Health Improvement Strategy - Cheshire West and Chester
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Cheshire West & Chester Council
Health Improvement
Strategy
2018-2022
Visit: cheshirewestandchester.gov.uk
Visit: cheshirewestandchester.gov.uk
2 Cheshire West and Chester Health Improvement Strategy 2018-2022
Foreword
We are proud to present Cheshire West and design and deliver our services in ways that most
Chester’s first Health Improvement Strategy on effectively meet the needs of the people from across
behalf of the Health and Wellbeing Board. This our communities who use them.
document sets out how, over the next four years, we
will support all of our residents to live and enjoy a There is not a ‘one size fits all’ strategy model for
healthy lifestyle, with a particular focus on: these five areas. Each strategy has been developed
with input from different borough-wide partnership
• healthy eating and being active groups and focuses on specific goals, priorities, and
• smoking challenges. Running throughout, however, are
• alcohol and drugs misuse common principles – the cornerstones of our Health
• sexual health and Wellbeing Strategy. These are to:
Many cases of life-changing illness such as cancer, • focus on outcomes
respiratory and heart disease, stroke and mental • emphasise local action and community
illness strongly link to these issues and represent key involvement,
drivers of health inequality across and beyond the • ensure that our services continuously improve.
borough. Often individuals may face challenges with
more than one of the areas identified within this Shared approaches, which mirror our values, are also
strategy. Supporting people to live healthier lives a common thread. Each strategy highlights how we
now will help to prevent avoidable ill-health in the will:
future, and is central to the vision set out in our
Health and Wellbeing Strategy: • reduce health inequalities
To reduce health inequalities and improve the health • create the best opportunities to prevent health
and wellbeing of people in the borough, enabling our problems and offer support at an early stage
residents to live more fulfilling, independent and • make changes based on the best evidence of what
healthy lives. We will do this by working with works well
communities and residents to improve opportunities • work together with communities as well as
for all to have a healthy, safe, and fulfilling life professional colleagues from across the system
(Health and Wellbeing Strategy, 2015-2020) • empower people to take responsibility for their
health choices
The strategies contained within this document have
been developed at an important time as we prepare Our Health Improvement Strategy is presented as a
to recommission essential public services against the dynamic, living document, which will be reviewed
backdrop of a reduced budget. The aims and and refreshed annually to reflect key changes in
outcomes within each strategy reflect our policy, guidance and local issues. We would like to
understanding of local need, as described in our Joint take this opportunity to thank everyone who
Strategic Needs Assessment (JSNA), to ensure that we contributes to this important work.
Councillor Louise Gittins Dr Chris Ritchieson
Chair, Health and Wellbeing Board and Cabinet Vice-Chair, Health and Wellbeing Board and
Member for Communities and Wellbeing, Chair of NHS West Cheshire Clinical
Cheshire West and Chester Council Commissioning Group
Cheshire West and Chester Health Improvement Strategy 2018-2022 3 Contents Eat Well Be Active 4 Tobacco Control (Smoking) 11 Alcohol Harm Reduction 19 Drug Misuse 26 Sexual Health and Wellbeing 32 Glossary 40
Eat Well Be Active Framework 2018 – 2022
Cheshire West and Chester Health Improvement Strategy 2018-2022 5
Overweight and obesity and their related diseases cost
Introduction the National Health Service more than £5 billion each
year and this cost is expected to increase dramatically in
Healthy eating and being more active are important the future. If left unchecked, by 2050, the cost is
determinants of health and wellbeing. The key to estimated to reach £9.7 billion. However, it is not just
achieving and maintaining a healthy weight is not about the cost to the NHS that needs to be considered, there
short-term dietary changes. It is about a lifestyle that are other associated costs. In 2015, the cost of obesity
includes healthy eating, regular activity and balancing to society was estimated at £27 billion, including £352
the number of calories we consume with the number of million to Social Care (in extra hours of help per year),
calories our body uses. Staying in control of our weight and a spend on obesity medications of £13.3 million.
contributes to good health now and as we age. Physical inactivity costs the NHS £7.4 billion per year
but the total cost to the wider economy is estimated at
Eat Well Be Active is a framework based on several key
£20 billion.
Cheshire West and Chester partnership reports,
including the Executive Policy Commission on Health Eating a nutritionally balanced diet and being more
Inequalities - Obesity (2015), the Health and Wellbeing active is crucial to reducing levels of overweight and
Strategy (2015-20), the Council Plan (2016-20), and the obesity and ensuring everyone has the best chance to
Physical Activity Growth Strategy and Blueprint to Tackle live a long and healthy life. Overweight and obesity can
Physical Inactivity in both the Cheshire and Warrington lead to chronic health conditions such as heart disease,
Sub Region developed by Active Cheshire (2017). The type 2 diabetes, stroke and some cancers. As well as
framework has been developed through strong local reducing overweight and obesity, there are a range of
partnership working, recognising that our experiences other health benefits associated with eating a healthy,
are shaped by the wider social, economic and cultural balanced diet and undertaking regular physical activity.
context in which we live. As we look for innovative ways Evidence shows that those who meet the recommended
to tackle inequalities and improve the lives of our levels of physical activity and healthy eating reduce
residents, this document outlines our local strategic their risk of developing common, obesity-related
approach to maintaining a healthy weight throughout conditions.
life.
At the other end of the spectrum, being underweight can
also damage your health. Malnutrition (being
underweight or having a poor quality diet) can
Background contribute to a weakened immune system, fragile bones
and feeling tired. Malnutrition in children can affect
The United Kingdom ranks as one of the most obese growth, development and lead to poor concentration
nations in Europe and its increasing rate of overweight Similarly malnutrition affects older adults too and is a
and obesity has been described as the number one growing area of concern.
threat to health and wellbeing. Eat Well Be Active is This strategy and the resulting action plan will aim to
Cheshire West and Chester’s partnership approach to address issue of malnutrition and those who are deemed
maintaining a healthy weight. In developing the to be food insecure, being without reliable access to a
framework, we have taken a life course approach (from sufficient quantity of affordable, nutritious food.
conception through to older age) that includes all of our
residents. At the same time, we recognise the need to It is now widely known that for every individual, no
target those groups who are more at risk of becoming matter what their stage of life, being regularly active can
overweight or obese. We want to increase the number benefit health in a range of ways. Physical inactivity is
of children and adults with a healthy weight, promoting the fourth leading risk factor for global mortality,
healthy behaviours and keeping people well for longer. accounting for 1 in 17 deaths. In the UK, it is responsible
for one in six deaths. People who have a physically
Although overweight and obesity are common among all active lifestyle have a 20-35 per cent lower risk of heart
social groups, the rate increases with social disease and stroke compared to those who have a
disadvantage. This reflects the ‘socioeconomic gradient’ sedentary lifestyle with minimal day to day activity.
in health, illustrating how population health worsens as Regular physical activity is also associated with a
deprivation and poverty increases. In the UK, reduced risk of diabetes, obesity, osteoporosis, colon
socioeconomic inequalities have increased since the and breast cancer and with improved mental health. In
1960s and this has led to wider inequalities in both older adults physical activity is associated with
child and adult obesity, especially amongst women and increased ability to function well with daily tasks,
girls. maintaining independent lives for longer.
6 Cheshire West and Chester Health Improvement Strategy 2018-2022
Where are we now? Our aim
Data published nationally in November 2017 tells The aim of the framework is to improve the health of
us that in Cheshire West and Chester: people in Cheshire West and Chester, by increasing
the number of those who are eating well and being
• Breastfeeding initiation is 68.9 per cent compared more active. The framework strengthens the existing
to the England average of 74.3 per cent view that to achieve a change in people’s behaviour
• At six to eight weeks after birth, 35.4 per cent of we need a whole-system approach to integrating and
mothers are still breastfeeding compared with the embedding healthy eating and physical activity into
England average of 43.8 per cent everyday life. A whole systems approach links
• Almost one fifth of our children in their school together many of the factors that influence healthy
reception year are either overweight or obese weight, and requires co-ordinated action across
(23.1 per cent), slightly higher than the England multiple sectors.
average of 21.9 per cent Collaboration and partnership is therefore at the
• A third of our children aged 10-11 are either heart of the framework, which seeks to achieve a
overweight or obese (33.6 per cent), similar to the cultural shift towards a healthy, active and thriving
England average of 34.2 per cent borough. This collaborative, partnership approach
• 176,970 adults (64.2 per cent) are overweight or will support people to lead more healthy and active
obese, similar to the England average of 64.8 per lifestyles in an environment which promotes this as
cent the norm.
• 69,860 adults (25.5 per cent) are obese
Local data in 2017 tells us that:
Our principles
• 24.2 per cent of adults are inactive - i.e. do less • Outcomes–focused
than 30 minutes of moderate intensity activity per • Emphasis on local action
week
• Innovation
• 23.8 per cent of people are using outdoor space
for exercise/health reasons • Advocate for change
• 923 deaths per year are attributed to physical
inactivity and the annual cost to the local authority
is £17.3 million Our approach
• On average local residents spend seven hours per
day in sedentary positions. The most sedentary • Reducing inequalities
age group is 14-18 year olds, with lack of time and Cheshire West and Chester is often viewed as
motivation being the most frequently cited affluent and prosperous, but there are parts of our
reasons borough that are not. Our goal is to improve the
health and wellbeing of all our residents, but with
extra efforts focused where they are needed most.
• Prevention
We know that prevention, early detection and early
Our vision intervention leads to much better health and
wellbeing results and the issue of healthy weight is
To improve healthy life expectancy no exception. Prevention and early intervention can
and reduce health inequalities for happen at any time during a person’s life and this
principle is reflected across the framework.
everyone living in Cheshire West
and Chester, by supporting • Partnership working
opportunities for healthy eating Eating well and being more active is not the
and being more active. responsibility of one organisation alone. It is
therefore important that the framework is developed
and implemented by a partnership consisting of a
Cheshire West and Chester Health Improvement Strategy 2018-2022 7
wide variety of individuals and organisations,
including the public, private, voluntary and 1. Starting well
community sectors. Many of our challenges are
shared and require shared solutions. The framework Why is this a priority?
The World Health Organization has described
draws upon the experience and expertise of a broad
childhood obesity as one of the most serious public
range of stakeholders to deliver a robust and
health challenges for the 21st century. Excess
committed approach to eating well and being more
weight in childhood has consequences for health,
active. It promotes a comprehensive method of
both in the short and long term. Overweight children
partnership working to reduce levels of excess
are more likely to become overweight adults with a
weight across the borough.
much higher likelihood of developing physical health
• Evidence base problems later on in life. Emotional and
Decisions about services and programmes should be psychological wellbeing can also be affected –
based upon the best available information, and our children can find themselves being teased and
strategy is based on our knowledge and evidence of suffering from low self-esteem and anxiety.
local need. In our work to improve rates of healthy Giving every child the best start in life, supporting
weight in the borough we will focus our efforts on children, young people, their families and carers, is
specific groups and geographical areas where the key to reducing inequalities. Investment in early
need is greatest. This will allow us to make best use childhood interventions, particularly in the first two
of resources, providing people with the best possible years of life, reduces inequalities and has positive,
support and where needed, services. long-lasting impacts on wellbeing, ensuring a solid
foundation for the transition to adulthood. The Eat
• Personal responsibility and empowerment
Well Be Active framework supports giving children
The framework emphasises the importance of
the best start in life, by enabling children to eat
prevention and health promotion, empowering
healthily and be more active.
individuals, families and communities to take
responsibility for making their own healthy choices.
Outcome
Every child in Cheshire West and Chester has the
best start in life and is supported to eat healthily and
Eat Well Be Active framework be more active every day
The framework brings together organisations that
have an interest in supporting greater levels of
Key actions
healthy eating and physical activity in the borough.
• Encourage healthy weight before, during and after
It takes a whole-system approach which addresses
pregnancy
lifestyle, behaviour change, physical environments
and issues of access to healthy food and green • Encourage exclusive breastfeeding for the first six
space. The key elements of the framework are months of life
structured around the needs of people and places in • Work with schools and pre-schools to ensure
which they live. The components are: children eat well and are active
1. Starting well (pre-conception to 18 years old)
Indicators
2. Living well (19 years and older) • Breastfeeding rates (initiation and at six - eight
weeks)
3. Place and planning
• Child excess weight (four – five year olds)
Within these core themes, there are key (percentage of children classified as overweight or
workstreams. Each workstream will pursue a series obese)
of actions to be implemented by key stakeholders
• Child excess weight (10-11year olds) (percentage
and partners. Each of the actions will have a
of children classified as overweight or obese)
timescale and specific outcome attached. The range
of actions makes clear the importance of • Percentage of physically active and inactive
commitment from stakeholders and partners to children
reducing levels of overweight and obesity. This • Proportion of 15 year olds meeting the five a day
commitment is crucial to the framework’s success. recommendations
8 Cheshire West and Chester Health Improvement Strategy 2018-2022
• Average number of portions of fruit consumed Key actions
daily at age 15
• Promote environments that support people to eat
• Average number of portions of vegetables healthily and move more
consumed daily at age 15
• Cheshire West and Chester Council will explore the
• Number of primary schools signed up to Active opportunity to sign up to the Food Active Local
Kids Pledge and Change 4 Life Active Schools Authority Declaration on Healthy Weight
Planner
• Promote the Active Workplace Pledge and encourage
local businesses to sign up to it
2. Living well • Organisations represented on the Eat Well Be Active
Reference Group to lead by example and encourage
Why is this a priority? provision of healthier and more sustainable catering
in the workplace
Healthy weight is influenced by a wide range of social,
economic, and environmental factors, some of which are • Provision and promotion of physical activity, for
influenced by large-scale universal trends and others by example by introducing walking meetings or
individual behaviour. In Cheshire West and Chester, encouraging people to be more active during breaks
excess weight in adults is most common in the areas of and lunchtimes
Blacon, Ellesmere Port and Winsford. These areas • Consider adopting #PartOfTheMovement as a local
generally also experience the highest levels of long term physical activity campaign
unemployment, deaths from coronary heart disease, • Support hospital and care home environments to
long term illness and disability, income deprivation, and provide good quality, appetising menus that meet
the lowest levels of life expectancy and healthy eating different people’s nutritional needs
across the borough.
In Cheshire West and Chester, we are working hard to Indicators
reduce inequalities, ensuring fair access to opportunities
including education, jobs and services. We want to • Adult excess weight
empower individuals and communities to seize those • Percentage of physically active and inactive adults
opportunities so that everyone can make the most of
their potential. • Pecentage of the population meeting the
recommended five a day on a ‘usual day’ (adults)
We want to create an environment which actively • Average number of portions of fruit consumed daily
promotes sustainable healthy lifestyle choices - this is (adults)
critical if we are to really tackle obesity. We must
increase opportunities for active travel, pursuit of non- • Average number of portions of vegetables consumed
sedentary leisure activities and healthier eating options, daily (adults)
all of which are essential to reducing effects of the • Recorded diabetes
obesogenic environment. We will create a culture that
enables and empowers people to become more active. • Numbers of health checks offered and completed
We need to explore opportunities to support and
encourage individuals to grow their own fruit and
vegetables by utilising community and public spaces
and looking at policy around allotment usage.
Outcomes
• Adults reach and maintain a healthy weight
Cheshire West and Chester Health Improvement Strategy 2018-2022 9
The Eat Well Be Active Reference Group will explore
3. Place and planning the regulatory and policy approaches that are being, or
could be taken locally and initiate the discussion
Why is this a priority?
about what is possible.
Reaching and maintaining a healthy weight is not solely a • Air Quality (Local Government Association, 2017)
matter of individual choice. Where we live, learn, work, and
play influences how easy or difficult it is to maintain a - Air pollution is increasingly associated with a
healthy weight. We need to shape places that support number of adverse health impacts. It is
people’s ability to achieve and maintain a healthy weight, recognised as a contributing factor in the
making healthier choices easier. onset of heart disease and cancer.
Local government has a duty to promote the health of its Additionally, air pollution particularly affects
population and planners have a key role to play, but we the most vulnerable in society: children and
also need to harness the knowledge and experience of older people, and those with heart and lung
elected members and local communities to understand conditions. There is also often a strong
what matters to them, what they think makes it difficult to correlation with equalities issues, because
maintain a healthy weight, and what needs to change. areas with poor air quality are also often the
We want to tackle the ‘obesity promoting’ environments in less affluent areas. Concern regarding poor air
which many of our citizens live and create an environment quality can also raise anxiety and negatively
that supports a healthy life. We want to build healthy impact on emotional wellbeing.
eating and physical activity into people’s everyday lives by
increasing, amongst other things, accessibility to healthy
foods, active travel options, safe play, and access to leisure • Parks and green spaces
facilities, including the great outdoors. - Parks are the most frequently visited type of
green space - representing 90 per cent of overall
Outcomes green space use. In Cheshire West and Chester
• Our environments are planned well to promote eating we have many good quality parks, green spaces,
well and moving more forest and waterways and we will encourage our
• Residents and visitors take advantage of our leisure residents to make best use of them.
opportunities, including parks, green spaces, waterways, • Leisure and culture
and forests
- Access to appropriate leisure opportunities is a
key factor in the prevention and management of
Key actions obesity. Libraries and other community venues
• Planning and environment (Public Health England, are important sources of information and
2017) signposting to local leisure opportunities and
- Eat Well Be Active shares common agendas with support services. They can also play a greater
planners and regulatory services, such as the role in bringing activity into new places and
availability of healthy food choices, access to community settings. In addition, the use of the
physical activity, and the quality of public spaces. internet to find out ‘what’s on’ is also important.
These shared priorities create valuable opportunities
for collaboration and members of the Eat Well Be
Active Reference Group will initiate the discussion Indicators
about what is possible.
• Utilisation of green space for exercise/health
• Active Travel (Public Health England, 2017)
• Child excess weight (four – five year olds)
- There has been a major decline in walking and (percentage of children classified as overweight or
cycling in the last fifty years, and an increased obese)
reliance on cars. This decline in active travel is
reflected in the increase in the proportion of • Child excess weight (10-11year olds) (percentage of
overweight, obese and inactive people. Return on children classified as overweight or obese)
investment examples show that for every £1 spent • Excess weight in adults
on cycling provision the NHS saves £4 on health
costs. Similarly, a walking for health project • Proportion of physically active and inactive adults
demonstrated an £8 return on a £1 investment.
10 Cheshire West and Chester Health Improvement Strategy 2018-2022
5. Peer review
Strategy delivery The Eat Well Be Active Reference Group will seek
to enhance the performance of the strategy and
The framework is a dynamic product which will focus share learning locally, regionally and nationally
on effective partnership working and meaningful
action based on collaboration with stakeholders. The 6. The voices of local people, service users, carers
Eat Well Be Active Reference Group will provide and wider partnership
expert oversight and quality assurance to the Eat There will be regular opportunities for groups and
Well Be Active framework. It will ensure all strands communities to feedback their own views and
involved in increasing physical activity and experiences.
promoting healthy eating are pulled together to
create a robust, systematic and broad structure 7. An evolving framework
which addresses lifestyle, behaviour change, our This framework and its accompanying action plan
physical environments and issues of access to will develop as goals are achieved and
healthy food and green space. circumstances change. We will be responsive to
the information we gain through the continual
The group is chaired by the Cabinet Member for involvement of organisations, groups and local
Communities and Wellbeing, Cheshire West and people.
Chester Council.
Other members include:
• Active Cheshire
Conclusion
• Brio Leisure Creating environments that remove barriers to
• Cheshire West and Chester Council healthy eating and moving more will have a
significant, positive impact on the public’s health and
• Cheshire and Wirral Partnership NHS Foundation help to reduce inequalities. Raising awareness,
Trust generating public debate, working with our
• Edsential communities, schools and businesses and using local
• Groundwork organisations can all help to make the environment a
healthier one for our residents. In creating healthier
• Healthbox places we also have the opportunity to build robust
• Mersey Forest partnerships that can achieve meaningful
• NHS Vale Royal Clinical Commissioning Group engagement with local communities to reduce health
inequalities. We want to develop a culture and
• NHS West Cheshire Clinical Commissioning Group environment which proactively fosters active and
• University of Chester healthy lives, a borough which is designed to
encourage healthy eating and physical activity as the
Progress monitoring and feedback will also be norm.
achieved through the following,
1. Joint Scorecard
Key statistical data monitored regularly by the Eat
Well Be Active Reference Group and the Health
and Wellbeing Board
2. Exception reporting
Statistical data which is escalated to the Health
and Wellbeing Board requiring review or action
3. Health and wellbeing partnership updates
Updates will form part of a report that is presented
to the Health and Wellbeing Board
4. Themed discussions
The Eat Well Be Active Reference Group will have a
rolling programme focusing on key issues which
will generate challenge and actionsTobacco Control Strategy 2018 – 2022 Towards a smokefree generation
12 Cheshire West and Chester Health Improvement Strategy 2018-2022
most disadvantaged communities, and is also a
Introduction factor in maintaining many families in poverty.
Fewer people in Cheshire West and Chester smoke Prevention is at the heart of new policy approaches
than ever before, but smoking remains the leading in health and social care. This five year strategy sets
cause of preventable ill-health in the borough. That out the clear steps we will take as a Council, as
is why reducing smoking is recognised as a key health organisations and as other community and
objective within our Health and Wellbeing Strategy. voluntary partners to reduce smoking. The
opportunities to come together around a genuinely
Our understanding of local tobacco control priorities collective strategy are stronger than ever.
and the evidence around high impact changes has
never been better. Over the next five years we want Our actions will drive change on three fronts:
to see more than 4,000 of our most dependent 1. Preventing young people from taking up smoking
smokers put tobacco use behind them forever. Our and protecting them from second hand smoke
long-term ambition is to achieve a smokefree
generation where fewer than 1 in 20 adults smoke by 2. Ensuring a range of support is available to help
2030. people quit, whilst narrowing the smoking gap.
This means taking action to address the much
We do not underestimate the impact that smoking higher smoking rates we see in our more deprived
continues to have on the lives of thousands of local communities compared to the rest to the borough
residents. While smoking rates in the general
population have fallen to around one in nine (11.7 3. Creating an environment that provides the best
per cent), those in certain groups and areas have chance of quitting forever
remained stubbornly higher at close to one in four We are clear on where we want to focus our energy
(25.6 per cent). Each year smoking is the cause of and see the biggest changes, for example targeting
more than 3,000 hospital admissions and around smoking in pregnancy, amongst people with mental
800 deaths within Cheshire West and Chester. health conditions, and tackling the high rates of
Thousands more people continue to live with long- smoking linked to poverty and deprivation. Guided
term health conditions caused by smoking, reducing by the government’s new tobacco control strategy,
their quality of life and independence. Smoking we will also address new needs arising from recent
remains the single biggest contributor to the 10 year innovations, e.g. e-cigarettes, recognising the role
(men) and 8.7 year (women) difference in life they play for many as an aid to stopping smoking.
expectancy which separates our most affluent andCheshire West and Chester Health Improvement Strategy 2018-2022 13
National position Local position
Cheshire West and Chester’s smoking picture has been
similar or better than the overall situation in England in
recent years. During the past two decades the
percentage of people who smoke in the national
population has fallen by around 0.5-1.0 per cent each
year. Thanks in large part to a range of world-leading
laws on smoking – most recently plain packaging -
tobacco use amongst young people has shown a steeper
decline. In Cheshire West and Chester, 5.1 per cent of 15
year olds are currently regular smokers, compared with
England at 5.5 per cent These are encouraging trends
but more work is needed.
Smoking rates have always been higher amongst specific
groups. Whilst improvements have been seen, the gap is
large. In Cheshire West and Chester, as in England, more
than one in four people in routine and manual roles
smoke – twice the rate seen for employees in managerial
and professional roles.
Compared to other council areas in the North West,
Cheshire West and Chester performs well on key
smoking indicators, for example overall adult
smoking rates are the lowest in the region at 11.7 per
cent. However, this rate is not uniform across
Cheshire West and Chester. For example:
• Smoking rates reach 25 per cent in Blacon,
Ellesmere Port and Winsford amongst people
living on lower incomes
• 10 per cent of women smoke throughout
pregnancy
• 39 per cent of people with severe mental illness
smoke
• 5 per cent of 15 year olds are already regular
smokers
In summer 2017, the government published its new
national strategy, Towards a Smokefree Generation: Approximately 31,320 adults and 2,450 young
Tobacco Control Plan for England. Our local strategy people under the age of 18 smoke in Cheshire West
reflects the key ambitions and targets outlined in this five and Chester. One third of all adult smokers work in
year national plan. In particular, we recognise the change routine and manual occupations.
in direction away from using legal measures towards a
focus on evidence-based and intelligence led local With these figures in mind, it is clear that strategic action
action (see our JSNA chapter on smoking). on tobacco dependence is necessary to advance the
aims of the Health and Wellbeing Strategy - reducing
We also welcome the strong expectation that health inequalities and improving physical and
improvement initiatives should be based on high quality mental health across the life course. More widely,
evidence from the National Institute for Health and Care the focus on preventing ill health is aligned with the
Excellence (NICE), the responsible but enabling approach aims of our local Integrated Care Partnerships , with
to harm reducing technologies e.g. e-cigarettes, including potential to lower demand for health and social care
a firm commitment to ongoing monitoring and research, services.
and a high-profile role for health and social care partners
in delivering stop smoking advice and support.14 Cheshire West and Chester Health Improvement Strategy 2018-2022
Costs Our Aims
Smoking is harmful and costly. There is the human cost We want to:
of illness, fires, premature death and poverty, the cost to
our health and social care services and the 1. Prevent even more children and young people
environmental costs from littering. from taking up smoking and vaping
In 2016: 2 Reduce the number of residents who smoke,
particularly those who have the strongest
• Tobacco sales in Cheshire West and Chester totalled dependence and face the most challenges in
£86.3 million quitting successfully
• 3,085 smoking-related hospital admissions each year 3. Create an environment that supports people to
stop smoking for good
• 830 smoking-related deaths each year
• Healthcare costs associated with treating tobacco-
related illness, £11.7 million and £0.77 million for
illness due to passive smoking
Our vision
• Lost productivity from smoking breaks, sick days and
premature deaths, £68.4 million By 2022, cigarette smoking will be a
(Note, our local contribution in tobacco duty is £41.6
much rarer sight on our streets and in
million) our homes. Hundreds more young
people will have been protected from
(Note, one in two smokers will die prematurely) breathing second-hand smoke and
• Social care needs due to smoking-related ill health, starting smoking. Thousands of our
£7.74 million (including £4.2 million pounds paid by most vulnerable and dependent
the local authority and £3.5 million in self-funded smokers will have accessed advice
care) and support to quit smoking for good.
(Note, on average smokers develop social care needs Our shared dream is to achieve a
four years before non-smokers) smokefree generation by 2030.
• 36 tonnes of waste
• £1.5million costs due to fires caused by cigarettesCheshire West and Chester Health Improvement Strategy 2018-2022 15
Outcomes Objectives
We are committed to achieving the following To achieve our aims over the next five years we
ambitious and measurable outcomes, as set down will concentrate our collective efforts on six key
in the national tobacco control plan by the end of objectives
2022:
1.Aim: Prevent even more children and
• Pregnant women receive consistent, strong young people from taking up smoking and
support to quit, reduce the percentage of vaping
women who smoke throughout pregnancy to
6 per cent or less What’s driving this?
• One child a day in Cheshire West and Chester is
• Young people are protected from taking up
born to a mum who has smoked throughout
smoking and vaping, reduce the percentage of
pregnancy. Smoking during pregnancy can lead
15 year olds who smoke to 3 per cent or less
to serious short and long-term health issues,
• Adults know where to turn for a range of support including complications at birth, certain birth
to quit for good. Reduce the percentage of defects and brain development problems, and
adults who smoke to 9 per cent of the sudden infant death
population or less
• Pregnant women who smoke are more likely to
• Closing the smoking and health inequality gap - be under 20 and live in more deprived
people with the most challenges to quitting and communities with high rates of smoking, this can
highest dependence are offered effective, make it much more difficult to quit long-term
evidence-based support, reduce smoking rates
• Children who grow up around adult smokers are
amongst people in routine and manual
more likely to take up smoking and most adult
occupations and other priority groups to under
smokers start during childhood. We need to
20 per cent
break the cycle
• Smoking rates are highest amongst children who
face other vulnerabilities and health-risking
Our principles and approach behaviours in their lives
To ensure we create the right conditions to achieve • 23.9 per cent of 15 year olds have tried an
our aims we will act on the following principles: e-cigarette. The law bans sales to people under
• Working in partnership, developing strong 18. Current best evidence suggests only
collaborative networks within and between existing smokers will go on to vape regularly, but
organisations, locally and beyond Cheshire West this is not conclusive and it is best for young
and Chester people not to vape
• Be guided by high quality evidence and • The peak age for smoking spans the late teens
concentrate on changes we know to be effective and 20s. Most adult smokers start smoking
and good value for money during their teenage years
• Be led by local intelligence and our evolving Objectives and key actions
JSNA and be responsive to new evidence and
A smokefree pregnancy for all – reduce smoking
guidance at a national level
throughout pregnancy from 10 per cent to 6 per
• Seek out local people’s views from the ground cent or less
and from frontline colleagues when we develop • Local maternity services will fully implement
our services and improvement plans essential learning from the BabyClear
programme in addition to NICE guidelines PH26
• Work with our colleagues in Public Health and PH48
England to develop clear, consistent health
messages and ensure people have access to • Identify a system leader to champion and co-
high quality information ordinate action on smoking in pregnancy16 Cheshire West and Chester Health Improvement Strategy 2018-2022
• Work with local women to test and develop 2.Aim: Reduce the number of local residents
approaches that help prevent relapse and build who smoke, particularly those who have
resilience to smoking triggers e.g. buddying or stress the strongest dependence and face the
management techniques
most challenges in quitting successfully
• Consider changes in policy in relation to vaping as a
What’s driving this?
harm reduction measure in pregnancy within the
We know from our smoking JSNA that certain groups
context of existing guidance on nicotine replacement have smoking rates that are at least twice as high as
and the work of the national Smoking in Pregnancy those in the general population. These include:
Challenge Group
• People who are unemployed or in routine and
• Enable staff to participate in new training which is manual occupations (25 per cent). In Cheshire
being developed by Public Health England for all West and Chester the areas of Winsford, Blacon,
healthcare professionals Lache and Garden Quarter and Ellesmere Port
have the highest percentage of smoking residents
• People with mental health conditions (40 per
A smokefree childhood for all – reduce smoking and
cent). Smoking is the main cause of the much
vaping amongst 15 year olds from 6.8 per cent to less
lower life expectancy in people with long-term
than 3 per cent
mental health conditions
• Embed high quality brief advice training in services
that work with young people, for example within the • People who identify as lesbian, gay, bisexual, and
0-19 service, with particular emphasis on the needs of transgender (25 per cent)
those who work with the most vulnerable individuals.
This should include continuing advice on smokefree • Hospital inpatients (25 per cent). Life-long tobacco
homes, cars and vaping addiction is a major contributor to long-term
health conditions in middle and older age
• Develop consistent messages, consistent advice and
support pathways that span across maternity, 0-19 and • People who are homeless (87 per cent)
other services for young people, families and carers Social segmentation research gives us more insights
into the social and behavioural characteristics of
• Equip professionals and public with simple advice on
communities with higher than average smoking
preventing accidental injury to children from cigarettes
rates. For example we know that they are also more
and e-cigarettes. This should also include tips on how
likely to:
to report the distribution of illicit tobacco or
• have a range of health conditions and other
e-cigarettes, or illegal sales to under 18s
unhealthy behaviours
• Assess the need to update smokefree polices in
• be engaged with a range of health services,
schools and other settings in which children are cared including emergency services, hospital respiratory
for, including foster families, youth services and the and diabetes services, community and secondary
youth offending team mental health services
• Continue to promote smokefree environments, e.g. • be engaged with social services
smokefree playgrounds
• live in social rented accommodation
• Use national policy guidance to carefully weigh up the
need to deter children from vaping whilst accepting • have carer responsibilities
that e-cigarettes are widely considered as much less
• face financial stresses
harmful than tobacco and help many adults to quit
• prefer communication via text or phone
• Continue to enforce the full range of regulations
covering the sale and promotion of tobacco and And less likely to,
e-cigarettes • wish to be informed about health issues or
services (although this group is also more likely to
• Work closely with health services associated with include people who want to participate and get
higher and further education settings to enable more involved in community initiatives)
students to successfully quit smoking with a level of
support appropriate to individual needs • be regular users of the internetCheshire West and Chester Health Improvement Strategy 2018-2022 17
Objectives and key actions • Further develop the Smokefree Partnership Network
to bring together relevant collaborators, encourage
Develop a range of support to reflect the varying needs collective pathway development and harmonise
of all smokers, including those in priority groups smoking policy and health messages across
• Develop services that enable us to deliver the most organisations. This approach should also be
intensive interventions to key priority groups. widened out to a more regional footprint
Develop and support opportunities for evidence-
based brief advice and self-management information • Collaborate with Public Health England to ensure
for other smokers their commitment to offer training for all healthcare
staff is accessible locally, linking to the ‘Making Every
• Ensure relevant staff have the right skills to support Contact Count’ requirement in the standard contract
clients with complex needs for example, by fostering for hospitals
closer links with services that use social prescribing or
community referral models • Support health settings to examine the implications
of current and any new Public Health England
• Strengthen the links between the stop smoking guidance on vaping in relation to smokefree policy.
professionals and other public health services, e.g. Seek to develop common approaches
substance misuse, sexual health and children’s
centres, as well as other health and supportive
services e.g. debt advice, housing, mental health, work 3. Aim: Create an environment that supports
zones, housing associations and citizen’s advice people to stop smoking for good
bureaux
What’s driving this?
• Embed ‘Making Every Contact Count’ brief advice,
The success of universal measures such as the indoor
engagement and signposting into relevant services
smoking ban proves how much the environment
and care settings. Signpost others to training and
influences smoking behaviour, shaping the extent to
learning to expand the number of people who can
which smoking is accepted as normal amongst our
give effective brief advice
friends, family and wider society. The availability of
• Work closely with locality teams, district advisory illicit tobacco at a lower price undermines government
panels and the Poverty Truth Commission to best commitments to make tobacco less affordable and can
understand local opportunities and barriers and also act as a low-cost trigger to relapse. We need to
improve the design of our stop smoking offer know more about specific local issues for both
• Engage with third sector services and community cigarettes and e-cigarettes. New technologies such as
groups to hear first-hand about the needs of smokers e-cigarettes are now viewed as an acceptable part of
of all ages harm reduction approaches at a national policy level.
E-cigarettes are the nation’s most popular quit method
Achieve smokefree Hospital Trusts by 2020 and and can protect against returning to the known health
continue to support smokefree mental health services harms from cigarettes. However, public and
• Work with Hospital leaders to fully implement NICE professional opinions and beliefs about the
guideline PH48 and the Preventing Ill Health acceptability of this stance vary. There has been a lack
Commissioning for Quality and Innovation service of clear information to help the public reach an
(CQUIN's) improvement plans from 2018 informed decision and many people continue to smoke
as well as vape (dual use).
• Work with mental health services to continue
improvements that promote physical health, as set
out in the Five Year Forward View for mental health
Objectives and key actions
• Support joined up service improvement and tobacco
dependence pathways across acute and community Open up dialogue on novel tobacco products and
mental health services, taking account of NICE e-cigarettes and their place within tobacco control
guideline PH45 dealing with harm reduction strategy
• Support system-wide change by engaging with clinical • Respond to new guidance from Public Health
commissioning group partners to ensure a joined up England and NICE as it is published. Work closely
approach to service development. For example, to with partners to develop approaches to e-cigarettes
support the new health optimisation pathway (a and new forms of tobacco that are based on local
routine offer of support to tackle unhealthy risk assessment, harm reduction principles, and the
behaviours prior to planned surgery) and CQUINS most up to date evidence18 Cheshire West and Chester Health Improvement Strategy 2018-2022
• Promote sources of balanced advice about • Frame advice and guidance around NICE guideline
e-cigarettes, building on forthcoming PH5 (Smoking: workplace interventions)
publications from Public Health England. • Consider extending support more widely, e.g. through
Information for the public and professionals the workplace wellbeing charter initiative or similar
should include advice about health risks
compared to smoking and not smoking, nicotine • Explore the application of behaviour change theory
addiction, how to purchase and use the safest to enable organisations and businesses to develop
products, how to report sales of illicit e- more smokefree outdoor spaces and continue work
cigarettes, and a reminder about the laws against with educational, leisure and sports organisations
vaping for under 18s
• Maintain information sharing between partner Strategy delivery
organisations to encourage a harmonised approach
to this issue as far as possible, and reduce confusion This strategy will be implemented by partner
caused by different policies and health messages. organisations through local sub-groups with strategic
Extend this to include a Cheshire and Merseyside oversight from the Smokefree Partnership Network.
perspective if appropriate Membership, terms of reference and governance
• Develop an e-cigarette friendly stop smoking service. arrangements will be be updated in line with ASH Local
This means that people who smoke or smoke and Tobacco Alliance recommendations and regularly
vape, and would like to include e-cigarettes as part of reviewed to ensure effectiveness. Progress will be
a quit attempt can access the service. reported to and overseen by the Health and Wellbeing
Board. Membership currently includes the following
• Set up data collection to help improve our organisations:
understanding of e-cigarette use locally
• Cheshire West and Chester Council teams
• Closely monitor developments towards a
prescribable e-cigarette (anticipated but not • Brio Leisure
currently available) • Cheshire Fire and Rescue
• Make the best use of regulatory powers and • University of Chester
sanctions within the resources available. This will
help ensure local e-cigarette retailers are compliant • Cancer Research UK
with the law on under-age sales, only sell regulations • NHS West Cheshire Clinical Commissioning Group
compliant products and follow best practice in order
• NHS Vale Royal Clinical Commissioning Group
to limit the appeal of vaping to young people
• Countess of Chester NHS Foundation Trust
• Engage with vape shops to deliver stop smoking
advice in order to reduce dual use • Cheshire and Wirral Partnership NHS Foundation
Trust
Equip local workplaces and businesses with the
resources they need to maintain smokefree workplaces
and support employees to stop smoking High level outcome indicators
• Work with locality teams, district advisory panels,
business improvement districts and the voluntary Implementation over the coming five years will be
sector to engage local businesses around developing planned and monitored using an overarching action
smoking and vaping policy that helps employees quit plan, detailed local action plans and a dashboard
for good, and to promote local and national tracking relevant indicators, including top level
campaigns e.g. Stoptober measures from the Public Health Outcomes Framework.
Top level indicators
• Smoking status at time of delivery
• Smoking prevalence at age 15 – current smokers
• Smoking prevalence in adults – current smokers
• Smoking prevalence in adults in routine and manual occupations – current smokersAlcohol Harm Reduction Strategy 2018 – 2022 Reducing alcohol-related harm across the life course
20 Cheshire West and Chester Health Improvement Strategy 2018-2022
For families, excess alcohol consumption can lead to
Introduction relationship breakdown, domestic abuse,
safeguarding and financial issues.
Welcome to our Alcohol Harm Reduction Strategy
for Cheshire West and Chester. Our vision is to For communities, alcohol can fuel crime and disorder,
enable people to have a sensible relationship with which can transform our towns and city centre into
alcohol, which promotes good health and wellbeing no-go areas. It increases the level of assaults and
and ensures Cheshire West and Chester is a safe anti-social behaviour, increases demand on Blue
place to live. Reducing levels of harm caused by Light Services and damages the reputation of
alcohol is everybody’s business. The misuse of communities and the area as a whole. This in turn,
alcohol affects the health and wellbeing of all our can have a negative impact on the local economy.
residents, the safety of our communities and the
future success of our town centres and their night- This strategy sets out actions aimed at re-balancing
time economy. the relationship Cheshire West and Chester has with
alcohol. The harm caused by alcohol in Cheshire
This strategy builds upon a range of excellent work West and Chester is not a problem of a small
that has been undertaken by partners locally. It minority, it is a problem that cuts across our entire
outlines action across the life course (that is, from population and affects local residents of all ages. In
before birth through to older age), with a particular addition, Cheshire West and Chester has over 31
focus on prevention and protecting children and million visitors per year which brings with it an
vulnerable groups from alcohol-related harm. We added layer of complexity, with some aspects of
recognise that some people will have established tourism being associated with excessive alcohol
issues with alcohol misuse and for these people our consumption.
focus will be on recovery, allowing people to
maximise their potential and make a positive Working in partnership to
contribution to society. There are some things we
know that will reduce alcohol-related harm that we achieve success
cannot do locally, such as the introduction of a
minimum unit price for alcohol and restrictions on This strategy has been developed collaboratively and
advertising which targets young people. We will sets out how by working together, we can make a
continue to lobby the government for changes in difference. It describes the evidence-based actions
these areas. to reduce alcohol-related harm in Cheshire West and
Chester. All partner organisations and agencies
agreed the vision, outcomes, objectives and actions
included in the strategy.
Background
Alcohol plays a role in British culture, it is often part
of our social and family life. However, alcohol
misuse in Cheshire West and Chester is estimated to
cost more than £129 million a year, equivalent to
£393 for every person living in our local community.
More needs to be done to promote safe and sensible
drinking, as large sections of the population
experience an unacceptable level of alcohol-related
harm which has a negative impact on individuals,
local families and communities.
Regular drinking outside of recommended upper
limits (14 units a week for men and women) risks a
future burdened by illnesses (including cancer, liver
disease, high blood pressure and heart disease),
increases the risk of falls and fractures and impacts
negatively on people’s mental health and wellbeing
and excessive regular drinking can all too easily turn
into dependence.Cheshire West and Chester Health Improvement Strategy 2018-2022 21
The impact of drinking on public health and 5. Reduce levels of alcohol-related Ambulance
community safety is so great that radical steps are callouts and Accident and Emergency (A & E)
needed to change our relationship with alcohol. Department attendances. Linked to Outcomes 2
and 3.
6. Prevent alcohol-related domestic abuse. Linked to
Outcome 2.
7. Ensure the local licensing policy and enforcement
Our vision activity supports the alcohol misuse harm
reduction agenda. Linked to Outcomes 1, 2 and 3.
To enable people in Cheshire West
and Chester to have a sensible 8. Promote a diverse and vibrant night time
economy. Linked to Outcome 3.
relationship with alcohol that
promotes good health and wellbeing 9. Work to influence government policy and
and ensures Cheshire West and initiatives around alcohol-related harm: 50p
Chester is a safe place to live. minimum unit price for alcohol, restrictions of all
alcohol marketing, public health as a fifth
licensing objective and reduce the alcohol limit
for drivers. Linked to Outcomes 1, 2, and 3.
Our principles
Outcomes We have also identified seven ways of working that
In order to achieve this vision and minimise the harm will underpin our action plans and work streams:
from alcohol in Cheshire West and Chester, the • Prevention
strategy will seek to deliver three interlinked
outcomes: • Outcome focused
1. The population of Cheshire West and Chester • Working in partnership
lives free from health harms caused by alcohol
• Reducing inequalities
2. Local people and communities live without crime
and antisocial behaviour caused by alcohol • Protecting the vulnerable
3. Promotion of a diverse, vibrant and safe • Promoting evidence based practice
night-time economy • Improving effectiveness and cost effectiveness
(value for money)
Key actions
1. Increase awareness of alcohol-related harms
Our approach
across the life course and establish safe drinking The impacts of drinking alcohol on health and
as the norm. Linked to Outcomes 1 and 2. community safety as outlined in the Cheshire West
2. Identify and support individuals drinking above and Chester Joint Strategic Needs Assessment (JSNA)
recommended guidelines. Linked to Outcome 1. demonstrate that we need to find ways to create a
healthier relationship with alcohol. Our approach will
3. Ensure individuals identified as having an alcohol focus on prevention and early intervention and there
misuse problem can access effective alcohol is clear evidence that in order to tackle alcohol-
treatment services and recovery support. Linked related harm, we need to take a consistent and
to Outcome 1. multi-faceted approach. The following sections
below outline the actions being taken locally to
4. Reduce levels of alcohol-related crime and reduce alcohol-related harm across the life course
disorder. Linked to Outcome 2. and make recommendations for the future.You can also read
