Case study 4: Norfolk County Council
Interview with Maureen Cleall, Inspection and Compliance Team Manager.
One of Norfolk County Council's key objectives is to improve the health and wellbeing of Norfolk residents. This objective is reflected in its local area agreement (LAA), Norfolk Action.
The Health Improvement Management Group
To further this objective, a Health Improvement Management Group (HIMG) has been set up to work with Norfolk's primary care trusts (PCTs). The group is intended to:
- oversee the development of a health improvement strategy for the county council, comprising a vision, key strategic objectives and the actions that support them, in delivering health and wellbeing to Norfolk people
- identify and coordinate the actions of all services in support of the health objective in the county council plan
- provide a link to the wider health improvement strategy emerging from the joint strategic needs assessment (JSNA), specifically in tackling health inequalities in Norfolk
- contribute to joint planning on health improvement in collaboration with Norfolk PCT and Great Yarmouth and Waveney PCT
- monitor the county council's contribution to the ‘healthy and well' theme in 'Norfolk Ambition', the Sustainable Community strategy for the county
- take a lead role in monitoring the implementation of the health targets in the LAA.
The HIMG was initially chaired by the director of public health. It has provided an opportunity for all Norfolk County Council services, including Trading Standards, to identify work which impacts on health and wellbeing in the county. This information is then shared with other services represented in the group. With the group's assistance, Trading Standards has produced a work plan highlighting all those aspects of its work identified as impacting on health and wellbeing. It has linked these - with the assistance of the director of public health - to NHS priorities.
Evidence of partnership working
The director of public health has also been helpful in directing Trading Standards staff to NHS Norfolk. This is the new name for the PCT and its staff can provide expertise in areas lacking within Trading Standards' teams. For example, advice has been sought from the PCT on the development of a guideline daily amount calculator and its usefulness in promoting healthy eating. Assistance has also been sought from a dietician in connection with the analysis of nursery school meals.
The county council's Trading Standards department has also made contact with the other PCT for the area, Great Yarmouth and Waveney PCT. This has been done through channels including personal contacts made at health promotion events and, more recently, at an event organised by Norfolk Healthy Schools. This event brought together a number of agencies and services to share ongoing work and ideas with a view to formulating a strategy for improvement.
Maureen Cleall, the county council's Inspection and Compliance Team Manager, says:
“Interestingly, the links that have been made less formally seem to us to have been more fruitful in terms of joint working than those made at the more formal level,”
“Colleagues from Great Yarmouth and Waveney PCT are now assisting us with the nursery school meals project. This will match the nutritional content of meals against the Caroline Walker Trust guidelines and thus improve nutrition for children in those settings. We hope to roll out the results to all nurseries in Norfolk in partnership with them.
Nursery school meals project
“The nursery school meals project has gained regional funding from NHS and will feed into a national project being run by LACORS (Local Authorities Coordinators of Regulatory Services).”
She also explains that membership of the HIMG has led to useful contacts with colleagues in the county council. An example is with the policy and performance team which is overseeing the council's contribution to the LAA.
Salt shaker initiative
Cleall points out that before the setting up of the group, Trading Standards were already planning and delivering work which impacts on health and wellbeing. For example, they were running projects, as part of the Food Standards Agency's (FSA's) health improvement agenda, designed to reduce salt in bread, sausages and takeaway meals.
One small but effective measure was the distribution of salt shakers with fewer holes in the top to fish and chip shops, reducing the amount of salt consumed by 50 per cent. An important part of the process in achieving salt reduction in bread and sausages has been engaging and consulting with local bakers and butchers.
“These businesses were not aware of salt reduction targets and have been enthusiastic to work with us on these projects.”
Cleall also points out that the effect of this work will be to make local businesses competitive with national producers who are already meeting salt targets, having been lobbied by the FSA. This is an important point for Trading Standards as the salt reduction work will potentially impact positively on the economic wellbeing of local businesses, as well as health improvement. Thus two important objectives will be aligned.
Linking crime reduction and health improvement
The department is also engaged in the reduction of anti-social behaviour and, simultaneously, health improvement through its 'Minor sales - Major consequences' project. This seeks to reduce the supply of alcohol, tobacco, knives, fireworks and other age-restricted products to young people.
This project has run for four to five years now and has gathered pace and significance through the crime reduction and antisocial behaviour agenda and links with crime and disorder reduction partnerships (CDRPs) and Safer Neighbourhood teams. More recently the work on tobacco sales has attracted significant NHS funding (£50,000 in 2008) for the Eastern Region Trading Standards Authorities.
Further NHS funding of £250,000 was given to the East of England Trading Standards Authorities (EETSA) to fund an expanded tobacco enforcement programme. This programme has a wider remit including business support, advertising issues, tackling Internet sales and other illegal sales activity. This project ran from September 2008 until the end of June 2009.
Although many of the links with health improvement were already being made by trading standards, Cleall believes that the existence of the HIMG has provided an additional impetus. Her view is that work being done, corporately and through groups like the HIMG, is slowly gathering pace to achieve health outcomes. One measure of the corporate approach is the forthcoming ‘LAA challenge event' on health inequalities, which will bring together a wide range of partners, including Trading Standards, contributing to the health of Norfolk people.
One major challenge to a ‘joined up' approach to health improvement and tackling health inequalities has been the lack of knowledge many staff on the frontline have of the drivers for health and how their services might impact on it.
Filling in the gaps
There exists an equivalent lack of knowledge among health partners of the roles of officers of the county council and what their health contribution might be. The Trading Standards department has attempted to address this issue and to ensure that staff are aware of and engaged with the right kind of work by fully involving staff in service planning and in producing the ‘golden thread' work plan produced by the HIMG referred to above, which links Trading Standards' work to NHS priorities.
This summarises all the trading standards priority work areas, lists their potential health impact and relates them to national health trends, such as the rise in obesity. The emphasis on health outcomes is ‘future-proofed' by being aligned through the departmental management team and the HIMG with Norfolk County Council's overall objectives and the LAA.
22 September 2009