West Wandsworth Health Priorities

Local Initiatives 2012-13

CVD

Roehampton and West Hill also have higher CVD rates when compared to the national average. Locality clinicians will work alongside public health, local authority, patient representatives and service users living in the area to support the health education of adults, children and young people. The Locality will continue to support the uptake NHS Vascular Health Checks. This work will support the ‘prevention, screening, early diagnosis and awareness initiative,’ currently being implemented across Wandsworth.

Smoking Cessation

Smoking prevalence is above 25% in more than 50% of West Wandsworth practices. Admissions for Cancer in the period 2005-2008 were higher than the PCT average, particularly in the practices located in high deprivation areas. Locality clinicians will further support the smoking cessation programme to educate and promote reduction of smoking in the local population. The locality will also work alongside multiple organisations such as public health, local authority and patient representatives and service users living in the locality to tackle smoking prevention. This work will support the ‘long term conditions initiative’ currently being implemented across Wandsworth. Linked to this, the locality is working with Public Health and Paul’s Cancer Support Centre to raise awareness amongst members of the public of the signs and symptoms of lung cancer - this is being achieved through a team of Cancer Champions who are specially trained volunteer members of the public.

Obesity

The highest reception age obesity levels are in West Putney (11.0%). However Thamesfield and East Putney have similar prevalence at 10.4% and 9.7% respectively. Except for Thamesfield all wards in West Wandsworth show that one in five years 6 (aged 10-11) children may be obese. The Locality clinicians support the need to reduce adult and childhood obesity. Working alongside public health, local authority and patient representatives and service users living in the locality we will raise awareness of the health issues associated with obesity, promote healthier lifestyles and encourage obese patients to access weight management services. This supports the ‘prevention, screening, early diagnosis and awareness initiative,’ being implemented across Wandsworth.

Mental Health Services

Work needs to take place to prevent high rates of admission to mental health services and improve the health and wellbeing of the local population. The West Wandsworth clinicians will work alongside the mental health trust to Improve Access to Psychological Therapies (IAPT). The locality will also work alongside multiple agencies such as public health, local authority, voluntary organisation and patient representatives and service users living in the locality to promote positive mental health and reduce health inequalities across the local population. This work will support the work Mental Health agenda currently being implemented across Wandsworth.

Teenage Sexual Health

Wandsworth has had a teenage pregnancy strategy since 1st April 2001, with a target of achieving a 55% reduction on the 1998 baseline (71.1 conceptions per 1,000 girls aged 15-17). In the wards of Roehampton, West Hill and West Putney experience high rates of under 18 conceptions (per 1000 population. A clinical project lead will help promote clinicians knowledge and skills around sexual health within the young and better access to and use of effective contraception. This supports Wandsworth Teenage Pregnancy and Sexual Health objectives.

Alcohol / Drugs prevention in children and young people

Roehampton is estimated to have one of the highest numbers of problem drug users in the borough. There are high numbers of ambulance calls outs for alcohol related problems are around Putney town centre, Roehampton and West Hill. Locality clinicians will work alongside drug and alcohol services, public health, local authority and patient representatives and service users living in the locality to reduce the numbers of drug and alcohol related admissions to hospital and support the ‘urgent care initiative’ currently being implemented across Wandsworth and link with WCCG’s Long Term Conditions, Mental Health and Cancer/CVD priorities

CVD

Overall project lead:Amanda Cranston

Background
Taken from public health needs assessment 2010
Under 75 Cardiovascular disease mortality (2003-07):


Need for CVD prevention:
  • A recent health needs assessment looking at CVD mortality and associated risk factors found that the ward of Roehampton had the greatest need in relation to the improvement of heart health and primary prevention of CVD.
Admissions rates:
  • The Mayfield surgery, Roehampton surgery and Alton practice record high admissions for Coronary Heart Disease.
Estimated cardiovascular at risk population (QRISK 2):

NB:The locality have specific action plans to tackle smoking as key risk factor of CVD and related LTCs / Health issues. See below ‘Smoking’

Pilot of LDX
Action: Pilot of LDX machines to aid increased activity of NHS Health Checks. HN and KS to coordinate training and evaluation process with management team
Aim: Improve the uptake of NHS Health checks
Key Actions / Lead / Deadline / Progress / Key Risk / RAG

Children and Young People specific:

Action: What actions do the locality take forward to enable the below aims be achieved?
Aim: Improve health and wellbeing of children and young people
Increase uptake of Anti-Obesity and Healthy Lifestyle activity across Roehampton Extended School Cluster
Continued support to the Healthy Schools agenda
Healthy eating, exercise and tobacco education and policy to continue to be promoted through youth club settings.
Continued support to exercise promotion through Sports Development initiatives
Referral by Children’s Services to healthy lifestyle schemes run by Health – ensure services know about these schemes
Key Actions / Lead / Deadline / Progress / Key Risk / RAG
Ready for School Packs
Action: Distribution across WW practices. Evaluation of effectiveness of ready for school packs
Aim:To educated and promote health and wellbeing of nursery and preschool age
Specific to:
Childhood Imms
Healthy eating & physical activity
Toilet training
Applying for school / nursery
Key Actions / Lead / Deadline / Progress / Key Risk / RAG
‘Ready for School Packs’ to be distributed to locality practices. / HN
Agree with management team effective way to evaluated effectiveness of the packs

Smoking

Overall project lead: Amanda Cranston

Background
Taken from public health needs assessment 2010
GP registered smokers 2009

  • GP smoking data shows a clear distinction between prevalence at GP practices located in high deprivation areas and those not.
  • Danebury, Inner Park Road, Alton, Roehampton, Mayfield and Tudor Lodge practices all record prevalence above 25%.
  • GP practices located in less deprived areas record prevalence below 20%.
  • Smoking prevalence is under-reported across the borough therefore it is possible this pattern may change if all patients were questioned about their smoking status
  • The higher smoking prevalence areas in West Wandsworth coincide with the high deprivation areas in north West Hill and Roehampton.
  • Thamesfield shows relatively low prevalence of smoking.

Locality Actions:

Illicit tobacco
Action: West Wandsworth LCG requested Trading standards to undertake some focused work around illicit tobacco in West Wandsworth
Aims:
It is understood that there is illegal tobacco selling in the Roehamptopn area, this would be a hard project to evaluate but one would hope this would provide positive benefits to the area whist the locality works on more sustainable approaches with partner organizations.
Key Actions / Lead / Deadline / Progress / Key Risk / RAG
West Wandsworth LCG to provide evidence of issues in the area. / HN / 19.06.12
Smoking Cessation training for GPs
Action:Roll out smoking Cessation training for GPs and Health Care Assistants in West Wandsworth (more specifics, how many, rep per practice, how to disseminate within practices?
Aim: Smoking cessation training for practices, keep up to date with best produces to recommend using etc
Key Actions / Lead / Deadline / Progress / Key Risk / RAG
AC and HN to coordinate two separate training sessions for the locality and backfill for GPs. / AC/HN
Shared learning – Best practice
Action:Shared learning from in house and GP Engagement Scheme best practice
Aim: share learning across the locality, re best practice
Key Actions / Lead / Deadline / Progress / Key Risk / RAG
Coordinate session at LCG forum to share learning from 2011-12 GP ES / HN / 19.06.12

Children and Young People Specific(also see other comments above re. CVD prevention in general also apply)

PHSE
Action:How to take forward?
Aim:Involve School Nursing in Smoking cessation activity
Key Actions / Lead / Deadline / Progress / Key Risk / RAG
Coordinate session at LCG forum to share learning from 2011-12 GP ES / HN / 19.06.12

Obesity – Adult and Children

Overall project lead: Amanda Cranston

Background
Taken from public health needs assessment 2010
Child Obesity (Percentage of age group on 3-year average)


Childhood obesity
All children have their height and weight measured in reception and year 6 and are sent a letter outlining the results including the weight category their child is in (underweight/healthy weight/overweight/ very overweight).
The School Health and Nursing team conduct the measurements as well as follow up all those children in year 6 who have been identified as obese to provide support and signposting to services. The most recent results for this target ( measurements taken in 2010/11) are summarised below.
  • 534 children in year 6 were identified as overweight or obese (>91st Centile). 327 of these parents were contacatable and lived in Wandsworth . Of these:
  • 62 (19%) were referred to weight management services
  • 83 (25%) were sent more information and referral forms
  • 149 (46%) parents refused additional information or referral
  • 10 (3%) already had health or other professional involvement around weight issues.

Locality Actions:

Referrals to children’s healthy weight programmes.
Action:All GPs to opportunisticaly Identify obese adults who visit the surgery with their children, record BMI centile in the children, offer encouragement and support to reduce barriers to referral, refer families with overweight children to healthy weight programmes.
Target: (Percentage to be agreed based on current level of performance – this is currently being collated)
  • >xx% of children (<18 years) have BMI centile measured (EMIS report)
  • >xx% of children with BMI >91sth centile are referred to weight management service (Footsteps referrals by practice or EMIS coding?)
Aim:To improve on the proportion of parents of overweight children who are willing to accept referrals, further support and encouragement from their GP may help to:
  • reduce the stigma attached to BMI categories
  • help parents to understand the future risks for their children if the pattern of weight gain continues
  • explain the benefits of attending a family support programme (e.g. fun, learning, healthy lifestyle, family time together
GP Lead:
Key Actions / Lead / Deadline / Progress / Key Risk / RAG
National Children’s Measurement Programme
Action: Wandsworth Obesity lead to discuss with DoH National Obesity Team the possibility of routinely ensuring that all NCMP letters outlining results of height and weight measurements of children in school can be automatically sent to GPs (This does not happen at the moment due to information governance issue).
Contact for Healthy Schools is Lorraine King in the Council.
Aim: as above
Key Actions / Lead / Deadline / Progress / Key Risk / RAG
Anna Darcy
Walking groups from GP surgeries
Action: Explore opportunities for starting regular physical activity groups from GP surgeries
Aim:
Key Actions / Lead / Deadline / Progress / Key Risk / RAG
Link with Rebecca Willans – is this something health trainers can support with
Walking groups from GP surgeries
Action: Explore opportunities for starting regular physical activity groups from GP surgeries
Aim:
Key Actions / Lead / Deadline / Progress / Key Risk / RAG
Link with Rebecca Willans – is this something health trainers can support with / HN / health trainers can set up this service for the LCG and practices
Lifestyle Directory required
Action: Need to link into existing directories and know what these are- AC to follow up before deciding next steps
Aim:
Key Actions / Lead / Deadline / Progress / Key Risk / RAG

Children and Young People Specific(also see other comments above re. CVD prevention in general also apply)

Lifestyle Directory required
Action: How to take forward?
Aim:Increase uptake of Anti-Obesity and Healthy Lifestyle activity across Roehampton Extended School Cluster.
Key Actions / Lead / Deadline / Progress / Key Risk / RAG

Sexual Health

Overall project lead: Amanda Cranston

Background
Taken from public health needs assessment 2010
GP registered smokers 2009


  • The wards of Roehampton, West Hill and West Putney experience high rates of teenage pregnancy (per 1,000 population).
  • The wards of East Putney and Thamesfield record much lower rates of teenage pregnancy.

Locality Actions:

Pilot project- CRG specific
Action:LB to link with the CRG to understand if there is he scope to pilot a project in West Wandsworth.
Aims:Contribution to reduction of teenage pregnancy through the uptake of LARCs. Education, promoting and delivering use of STI services
Key Actions / Lead / Deadline / Progress / Key Risk / RAG
Shared learning – Best practice
Action:HN coordinate a shared learning session via LCG forum, what is happening within practices to promote sexual health.
Aims:
Key Actions / Lead / Deadline / Progress / Key Risk / RAG
TBC (AC to liaise with VG to find out if the locality could increase or further partake in any other existing primary care CCG work streams to reduce teenage pregnancy and improve sexual health)
NB. Is LCG involving Teenage Pregnancy Co-ordinator (Beth Kelly) on initiatives in this area?
Action:
Aims:
Key Actions / Lead / Deadline / Progress / Key Risk / RAG
Roehampton Primary Schools to commission Christopher Winterson SRE project
Action:Raising Aspirations Project roll out in key Roehampton Primary Schools, with effective targeting through profiling
PHSE/SRE/Testing: Ensure effective use of school nursing team (is this different action to the above?)
Aims:
Key Actions / Lead / Deadline / Progress / Key Risk / RAG

Drugs and Alcohol

Overall project lead: Amanda Cranston

Background
Taken from public health needs assessment 2010
Alcohol Related London Ambulance Service Callouts (2008-09)


  • The highest concentrations of callouts are around Putney town centre.
  • The immediately surrounding areas also seem likely to have slightly elevated volumes of callouts.
  • The cluster of callouts in Roehampton is around much smaller shopping parades, with less night life, which may indicate areas of more embedded drinking in the home rather than binge drinking.
  • Most alcohol related hospital admissions come from Roehampton and West Hill.
However there is not a high concentration of people engaging with treatment services from this area, suggesting people are not accessing treatment and therefore are much more likely to present in hospital with a non-emergency condition related to their drinking.

Locality Actions:

ACTION: DS to liaise with Tom Bailey, fresh start clinic lead and locality lead for the CRG. Find out if there are existing activities the LCG can support with. If there is anyway practices can link in with alcohol liaison service to support patients being discharged.

Children and Young People

Catch 22 ??
Action:LB to link with the CRG to understand if there is he scope to pilot a project in West Wandsworth.
Worth linking with Drug and Alcohol Reference Group (Clare O’Connor) and noting that the Council’s Youth Work Service employs a FT drugs and alcohol education worker
Aims:
Action:LB to link with the CRG to understand if there is he scope to pilot a project in West Wandsworth.
Aims: / Lead / Deadline / Progress / Key Risk / RAG
Key Actions
School Nursing Involvement
Action: How to take forward?
Aims: School Nursing Involvement in PHSE delivery. Effective targeting using A and E admissions data. Community Delivery by School Nursing Team
Also part of healthy schools agenda and curriculum of youth clubs.
Worth noting that Wandsworth uses an assessment and prompt tool called DUST for use with young people. Used or could be used by school nursing?
Key Actions / Lead / Deadline / Progress / Key Risk / RAG

Mental Health

Overall project lead: Amanda Cranston

Background
Taken from public health needs assessment 2010
Patients recorded on the Sereve Mental Health (SMI) register per 1,000 (January 2009 Mental health Needs Assessment)

  • GP practices in Roehampton and West Hill record the highest rate of patients on the SMI register.
  • They include; Mayfield, Inner Park Road, Danebury and St. Paul’s Cottage.
  • Roehampton also has one of the highest JSA claimant rates and lone parent claimant rates in Wandsworth.
Admissions to Mental health services, 2005/6 – 2007/8


  • GP practices in high deprivation show the highest admissions to mental health services.
  • The highest rates are seen at Danebury Avenue, The Alton practice, Mayfield and Tudor Lodge.
Danebury Avenue experiences admission rates four times the rates in practices with the lowest rates (Balmuir Gardens, Putneymead and Heathbridge).
Gaps exist in services for mental health.
ACTION: PI to invite MH commissioning manager to 30th May LCG management team meeting to understand local services and possible gaps before LCG can work up a locality initiatives.
Children and young people
Worth noting scope for mental health promotion and not just increased uptake of mental health services. MH commissioning manager could advise on this too. This applies to all age groups of course.

Locality Actions: