Wiltshire's Joint Health and Wellbeing Strategy

The Health and Social Care Act 2012 introduced Health and Wellbeing Boards which became operational on 1 April 2013 in all 152 local authorities with social care and public health responsibilities.

The boards:

provide a strong focus on establishing a sense of place
instil a mechanism for joint working and improving the wellbeing of their local population
set strategic direction to improve health and wellbeing

The Health and Care Act was updated in 2022, but the updated act did not change the statutory duties of the Health and Wellbeing Boards. It did however establish NHS Integrated Care Boards and require the creation of Integrated Care Partnerships in each area. Our local Integrated Care Board (bsw.icb.nhs.uk) (opens new window) covers Bath and NE Somerset, Swindon and Wiltshire and the Integrated Care Partnership (bswtogether.org.uk) (opens new window) mirrors this.

Further guidance on the work of Health and Wellbeing boards can be found on Committee details - Health and Wellbeing Board (cms.wiltshire.gov.uk) (opens new window).

The board is made up of voting and non-voting members from Wiltshire Council, the NHS and Healthwatch Wiltshire, Wiltshire Police and Dorset and Wiltshire Fire and Rescue Service (DWFRS).

The statutory functions of the Board include:

to prepare a Joint Strategic Assessment (JSNA); a Pharmaceutical Needs Assessment (PNA) and Joint Local Health and Wellbeing Strategy (JLHWS)
a duty to encourage integrated working between health and social care commissioners in connection with the provision of health and social care services
a power to encourage close working between commissioners and health-related services and the board itself
a power to encourage close working between commissioners of health-related services and commissioners of health and social care services

For information on the membership of the board and the next meeting date can be found: Committee details - Health and Wellbeing Board (cms.wiltshire.gov.uk) (opens new window).

Foreword

The health and wellbeing of Wiltshire residents is the highest priority for the Wiltshire Health and Wellbeing Board, we are determined to ensure that people in Wiltshire are empowered to live full, healthy and enriched lives.

This strategy has been developed based upon the evidence of need and has enabled the board to focus on four thematic areas where it can have its most impact, ensuring everyone has access to the opportunities and services that we would expect for our own friends and families. We know that our population is ageing (there is a forecast increase of 87% in our aged 85 and over population by the year 2040). We also know that where someone is born and raised in Wiltshire can have a significant influence on how healthy they are and how long they will live and that, sadly, the pandemic and ensuing cost of living challenges have further exacerbated these health inequalities. We want to ensure everyone can thrive in Wiltshire. Achieving this will mean a clear focus on reducing inequalities but also connecting with communities to encourage local action and better tailoring the delivery of our services to reflect the needs of local areas.

As organisations responsible for designing, commissioning and delivering a huge range of health and social care services for Wiltshire residents, we are keen to make services the best they can be and excellent value. Integrated working is an essential part of this. We also recognise the need to shift the focus from acute to primary and community care and, in turn, to preventative activity and population health. A population health approach will allow the risks and rewards of investment in services to be shared locally and the potential to try new approaches such as clustering more care services around GPs or commissioning on the basis of whole population health outcomes rather than systems which reward increased contact. It will also mean we fully recognise the difference good jobs, housing, natural environments, education and community can make to health and wellbeing.

We must work with local communities and target our collective resources where the evidence tells us action will make the greatest improvements to people's health and wellbeing.

Therefore, our four guiding themes for this strategy build on those of our previous strategy (and those reflected in our Business plan) as a clear long term commitment to this way of working.

Our four guiding themes are:

improving social mobility and tackling inequalities
prevention and early intervention
localisation and connecting with communities
integration and working together

As a board we will continue to work closely together to deliver the vision of this strategy so that our ambition is realised.

Cllr Richard Clewer
Chair, Wiltshire Health and Wellbeing Board

Introduction

The Wiltshire Health and Wellbeing Board (HWB) was introduced by the Health and Social Care Act 2012. It is a partnership that brings together the leaders of the health and social care system.

The board is required by legislation to deliver specific responsibilities:

produce a Joint Strategic Needs Assessment (JSNA) and Pharmaceutical Needs Assessment
develop a Joint Local Health and Wellbeing Strategy
encourage and enable integrated working between health and social care

The JSNA uses current data and evidence about health and wellbeing in Wiltshire, to highlight the health needs of the whole community. It demonstrates how needs may vary for different age groups, as well as identifying health differences for disadvantaged or vulnerable groups. The JSNA looks at a wide range of factors that help shape and influence the health and wellbeing of individuals, families and local communities such as education, employment, housing, transport and the environment.

Further information can be found on the Wiltshire Intelligence Network (wiltshireintelligence.org.uk) (opens new window) website which provides a wide range of data sets, indicators and assessments that have relevance to Wiltshire's residents.

Within this document the word 'health' is understood to be a dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity.

This Health and Wellbeing Strategy is a shared strategy, which aims to improve the health and wellbeing of the local population. It uses the analysis and data from the JSNA, to help identify and agree the key ambitions for our population which as a Health and Wellbeing Board we will work together to deliver.

It does not list everything that all organisations will be doing to improve health and wellbeing. Instead it focuses on where Wiltshire's Health and Wellbeing Board can add value and sets out our vision for integrated working for the future.

The purpose of the strategy is to enable:

all health and wellbeing partners to be clear about our agreed priorities
all members of the HWB to embed the priorities within their own organisations and ensure they are reflected in a joined-up way in their commissioning and delivery plans (this is a statutory duty for the council and the NHS)
the board to hold organisations to account for their actions towards achieving the objectives and priorities in the strategy.

Wiltshire's strategy has been developed in tandem with the new Integrated Care Strategy (the 'system level' strategy) for Bath and North East Somerset, Swindon and Wiltshire (BSW) and the first five-year Joint Forward Plan for the Integrated Care Board which will deliver it. The two strategies are complementary and differentiate the activity that will be taking place at 'system' (ie BSW) and 'place' (ie Wiltshire) levels. To ensure alignment Wiltshire's Health and Wellbeing Board is consulted on the system level strategies and related delivery plans and has the opportunity to include a statement on compliance with the JSNA and JLHWS within the forward plan, as well as to be consulted on the annual report for BSW.

Wiltshire's Health and Wellbeing Board will consider regular progress reports on the delivery of this strategy, which will inform the work programme of the Wiltshire Integrated Care Alliance and the individual work of members of the board. The progress reports will also inform the timescale for any refresh of this strategy before 2032.

The following information has been extracted from the Joint Strategic Needs Assessment (JSNA), for the further information please refer to JSNA (wiltshireintelligence.org.uk) (opens new window).

Wiltshire's JSNA provides an in-depth analysis of the needs of the population of Wiltshire. Below is an overview of population and deprivation.

Wiltshire's current population:

510,400 people
51% female and 49% male

Wiltshire's population by the year 2040:

those under the age of 65 is expected to have decreased by 3%
those aged 65 and over are expected to have increased by 43%
those aged 85 and over are expected to have increased by 87%

Areas of deprivation

Eight of the 285 small areas of geography in Wiltshire, also known as LSOAS (Lower Super Output Areas), are within the 20% nationally most deprived. They are classified as 'urban city and town', and are found in:

Trowbridge
Chippenham
Melksham
Salisbury

Households in Wiltshire in the most deprived areas experience higher levels of fuel poverty (17% of households compared with 7% in the least deprived areas) and a gap in life expectancy of up to 7 years with the least deprived areas (76.3 years life expectancy for men in the 10% most deprived areas compared with 83.5 years for men in the 10% least deprived areas).

Health inequalities are understood to be avoidable, unfair and systemic differences in health between different groups of people. There are many groups experiencing health inequalities including those from ethnic minority communities, those experiencing homelessness, those with a learning disability and those living in rural areas. It is useful to keep this in mind when reading through the JSNA.

The health of those in Wiltshire is generally very good compared to the national average. On the whole people in Wiltshire have a higher life expectancy and healthy life expectancy than the England average. Fewer people are living in areas of deprivation, smaller proportions are living unhealthy lifestyles, more people have been vaccinated and crime and unemployment rates are very low. However, evidence from the Joint Strategic Needs Assessment has highlighted that the most deprived 20% of areas within Wiltshire have repeatedly poorer outcomes than the least deprived 20%.

Our communities living in those least deprived areas of the county, will enjoy a greater array of life chances and more opportunities to lead a flourishing life. They also have better health. The two are linked: the more favoured people are, socially and economically, the better their health. Inequalities within Wiltshire, and the need to maintain a focus on major health issues, for example reducing deaths from cancer and cardiovascular disease, mean that local services should always be accessible to all.

Inequalities do exist in Wiltshire and, with an ageing population structure, health needs are due to change further over future years. This, combined with the reduction in the working age population, means that the current approaches to health and care will not be sustainable in the future and could have an impact on all aspects of our lives if good health is not prioritised. Therefore, we must narrow the gap in health and wellbeing outcomes. We have to make sure everyone has the opportunity to have an excellent education, to learn skills and get a good job, to live in a nice environment and live healthier lifestyles into old age.

People in Wiltshire are empowered to live full, healthy and enriched lives.

The four key themes of Wiltshire's Health and Wellbeing Strategy

In everything we do, we consider the impact of the action on social mobility and ask how we can help to tackle the disparities in opportunities, experience, access and health outcomes that exist within Wiltshire. We focus on the factors that have the greatest influence on people's health, such as ensuring good and secure homes and jobs.

Case for change

Whilst a significant proportion of our population are healthy; good health isn't just about the treatment of illness. It is the food we eat, the relationships we maintain, the environments in which we live and work and the opportunities we have to thrive. Supporting people to remain healthy, independent and well is a crucial feature of this strategy. To make the biggest changes in people's health and wellbeing, we need to focus on the social and environmental factors impacting on people's lives. Addressing these wider determinants of health - such as housing, unemployment, homelessness, education, social isolation, transport and community safety - alongside recognition of the rurality of much of Wiltshire, is critical for improving social mobility and tackling inequalities.

Achieving change

We will:

promote health in all policies - including housing, employment and planning. This will include the development of sustainable communities, whole life housing and walkable neighbourhoods. The review of Wiltshire's Local Plan and Local Transport Plan is an important opportunity to deliver this.
support healthy home settings - with action on fuel and food poverty, helping people to find stable well paid work and higher incomes, mental health and loneliness and by increasing digital inclusion
give children and young people the best start in life - with a focus on the whole family, family learning, parenting advice, relationship support, the first 1000 days (early years), and community health services
target outreach activity - identifying particular groups to improve health outcomes and access to services (identifying and then focusing on several of these each year) - work to tackle root causes, plan delivery and carry out evaluation.
improve access through online services, community locations and mobile services as well as community diagnostic hubs.

We ensure our dialogue with communities is open, transparent and inclusive, in the right place and at the right time so that the distinctive needs of local communities are met. We enable stronger and resilient communities and support broader social and economic development

Case for change

Population growth and management of long term conditions means our health and care system is under increasing pressure, particularly as it recovers from the pandemic. When people have the skills, knowledge and confidence to manage their own health and care, not only do they achieve better health outcomes, there is also the benefit of reduced healthcare costs and increased satisfaction with services. However, when individuals in a community feel isolated, this impacts their ability to remain resilient, which is a strong predictor for poor outcomes. Enabling communities to be stronger and more resilient allows local solutions for local problems, by working together with partner agencies and the voluntary sector to meet their health and wellbeing needs.

Achieving change

We will:

support local community action - through initiatives such as neighbourhood collaboratives allied to the development of Primary Care Networks, community based programmes and social prescribing, the community mental health model, area board activity using community area JSNAs to inform local action planning and the allocation and bidding for wellbeing grants
pilot community conversations - starting with neighbourhoods in Wiltshire that have significant deprivation and roll these out gradually across the county.
consider the way in which we buy goods and services can deliver improved local job opportunities (acting as 'anchor' institutions) and other wider benefits (social value)
embed Healthwatch Wiltshire and voluntary and community sector voices in relevant decision-making structures and ensure the public voice is heard with consultation results and co-production reflected in decision papers and relevant attendance at the Health and Wellbeing Board

We design and deliver our activities in partnership with service users, the voluntary, community and social enterprise (VCSE) sector, local communities and public sector partners. We collectively consider how to integrate our work, get maximum value for public sector spend and plan our use of the public sector estate together.

Case for change

Our current health and care system is under pressure and can be confusing for staff, patients, families and carers. As our populations get older and more people develop long-term health conditions, our system is becoming less able to cope with the changing needs and expectations of the people it serves. This is leading to higher demand for social care, carers and community health services and these pressures will continue to increase with a reduction in the working age population. The way we pay for health and care services can encourage high-end care in expensive settings, often reinforcing isolated working practices. We currently spend too much on services responding at the point of crisis and not enough on early intervention and preventative support that aims to keep people well for longer. Initial signs are that COVID has reinforced the investment in acute services and although there has been some staffing growth there are also challenges with increasing activity and productivity across the system to address the elective care backlog.

Achieving change

We will:

provide integrated, personalised services at key stages in a person's life - this will include starting to complete later life planning with people in their early 60s (or before that in more deprived areas) so that we are preparing for when they are older, end of life care, and increasing the provision of personal budgets and coproduction of services
boost 'out-of-hospital' care, encouraging a 'hospital without walls' model with improved digital and local access to consultants, and dissolving the divide between primary and community health services - through coordination of community multi-disciplinary teams, clustering services around primary care networks, and guaranteeing support to people in care homes
enable frontline staff to work more closely together - planning our workforce needs together, developing case studies on front line cooperation, supporting shared records and IT and sharing estates wherever possible
ensure carers benefit from greater recognition and support by improving how we identify unpaid carers
improve join-up of services through community healthcare, primary, secondary and tertiary healthcare (including specialist services, for the armed forces and their families, pharmaceutical services and healthcare in the justice sector)
drive improvement by delivering our vision through collective oversight of quality and performance, reconfiguration of clinical pathways, recommissioning of services and overseeing pooled budgets and joint teams together (through the Wiltshire Integrated Care Alliance). The ICA will bring together officers from the relevant organisations and report regularly to the Health and Wellbeing Board on progress against this strategy and its own transformation programme as well as the Better Care Plan

If you require more information, please contact executivebusinesssupport@wiltshire.gov.uk (opens new window)

Wiltshire's Joint Health and Wellbeing Strategy

Overview

Wiltshire Health and Wellbeing Board