with both expected and unexpected events, having the knowledge or being able to access the tools to feel more secure, in control and less stressed about money.

The report says that the group is working to:

Improve the financial resilience of our residents across North Northamptonshire.

To achieve this the report argues that:

the aim needs to be adopted as everyone’s business across the system

The strategy document says that:

This can be achieved by:

• Addressing the causes of deprivation
• Promoting a more holistic approach to the wider determinants that affect financial resilience
• Focusing on financial literacy
• Supporting residents to access skills, employability training, and support
• Supporting residents to access all the benefits to which they are entitled
• Supporting residents to return to work following illness
• Targeting work with multi-exclusion communities
• Tackling the stigma associated with poverty
• Maximising grass roots initiatives such as through food banks, warm spaces, and community hubs and the wider VCSE offer

The strategy document says that “it is however critical that any actions associated with these ambitions be co-produced with residents who have lived experience”, explaining that:

the first workstream will be to collate the data and intelligence to help us target the right places and the right communities and then using an asset-based approach to work with statutory partners, residents, the Local Area Partnerships, Family Hubs, and community partners develop a Theory of Change model which will adopt sustainable solutions for the short, medium, and longer term.

The report says that:

Financial Resilience has already been identified as one of the emerging strategic priorities for the Wellingborough and East Northamptonshire Place Based Partnership. It is recognised by the VCSE PBP Chairs that a positive collaboration on this programme of work by the PBPs provides a good opportunity to demonstrate a golden thread between the Health and Wellbeing Board and the PBPs to deliver positive outcomes for our residents.

Better Care Fund Quarterly Update

The report pack contains an update on the Better Care Fund (BCF). This is a national scheme that brings together health and social care. It aims to join up services seamlessly around the person, and has 2 core objectives:

• enable people to stay well, safe and independent at home for longer
• provide people with the right care, at the right place, at the right time

The report says that the BCF is “crucial in supporting people to live healthy, independent and dignified lives” and says that:

Since 2015, the BCF has been crucial in supporting people to live healthy, independent and dignified lives, through joining up health, social care and housing services seamlessly around the person.

Northamptonshire Integrated Care Board Annual Report 2023-2024

The report pack contains the Northamptonshire Integrated Care Board (ICB)'s annual report for 2023-2024. The ICB replaced the former Clinical Commissioning Group (CCG) in July 2022, and is responsible for planning and funding healthcare for everyone who is registered with a GP in Northamptonshire. The annual report details the ICB's performance against a variety of national healthcare targets, and describes its achievements. It also sets out the challenges that the ICB has faced.

The ICB's Chief Executive, Toby Sanders, says in his foreword to the report that:

this has been one of the most challenging years for the NHS that I can recall. The NHS is still recovering from the effects of the pandemic and on-going industrial action as well as significant financial pressures has led to considerable challenges for Northamptonshire ICS. These are challenges which are being experienced across the country.

He goes on to say that:

Despite these challenges we have been working hard alongside our partners to support our system’s on-going recovery and provide the best care we can for the local population we serve. There are several positive examples of our partnership and collaborative approach making an impact, including around our work for mental health, primary care, maternity services and elective care. I would like to take this opportunity to thank all the hard-working health and care staff who are the backbone of our local system and without whom we could not do what we do.

The report also contains a statement by the ICB's chair, Naomi Eisenstadt. She says that:

Despite these challenges, we are continuing to make improvements to our health system. Significant progress has been made in our use of technology, with digital applications allowing us to better share information without compromising patient confidentiality. Progress has also been made in extending the talking therapies service to provide more people with early help for common mood disorders such as depression and generalised anxiety. Responding to additional demands on services for children and young people, we have established two additional wellbeing cafes to offer support and guidance for children aged 10-18 and their parents/carers. We are also on track to meet the national target of 75% of annual health checks for people with a learning disability and have undertaken a lot of work in the last year to promote and increase health checks to the younger age group by working with schools.

She goes on to say that:

Waiting times for elective care have reduced but there is still work to be done in this area, and we continue to work with all our partners to make best use of the resources we have in the system. Progress has been made in the Community Diagnostic Centre programme, which aims to help reduce waiting times for tests. Two of the facilities at Corby and Kings Heath in Northampton are anticipated to be open by the summer.

She also mentions the national Primary Care Access Recovery Programme, saying that:

One of the notable schemes of the programme is the Pharmacy First scheme, which offers expert clinical support at local pharmacies for seven conditions including middle ear inflammation, impetigo, infected insect bites, shingles, sinusitis, sort throats and UTIs. In Northamptonshire we have over 90% of local pharmacies signed up to the scheme.

The ICB's annual report also describes the Integrated Care Partnership (ICP), of which the ICB is a part. The report describes the ICP as:

a statutory committee that brings together all system partners to produce a health and care strategy. As a forum to support partnership working, the ICP brings together local authorities, health and social care, and housing providers.

Director of Public Health Annual Report 2023-2024

This meeting was scheduled to include consideration of the annual report of the Director of Public Health. The report says that this year, the report:

focuses on “Place” as a foundation and anchor for the work of the Public Health Team, and how it will be used to deliver on the priorities of the Health and Wellbeing Board Strategy

It explains how the:

importance of using an evidence-based approach to decision making, working with communities using an asset-based approach, maintaining a relentless focus on reducing inequalities and working in partnership with others in the Council as well as with wider stakeholders is recognised

The report says that:

A Sense of Place has been instrumental in the development of the Integrated Care System across Northamptonshire from the outset. Building on the incredible examples of community support and resilience demonstrated across the North Northamptonshire area during recent years, it has been a key driver underpinning this activity. It uses the principles of Asset Based Community Development (ABCD), recognising what is strong in communities and using this resource to resolve local issues. Creating vibrant, healthy, and resilient communities is achievable: a focus on what is strong, not what is wrong.

It describes how there are 4 Community Wellbeing Fora (CWFs), one for each of the former districts of North Northamptonshire (Corby, Kettering, Wellingborough and East Northamptonshire). The report says that each of these has several Local Area Partnerships (LAPs) “aligned with specific CWFs and are focused on working at a community level”, arguing that:

This structure ensures that stakeholders and going forward, crucially, local people, have a strong voice in influencing service development, identifying priorities and ultimately helping resolve difficult health and wellbeing issues in a sustainable way.

The report lists the priorities of each LAP:

The report says that the Community Wellbeing Fora will be replaced by Place Based Partnerships in the coming year, and says that this reflects:

the maturity in the system and the better understanding of the role they can play in supporting communities to flourish

The report also sets out some of the work the Public Health team is undertaking. The report says that the Health Protection team have:

strengthened outbreak communication templates, outbreak standard operating procedures, and outbreak fact sheets

engaged with partner organisations across the system to ensure we are ready to respond in an effective manner when any outbreaks occur

The report says that the team delivered a programme of infection, prevention and control training in 32 care homes.

The report says that the Healthy Schools Team has:

made a strong commitment by permanently establishing the Healthy Schools Team as part of the substantive Public Health Team structure

It says that 51 schools are participating in the Healthy Schools Awards, and that 21 have already achieved their bronze award and are working towards their silver awards.

The report says that the Children and Young People’s Team has:

delivered oral health education, training and support to frontline staff working with vulnerable children and adults across the area

It also says that the team is:

delivering a supervised tooth brushing scheme in early years settings, focused on the areas of North Northamptonshire with the poorest oral health outcomes

The report says that the Public Health team have been “working with many important partners across the system, including West Northamptonshire Council and the Northamptonshire Healthcare NHS Foundation Trust” to implement the suicide prevention strategy. It says that the team:

delivered a Mental Health and Suicide Prevention Training framework

It also says that:

over 500 people have been trained in various sessions, including on mental health awareness, suicide awareness and prevention, mental health first aid, and youth mental health first aid.

The report says that a new Commissioning Team has been established and that it is “leading on commissioning activities with an approach that prioritises the needs of local people to ensure best use of resources and to maximise access for those in need of support”.

It also says that a multi-stakeholder steering group has been established to deliver the Joint Strategic Needs Assessment.

Finally, the report sets out how the Public Health Team is building relationships with academics. The report says that “substantial progress [has been made] developing strategic relationships with academic institutions. These include links locally with the University of Northampton and regionally with the University of Nottingham”. It also says that the team is “starting to be involved in delivering research” and cites an example of a research project “funded by the National Institute for Health and Care Research (NIHR) East Midlands Clinical Research Network” that was undertaken with West Northamptonshire Council. This research was “focused on understanding the health needs of our Eastern European communities, which is key for us to make sure our services respond to the needs of all our population”.

It is important to note that this article is based only on the documents that were prepared in advance of the meeting. It is therefore possible that some of the topics listed above were not actually discussed, and it is certain that this summary does not contain any information about what decisions were taken.