MD2323 Health Team work programme 2018-2019

Type of decision: 
Mayoral decision
Code: 
MD2323
Date signed: 
25 September 2018
Decision by: 
Sadiq Khan, Mayor of London

Executive summary

This MD seeks approval for the delivery of elements of the Health Team’s work programme and associated expenditure for 2018-19.

The Health Team work programme is now presented under the key aims of the new London Health Inequalities Strategy.

This decision builds on previous decisions regarding Health Team programmes and expenditure, and these are referenced below.

This expenditure will support the Mayor’s ambition to improve the health and wellbeing of Londoners
and reduce inequalities in healthy life expectancy.

Decision

That the Mayor approves:

Expenditure of up to £788,000 to deliver the work set out below in the Health Team’s work programme for 2018-19

Part 1: Non-confidential facts and advice

Introduction and background

The GLA Health Team has developed a programme of work to lead and develop the Mayor’s Health Inequalities Strategy for London with relevant partners and stakeholders; and support his leadership role as chair of the London Health Board.

 

The Mayor is required to produce a health inequalities strategy for London under the GLA Act.  Londoners experience stark health inequalities that are amongst the widest in England.  This means that some Londoners are unnecessarily spending long periods of their lives in poor health or dying prematurely from potentially avoidable causes.  Addressing health inequalities will contribute to economic and social development, and reduce avoidable demand on the health, social care and welfare systems.

 

The Health Team is supporting the Mayor in developing a comprehensive approach to health for all Londoners which addresses the range of factors affecting health inequalities in London over the Mayoral term and beyond.  Social, environmental and economic factors, known as the ‘wider determinants of health’ are a significant cause of health inequalities. 

 

Health and social care services play a key role in Londoners health, although most studies suggest that health care accounts for less than half of the inequalities in people’s overall health.  The Health Team is also supporting the Mayor’s role in championing and challenging the health and social care system in London, ensuring it is as effective as possible in addressing health inequalities and in responding to challenges including workforce recruitment and retention, the need to prevent poor health, development of NHS estates for health facilities and housing, and health and care service integration.

 

The Health Team’s programme has five aims and a focus on leadership for health, aligned to the London Health Inequalities Strategy published in autumn 2018. They are:

 

  • Healthy Children
  • Healthy Minds
  • Healthy Places
  • Healthy Communities
  • Healthy Living
  • Leadership for Health

 

The Health Team work programme in 2018/19 includes project funding that has already been approved, summarised below. 

 

Previous approvals

MD2115

London Healthy Workplace Charter

 

£175,000

MD2115

Healthy Schools London Programme and Healthy Early Years London Programme

£445,000

MD2222

London’s Childhood Obesity Taskforce

 

£135,000

MD2265

Young Londoners Fund - Mental Health First Aid in Schools

£375,000

ADD2238

Thrive London Campaign

 

£50,000

DD2191

Social Prescribing: Digital & Voluntary Sector Requirement

£110,000

MD 2171

Young London Inspired

 

£100,000

 

This MD seeks approval for expenditure of £778,000 which, together with the above, will fund most of the Health Team’s work programme in 2018/19.  The table below summarises the proposed spend described in this MD. 

 

Programme

Proposed expenditure

Health Inequalities Strategy

£60,000

Healthy Children

£60,000

Healthy Minds

£200,000

Healthy Places

£114,000

Healthy Communities

£175,000

Healthy Living

£28,000

Leadership for Health

£151,000

Total

£788,000

 

In terms of leadership for health, discussions are in progress to finalise the London Health and Care Partnership funding arrangements between London partners for 2018/19.  It is proposed that a further MD will be brought forward outlining partnership contributions for both the work of the London Health Board and the London Health and Care Devolution Programme in the Autumn.

 

Objectives and expected outcomes

The objectives and expected outcomes of health team proposed expenditure are detailed in the table below:

 

2.2     Health Inequalities Strategy

 

The HIS was launched in September 2018 and will be delivered through a range of GLA actions and partnership arrangements overseen by the London Prevention Board and reporting in to the London Health Board.  Mobilisation will focus on the five strategic aims and development of leadership for health.  This will include a comprehensive communication programme with an extensive range of audiences, and engagement activity with a range of audiences including statutory partners, the voluntary and community sector, and excluded and marginalised groups. Expenditure of up to £60,000 will fund the mobilisation of the Health Inequalities Strategy and its associated projects.

This will include:

  • Development and dissemination of resource packs for partner agencies, consisting of slides, local audit tools, and bespoke implementation resources.  
  • Production of an animation or film that will be developed with partners to promote the strategy through local health and wellbeing boards and partnerships.
  • A mobilisation plan with associated engagement events, conferences and deep dive workshops, involving statutory partners and communities

 

Decision

  • £60,000 to towards the launch and communication of the HIS

 

Total funding decision under this MD: £60,000

 

2.3      Healthy Children: every London child has a healthy start in life

 

Experiences in early childhood set the foundation for physical, intellectual and emotional development.  During the first few years of children’s lives, differences emerge in health outcomes including birth weight, dental health, eye health, weight and obesity, and mental health and wellbeing.  The main areas of concern include healthy food and drink, levels of physical activity, and their mental and emotional wellbeing.

 

Healthy Young London encompasses the Healthy Early Years programme and Healthy Schools London, comprehensive award schemes for schools and early years settings. It follows London’s children through their learning environments as they grow up. Healthy Young London is open to all of London’s 13,000+nurseries, playgroups, children centres, creche, and childminders and all 2,500 primary, secondary and special schools. It helps to improve the health and wellbeing of London’s children and to reduce health inequalities by creating environments which support a healthy start to life in everything children do. The Mayor’s key ambition is to ensure the new Healthy Early Years London programme is widely adopted, particularly in deprived communities.

 

London’s Childhood Obesity Taskforce aims to deliver an overall reduction in childhood obesity – specifically reducing the inequalities that exist between the richest and poorest communities in London. London’s children experience the worst rates for excess weight in the country, with 38% of children overweight or obese by the time they reach secondary school.

 

The Health Team is also initiating work with partners to support children’s mental health and emotional wellbeing with schools. This is an emerging programme, delivered with Healthy London Partnerships and linked to the social prescribing programme.  It will produce a web-based toolkit that will be promoted to all schools in London providing a best practice guide for school leaders, governing bodies and commissioners in health and local authorities leading to:

  • Improved mental and emotional support for children and young people in schools
  • Better understanding across schools and commissioners on how to access guidance
  • A platform to continue to share good practice and further improve services as anticipated government policy is finalised.

The tool will be launched at a conference for schools, health and local authority commissioners in the Autumn.

 

Specific projects/programmes for which expenditure approval is being sought

  • £60,000 to fund the development and launch of a web-based tool kit to support schools in procuring evidence-based services/programmes that improve the mental health and emotional wellbeing of their students. 

 

Approvals already in place

  • Separate expenditure approvals totalling £445,000 already exist for the Healthy Schools London programme and the Healthy Early Years Programme pilot (named ‘Healthy Young London’) under MD2115 and the Childhood Obesity Taskforce under MD2222.

 

Total funding decision under this MD: £60,000

 

2.4      Healthy Minds: All Londoners share in a city with the best mental health in the world.

 

The Mayor is championing mental health through his support of the Thrive LDN partnership programme, and his leadership of the London Health Board. Good mental health is as important as physical health to Londoners.  It is also vital for both the economy and wider society.  Around two million Londoners will experience poor mental health every year.  The Mayor’s key ambition is to inspire more Londoners to have mental health first aid training – starting with young Londoners. 

 

As part of the Young Londoner’s Fund, the GLA has committed funding towards mental health first aid in schools. This project is funding youth mental health first aid training (for teachers and other professionals working with young people) to increase the number of trained Youth Mental Health First Aid (MHFA) Instructors in schools (MD 2265).

 

Thrive LDN is delivering research, campaigns and projects to reduce inequalities and discrimination that can cause poor mental health, and improve the mental health and wellbeing of Londoners.  This includes projects to reduce the number of suicides in London. A key focus this year will be to work with partners to deliver a campaign to raise awareness of how inequality and discrimination affects mental health and wellbeing.

The GLA’s mental health investment will fund a citywide campaign to raise awareness of how inequality and discrimination affects mental health, a young Londoner cultural festival and several projects working with individuals from traditionally under-represented and at-risk groups.

 

Specific projects/programmes for which expenditure approval is being sought

  • £70,000 GLA partner contribution towards the This is Me anti-mental health stigma and discrimination campaign.  This targets London employers, delivered in partnership with the City of London Corporation.   Costs relate to commissioning the campaign, associated programme costs and evaluation,
  • £75,000 towards the ‘Right to Thrive’ project being delivered through ThriveLDN: Right to Thrive is a project with Londoners who experience identity-based discrimination and are at greater risk of developing poor mental health.  Costs relate to initial London wide and targeted communication and research activities, analysis of findings, and dissemination.  
  • £25,000 to deliver the Thrive festival (in collaboration with the Mayor’s Culture Team and Mental Health Foundation): Thrive festival is a young Londoner-led mental health arts festival.
  • £30,000 towards delivery of the Thrive LDN Champions leadership development programme: this will deliver an open network for Thrive LDN champions and a leadership development programme for Londoners from traditionally underrepresented at-risk groups.  Costs relate to training of champions, and development of the network through events and resources. 

 

Approvals already in place

  • Separate expenditure approvals totalling £375,000 already exist for the Young Londoners Fund under MD2265 for Mental Health First Aid, £100,000 for Young London Inspired under MD 2171 and £50,00 for the Thrive London Campaign under ADD2238.

 

Total funding decision under this MD: £200,000

 

2.5     Healthy Places: All Londoners benefit from a society, environment and economy that  

          promotes good mental and physical health

 

Tackling underlying issues in our social, economic and physical environment will have the biggest long-term impact on health and health inequalities i.e. the conditions in which we are born, grow, live, work and age.  The differences in these circumstances, which are considerable across London, result in health inequalities. The Mayor’s key ambition is to work towards London having the best air quality of any major global city, with the fastest progress in the most deprived or polluted areas.

 

The Health Team supports teams across the GLA to adopt a ‘health in all policies’ approach, with a particular focus in 2018/19 on transport, air quality, the London Plan, health and housing, and the Police and Crime Plan (including serious youth violence).

 

The Mayor’s London Healthy Workplace Charter (LHWC) is a voluntary employer accreditation process that supports and rewards employers for investing in workplace health and wellbeing, providing a series of standards for workplaces to meet to guide them into creating a healthier workplace. The programme aims to reach 750,000 employees by 2020.

 

Specific projects/programmes for which expenditure approval is being sought

 

  • GLA investment of up to £114,000 to continue to fund specialist public health expertise to ensure due consideration of health and health inequality in the Mayor’s statutory strategies and other key Mayoral priorities (detailed above). There are currently two public health specialists embedded within the organisation (GLA Planning team & Transport for London). This funding will ensure these teams continue to maximise the contribution of transport, planning and other strategies to health improvement and tackling health inequalities.

 

Other Income

  • This will be supplemented by income from Transport for London (£81,000) and OPDC (£42,000).

 

Approvals already in place

  • A separate expenditure approval totalling £175,000 already exists for the London Healthy Workplace Charter under MD2115.

 

Total funding decision under this MD: To receive £81,000 and £42,000 for this purpose, and agree GLA expenditure of £114,000 bringing the total spend to £237,000

 

2.6      Healthy Communities: London's diverse communities are healthy and thriving

 

Londoners are more likely to experience social isolation than people in other parts of the UK. Communities that are better connected and engaged are more socially integrated and are also healthier.  The Mayor’s key ambition is to support more Londoners in vulnerable or deprived communities to benefit from social prescribing, to improve their health and wellbeing. 

 

Development of a social prescribing vision is a core part of the HIS and has involved a scoping exercise to understand how best the GLA can support good health through community-based approaches.  A social prescribing vision is currently being developed following a commission focusing on the role of local authorities and the VCS in social prescribing and digital infrastructure requirements. Other projects will include:

  • a small grants programme for VCS organisations starting in 2019 to deliver the Mayor’s social prescribing vision
  • projects focused on mobilising support for people experiencing social isolation and/or unable to access affordable food;

 

Support for healthy communities also means supporting those at risk of infections, such as TB and HIV, in terms of prevention, and in terms of addressing stigma and discrimination.  The Mayor is a signatory to the London fast track cities initiative which is being mobilised in 2018/19 through a co-produced gap analysis for London, and a series of engagement events.

 

In response to the HIS consultation, the Mayor has committed to exploring how he can give voice to those marginalised or excluded communities experiencing the starkest inequalities, through a co-designed community forum.  He will also fund a set of masterclasses for local teams and policy makers to share the learning from the Well London programme on effective community development approaches to tackle health inequalities and foster a community of practice through action learning sets.

 

Finally, the Mayor has committed to making London a Dementia friendly city, working with Alzheimer’s UK to train up Londoners as dementia friends, share learning and ideas between agencies and stakeholders, and celebrate the contributions people with dementia can make in the City

 

Specific projects/programmes for which expenditure approval is being sought

 

  • £15,000 to draft and launch the Social Prescribing vision, including resources and an event
  • £40,000 to commission research and development priorities identified through the Social Prescribing Advisory Group
  • £20,000 support for a national social prescribing conference.
  • £45,000 to establish a community forum focused on inclusion health, delivering engagement events and reports 
  • £35,000 for a ‘Learning Labs’ programme delivering training, resources and action learning sets focused on community development approaches to tackling health inequalities, based on learning from the Well London programme 
  • £10,000 for mobilisation of London Fast Track Cities programme on HIV with partners including events and commissioning of a needs assessment and gap analysis.
  • £10,000 for the development and delivery of the second dementia-friendly London summit in March 2019

 

Approvals already in place

  • Separate expenditure approvals totalling £110,000 already exist for Social Prescribing: Digital & Voluntary Sector Requirement under DD2191.

 

Total funding decision under this MD: £175,000

 

2.7      Healthy living: The healthy choice is the easy choice for all Londoners

 

Addressing health-related behaviours is essential in tackling health inequalities and enabling London to be the world’s healthiest global city. Healthy living encompasses physical activity, food habits, and harm caused by tobacco, alcohol and drugsThe Mayor’s key ambition is get more Londoners to be active every day.

 

The focus in 2018/2019 will be to deliver the devolution MOU commitments on illegal tobacco, and supporting work to reduce alcohol harm in London. Like last year’s programme, the funding will contribute towards campaigns which aim to reduce the impact of harmful binge drinking on Londoners and emergency services.

 

Specific projects/programmes for which expenditure approval is being sought

  • £20,000 towards supporting an annual campaign to reduce harmful binge drinking:
  • £8,000 to deliver policy expertise on drugs, alcohol and tobacco through networks and learning events.

 

Total funding decision under this MD: £28,000

 

2.8       Leadership for Health

 

The Mayor plays a key role as Chair of the London Health Board.  The Board seeks to drive improvements in London’s health, care and health inequalities where political engagement at this level can uniquely make a difference, for example through political oversight of health and care devolution and through supporting and accelerating the transformation of health and care services in the capital

 

The Board will seek ways of giving additional impetus to the ambition to make London the healthiest global city.  It will:

 

  • hold four meetings a year and further activity as needed e.g. events, polling, report(s)
  • hold an annual public-facing Better Health for London conference

 

Further work to support the Mayor to effectively champion and challenge the health and social care system will be commissioned in 2018/19. These projects will support delivery of the Mayor’s manifesto commitments to champion and challenge the NHS, advocate for appropriate social care funding, and address public health priorities.

 

The NHS Liaison programme will continue to enable the Mayor to engage with key NHS leaders, and meet his manifesto commitment to champion and challenge the NHS through regular monitoring, analysis of NHS plans and announcements, and briefing the Mayor’s office on emerging NHS health policy issues.

 

The London Health and Care Devolution agreement was signed in November 2017, based on collaboration across the health and care strategic partnership in London through the Strategic Partnership Board. Devolution provides opportunities for improvement across the prevention, estates, workforce and service integration agendas. 

 

 Specific projects/programmes for which expenditure approval is being sought

 

  • Expenditure of up to £100,000 towards funding for a Senior Policy Officer (NHS Liaison) and a Senior Health & Care Policy & Partnership Manager. These posts will lead the strategic development of GLA policy, programmes and projects relating to NHS services and undertake health policy support and advocacy elements of our NHS service work. This will also include the ongoing development of the GLA’s NHS remit and working closely with the NHS & Healthy London Partnership. These posts were previously agreed via HOPS 0272.
  • Expenditure of up to £51,000 to fund a G10 Secretariat Manager post that will support delivery of the priorities of the London Health Board for 2018-19. This is the GLA contribution to this Health & care partnership activity.

 

Further Decisions

  • Further decisions will be submitted under a separate MD in the Autumn outlining expenditure plans for partnership contributions for both the London Health Board (£312,000) and the London Health and Care Devolution Programme (£306,000). This funding is in addition to the £151,000 referenced above.

 

Total funding decision under this MD: £151,000

 

Equality comments

An Integrated Impact Assessment, which includes Equalities Impact Assessment within its scope, has been conducted as part of the development of the Health Inequalities Strategy. This identifies major positive and negative impacts of the programme for groups protected under the Equality Act 2010 and propose ways to strengthen benefits and mitigate negative impacts, as well as identify issues concerning the four cross-cutting themes under the GLA Act 1999.

Impact assessments have also been carried out on the other main elements of the programme, including:

• The new Healthy Young London programme is a universal offer but aims to target those areas of London with high levels of child poverty and ingrained health inequalities. The prospective health and health inequalities impact assessment of the early years elements of the programme suggest that it should have a positive effect on health inequalities. However, careful consideration needs to be given to the support available, to settings and childminders who participate in the early years programme. Take up of the programme will need to be monitored to ensure it is being taken up equitably across London, particularly in areas with a higher level of deprivation or where more of the population is from an ethnic minority group.

• Evaluation of Healthy Schools London (September 2016) has shown that schools in areas with low socio-economic status (SES) are more likely to be enrolled in the programme than schools in high SES areas.

• In London in 2015 the employment rate for the white ethnicity group was 78.3 per cent compared with 65.1 per cent for all ethnic minorities. The employment rate for disabled people was 50.1 per cent, compared with 77.4 per cent for non-disabled people. These groups are also likely to experience poorer health and shorter life expectancy, resulting in significant, unacceptable health inequalities between Londoners. A Health Inequalities Impact Assessment was carried out on the Healthy Workplace Charter programme in 2013. This looked at the likely potential impacts on those with protected characteristics and concluded that the programme has beneficial impacts. A focus on low paid sectors will also help to support those with protected characteristics.

• Partners are still developing the Thrive London programme, so a full equalities impact assessment has not yet been conducted, but is based on a principle of proportionate universalism, meaning that it will seek to improve the mental health of the whole population, while recognising that some people have greater needs and need proportionately greater support. Development of the programme has included extensive engagement with a wide range of organisations representing groups with protected characteristics and people who have experienced mental health problems

Other considerations

Major risks and issues

 

Risk assessments have been conducted for each element of the programme. The biggest cross

cutting risks identified are as follows.

 

Risk

Mitigation

Changes in partnership funding arrangements affect ability to deliver projects

 

Clarification of partner funding contributions, and active participation in partnership forums

Ability to recruit high calibre candidates to vacant roles in the team following restructure

Recruitment strategy, on-going team development, and focus on team delivery and reputation

National policy development cut across the aims of the health inequalities strategy

 

Close partnership working, and staying abreast of policy development, including NHS 10-year view, health inequalities, social care and public health

 

Links to Mayoral strategies and priorities

 

The health team work programme has been designed to fulfil of the Mayor’s manifesto commitments to be a champion for health in the city, to improve public health, and to meet statutory duties to develop a health inequalities strategy.

 

The GLA health programme is directly related to delivery of the Mayor’s Health Inequalities Strategy, a statutory duty under the GLA Act 1999.

 

It is also directly linked to the delivery of the Mayor’s manifesto commitments to:

 

  • Champion and challenge London’s NHS;
  • Get to grips with health inequality in London;
  • Promote active lifestyles, support those who want to shake off lifestyle risks and tackle

childhood obesity;

  • Renew focus on HIV prevention;
  • Break down the stigma of mental illness and coordinate efforts to reduce the number of

      people who take their own lives.

 

In addition, elements of the health programme will support delivery of other statutory and non-statutory strategies and programmes, including: The London Plan, Transport, Economic Development, Environment, Housing, Culture, Sport, Social Integration, and Food.

 

Impact assessment and consultations

 

Impact Assessments have been conducted on the key elements of the programme, as detailed

above. Consultation with Londoners and stakeholders on the Health Inequalities Strategy took place in 2017, and a comprehensive report to the Mayor has been compiled.

Financial comments

Approval is sought for expenditure of up to £788,000 on the Health Team’s work programme for 2018-19.

 

The total cost will be funded from the Health Team’s Budget for 2018-19. Below is a breakdown of expenditure by programme

 

Programme

Expenditure

Health Inequalities Strategy

£60,000

Healthy Children

£60,000

Healthy Minds

£200,000

Healthy Places

£114,000

Healthy Communities

£175,000

Healthy Living

£28,000

Leadership for Health

£151,000

Total

£788,000

Activity table

Activity

Timeline

Thrive LDN workplan

On-going

Delivery of mental health first aid training

Sept 2018

Launch of healthy early years programme

May 2018

Child obesity taskforce launched

July 2018

Launch HIS

Sept 2018

Mobilisation of HIS through communication and engagement plan

Autumn 2018

HIS implementation and monitoring

Ongoing from

Autumn 2018

London Social prescribing vision launched

Winter 2018 /19

Report on London sub-regional transformation published

Autumn 2018

Child obesity taskforce workplan agreed

December 2018

 

 


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