Newcastle operates a Health in All Policies (HiAP) approach in which health and wellbeing is embedded across the council.
This includes involvement in:
- healthy transport and air quality
- leisure services and physical activity
- planning
- health improvement in community settings such as Community Family Hubs
- health at work.
Background
Newcastle is city with a population of 293,000 on the north bank of the River Tyne and forming part of the wider conurbation of Tyne and Wear. Newcastle has many sites of historical interest, modern culture and sport, and has several large and well-established parks. Newcastle is one of the 20 per cent most deprived districts/unitary authorities in England, with about 29 per cent (13,800) of children living in low income families. Life expectancy for both women and men is lower than the England average. Within Newcastle, the difference in life expectancy is 13.1 years lower for men and 10.9 lower for women in the most deprived areas compared to the least.
Organisation
Newcastle was a case study in the Public Health Annual Report 20157. This case study catches up on progress from that time, as well as looking at new developments. Newcastle has continued to focus on a HiAP approach to embedding health and wellbeing across the work of the council. To support this, public health has moved from the wellbeing care and learning directorate and is now a team working to the chief executive and to the portfolio holder for public health and Housing. The DPH works closely with the assistant chief executive’s management team which drives cross-cutting activity in the council.
Earlier plans to move a hospital-based health improvement team into the council to refocus on health and wellbeing in communities have now taken place. The public health team now includes responsibility for leisure services, which include in-house services as well as a range of assets transferred to external providers.
Health and wellbeing initiatives
Healthy transport and better air quality
The council is keen to tackle the spectrum of health issues associated with busy vehicle transport routes: problems from poor air quality, lack of opportunities for exercise, social isolation and mental health problems.
Public health supports the development of Newcastle as a Cycling City. In terms of infrastructure, many secure cycle routes have been created which currently are partially linked. The aim is that, eventually, there will be a fully joined-up cycle network around the city, ultimately expanding the travel corridor around the metro system, allowing people to bike to stations. Public health provides revenue funding, training and activities to increase the use of safe cycling.
Following a pilot of a bike library funded by public health, the council has supported the establishment of a smart bike-share scheme on a commercial basis. Starting in October 2017, the first stage of the scheme uses drop-off and pick-up sites provided by the council. The Mobike app will guide users
towards the best locations to pick up and park bikes. If the first stage is successful, it will be extended across the city and may be widened to include E-bikes. The council has recently signed a partnership
agreement with British Cycling to deliver major cycling events and promotions to increase the number of people cycling in the city and to support ongoing initiatives such as bike sharing, social rides and promotional activities.
Much local data on activity is based on sources such as the Active People Survey, which are high level and insufficiently timely. Public health is seeking to improve realtime measures of walking and cycling. For example, hire bikes can be tracked through GPS, providing heat maps of usage and
desire lines for travel.
Public health is working to improve air quality near schools. Public Health England has seconded a worker who is looking at car usage around schools with the aim of reducing traffic in the school run and involving children in activities to improve air quality. If successful this will be rolled out further, alongside plans to increase the capacity to monitor air quality around hotspots, particularly schools.
Newcastle, Gateshead and North Tyneside have been identified in Defra’s ‘Air quality plan for nitrogen dioxide (N02) in the UK’8 as places with high levels of N02 in some locations. They are now working on a collaborative response to Defra requirements, and have agreed that this work should include a vision for public health.
Leisure services promoting health and wellbeing
The main purpose of Newcastle Council’s leisure services is increasingly focused on improving health and wellbeing, particularly the promotion of sport and physical activity for people of all ages. This includes strength and balance training to prevent falls in older frail people, and a range of initiatives through links with Sport England, the Lawn Tennis Association and major local sports clubs.
Many of Newcastle’s leisure centres and pools have been asset transferred, but the council continues to deliver programmes through the facilities. Public health intends to work with the local NHS and within the sustainability and transformation partnership (STP) to develop opportunities for secondary
prevention through sport and leisure facilities.
Public health is also supporting and contributing funding to the development of a parks trust to assure a sustainable future for city parks. Health and wellbeing objectives are being written into the objectives of the parks trust so that they are at the core of delivery. Public health intends to work closely with the trust, with events and new initiatives that will utilise parks’ ‘green gym’ potential.
Health improvement in the community
Newcastle Health Improvement Team provides leadership, oversight, training and support for major workstreams including:
- sexual health
- healthy schools
- breast feeding
- health at work
- obesity and food policy
- brief interventions – alcohol
- smoking cessation
- You’re welcome – accreditation of services for young people.
Moving the team from a hospital setting to the council has meant greater emphasis on early prevention and health within communities, and has allowed some reshaping, including a new post to support black and minority ethnic communities. It means that the team works more closely with community services, such as Community Family Hubs, and can respond to and promote new opportunities for health and wellbeing, some of which are described below.
Tackling obesity
Support for the campaign NEWCASTLE CAN, fronted by chef and broadcaster Hugh Fearnley-Whittingstall, aims for Newcastle people to lose 100,000 pounds of weight in a year. Working with Planning on a supplementary planning document to establish a 10-minute walking distance exclusion zone for new fast food outlets near schools, which will be enforced by the council. There has been considerable public support for this development, and in 2016 McDonalds withdrew an application for a drive-through outlet near a school as a consequence.
Children’s health
Support to help hospital children’s services gain national ‘You’re Welcome’ accreditation which shows that services are child and young person friendly. Up to now, five of the hospital’s services have been accredited, with the others underway.
Health at work
Better Health at Work is a long-standing regional programme, commissioned by councils across the North East. It is open to employers, large and small, who work towards the Health at Work Award, which has four levels: Bronze, Silver, Gold and Continuing Excellence. Employers are supported by a dedicated workplace health improvement specialist who links with a workplace health advocate in each organisation to drive improvements.
Better Health at Work has proved a successful programme, with 380 organisations signed
up across the region. In 2016, Newcastle and the North Tyneside sub-region received 80 awards. It is also a useful framework for focusing on specific workplace health priorities, including promoting good mental health. Newcastle and Gateshead councils, with many other local employers, have signed up to the national Time to Change Charter, which aims to end mental health discrimination. In October 2017, over 150 employers responsible for 70 businesses met for a Better Health at Work mental health event at St James’ Park.
Public health has seen employers’ commitment to physical and mental health at work increase, and believes that this is a key area for further development.
Recommissioning services
In the 2015 case study, a number of contracts were being reviewed prior to re-tendering to provide high quality, cost effective services with an emphasis on integration and individualised support in the community. As well as those identified in the first case study – smoking cessation, maternal obesity, drugs and alcohol – two more areas were re-commissioned: services for children and young people 0-19, and sexual health.
The recommissioning process has met its goals, with the new services performing as well as, or better than, before (see stop smoking, below). The exercise also produced significant financial efficiencies which have been used for health and wellbeing developments, such as supporting
the establishment of a park trust.
Drugs and alcohol
There have been a number of changes in misuse of drugs and alcohol in Newcastle (also nationally), including a significant increase in violence and acute presentations associated with previously legal psychoactive drugs across Newcastle’s night-time venues and amongst students. Council public
health and regulatory services, the NHS and the police have worked together in a strong collaborative response to tackle these problems. This has resulted in the police closing down various supply lines, and continued efforts to tackle the changes in supply.
The use of psychoactive substances has reduced, but become an issue connected to broader drug supply markets. There are a number of issues with this changing market leading to increases in drug related deaths both locally and nationally. Newcastle’s response to drugs and alcohol will need to
be increasingly robust and depends upon partners working together to combine efforts, offering health and treatment interventions but also tackling supply.
Future plans include extending the intervention and brief advice (drugs and alcohol) train-thetrainer
network, a focus on children and young people’s drug and alcohol use, and harm reduction, while also establishing a new drug and alcohol recovery centre by a refurbishing a currently derelict building.
Smoke Free Newcastle
Smoke Free Newcastle is a long-standing partnership working to reduce the impact of smoking across Newcastle. It covers all aspects of reducing harm related to smoking: second hand smoke, stop smoking services and campaigns, regulation and enforcement.
The partnership continues to be extremely active, with an action plan which is monitored quarterly. Recent achievements include:
- smoke free signs in all outdoor children’s playgrounds
- action by the council’s commercial services team, Northumbria police and the Border Force to seize illegal shisha tobacco
- so far six organisations have signed up to the council’s responsible retailer award scheme
- a new care pathway in the hospital for pre-operative assessments in which the anaesthetist will point out the benefits of stopping smoking for several days before the operation, and post-op will follow up with a brief intervention on stopping smoking for good.
Newcastle Stop Smoking service is available on an appointment and a drop-in basis available in pharmacies, some GP practices, locations across the city centre, and in community venues. In the most recent quarter, the city’s quit rate per smoker was 15 per cent higher than the national average, with a fourweek success rate of 49 per cent.
Public health in the STP
Public health strands of the Northumberland, Tyne and Wear and North Durham STP are now being implemented. Currently, the most advanced of these is the tobacco control and smoke free NHS work strand. Newcastle’s DPH is co-chair of the regional taskforce which is developing a memorandum of
understanding to implement standardised pathways and prescribing, Making Every Contact Count (MECC) training, and a communications programme.
Research and development
The DPH is a member of the Programme Advisory Board of the National Institute for Health Research Public Health Research Programme, and promotes links with universities and medical schools to develop the potential for research and evaluation of practical health and wellbeing interventions.
Current examples include work on transport and air quality, and there is a prospect of expanding this further through continued engagement with research collaborations.
One of the most significant achievements has been the ‘BabyClear’ programme for smoking cessation in pregnant mothers, which is currently being implemented by many public
health teams in England.
Challenges
Budget pressures on the council have been a major challenge. By one off measures such as re-commissioning, public health has been able to retain a ‘remarkably large’ range of functions, and to contribute towards wider council developments that impact on health. However, there are limits to how long this can continue.
A major concern for the future is the impact of austerity. Although employment is rising, so is child poverty. Services cannot breach the gap of poverty; they can only try to deal with some of its impact, such as an increase in drug misuse.
Councillor Jane Streather, Cabinet Member for Public Health and Housing
In Newcastle there is considerable political enthusiasm for improving health and tackling health inequalities, and public health has become a responsibility of the whole council, through adopting a HiAP approach. Newcastle is also a designated city in the World Health Organisation’s European Healthy Cities Network – working towards Healthy City status, which shows that there is top level strategic commitment to improving health.
Cabinet members work closely together on health issues. For example, I work closely with the cabinet member for transport and air quality and I also co-chair the Healthy Streets Board, which was set up in 2016 to link work delivered by transport and public health officers within the council.
We have laid the foundations for a coherent approach to closing the gap in life expectancy and tackling the growing problem of poverty, but there is much more to do. For example, we are about to launch a new strategic partnership initiative to tackling food poverty: Newcastle’s Good Food Plan. We also intend to work with the regional STP to deliver a strong focus on prevention. It is important that our health and wellbeing plans are shaped through dialogue with local people, and the cabinet runs regular policy meetings at which the public can provide their views on topics such as mental health and wellbeing, Healthy City and housing.
Key messages
- Central to Newcastle’s approach and thinking is the understanding that public health is a function of the whole council – not simply a set of services or the exclusive responsibility of a public health department.
- Where long-term interventions are strong and continue to produce results, it is important to maintain and reinvigorate these, to promote continuity of approach. Newcastle also seeks to make partnerships with national bodies, such as Sport England, to support local initiatives.
- Public health research, particularly on the new approaches being developed in councils, is essential for developing effective public health interventions going forward.
- Expertise in commissioning and procurement in the council greatly helped public health to undertake an effective re-commissioning programme.
Contact
Professor Eugene Milne, Director of Public Health
Email: [email protected]