A Health and Wellbeing Framework for Jersey

R.21/2020

Contents

Foreword - Senator Steve Pallett, Assistant Minister for Health and Community Services

1. What is health and wellbeing and why is it important?  3

2. Government commitments to health and wellbeing  4

3. The Health and Wellbeing Framework - a new systematic approach  5

4. Evidence-driven action through a Jersey Needs Assessment process  7

• Jersey's health and wellbeing challenges: what we know  7

• Data-driven needs assessment to address the challenges  8

5. Prioritising and leading on prevention across government  9

• Sustainable wellbeing at the heart of each Government Plan  9

• A focus on prevention and early intervention  9

• Working together to improve the health and wellbeing of Islanders  10

• Leadership through a Sustainable Wellbeing Political

Oversight Group  12

6. Monitoring how well we are doing through Jersey's Performance Framework  13
7. Summary  15

Foreword

Over the coming decades we will face unprecedented population health challenges. These will impact all of us, our children, our parents, our friends, and the services we rely on. Jersey's government recognises this in our Common Strategic Policy 2018– 2022, which commits to improving Islander's wellbeing and mental and physical health' and to a shift in focus towards preventing disease and ill health.

Much good work is already underway to meet these commitments. The Ministerial team for Health and Community Services is redesigning the way our health and care system is delivered, through the new Jersey Care Model. The new model aspires to afford Islanders every opportunity to make the right choices to stay healthy across all ages. However, the new model of care will not achieve our aspirations in isolation.

We need to broaden our view to consider wider health determinants: the impact of housing and our living conditions, our employment opportunities, and our transport and education systems. We must ensure that health and wellbeing are prioritised in policy and decision-making across government departments and are balanced fairly against competing priorities.

This framework will help us all think and act differently to improve health and wellbeing in Jersey. A new political oversight group endorsed by the Chief Minister and Council of Ministers will lead on this important work, providing direction and co- ordinating government action. Their focus will be broad, ensuring sustainable wellbeing for Jersey and societal and community wellbeing as a whole.

Health, wellbeing and prevention will no longer be considered in isolation, or solely within the context of health care services. Rather, they will be balanced against wider issues around the environment, our economy, and around consideration for how our actions now will affect future generations and our island. This framework, driven by the political oversight group, will for the first time enable government to have oversight and co-ordination of all prevention strategies and policy areas impacting on health and wellbeing. This is vital in ensuring we're effective in delivering real change for Islanders.

Through elected Ministers, we as a government have a responsibility of stewardship, ensuring efforts to address the challenges we face are sustained, based on need, and make a difference. Our Government Plan provides crucial funding to support prevention programmes and prepare for these challenges. This first Health and Wellbeing Framework for Jersey provides the foundations for a collaborative, long- term approach to moving forward into action, so that together we can improve health and wellbeing for all Islanders.

Senator Steve Pallett

Assistant Minister for Health and Community Services

1. What is health and wellbeing and why is it important?

Health can mean something different to each one of us. Most will agree that it is more than just the absence of illness and that opportunities for good health start long before a need for health care and hospitals.

"Health is a person's level of good physical and mental health and the extent to which individuals in a society are enabled to live healthy' and flourishing lives" [1]

We often think of wellbeing' in a broader sense, associating it with the presence of positive emotions, satisfaction and fulfilment.

Aside from the benefits to each of us individually, the health and wellbeing of a population is an essential community asset, enabling a prosperous, cohesive and flourishing society. We know that:

• healthy children have better educational outcomes, which positively impacts employment levels and productivity in adulthood

• healthy adults can continue to work and stay active in our community and economy later in life

• healthy populations have higher community and workforce engagement and higher productivity, which contributes to the overall success and prosperity of our society.

Sustainable wellbeing' takes us beyond this traditional health-focused understanding of wellbeing - considering the economic, environmental, social and cultural wellbeing of a population, as well as physical and mental health.

2. Government commitments to health and wellbeing

As a government we invest strongly in health care, providing specialist services and technology to treat ill health when Islanders need it. But we know more can be done to prevent ill health occurring in the first place. We know that prevention is better than treatment for the individual and their family, and that it is more cost-effective. This is reflected in the Council of Ministers' commitments to prevention and supporting the health and wellbeing of Islanders.

First, in the Common Strategic Policy 2018-2022, Ministers made improving Islanders wellbeing and mental and physical health' one of five strategic priorities. They agreed to:

• supporting Islanders to live healthier, active, longer lives

• improving the quality of and access to mental health services

• putting patients, families and carers at the heart of Jersey's health and care system.

Second, the Government Plan 2020-2023, which sets out the strategic actions and budget to achieve these aims, reconfirmed a commitment to increasing resources and attention on tackling the causes of ill health and poor wellbeing, and placing sustainable wellbeing' at the heart of Government. The Plan also commits to the development of this Health and Wellbeing Framework, which sets out how this government will drive forward the prevention agenda and new ways of working across Government, as well as sustaining these commitments over time.

Third, the obligation to take account of sustainable wellbeing is now embedded in legislation. In June 2019 the States Assembly approved the Public Finances (Jersey)  Law 2019[2] which requires each Council of Ministers to:

1. in preparing the government plan, take into account the sustainable wellbeing (including the economic, social, environmental and cultural wellbeing) of the inhabitants of Jersey over successive generations; and
2. set out in the government plan how the proposals in the plan take that sustainable wellbeing into account.

This places sustainable wellbeing as a central government priority, both now and in the future.

Sustainable wellbeing is now being considered a priority across many countries, in recognition that our wellbeing and the wellbeing of future generations is strongly intertwined with our environment, our economy and our society and culture. By placing sustainable wellbeing at the heart of the Government Plan, we acknowledge that the pursuit of wellbeing cannot be addressed in isolation.

3. The Health and Wellbeing Framework - a new systematic approach

We recognise that the government and public services in Jersey need to work differently, to support a greater focus on health and wellbeing. We need to work across departments; we need to do more earlier, by helping people and families to tackle problems before they escalate, and we need to empower people and communities to look after their own wellbeing as far as possible. The Health and Wellbeing Framework will facilitate this new focus and champion a shift in ways of working across the government and public services. The framework is aligned with the Jersey Care Model, providing further detail on how critical prevention and early intervention actions will be driven forward.

The purpose of the Health and Wellbeing Framework is to provide a systematic and collaborative approach that increases government focus on prevention and early intervention, to reduce the risk and impact of preventable disease and improve quality of life for Islanders.

This will be achieved through:

• evidence-driven action through a Jersey Needs Assessment process

• prioritising and leading on prevention across government by:

o sustainable wellbeing at the heart of each Government Plan

o a focus on prevention and early intervention

o working together to improve the health and wellbeing of Islanders

o leadership through a Sustainable Wellbeing Political Oversight Group

• monitoring how well we are doing through Jersey's Performance Framework.

This gives us an opportunity to join other forward-thinking nations in tackling the complex issues impacting on health and wellbeing today. Some of the changes needed will be incremental and over the long-term, meaning our efforts must be sustained.

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4. Evidence-driven action through a Jersey Needs Assessment process

Jersey's health and wellbeing challenges: what we know

While advances in vaccination and sanitation keep infectious diseases at bay, non- infectious diseases (those that cannot be passed from person to person) now lead to early and preventable death[1] for more than three in five people.

Cardiovascular disease such as heart disease, high blood pressure and stroke; respiratory disease, such as chronic obstructive pulmonary disease; cancers; and diabetes, account for more than 80% of all non-infectious diseases.[2] Mental ill health is also a significant risk and one that is now much better understood. An estimated 792 million people live with a mental health disorder, which equates to roughly one in ten people[3].

Statistics Jersey's Disease Projections Report[4] predicts that by 2036, estimated population growth and an ageing population in Jersey will see an increase in:

• diabetes by 42% (3,600 to 5,100 people)

• stroke by 64% (1,400 to 2,300 people)

• dementia by 100% (500 to 1,000 people)

• chronic kidney disease by 74% (2,700 to 4,700 people)

• chronic obstructive pulmonary disease by 50% (2,000 to 3,000 people)

• mental ill health by 29% (700 to 900 people).

While genetics do have a role to play, evidence continues to emerge of the significance of our social, economic and environmental circumstances and of our health-related behaviours in determining our risk of these diseases[5].

Data-driven needs assessment to address the challenges

While we have good data on population averages and trends, we know that risk factors are not equally distributed in our population and that inequalities exist between different communities. For example, there are differences in levels of childhood obesity depending on where children live in Jersey, and different likelihoods of an Islander smoking depending on what they do as a job. This worsens differences in people's quality of life, economic opportunities, and has a negative impact on the population as a whole.

The Jersey Needs Assessment process will form an integral part of a new Performance Framework for Jersey and will enable us to dig deeper to understand inequalities across Jersey and their causes, so we can act to address them more effectively. The first Jersey Needs Assessment exercise is now underway, trialling new ways of gathering and analysing data on the needs of children and young people.

The Jersey Needs Assessment process will focus equally on physical and mental health. It will collate what we know from local data, alongside qualitative information such as that from focus groups and community feedback, with evidence of what works. The needs assessment will be an ongoing and constantly improving process where needs, experiences and local assets are better understood - ensuring that priorities reflect what will lead to the best health and wellbeing outcomes, and what matters most to Islanders.

5. Prioritising and leading on prevention across government Sustainable wellbeing at the heart of each Government Plan

With sustainable wellbeing now at the heart of each Government Plan through our new Public Finances Law, we have the ability to consider and prioritise wellbeing across a broader range of government actions. Having this focus will mean we are more able to balance economic, environmental, social and cultural factors, with those that improve Islanders' health and wellbeing.

A thriving and diverse economy is a vital contributor to the wellbeing of us all. We will, however, place economic progress in the context of other factors that determine our collective population and individual wellbeing.

Sustainable wellbeing pushes government, and all of us as a society, to aim for balanced development and considers what's right for the long-term, not just for now.

A focus on prevention and early intervention

The government's commitment to put children first' has provided a renewed focus on prevention through Early Help', recognising the significance of the conditions in the early years of life and their role in shaping our life chances. Our Children's Plan already shows a shift towards policies and interventions that support the early identification of needs through the right time – right help' agenda. This shift will see children and families who need additional support being able to access it at an earlier stage, through simpler referral routes.

Within our health and care system, we will focus more closely on the detection of risk factors and catching diseases in their early stages, as well as on treating complex conditions.

The new Jersey Care Model' looks to achieve this shift towards prevention and early intervention through a new model for healthcare. For example, a new prevention and primary care workstream will focus on:

• enhancing prevention and screening to identify and treat risk factors and precursors of disease as early as possible

• removing potential barriers to access for patients who are financially, clinically and socially vulnerable

• supporting self-care and lifestyle changes to help people manage physical and mental health symptoms therefore preventing some problems from getting worse.

Prevention services will be provided by a range of disciplines, in a range of settings, in a clinically-effective as well as cost-effective way. Supporting healthier behaviours will over time become part of normal care services.

Working together to improve the health and wellbeing of Islanders

Some of the biggest influences on our health lie in our wider environment and the conditions in which we are born, grow, live and work.

We recognise the influence of these environmental, economic, social and cultural conditions and the importance of co-ordinating action across all parts of government, and with partners in the community and voluntary sectors, to ensure these conditions are supportive of health and wellbeing.

The Government Plan 2020-23[6] recognises the need to priortise health and wellbeing across departments, setting out actions which will improve health and wellbeing beyond typical health care intervention. Figure 4. gives some examples of these actions.

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As well as working across government, we need to work with our Island community, building strong relationships with parishes and the community and voluntary sectors. These partnerships are key to bringing prevention services, support and care closer to home.

Leadership through a Sustainable Wellbeing Political Oversight Group

This is a challenging agenda, not only requiring changes to government services, but also to long-established ways of working across public services. A Sustainable Wellbeing Political Oversight group has been established to champion and oversee the work of the Health and Wellbeing Framework, with an initial focus on health and wellbeing, and a broader focus on sustainable wellbeing in the long-term. The group will be supported by Ministers and senior officials from across government, allowing for action beyond health services alone.

The political oversight group will:

• set direction and co-ordinate action across ministerial portfolios and across departments, to promote sustainable wellbeing, with an initial focus to improve Islanders' mental and physical health

• monitor and promote the increased focus on wellbeing and prevention of ill health across government

• promote policies and service changes that support and enable healthier choices to become the norm

• embed approaches that ensure health and sustainable wellbeing considerations are at the heart of government decision making.

As sustainable wellbeing is now embedded as an enduring priority in legislation, our intention is for this political oversight group to continue across political terms. To help achieve this, a handover' report will be produced by Ministers on the political oversight group prior to the next election, for consideration by their successors.

6. Monitoring how well are we doing through Jersey's Performance Framework

It is vital we monitor and evaluate our actions and assess how effective government services and interventions are – asking ourselves transparently, are we really making a difference?'. We will do this through the new Jersey Performance Framework, which measures how well Jersey is doing across all the dimensions of sustainable wellbeing. Health and Wellbeing' is a core dimension of the performance framework, sitting equal to economic, social, environmental and cultural indicators.

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In selecting these metrics, we have drawn upon Future Jersey[1], adding international best practice measures such as the OECD Better Life Index[2], and enhanced this further with official Statistics Jersey data and other official data sets. In this way, the performance framework comprises a wide range of evidenced-based indicators. For example, the metric Healthy Lifestyles' within the Health and Wellbeing' domain, is informed by indicators that impact most on healthy lifestyles, including levels of obesity, physical activity, smoking and alcohol use.

The government will publish performance reports regularly online, to enable public and political scrutiny, and will use the information internally, to manage service performance and support improvements. Where areas of concern are highlighted and prioritised, we will use the Jersey Needs Assessment approach to understand trends or patterns in more detail – enabling us to target additional support, or change what we're doing, as needed.

7. Summary

The Health and Wellbeing Framework sets out the new systematic approach being taken across government to drive a shift towards early, preventative, joined up action to improve health and wellbeing, in a way which complements acute care services. The approach comprises:

• evidence-driven action through a Jersey Needs Assessment process

• prioritising and leading on prevention across government

• sustainable wellbeing at the heart of each Government Plan
• a focus on prevention and early intervention
• working together to improve the health and wellbeing of Islanders
• leadership through a Sustainable Wellbeing Political Oversight Group

• monitoring how well we are doing through Jersey's Performance Framework.

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