Unlocking the Power of Six- Eight Right Physical, Social and Personal Resources

The assignment content highlights the importance of addressing health inequalities by understanding the wider social and economic determinants of ill health. The Dahlgren and Whitehead 'Policy Rainbow' model illustrates the layers of influence on an individual's potential for health, including personal lifestyle, physical and social environment, and socio-economic conditions. To tackle health inequalities, it is crucial to consider how different departments' areas of responsibility affect people's health, shape services to ensure maximum impact on public health, and focus on preventative actions. The three strategic priorities are to create a foundation for a more joined-up service approach with preventative action at its heart. The underlying principles include meeting peoples' health needs earlier, improving outcomes, and making cost-effective use of limited resources.

Executive summary
This strategy has been developed by West Lancashire Borough Council. It is our
overarching plan to improve the health and wellbeing of children and adults in our
borough.
The vision of this strategy is to:
Reduce health inequalities and improve the health and wellbeing of our local
communities and residents.
We have identified three priority areas that will help deliver this vision. They are:
 Place social value at the heart of our commissioning and procurement cycles;
 Integrate health and wellbeing within all policy documents, plans and projects;
 Achieve health and wellbeing coherence and strategic focus.
The three key areas were chosen due to a strategic ability to bridge social gradients in
health. There is a strong belief on what the Council can achieve through realigning its
existing services to tackle health inequalities; 'the basis of this strategy'.
For us to achieve this the strategy steers towards building a framework which will allow
over time for the realignment of existing services to permit a more integrated and
person-centred service approach.
This approach will help us to build the brighter future we wish for our community, people
and future generations; a core principle in the development of the strategy.
We expect the strategy to be a “living document” and to make sure that our planning
stays in tune with the changing needs of our West Lancashire people, our focus for
action will change with it, as priorities change.
We believe that everyone has a right to enjoy good health and it is our vision to support
this wherever possible through the services we provide, the way we deliver those
services, and importantly as we progress through collaboration with our partners and
others.
Thank you to everyone who has contributed to the development of the strategy.

Introduction
Our vision: To be a Council which is ambitious for West Lancashire
At the heart of this strategy is a clear desire to promote wellness, in its broadest sense,
throughout West Lancashire.
Within the strategy, we have outlined our strategic approach, principles and
responsibilities to achieve this by tackling health inequalities and promoting better
quality of life for everyone who lives or works in the borough.
The priorities were developed in a way in which to provide a roadmap to give a clear
sense of direction in this journey.
By setting a policy framework that focuses on better joined up working, shared vision
and effective collaboration across a range of Council services we aim to better influence
health outcomes by tackling the wider determinants which impinge quality of life.
It is anticipated that once the strategy is implemented we will create a supportive and
permissive environment to tackle the health challenges we face and set the scene for
future health development.
During the development of this strategy, we took on board the strong argument in the
NHS ‘Five Year Forward View’, "that the future health of millions of children, the
sustainability of the NHS, and the economic prosperity of Britain all now depend on a
radical upgrade in prevention and public health".
The strategy acknowledges that good health and wellbeing is in everyone's interest and
therefore, everyone has a responsibility to play their part and we want to play ours.
Scope and context:
This is a strategic document, which sets out the high-level objectives and possible
actions in relation to three broad priority areas.
It does not provide detailed information about how the priorities will be delivered; these
details will be contained in individual policy documents and corresponding action plans.
This work will follow and be led by the Council's Health and Wellbeing Strategy
Manager.
Governance and regulation:
The overall delivery of the three key areas cannot be delivered in silos. We have
identified that the policy document will be "living" and will evolve and change dependant
on the health and wellbeing needs of our community, mainly in relation to delivering

better health outcomes in the most effective, efficient and equitable ways we can by
utilisation of our existing services.
To add, each priority will require a cohesive and joined up approach to ensure we can
achieve the milestones.
It is anticipated that the Council's Health and Wellbeing Strategy Manager will develop
the supporting policy documents and action plans to bring the strategy to fruition. This
work will require buy-in and support from several internal services and officers.
To deliver the core functions accountability will be key. To enable accountability a task
and finish team will be formed for each individual priority. Within the teams’ key officers
will be actively involved, or deputies on their behalf who have autonomy to make
decisions and influence the required outcomes.
During task and finish group meetings implementation plans will be reviewed, outcomes
discussed and progress monitored.
The groups will be chaired by the Health and Wellbeing Strategy Manager and will be
held quarterly and will last no longer than 2 hours. Schedules of meetings will be
circulated well in advance and on an annual basis.
Regular updates on priority progress will be reported to the Director of Leisure and
Wellbeing Services with the accompanying action plans and performance metrics on a
quarterly basis.
To make sure this strategy stays in tune with the changing needs of our West
Lancashire people the strategy will be a “living document” and as the strategy evolves
and work is added or changed notification through our formal governance (delegated
authority) will be followed.

Why did we develop this strategy?
Each and everyone of us is affected by levels of health and wellbeing we experience.
Many West Lancashire residents enjoy good health and wellbeing and West Lancashire
performs well compared to other areas. However, significant problems persist such as
the low level of physical activity in children and young people and the fact that if you live
in the most deprived wards of West Lancashire on average you will live 8.8 years less
than if you lived in the least deprived.
However, West Lancashire has a clear identify, a strong heritage and is a cultural home
to ###### residents.
West Lancashire is a borough of dramatic contrasts with rural, idyllic villages, industrial
heritage and ‘new town’ developments. The town of Skelmersdale in the centre of the
borough is the largest and most densely populated. There is a marked difference in
prosperity and the quality of life between the inner wards and affluent outer suburbs and
villages. ## neighbourhoods, concentrated around the town of Skelmersdale and home
to around 68,000 residents are amongst the most deprived areas in the UK.
West Lancashire population has risen over the last 30 years and this is expected to
continue with projected growth to ###### by 20##
We currently have a relatively young population; however, the population is ageing
rapidly. We face demand from a significant cohort of frail older people, who are
attributes to our society but bring with them issues for our care system of physical frailty
and dementia.
West Lancashire is not alone in that the major challenge we face is managing significant
reductions in our funding whilst facing increasing demand for our services.
The NHS will be approximately £30 billion short of funds by the end of this decade
whilst local authorities have had cuts imposed by central government of more than 30%
in recent years. Taken together the impact of the funding squeeze affects the financial
viability of the system.
Alongside this, the next decade will bring a growing demand for the health and social
care. This rise in demand comes from the demographic fact that there will be a steep
rise in the number of very old people and it is certain that very old people have a larger
number of long term conditions than the rest of the population.
The case to transform health and social care is overwhelming. Just consider some of
the killer issues in our borough; smoking related deaths, ##### #####. A ### of the
adult population are excessively overweight. Life expectancy within West Lancashire
varies considerably with men in our most affluent communities living more than 9 years
longer than those in our most deprived areas.

In acknowledgement, under the 2012 Health and Social Care Act, central government
has given local authorities a core role in public health to tackle these health inequalities
and others. Supported by a new executive agency, Public Health England, and a new
public health outcomes framework (PHOF). It has been recognised that local
authorities are best placed to understand the needs of their communities and operate
the infrastructure to influence and tackle the physical, social and economic conditions
which threaten societies health and wellbeing.
Where we are born, grow up and work, the services which shape our health directly and
indirectly by influencing our lifestyles are identified as being the key fundamental to
improving quality of life and life expectancy.
Below is a chart to highlight the different contributing factors for premature death. It is
clear to see a large percentage of our health is determined by our behaviour. Other big
percentages are obviously from our genes, which you can see here in genetic
predisposition, but also in our health care, our social circumstances, and our
environmental exposure. Some of those social circumstances and environmental
conditions we might have some control over. So, if you include those, over half of the
relationship between premature death and longevity are due to behaviour,
environmental exposure and social circumstances, things that we potentially have
control over and can influence through the services we operate.

To add, at a time of economic hardship, ongoing government cuts and tough reductions
in spending and ever increasing pressure on the national health service we recognise
more than ever improving public health is core business and central to our role as
community leaders and stewards of community wellbeing, especially in relation to
protect and improve the quality of lives of our residents’.
Many people still think of health as being largely the remit of the NHS this strategy
acknowledges that good health and wellbeing is in everyone's interest and therefore,
everyone has a responsibility to play their part.
Health is not just an issue for the NHS; each of us has a duty in making West
Lancashire a healthier and happier place to live and this strategy sets the framework to
be able to do this.
What do we want to achieve?
At the heart of this Strategy is a desire to promote wellness, in its broadest sense,
throughout the West Lancashire population. For too long, the focus has been on the
health and care needs of individuals, and on treating specific diseases, conditions or
problems. There has been less emphasis on preventing ill health, and on identifying
and using the vast array of assets at our disposal to support this.
As a country, we have tended to organise services and treatment around specific
illness, rather than taking a more holistic, person-centred approach. Which means,
when developing services etc. to focus more on considering people’s needs, values,
family situations, social circumstances and lifestyle. Become more considerate and
compassionate, fitting services to the people, not people to the services.
As we know we can no longer afford to continue to merely organise services and
treatment around specific illness. It is simply not viable to continue trying to respond to
increasing demand for services, particularly at the expense of preventative action. We
understand we need to find new ways to achieve better outcomes for individuals and
their families, in a way that is financially sustainable and makes best use of collective
resources.
Adopting a service approach characterised holistic is unchartered territory for the
council, but something we understand we must do if we want to improve the health and
wellbeing of our people and this strategy sets out how we propose to do this, based
around three priority areas:
 Place social value at the heart of our commissioning and procurement cycles;
 Integrate health and wellbeing within all policy documents, plans and projects;
 Achieve health and wellbeing coherence and strategic focus.

As mentioned, central government has handed local authorities responsibility to improve
the health and wellbeing of their communities and residents by tackling root causes of
poor health, known as health inequalities.
This action has made local authorities think differently about how they deliver services
and think more about how services can influence people to live a healthier life.
In support, it is the intention of this strategy to provide the overarching framework to
deliver real solution focused health outcomes by targeting three priority areas which
have the capacity to place health and wellbeing at the heart of everything we do, and
allow for a more cohesive and joined-up way of working.
These priorities will allow overtime for a rebalance in focus away from expensive
specialist services to universal effective preventive ones with the core function to
improve health and wellbeing.
The actions can help underpin the strategic framework to transform our public services
to ensure that people are the real focus of our service delivery.
The long-term goal of the strategy is to add our contribution towards alleviating demand
on local health services, economic cost of ill-health and the associated wider social
costs.
How did we arrive at our priorities?
We understand lack of income, inappropriate housing, unsafe workplaces and poor
access to healthcare are some of the factors that affect the health and wellbeing of
individuals and communities. Similarly, good education, employment and safe, crime
free, attractive environments all support healthy living and directly contribute to the
wellbeing of communities.
We can see evidence of health inequalities across West Lancashire when we compare
the life expectancy of people who live in our least deprived communities with those that
live in our less affluent areas.
We understand from research by public health pioneer: Professor Sir Michael Marmot in
his post 2010 strategic review – ‘Fair Society Healthy Lives’ that to reduce health
inequalities there needs to be a focus on tackling the wider determinants which impinge
quality of life.
These determinants have been described as ‘the causes of the cause’. They are the
social, economic and environmental conditions that influence the health of individuals
and population. They determine the extent to which a person has the right physical,
social and personal resources to achieve their goals, meet needs and deal with
changes to their circumstances.

There is a clear link between the wider determinants of health and health inequalities,
defined by the World Health Organisation as “the unfair and avoidable difference in
health status seen within and between countries”.
Addressing the contribution of the wider social and economic determinants of ill health
is crucial to health and wellbeing as we cannot make the large-scale progress we need
to tackle the big health issues which can impact negatively on people’s lives. One of
the difficulties in tackling health inequalities on the ground is a failure, for numerous
reasons, to get a proper grip on these social determinants of health.
A model often used to illustrate the wider determinants is the Dahlgren and Whitehead
(1991) ‘Policy Rainbow’, which describes the layers of influence on an individual’s
potential for health (Figure 1). Some of these factors as previously mentioned are fixed
(core non-modifiable factors), such as age, sex and genetics but there are the others,
potentially modifiable factors expressed in the diagram as a series of layers of influence
including: personal lifestyle, the physical and social environment and wider socio-
economic, cultural and environment conditions.
Figure 1: The Determinants of Health - Policy Rainbow
There is the compelling business case for putting public health at the top of the local
government agenda.
With all this said, it has been critical to decide which actions we can take to have the
most impact and that will be the most cost effective. To do this, the following factors
were taken into consideration:
 How do the areas that different departments are responsible for affect people’s
health?
 How can all our services shape the way they work to ensure maximum impact on
the public’s health?
 What does the evidence say about which actions are most effective?

 Which actions will tackle the social determinants of health, save money and
create value?
The idea behind the three strategic priorities is to create the foundation for a more
joined-up, creative and innovative service approach with preventative action at its heart.
This can be illustrated by the upstream – downward stream diagram below, where
prevention (stopping people falling into the river in the first place) is the main aim.
Finally, to achieve the set of priorities underlying principles have informed the
development of the strategy. These include how best to meet peoples’ health needs
earlier, improve outcomes, and improve quality and equity, while making cost-effective
use of limited resources at a time of rising demand, rising expectations and financial
constraints. These underlying principles have help to shape the actions for the strategy.
Priorities
The health and wellbeing priorities have been selected to provide several high-level
objectives/ priorities which are a challenge to resolve and span organisational
responsibilities. These priorities will be reviewed quarterly to allow for progress to be
monitored and each priority will be refreshed annually to ensure they remain align with
our organisational vision and overarching priorities.
Priority 1
Place 'Social Value' at the heart of commissioning and procurement.
What is ‘Social Value?
Social Value can be defined in many ways. For this purpose, we have defined 'as a
process whereby organisations meet their needs for goods, services, works and utilities

in a way that achieves best value for money on a whole life basis in terms of generating
benefits to society and the economy, whilst minimising damage to the environment'.
Thinking 'Social Value’ should shift the focus from the bottom-line price or cost of a
service towards the overall value of the outcomes delivered. How a service is delivered
is taken into account along with what is delivered.
Why is it important?
The Public Services (Social Value) Act came into force in early 2013 and requires for
the first time all public bodies in England and Wales to consider how the services they
commission and procure might improve the economic, social and environmental well-
being of the area. It asks public bodies to consider the ways that they could most
benefit society as part of each decision made.
In many ways, a focus on Social Value is an extension of the 'three pillars of
sustainability' – society, the economy and the environment. Some Social Value
considerations which can be used to underpin the 'three pillars of sustainability' are set
out in the diagram below:
By working with suppliers to deliver Social Values in contracts, where appropriate and
proportionate to do so, direct and indirect benefits can be achieved. As a consequence,
where commissioners are already choosing a 'sustainable' route through procurement
they will also be providing Social Value to their area.
Embedding the Social Value Act to the commissioning and procurement cycle
encourages wider public benefits for communities beyond the service being
commissioned. For example, when undertaking a pre-procurement exercise they would
be the expectation for contractors to demonstrate when bidding for public sector
contracts how they can contribute to the wider aspects of society by providing some
form of 'Social Benefit'.

Social Benefits could include (but are not limited to):
 Social: Promote training and employment, raise living standards of local
residents, practical support for local voluntary and community groups;
 Economic: Support sourcing labour within the local area, target effort towards
those in the greatest need or facing the greatest disadvantage and tackle
deprivation;
 Environmental: Reduce waste, limit energy consumption and procure materials
from sustainable sources.
By creating a set of accountabilities to allow for health improvements and ways to
reduce health inequalities using the means of local and national commissioning and
procurement further action to tackle the social determinants of health can be achieved:
a key component for the development of this strategy.
The aim of 2013 Act is not to alter the commissioning and procurement cycle, but to
ensure that as part of these processes, councils give consideration to the wider impact
of service delivery, which allows local authorities to, for example, choose a supplier
under a tendering process who not only provides the most economically advantageous
service, but one which secures wider benefits for the community.
Acting to increase Social Value also has the potential, in the longer term to reduce
demand on health services by improving the health and wellbeing of the population.
Adding Social Value within the framework of West Lancashire Borough Council will help
to encourage finding innovative and more effective solutions to meet public need
through the commissioning and procurement of services.
The new framework would also allow us to encourage a new way of thinking to best
utilize limited public resources to achieve the greatest economic, social and
environmental value for local residents. Consideration could be taken beyond the price
of each investment and to look more at what the collective benefit to a community is
when choosing to award a contract or deliver a service. These actions would help us
provide greater economic growth, greater engagement with the voluntary, community
and social enterprise sector, and improve wellbeing and quality of life.
Integrating Social Value would also make a huge difference to our service delivery and
local communities, each year, West Lancashire Borough Council spends approximately
£###m on the procurement of goods, services and works for the borough. By
embedding Social Value we will be prompted to ask the question, 'If £1 is spent on the
delivery of goods, works or services can that same £1 be used to also produce a wider
benefit for the community by looking beyond financial value alone and considering the
collective benefit to the local community'.

It is a key priority that we achieve value for money for the pound and the taxpayers who
live here. Social Value can bring long term benefits not only to end users of a service
but to our communities in general. This action alone would be of immense benefit to
our local economy and future generations.
To integrate Social Value into commissioning and procurement process will take time,
but something once achieved would add a real solution focused benefit to our
communities and residents’ wellbeing.