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Health & Wellbeing Strategy – Engagement Response Report

August 2012

Preface – Richard Roberts

In April this year the shadow Health and Wellbeing Board (HWb Board) launched a stakeholder engagement exercise on the proposed initial priorities for the Health and Wellbeing Strategy for Hertfordshire. The aim was to give local organisations, voluntary and community groups and residents the opportunity to comment on what they feel matters most to helping people in Hertfordshire live healthy and fulfilling lives.

In total, we have heard from over 150 partners and community organisations and nearly 3000 residents. This is a positive response and shows the genuine commitment that our partners and citizens have for improving health and wellbeing and tackling health inequalities. The responses to the engagement will play a central role in creating a stronger, more effective strategy that works for the people of Hertfordshire.

In the vast majority of responses, it is clear that there is an ambition and drive to go build on our progress to date as we all seek to improve the health and wellbeing of Hertfordshire citizens. It is also clear that a lot of excellent work targeting the reduction of health inequalities is already being carried out by an array of groups and individuals. I am confident that by harnessing this shared enthusiasm, and working together to combine our energies and knowledge, great strides can be made, not only for the strategy’s initial priorities but for improving the health and wellbeing of Hertfordshire as a whole.

I would like to personally thank all those who have taken the time to respond to the engagement, your views matter and will help ensure that the final strategy is right for Hertfordshire. I look forward to your continued positive engagement with the Health and Wellbeing Board.

Richard RobertsChair – Health and Wellbeing Board

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ITEM 4 APPENDIX A

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Summary

The engagement exercise ran from 16 April to 16 July 2012 and targeted key stakeholders, local groups, and members of the public.

In total, 2753 responses were received: 60 responses from key stakeholders, 2253 responses from a written survey and 433 from an online survey

In total, 165 responses were received from groups and organisations and 2582 from individuals.

Key messages include a general approval of the proposed strategy’s approach and choice of initial priorities.

Identified areas for expansion include the inclusion of physical activity as a priority and the prioritising of joined up working on future initiatives.

Background

The aim of the engagement exercise was to gain opinion from a range of stakeholders on the proposed initial priorities for the Health and Wellbeing Strategy. Stakeholders were encouraged to consider the methodology used to determine the top initial priorities, the evidence used to determine the scoring and finally whether there were any areas which may have been missed.

The exercise was approached in a number of different ways:

Key Stakeholders were written to directly to respond. These included local authority groups, school groups, the voluntary sector, health partners, and the police. Community Groups were given the opportunity to express their views at organised engagement events. These were hosted in partnership with NHS Hertfordshire and included a presentation and supported discussion. Groups included Hertfordshire LINk and the Patient and Public Interest Group of Welwyn Hatfield Commissioning Locality.

Members of the Public and local groups could view a number of explanatory documents on the HWb Board website (www.hertsdirect.org/hwb).This included access to the Priority Evaluation Tool (PET) to view how priorities had been selected. This group could either respond via the website’s online survey or via a similar written survey which was available in postcard form in libraries, Children’s Centres and GP surgeries.

This report is divided into two sections. The first will analyse the responses from organisations and the second will analyse responses from individual respondents. In both sections key themes and messages are identified and analysed.

Due to a delay in receiving all written survey responses, including postcard responses from GP surgeries, this report is to be considered in draft format. The key messages are not expected to differ widely from those that have been currently identified once the additional responses have been combined.

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Feedback

Organisations This section will analyse those comments from organisations. For a list of these respondents please see Appendix One.

To summarise, the response to the proposed strategy from organisations was generally very positive:

Organisations largely approved of the principles underlying the strategy.

There was a majority agreement of the methodology used to select the initial priorities including the use of the PET.

A common thread was a very real desire to reduce social and health inequalities in Hertfordshire.

A clear recognition of the benefits of working in partnership to address the challenges we face.

“The strategy is very clear and the priorities welcome, showing how the most vulnerable groups of people will be targeted first and supported”

Hertfordshire Partnership NHS

Many organisations felt the initial priorities were interlinked and could not be considered in isolation to one another. Mental health for example was felt to be linked to other priorities which should be taken into account when commencing initiatives. It was partly for this reason that the multi-agency approach was praised and recognised as integral to the overall success of the strategy.

“For some groups of people with particular health and wellbeing needs, their needs cut across a number of priories and if their quality of life and health are to be

improved, then action needs to be cross cutting too.”Centre 33, St Albans

“Recent initiatives from the HWB were welcomed, for example, ensuring that planning applications to District Councils for new nursing homes would be discussed

with local GPs before applications were decided”East and North Hertfordshire Clinical Commissioning Group

An important observation that has come across from responses is the number of leading and innovative projects aimed at reducing inequalities already underway by organisations in Hertfordshire. There was a clear desire to capitalise on such initiatives through sharing knowledge to build a better picture on Hertfordshire’s health. Many of these initiatives already complement the strategy priorities.

“We agree with the priorities, the majority of which through established partnership working, we are already significantly involved with.”

Hertfordshire Constabulary and Hertfordshire Police Authority

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Physical Activity Case Study

“The projects are named ‘Nudge’ and aim to offer participants a ‘nudge’ towards becoming more active…they utilise technology that allows individuals to monitor their physical activity using a small devise called an ActiPed+. Activity is stored on the devise and wirelessly downloads to a personal online portal where users can view how close they are to meeting their targets for steps, calories, distance and time.”

Herts Sports Village and University of Hertfordshire

Areas of the strategy organisations particularly approved of were:

Mental health – many were pleased this was singled out as a priority. The holistic approach to health inequalities including emphasis on

early intervention, the role of the community in improving health and the idea of individual responsibility.

The JSNA (Joint Strategic Needs Assessment) was recognised as a valuable data tool particularly for gathering data unique to Hertfordshire.

A focus on early intervention when tackling current and future health issues.

“It is noted that across the priorities the ambition of the Board is to cut across generations and take a holistic approach. This is to be welcomed”

Harpenden Town Council

Mental Health Early Intervention Case Study

A twelve month ‘Navigator’ pilot project, which started in April 2012 and is being carried out jointly between Dacorum, St Albans and Welwyn Hatfield Councils, is looking at early intervention opportunities to identify people who are at risk of suffering mental illness…Once identified, the project signposts them to support agencies”

Dacorum Borough Council

Although it was largely felt that implementation of the strategy will result in a real difference to tackling health and social inequalities, some organisations felt certain areas could be expanded. To summarise, these were:

The majority of responses felt that there should be greater reference to healthy lifestyle. In particular, many recommended that physical activity be included as a priority on its own.

The term ‘tackling obesity’ was deemed negative and potentially isolating for individuals.

The strategy should emphasise emotional wellbeing when referring to mental health.

Due to the significance of this issue, dementia should be tackled as a priority on its own.

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Other significant areas recommended for inclusion were: the provision of adequate housing, the accessibility of leisure facilities (including open spaces), transport, bullying and the needs of older people.

Some organisations wanted to be kept informed about how the strategy will be delivered.

“Promoting physical activity for all ages should be a priority”East and North Hertfordshire NHS Trust

“Increasing levels of physical activity has many benefits, and can contribute to several of the proposed priorities…District and Borough Councils have a major role in

providing and promoting physical activities, and could make a big contribution to delivery of a priority centred on this issue”

Broxbourne Borough Council

Holistic Targeted Approach Case Study

“Watford Community Housing Trust provides diversionary activities for young people from some of Watford’s most deprived estates, helping to tackle obesity and reduce smoking. In the last year these projects have included dance groups run in partnership with The Dan Tien performing arts school and football activities in partnership with Watford Football Club’s Community Sports and Education Trust.”

Watford Community Housing Trust

It was clear from the responses that the HWb priorities cannot be considered the only priorities of partners and other organisations. There should be recognition of the differing priorities of each partner and that the final priorities for the Health and Wellbeing Board must be those where working in partnership can have the greatest impact.

Overall, organisations were pleased to be consulted on the strategy and are eager to begin pooling their knowledge and resources at the next stage of engagement. Responses indicate considerable confidence that the strategy can be successful in achieving its health and social goals.

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Individuals

This section considers the written responses of individual respondents to the surveys. The surveys consisted of a number of set questions with several spaces for written comment.

Prior to and during the engagement exercise, considerable effort was made to target a wide range of stakeholders that included BME (Black, Minority and Ethnic) groups. This involved working in partnership with NHS Hertfordshire to hold engagement events for the nine district Health and Wellbeing groups, supporting local groups to hold focus sessions, and targeting BME community groups. Information on the strategy was also published widely and documentation was made available in multiple formats which included an easy-to-read version.

Respondents

The engagement sought to consult with individuals and groups across the county. Responses were monitored throughout the engagement to ensure good representation from across all groups. Where under representation was identified, action was taken to promote the engagement with these groups. An example of this was with under represented BME groups. Key BME partners, such as the Herts Equality Council and Community Engagement Workers helped mobilise their stakeholders to engage through existing communication channels and events. This monitoring and the targeted engagement have helped ensure good representation across all groups.

Analysis of the survey responses indicate a fairly even distribution of responses across districts. Results from the written survey show a high response rate when compared with population from Dacorum, North Herts and Watford. Results from the online survey show a high response rate when compared with population from East Herts and Stevenage. For a breakdown of these figures please see Appendix Two.

Out of 2747 responses, 312 respondents gave their postcode and 253 of these were able to be matched using the Mosaic Public Sector tool which is able to give a general picture of a citizen’s lifestyle, demographics and behaviour according the their location. Using this tool as a guide, there was an over representation of respondents from middle-class often fairly affluent backgrounds. For example, proportionately (compared to whole of the County) responses within Mosaic Group D 'Successful professionals living in suburban or semi-rural homes' were over-represented by 5.4% and K 'Residents with sufficient incomes in right-to-buy social houses' over-represented by 4.7%.

Conversely responses within Mosaic Group H 'Couples and young singles in small modern starter homes' were proportionately under-represented when compared to whole of the County by 7.7%. The Mosaic tool infers a definite representation of more affluent, better educated and therefore healthier respondents but a more questionable representation of those less well-off, and from younger and older backgrounds. Nearly 40% of responses were

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from four postal towns of Hemel Hempstead, St. Albans, Stevenage and Watford.

The online survey respondents were asked to state their age. Using the age boundaries stated in the survey and comparing these to the population of Hertfordshire, it can be seen that the vast majority of respondents were aged between 40-59 (in total 39% of survey respondents). Other age ranges can be seen to be underrepresented, in particular the younger categories and especially those aged between 16 and 24.

Age of online respondents compared to Hertfordshire population figures

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20

30

40

50

60

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16-24 25-39 40-59 60-64 65-74 75+

Age Ranges

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Hertfordshire Population

Responses

The online survey respondents were asked to state their ethnicity. When removing the 30% of respondents who preferred not to say, 88% of respondents stated their ethnicity as white British while 12% stated their ethnicity as a BME group. The overall population figures for Hertfordshire are 82% White British and 18% a BME group. This suggests a marginal under-representation of BME groups within the survey. A breakdown of ethnicity can be seen below.

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Ethinicity of online survey respondents

Black African

Black Caribbean

Chinese

I'd rather not say

Indian

Other

Other Mixed Background

Other White Background

Pakistani

White and Asian

White and Black African

White and Black Caribbean

White British

Other data asked by the online survey includes sex of respondents: 52% were female, 21% were male, and 27% preferred not to say.

Nearly 20% of all online survey respondents were carers, 83% of who care for an adult. Of those respondents who answered the questions, 38% of respondents described themselves as a parent and 5% had a child with a disability.

Question 3 of the online and written survey asked respondents that, if they felt the HWb Strategy had missed out any important factors, why they felt this was. Responses were:

Reasons given by written and online survey respondents to Q3 'If you have suggested something we’ve missed, is this

because of…'

0%5%

10%15%20%25%30%35%40%45%

Personalexperience

of theissues

Lack ofservicescurrentlyavailable

Lack offairness in

currentservices

Cost toservices ifnothing is

done

Impact onthe

economy

Other Blank

Reason

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As can be seen, approximately 42% of respondents responded in the way they did due to personal experience of the issue. document.doc 8

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Responses

Question 1 of the survey asked whether respondents agreed with the way that priorities had been analysed to choose the initial eight.

Summary of question oneResponse Written Survey Online Survey Total PercentageNo 437 102 539 20%Yes 1776 296 2072 77%Blank  40 35 75 3%Grand Total 2253 433 2686 100%

Over 75% of respondents approved of the selected priorities and the method in which they were chosen.

Question 2: Do you think we have missed out any important factors?

Summary of question twoResponse Written Survey  Online Survey Total PercentageNo 1535 216 1751 65%Yes 635 179 814 30%Blank 83 38 121 5%Grand Total 2253 433 2686 100%

Although 65% of respondents were satisfied with the strategy, several key factors were identified as absent. The highest rated of these were services for older people (15% of respondents), followed by a need to improve the quality of current and proposed health services (14% of respondents). An emphasis on a healthy lifestyle was also deemed important (7% of respondents) particularly physical activity which many felt should be a priority on its own. Respondents were particularly pleased to see that mental health and support for carers were included as priorities.

“We need to put more emphasis on physical activity…we need to educate children in school early on the importance of good nutrition and physical activity”

Individual – Online Survey

Respondents largely approved of the focus on issues relevant to Hertfordshire and it was felt that, as the priorities are interlinked, organisations need to work together to target inequalities in their communities.

“Besides the priorities, and flowing through them, there needs to be a major focus on engaging our communities – in an explicit attempt to find ways of breaking the cycle

of parents passing on unhealthy lifestyles to children, and peers exerting strong pressures on young people.  Take for example the provision of healthy meals at

schools, which are ignored by children in favour of going to the local convenience store or eating less healthy food brought from home with parents’ support”.

Individual – Emailed Response

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For a further breakdown of responses to question 2 and question 3 please see Appendix Three.

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Conclusion

There is good evidence that the engagement exercise has been able to engage with a wide variety of key organisations, including local authorities, voluntary and community groups, and a considerable number of residents from across the county.

It can be seen from organisational feedback and survey results that responses to the strategy, its underlying principles, methodology and use of evidence, are overwhelmingly positive. Respondents are pleased that:

The community should play a central role in tackling health inequalities

Priorities will be based on the specific needs of Hertfordshire residents

Implementation of the strategy will involve a holistic approach that will benefit from the input and involvement of a wide variety of local organisations.

In particular, respondents are pleased that issues such as mental health and support for carers have been recognised.

Respondents noted that certain issues should receive greater consideration, namely:

A high proportion of organisational responses proposed that physical activity should be included as a priority.

While physical activity was also considered important by survey respondents, the needs of older people and the importance of ensuring good quality service were also highlighted.

Ensuring that there will be a measurable definition of realistic and achievable progress going forward.

A continued focus on local issues.

“We are convinced that the Strategy should more explicitly reflect JSNA intelligence on what specific priorities exist for many disparate local communities across

Hertfordshire. Identifying priorities for smaller geographies should provide a more transparent and coherent approach to tackling health inequalities across the county”

North and East Hertfordshire NHS Trust

All organisational respondents and most survey respondents were pleased to be consulted. Some of their comments relating to the engagement exercise were:

The majority were keen to be involved in future engagement. A shared desire to continue current momentum and cooperation. A recognition of the need to continue targeting all groups including

members of the public of all ages and BME groups. This includes the continued implementation of effective media tools including non-web based resources.

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“It is important that equality and diversity issues that stem from cultural diversity and the multiple disadvantages and discrimination suffered by some specific target

audiences is factored into the action plan that materialises on the Strategy”Herts Equality Council

Overall enthusiasm and support is very high for a strategy that, with the continued involvement of key stakeholders, promises to deliver considerable improvements to the health and wellbeing of the people of Hertfordshire.

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Appendix One

Organisations who submitted written responses

DistrictsBroxbourne Borough CouncilBroxbourne Health ForumDacorum Borough CouncilEast Herts CouncilHertsmere Borough CouncilNorth Hertfordshire District CouncilSt Albans Health and Wellbeing PartnershipThree Rivers District CouncilWatford Borough Council Housing TeamWelwyn Hatfield Borough Council NHSEast & North Hertfordshire NHSEast & North Hertfordshire CCGHertfordshire Partnership NHSHerts Valleys Clinical Commissioning group Other OrganisationsActive Broxbourne Community Sport NetworkAge UK DacorumB3LivingChorleywood Residents AssociationFinesse Leisure PartnershipHarpenden Town CouncilHemel Rugby LeagueHertfordshire Association of Cultural OfficersHertfordshire Constabulary and Hertfordshire Police AuthorityHertfordshire LINkHertfordshire Local Nature PartnershipHertfordshire Physical Activity AllianceHertfordshire Probation TrustHerts Sport PartnershipHerts Sport VillageHightown and Churches Housing AssociationMencap Hertfordshire County GroupMental Health and Learning Disability Theme GroupNational Housing FederationNorth Hertfordshire HomesOlder People's Theme GroupOrigin HousingPatient and Public Interest Group, Welwyn Hatfield Comissioning LocalityPhysical and Sensory Disability GroupSportspaceSport EnglandSt. Albans and Harpenden Patient GroupUnison, University of Hertfordshire Branch

University of HertfordshireWatford and Three Rivers Health and Social Care Group

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Watford Asian Community CareWatford Community Housing TrustWelwyn and Hatfield Sport and Physical Activity AllianceWodson Park TrustWoodland Trust Internal to HCCChildren and Young People TeamCountryside Management ServiceHCC EnvironmentHerts Equality CouncilMoney Advice UnitYoung People's Substance Misuse TeamCouncillor John BarfootLiberal Democrat GroupCouncillor Maxine Crawley

Organisations who responded to the online survey

Active St AlbansADD-vanceAge Concern bishop's StortfordAge Concern DacorumAll Engage LimitedB & A -ISLBADMINTON EnglandBritish CyclingBritish GymnasticsBritish Nordic WalkingCAMHS Strategic Commissioning GroupCARERS IN HERTFORDSHIRECentre 33 (St Albans)Crossroads Care Hertfordshire NorthCruse Bereavement Care HertfordshireDacorum Arts PartnershipDiabetes Voices UKFaculty of Sport & Exercise MedicineGuideposts TrustHarbour Hights Scuba Diving Club & Matthews Sharks Scuba Diving clubHCC Community Protection DirectorateHCC, Health and Well Being TeamHertfordshire CricketHertfordshire Geological SocietyHertfordshire Local Pharmaceutical CommitteeHertfordshire Probation TrustHerts County Athletic NetworkHerts Hearing Advisory ServiceHerts self advocacy network , second response as first was unfinishedHerts sports partnership

Herts Valleys Clinical Commissioning Group, covering Dacorum, Watford, Three Rivers, St Albans and HertsmereHMP The Mount

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Home Instead Hemel HempsteadHome-StartHome-Start StevenageI am responding on behalf of all 10 CABx in Hertfordshire, covering all districts as aboveITALIA CLUB 2000Kaisho Martial ArtsKRJLetchworth self advocacy groupLinkage GroupMarshalswick Judo ClubMencap Herts County GroupMental Health ServicesNacro XS ProjectNHHOASISPhysical & Sensory Disabled, HertsLinkSafer PlacesSafer PlacesSaracens Sport FoundationSenior Italian Luncheon ClubSignpostSport Stevenage (Community Sports Network)Stevenage Borough CouncilStevenage CVSThe Ark Children's CentreThe ASAThe Herts self advocacy networkThe Shenley Village cricket clubThrive HomesThrive HomesWatford FC CSE TrustWatford Indian AssociationWodson Park Trustwww.cycleinstructor.co.uk

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Appendix Two: Breakdown of written and online survey data

District responses for written and online survey

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

District

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Written survey response rate

Online survey response rate

Population

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Appendix Three: Breakdown of data for Question 2 and Question 3

Question 2: Do you think we’ve missed out any important factors? If ‘Yes’, tell us about other factors we need to consider when deciding on out initial top priorities

Summary of all written and online responses

Factor Written Survey  Online Survey Total PercentageOlder People 121 4 125 15%

Quality of Services 102 14 116 14%

Other 55 11 66 8%

Lifestyle Factors 28 32 60 7%

Equality & Discrimination

41 2 43 5%

Early Intervention/Prevention

38 3 41 5%

Engagement & Empowerment

23 17 40 5%

Children & Young People

35 4 39 5%

Medical Conditions 32 1 33 4%

Community Issues 20 4 24 3%

Blank 140 87 227 29%

Grand Total 635 179 814 100%

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Breakdown of individual responses

Factor Breakdown TotalOlder People Improvement of services for older people

including dementia115

Quality of Services Quality of both current and future health services 61Greater emphasis to be placed on an existing priority – i.e. carers

53

Other Criticism of current priority (mainly those which relate to drugs, alcohol, smoking and obesity)

37

Other – including alternative therapy and other conditions such as autism

19

Physical Disability 10Lifestyle Factors The importance of physical activity 43

Availability of leisure facilities 6Diet and nutrition 11

Equality & Discrimination

Ability to access current and future services 23

Transport to/from services 14Tackling discrimination 6

Early Intervention/Prevention

Early intervention aimed specifically at children and young people

18

Preventative measures for physical illnesses 12Helping people into work 11

Engagement & Empowerment

Request for continued strategy engagement 29

Community engagement and empowerment 9Greater focus on district level issues 2

Children & Young People

Services for children and young people 17

Natal care 13Services for families 9

Medical Conditions Cancer services 17

Other medical conditions 15Heart or liver disease 1

Community Issues Domestic violence 5

Sexual Health 9Housing and homelessness 6Anti-social behaviour 4

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