Leeds City Council: a strong economy within a compassionate city

Leeds City Council and partners are working on a ‘breakthrough project’ on early intervention and reducing health inequalities through linking integrated healthy living services, community development, GP social prescribing, NHS Health Check, and a range of other community activity with clear referral pathways.

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Leeds has effectively recommissioned integrated services in sexual health, drugs and alcohol and early years. It has also taken a joined-up approach to the built environment, health protection, healthy ageing, mental health and a healthy workforce.

Leeds is the second largest city outside London, with a population of around 800,000. Leeds is a largely urban area with many large, well-established parks and open spaces. The city has a growing economy and many affluent areas. However, 20 per cent of the population live in areas that are in the 10 per cent most deprived in the country. The health of people in Leeds is generally worse than the England average. There is a gap in life expectancy of 12.1 years for men and 8.6 years for women

between the most and least deprived areas of Leeds. The two strategies which will be important to tackle these challenges will be the Leeds Health and Wellbeing Strategy 2016-21 and the Inclusive Growth Strategy (currently under consultation).

Organisation

Since the transfer, Leeds Public Health has operated a hub and spoke model in which staff are embedded across local authority departments to develop health and wellbeing throughout council functions. In April 2017 as part of a wide corporate restructuring, the public health team moved into a new adults and health directorate. Public health works to the portfolio holder for health, wellbeing

and adults.

Public health has based a consultant in each of Leeds’ three clinical commissioning groups (CCGs) to provide mandatory advice and a strategic link for health and wellbeing across the council and the NHS. The CCGs intend to merge in 2018, and, in preparation, are working in a partnership. Public health has established a small consultant-led public health team to support the partnership. It has also revised its memorandum of understanding, which now sets out the public health offer at three levels:

  • macro level strategic commissioning – whole population public health support
  • meso level system support – contributing to the development of an accountable care system and health and care pathways 
  • micro level locality partnerships – developing health and wellbeing in GP practices and localities, and risk stratification. 

Health and wellbeing initiatives

Leeds City Council’s ambition is to have a strong economy within a compassionate city. The council works very closely with the three CCGs, and there is a shared focus on tackling health inequalities – particularly for people in the 10 per cent most deprived neighbourhoods – around 150,000 people.

Narrowing the health gap between the most and the least deprived areas is a key measure of progress.

A wide range of health and wellbeing initiatives are underway in Leeds. These are reflected in Leeds Best Council Plan, with its 2017/18 update focusing on ‘poverty and health inequalities’, and Leeds Health and Wellbeing Strategy. 

One You Leeds

Leeds City Council, Leeds CCGs and partners have identified eight ‘breakthrough projects’ – cross-cutting priorities in which a common purpose, shared outcomes and removing barriers can ‘make a breakthrough’. The ‘early intervention and reducing health inequalities’ project is led by public health

and is initially focused on commissioning an integrated healthy living service and ensuring other services commissioned by partners are aligned within this.

When public health transferred to the council, healthy living services were generally offered as single services operated by multiple providers which meant that people who had more than one issue to tackle did not receive seamless support. Following comprehensive health needs assessment, evidence reviews and consultation, an integrated healthy living service model was developed. The model includes programmes in specialist smoking cessation, adult weight management, physical

activity, healthy eating and cooking skills. Individuals can self-refer to the service and identify which health issue they wish to tackle first. They can then progress between different lifestyle programmes at their own pace.

People are also referred by health professionals, including via the GP social prescribing service. The programmes offer a range of personalised support including individual assessment and support, group activity and ‘intensive personal support’ with a health coach for those with complex needs.

The service has been designed to offer services across the city, but with particular emphasis on attracting those in the most

deprived areas.

Following open procurement, the contract for One You Leeds was recently awarded to a single provider. Clear referral pathways are being established between One You and other community-linked initiatives such as GP social prescribing, NHS Health Check, Third Sector Health Grant activity, a new community blood pressure detection and monitoring project funded by the British Heart Foundation, and the new Better Together programme.

As One You becomes established, the service will be involved in wider developmental work. As an early example, the physical activity programme will work with council leisure services to promote physical activity as a whole system in a deprived neighbourhood with funding from Sports England.

Better Together

Better Together is Leeds’ new community-based health development and improvement service, largely focused on the 10 per cent most deprived neighbourhoods. The previous service was delivered through 14 contracts which could be better joined up. Better Together is provided in the three localities of Leeds, broadly matching CCG areas, through three contracts with third sector organisations – two consortia with a lead partner, and one single provider.



Better Together takes a community development approach to health improvement, with each area delivering priorities identified by communities and building on strengths and assets. A wide range of activity is being delivered, including confidence building, coping with bereavement, skill-based courses, advocacy and self-help, community integration events, recruiting volunteers, health campaigns and applying for grants.

The service has not been operating long enough for formal evaluation, but individual case stories collected from Better Together show how people are improving their lives and their health.

Age Friendly Leeds

Age Friendly Leeds is another breakthrough project, co-chaired by adult social care and public health. The overall aim is to make Leeds the best city to grow old in by working together on all aspects of life that affect older people. A few headlines from the 2017 annual report include:

  • Improving our parks – improvements in access, walking routes, seating, and low impact exercise facilities in 15 local parks.
  • Road safety – 20mph speed limits, producing ‘Getting around Leeds – a guide for older road users’, a new assessment framework for requests for pedestrian crossings, and rolling out hi-vis shopping bags.
  • Housing – a consultation on developing ‘Me and my home, an older person’s housing strategy’. This will include promoting new sites for older people’s housing in the site allocations plan, and further work on improving adaptations.
  • Social participation – a huge range of social and physical activities across the city.

Whole-system health coaching

‘Better conversations for health and wellbeing’ is a key theme of Leeds Health and Care Plan. At the basis of this is a large-scale approach to health coaching across health and care which links strength based social care, Making Every Contact Count (MECC), collaborative care and support planning. Five hundred staff have been trained in health coaching to shift conversations from the traditional approach of trying to fix problems to one in which they enable people to self-manage. The approach

has been recognised as a pioneer by the national health coaching coalition.

The project is being evaluated in partnership with Leeds Beckett University, and interim results include a more person-centred experience for the citizen and measurable health improvements.

Developing integrated services

As well as the examples above, Leeds has recommissioned or developed a range of integrated services. Re-commissioning involves using the expertise of the council in commissioning and procurement, combined with public health expertise in methodology such as health needs assessment and data analysis.

Sexual health

While part of the NHS, public health had sought to integrate sexual health services, but this had not proved possible. It has now commissioned integrated sexual health services, including family planning and GUM, with an emphasis on links with communities and outreach in accessible settings. Following open procurement, a lead provider was appointed from the NHS to run the service,

working closely with other NHS and third sector partners on measures such as shared training, seamless pathways and links with other services. Monitoring has shown that performance is good.

Drugs and alcohol

Before the transfer, Leeds had separate drug and alcohol services. These have now been re-commissioned as an integrated drug and alcohol service. Following procurement, a third sector organisation was selected as lead provider, sub-contracting to NHS organisations for specific services. The service’s specification has also been designed to place much greater emphasis on social determinants, such as links with domestic abuse and children and young people’s services. The integrated service is better placed to tackle emerging challenges such as different patterns of drug misuse, and an ageing drug and alcohol misusing population with increasing health problems.

Integrated Early Start Service

The Early Start Service for children aged 0-5 years combines health visitors and children’s centre workers in fully integrated teams based in health centres and children’s centres across the city. Early Start provides a family-based offer, including the Healthy Child Programme, the Early Years Foundation Stage framework, and a range of childcare, play, early learning and school readiness support, as well as a gateway to specialist services. The service recognises that some families need more support at certain times, and has a range of offers geared to levels of need. Early Start is part of Leeds Best Start Strategy which has city-wide sign up. There has been strong support to keep all Leeds children’s centres open, and partners across the city have jointly invested in new initiatives including:

  • Baby Steps – supporting parents with complex lives prepare for parenthood.
  • Best Start offer in South Leeds – providing additional services such as peer support, preparation for birth and beyond.

NHS Health Check

Public health has recently undertaken an extensive review of NHS Health Check, taking into account public and clinical views, local and national data analysis and national good practice. Overall, the research found that engagement from both GP practices and patients is declining, but there is also

significant feedback that NHS Health Checks in a GP practice bring many advantages. Also, alternative flexible models may be most effective for certain groups such as BME people and younger full-time workers. The detailed results of the review will inform an options appraisal for the future direction of the service.

The built environment

As Leeds continues to grow, it is important to include public health in the planning process. The DPH’s annual report 2014/2015 focused on public health and the built environment, and the 2017 report provided an update on progress. Headlines include:

  • There have been several examples of public health involvement in housing developments, but a more systematic and targeted approach should be developed.
  • Public health are involved in supporting the active travel agenda; NICE guidance principles have informed a number of travel projects and funding bids; and links have been made with the Sport Leeds Board.
  • The three CCGs have identified housing leads, and prepared a report looking at the potential impact of housing growth on primary care.

Health protection

Health protection is a critical public health function, and the public health team has focused on building a good understanding in councillors of this new local authority function, strengthening the capacity for response and developing links with emergency planning. Leeds Health Protection Board was established as a sub-committee of the health and wellbeing board which means that health

protection is considered together with other strategic priorities for health and wellbeing.

Some headlines from the recent annual report to the health and wellbeing board include:

  • A pilot to increase blood-borne virus screening in primary care, including for the new migrant community, directly resulted in identification of new positive cases of HIV, and hepatitis B and C. Testing in participating practices increased by almost 250 per cent.
  • Rates of tuberculosis (TB) are declining nationally and in Leeds, but the city remains the second highest local authority area for TB in Yorkshire and Humber. A range of interventions are taking place, and the community TB service delivers above average completion rates.
  • Antimicrobial infection – rates of prescribing broad-spectrum antibiotics has reduced to below the national target. Leeds was nominated for five awards in the UK Antibiotic Guardian awards event and was highly recommended in two categories.

Mental health

Leeds Health and Wellbeing Board has been focused on improving mental health across the city. Leeds was one of the first Time to Change hubs in England, a partnership of local organisations and mental health champions committed to improving attitudes and behaviours to end discrimination. A

number of mental health champions have been appointed, including elected members, and a ‘Champions Fund’ has been set up to run anti-stigma activity. Other important mental health activity in

which public health has a role in includes:

  • The award-winning Leeds MindWell website which brings together mental health information from across Leeds into one place for people with mental health problems, their families and carers and
  • professionals. The resource was co-created with people with mental health problems.
  • Mindful employers Leeds – a network of over 200 Leeds-based members providing information and support to create positive working environments.
  • Suicide prevention work, including working with men at high risk of suicide and funding a Bereaved by Suicide service.
  • In July 2017, starting to procure a new Mentally Healthy Leeds service aimed at improving mental health and wellbeing in communities most at risk of poor mental health through community
  • development approaches.

Challenges

The health and wellbeing system is facing huge challenges for the future. At a time of ongoing and severe financial cuts, austerity is starting to have a significant impact, with an increase in demand for services such as drug and alcohol support, sexual health and foodbanks. The services that have been recommissioned in Leeds are proving popular and have revealed previously unmet need,

which is also increasing demand.

A councillor’s perspective:

Councillor Rebecca Charlwood, Executive Member for Health, Wellbeing and Adults

The transfer of public health has made a big impact in Leeds. Within the council there is a good understanding of the social determinants of health across all directorates, and health is seen as everyone’s business. Building on this, we are working to make Leeds a Healthy City. Having responsibility for public health has given councils a greater profile when working with the health sector. The Leeds Plan is the Leeds element of West Yorkshire and Harrogate Sustainability and Transformation Plan. It reflects the fact that there is extremely close working between the council and the NHS in Leeds, and significant progress is being made on plans for integration.



The council is keen to influence the STP to further promote prevention and early intervention, particularly in primary care which works closely with council neighbourhood teams. Thanks to the preventative approach undertaken by Leeds City Council and partners, the latest figures from Shelter show that Leeds has the lowest ration of homelessness among the core cities. By pulling prevention and early interventions together across health we can promote good health and wellbeing throughout our city.

Key messages

  • Being part of the local authority has made it possible to re-commission previously separate services into integrated services with improved access and more seamless delivery. Where these have a medical base (such as sexual health) this has been augmented with a focus on social determinants of health and links with communities.
  • It is important to ensure that major elements of public health’s work are joined up both strategically and operationally; these include community development in disadvantaged areas and lifestyle support for people facing health inequalities.
  • Being part of the local authority has also enabled greater engagement with the breadth of roles of the council, for example on planning and housing as well as a stronger partnership approach to health protection.

Contact

Dr Ian Cameron, Director of Public Health

Email: [email protected]

Documents and links

Available from the contact or to download.