1. Essex Prevention Strategy 2015 - 2020 Date: 19/11/14 Author: Ian Wake, Consultant in Public Health Approved by: Cllr. Anne Brown Contact: Name: Ian Wake Email: ian.wake2@essex.gov.uk

2. Process This Strategy forms part of Essex County Council’s (ECC) readiness for the introduction of the Care Act 2014. It focusses upon the preventative measures that the Council is currently undertaking to help people to maintain independence for as long as is possible and identifies what areas are in need of improvement. The following pages provide more detail on our current progress using existing data, and set out what we think we hope to commission in the future. In producing this document we have consulted with ECC Commissioners, all Essex Clinical Commissioning Groups, Cabinet Members, District and Borough Council Officers and the Essex Health and Wellbeing Programme Board. A series of meetings were organised between the authors and these groups, and the content of the Strategy reflects these engagements. This document is a high level summary of five more detailed versions of the Prevention Strategy that have been developed at CCG locality level. These versions are embedded on page 5. Strategy Development 2 Lead Member: Lead commissioner(s): Supporting Officers: Councillor Anne Brown – Cabinet Member for Public Health and Adult Social Care Dr. Mike Gogarty- Director of Commissioning: Healthy Lifestyles Ian Wake - Consultant in Public Health Michael Cleary- Public Health Fast Track Manager ECC Integrated Commissioning Directors ECC Public Health and Social Care Commissioners Essex Clinical Commissioning Groups City, District and Borough Local Authorities

3. 3 Contents 1.Introduction 2.Background 2.1 Influences on Health and Wellbeing 2.2Health and Social Care Commissioning in Essex 3.Strategic Vision and Context 3.1Strategic Vision 3.2National Strategic Drivers 3.3Local Strategic Drivers 4.Assessment of Current and Future Need 5.Commissioning for Prevention 5.1 Primary Prevention 5.2 Secondary Prevention 5.3 Tertiary Prevention 6. Monitoring Outcomes

4. Introduction and Background

5. 5 1. Introduction The Health and Social Care system both nationally and locally is under increasing pressure. The NHS has faced a slowdown in spending growth in recent years, and local government significant spending cuts. Against this there is increasing demand for services both from an ageing chronically ill population, and through the increasing expectations of individuals. In order to prevent the system from becoming unsustainable, both health and social care will need to work in radically different ways than they did in the past. One key solution is for health and local government, in partnership with the communities they serve to embrace and deliver the prevention agenda. This requires a fundamental shift from reactive services that address ill health and care needs once they have arisen, to proactive services that seek opportunities to intervene at the earliest possible stage and throughout the life course of our population in order to empower individuals and communities to stay healthier for longer. It requires a shift in thinking from ‘doing to’ to ‘doing with’ and it involves holistic integration of what are often currently fragmented services around the individual. The Care Act (2014) sets out a range of additional statutory duties for local authorities related to the prevention agenda. It is critical to the vision in the Care Act that the care and support system works proactively to promote wellbeing and independence, rather than simply waiting until people reach crisis point. As such it requires responsible local authorities to work with key strategic partners to develop and agree a strategic approach to deliver the prevention agenda. This strategy has been produced by Essex County Council in partnership with CCGs and District and Borough Councils. It sets out our thinking in terms of how to deliver The Prevention Agenda across the services that we commission and provide. It is a high level Executive Summary of five more detailed versions of the Prevention Strategy that have been developed at CCG locality level. These detailed local prevention strategies are also available on Essex Insight. Basildon and Brentwood Prevention StrategyCastle Point and Rochford Prevention StrategyMid Essex Prevention StrategyNorth East Essex Prevention StrategyWest Essex Prevention Strategy

6. 6 2. Background (1/4) ‘Prevention’ can refer to a range of measures, services, facilities or other resources. There is no one definition for what constitutes preventative activity; it can range from wide-scale whole population measures aimed at improving health, to more targeted, individual interventions designed to improve the skills or functioning of one person or a particular group of people. It can also include measures to lessen the impact of caring on a carer’s health and wellbeing. “Prevention” is often broken down into three general approaches: primary, secondary and tertiary prevention which are described below. Primary Prevention: Measures to prevent ill health and promote wellbeing. Primary prevention is defined as interventions, services, or resources aimed at individuals or populations who have no current particular health or social care support needs. The aim of primary prevention is to help people avoid developing needs for care and support by maintaining independence, good health and increased wellbeing. Examples include programmes to promote healthy living and programmes to build strong resilient communities. Secondary Prevention: Measures to identify those at increased risk of poor health or wellbeing and intervene early. Secondary prevention refers to interventions or services aimed at individuals who have an increased risk of developing needs, with the aim of helping to slow down further deterioration or preventing more serious ill health from developing. In order to identify those individuals most likely to benefit from such targeted services, screening or case finding is generally employed. Examples include NHS Health Checks and providing additional support to carers. Tertiary Prevention: Measures that delay or minimise the impact of existing health conditions Tertiary prevention refers to interventions aimed at minimising the effect of disability or deterioration in people with existing health conditions, complex care and support needs or caring responsibilities including supporting people to regain skills and reduce need where possible. Local authorities must provide or arrange services, resources or facilities that maximise independence for those who already have such needs. Examples include reablement and support to people with serious mental ill health.

7. 7 2. Background (2/4) The course of someone’s journey through prevention services is not necessarily a straight line with a person moving through the levels of preventative services in a successive way. For example, a person may still benefit from good quality information (primary prevention) whilst they are in or being discharged from Intermediate Care (tertiary prevention). Although broader in scope, the interventions identified in this strategy are in line with the approach underlying the recent King’s Fund review of what works in avoiding hospital admissions: This includes bringing together different parts of the health and social-care system, doing things we know are effective, stopping doing things we know are not effective, and evaluating the outcomes of things we do not know about. The 2013 Essex Council Annual Public Health Report builds on this by undertaking a comprehensive critique of published evidence relating to interventions that are effective and ineffective in delivering system savings through reducing demand on unplanned health care and social care services. Figure 1 depicts a system-level overview of transitions between stages of dependence. These stages (general population, low to moderate needs, substantial needs, complex needs) are depicted in boxes, with the flows into and out of them depicted as the arrows joining them. The factors potentially affecting these flows are located at the top part of the diagram (for factors potentially preventing flow towards reduced independence) and the bottom part of the diagram (for factors potentially promoting regaining of independence)..

8. 8 2.1 Influences of Wellbeing The diagram below shows the potential chain of influences on levels of wellbeing, disease and disability. In order to deliver the prevention agenda it will be important for health, local government and voluntary and community organisations to work proactively and in partnership with the people of Essex to address and improve outcomes along all elements of the chain. It is also imperative that the health and social care services at the end of chain deliver care in a more integrated and holistic way. Evidence from the Kings Fund suggests that prevention initiatives targeted towards the end of the chain (health and social care services) will deliver in the shortest time, whilst those that address wider environmental and socio- economic will yield the greatest impact. 2.Background (3/4) Air Quality Built Environment Green Spaces Housing Access to High Quality Education Employment Transport Leisure Services Air Quality Built Environment Green Spaces Housing Access to High Quality Education Employment Transport Leisure Services Wider Environmental and Socio-Economic Community Safety Community Norms Community Assets Aspiration Social Capital Parenting Community Safety Community Norms Community Assets Aspiration Social Capital Parenting Self-esteem Self-efficacy Personal motivation Self-esteem Self-efficacy Personal motivation Psycho-socia l Smoking Diet Physical Activity Drug/Alcohol Consumption Lifestyle Body Weight Blood Pressure Blood Sugar levels Cholesterol Levels Physiological Disease and Disability Primary Health Care (GP surgeries, Pharmacists, Dentists, Optometrists) Primary Health Care (GP surgeries, Pharmacists, Dentists, Optometrists) Community Health Care Mental Health Care Social Care Secondary Health Care (Hospitals) Health and Social Care Services Fastest Result Biggest Impact

9. 9 2.2 Health and Social Care Commissioning in Essex The Health and Social Care economy of Essex is diverse and complex. Essex County Council (ECC) spends approximately £500m gross on social care services. Health and Social Care services in Essex collectively cost approximately £3.1bn. All of these services are facing demand pressure, increased public scrutiny over service quality and reductions in funding. The Essex Health and Wellbeing Board locality covers an area with a population of 1.41 million. Essex has a two tier local authority system with ECC being responsible for social care services and pubic health provision and five NHS Clinical Commissioning Groups (CCGs) responsible for purchasing secondary, community, continuing and mental health care for their communities. The Essex Area Team of NHS England is responsible for commissioning Primary Health Care across Essex. The five CCGs in Essex are:- 1.Basildon & Brentwood CCG (BBCCG) covering the local authorities of Basildon and Brentwood 2.Castle Point & Rochford CCG (CP&R CCG) covering the local authority areas of Castle Point and Rochford 3.Mid Essex CCG (MECCG) covering the local authorities of Chelmsford, Maldon and Braintree; 4.North East Essex CCG (NEECCG) covering the local authorities of Colchester and Tendring; and 5.West Essex CCG (WECCG) covering the local authority areas of Harlow, Epping Forrest and Uttlesford; District, Borough and City Councils are responsible for Housing in their areas and also for discharging the legal responsibilities relating to the Disabled Facilities Grant (DFG). There are also a large number of community and voluntary organisations who work within Essex on a number of community based schemes and projects. 2.Background (4/4)

10. 10 3. Strategic Vision and Context 3.1 Strategic Vision The prevention agenda needs an over-arching vision that gives focus for all the interventions that take place. This strategy presents a strategic vision that puts the residents of Essex at the heart of the prevention agenda and aligns with the strategies and outcomes supported by Essex County Council. This Vision has also been presented to, and is supported by, our Health and voluntary sector partners. Our strategic vision for prevention is that; Health, local government and community and voluntary sector services will work in partnership with the people of Essex to allow every individual to enjoy the best possible health and well-being that they can, to stay independent for as long as possible and to create strong resilient communities.

11. 11 3. Strategic Vision and Context 3.2 National Strategic Drivers The Care Act (2014) The Care Act (2014) sets out a range of additional statutory duties for local authorities including a number related to the prevention agenda. It is critical to the vision in the Care Act that the care and support system works proactively to promote wellbeing and independence, rather than simply waiting until people reach crisis point. The Care Act places a duty on local authorities to provide or arrange for the provision of services, facilities or resources, or take other steps, which it considers will contribute towards preventing or delaying the development by adults in its area of needs for care and support; contribute towards preventing or delaying the development by carers in its area of needs for support; reduce the needs for care and support of adults in its area and will reduce the needs for support of carers in its area. In particular, local authorities must consider how to identify “unmet need” – i.e. those people with needs which are not currently being met, whether by the local authority or anyone else for example through activities including screening or case finding. Understanding unmet need will be crucial to developing a longer-term approach to prevention that reflects the true needs of the local population. In order to better deliver the prevention agenda, the health and social care system will need to fundamentally change such that it intervenes early to support individuals, and helps people to retain or regain their skills and confidence and prevents or delays further deterioration wherever possible. The Care Act specifies that a local authority’s responsibilities for prevention apply to all adults including: Adults who do not have any current needs for care and support Adults with needs for care and support, whether their needs are eligible and / or met by the local authority or not Carers, including those who may be about to undertake a caring role, or who do not currently have any needs for support. The table below sets out what the Care Act 2014 mandates local authorities to do relating to the prevention agenda, and it suggests they should do, together with a cross reference to where detail in the five locality Prevention Strategies can be found relating to each of these requirements. We MUST : Where this can be seen in the locality versions of this strategy Identify and understand current and future demand for preventative services Chapter 4 Understand the supply of services, facilities and other resources already available that could support prevention and be part of an overall local approach (Healthwatch Assets catalogue, Market position statements and asset based elements of JSNA) ‘The current situation in Basildon and Brentwood/Essex’ sub sections of Chapters 6,7 and 8. Consider how to identify “unmet” need Sections 6.1.4, 6.2.4, 6.3.4, 6.5.4, 6.6.4, 6.7.4, 7.1.4, 7.2.4, 7.3.3/4, 7.4.4, 7.5.4, 7.7.4, 7.8.4, 8.1.4, 8.2.4, 8.3.4, 8.5.4, 8.6.4, 8.8.4, 8.11.4, 8.12.4 Promote diversity and quality in provision so that people have a choice of provider Sections 6.2.4, 6.3.2, 6.6.3/4, 6.7.3/4, 7.6.4, 7.8.4, 8.6.4, 8.11.3/4 Ensure the integration of prevention with health and health-related services including housing Chapter 6, Primary Prevention Sections 7.1, 7.2, 7.3, 7.4, 7.5, 7.6, 7.7, 8.1, 8.3, 8.6, 8.8, 8.11, 8.12 Establish a service providing information and advice - including preventative services. 6.7 Promoting Self Care; Information, Advice and Guidance We SHOULD: Engage all providers to encourage innovation in supporting a preventative approach Chapter 6, Primary Prevention Chapter 7, Secondary Prevention Chapter 8 8, Tertiary Prevention Consider how to align/integrate prevention approaches with local partners Chapter 6, Primary Prevention Chapter 7, Secondary Prevention Chapter 8, Tertiary Prevention Consider the different opportunities for coming into contact with people including where the 1 st contact is not the local authority. Sections 6.1, 6.3, 6.4, 6.5, 6.7, 7.1, 7.2, 7.3, 7.4, 7.5, 8.1, 8.2, 8.3, 8.4, 8.5, 8.6, 8.7, 8.8, 8.11, 8.12

12. 12 3. Strategic Vision and Context 3.3 Local Strategic Drivers Prevention has links to many strategies in Essex: Commissioning Strategies (All Outcomes) ECC is operating an outcomes based commissioning model. This has led to the development of commissioning strategies based on each of the seven corporate outcomes. Housing Strategy (in development) Good quality housing can play a key role in a person’s wellbeing. The Care Act makes this link between wellbeing and housing clearer by making housing a health related activity. Assistive Technology (in development) Assistive technology and equipment can enable people to remain in their own homes for longer offering a means for them to undertake day to day tasks that they may otherwise be unable. It is therefore a vital preventative service. Reablement Reablement is referenced in the Care Act guidance as a preventative service. At Essex County Council we believe in the benefits of reablement and have increased the focus on this service in recent years, with it now forming a key part of our adult social care offer. Physical Impairment Strategy (in development) Whilst our main commissioning approach has been based around outcomes, additional strategies have been developed to emphasis the needs of particular groups. This targeting of services fits the definition of secondary and tertiary prevention where services are focussed on at risk groups. Older People’s Strategy As above this strategy has been developed to highlight the particular needs of this group. As older people are the largest client group for adult social care in Essex, it will be vital that this prevention strategy reflects the needs of this group. Carers’ Strategy Carers play a vital role in helping people remain in their own homes and keep a level of independence. Essex County Council has acknowledged the role they play and outline our commitment to supporting them in a Carers Strategy. Information, Advice & Guidance Strategy Information advice and guidance can provide an effective means of helping people access support away from formal social care. Who Will Care? In January 2013, Essex partners tasked five independent commissioners to answer the question: how will we care for ourselves and our communities right now and in the future? There were 5 recommendations: Agree a new understanding between the public sector and the people Prevent unnecessary crises in care Mobilise community resources Use data and technology to the advantage of the people of Essex Ensure clear leadership, vision and accountability

13. 3. Strategic Context 13 3.3 Local Strategic Drivers (continued) Essex 5 year health and care plan This plan focuses upon pan-Essex improvement interventions and pan-Essex enablers, and also provides an overview of the financial impact of the plans of contributing organisations. The Shared vision is: ‘By 2018 residents and local communities will have greater choice, control and responsibility for health and wellbeing services. Life expectancy overall will have increased and the inequalities within and between our communities will have reduced‘. Market Position Statement This Market Position Statement (MPS) has been produced to provide a better understanding for organisations about the supply and demand of integrated care services in Essex in the medium and long term. The Council wishes to see service offers from all parts of the market that are targeted at prevention and avoiding harm to vulnerable people wherever possible. Market collaboration involving the Third Sector in solutions will be a priority for our service offer moving forward as will direct bidding from the Third Sector. CCG Five Year Strategies Each of the Essex CCGs have Five Year Strategies that include a number of key strategic objectives that support the prevention agenda.

14. Assessment of Current and Future Need

15. 15 4. Assessment of Current and Future Need 4.1 Demographic Pressures Figure 4.1 Figure 4.1 shows the predicted growth in the population of Essex over the next 20 years for children, working age adults and older people (aged over 65). Figure 4.2 shows the predicted growth in population in the entire population and those aged over 65 as a percentage increase of current levels. Figure 4.2

16. 16 4. Assessment of Current and Future Need 4.1 Demographic Pressures Figure 4.3 shows the current demand for older people’s social care services by age and sex. It demonstrates that demand increases with age. Whilst the entire population in Essex is predicted to grow, the rate of growth in older people aged over 65 is far greater than the rate of growth in the population as a whole. There are two key significant consequences for Essex, namely; 1)As our population ages and older people make up a greater and greater proportion of the Essex population structure, demand for health and social care services will significantly increase from their current levels. 2)Resources to fund this increased demand (largely funded through taxation of economically active adults) is unlikely to be sufficient as in future working age adults will make up a smaller proportion of the over all population. Unless we act now to ensure that our population remains healthier for longer, it is likely that over time, demand for health and social care services will outstrip our ability to pay for them and the entire system will become unsustainable. Figure 4.3

17. Commissioning for Prevention

18. 18 5. Commissioning for Prevention The five locality based Prevention Strategies contain a wide range of sub-sections that set out the evidence base, current local situation and proposed future commissioning intentions to deliver the prevention agenda across Essex. They are structured across three main chapters relating to Primary, Secondary and Tertiary prevention. This section of the Essex strategy summarises these key strategic actions that ECC, CCGs and District and Borough Councils will take in partnership with the communities we service to promote wellbeing, keep our population healthier and more independent for longer and reduce future predicted demand on our health and social care services. 5.1 Primary Prevention We will continue to commission integrated tobacco control programmes that reduce the prevalence of smoking including NHS stop smoking services and work with trading standards to reduce the sale of smuggled and counterfeit cigarettes. We will expand the provision of alcohol intervention and brief advice and treatment services in order to reduce the overall harm caused by excess alcohol consumption and in particular alcohol related hospital admissions We will reduce the prevalence of obesity by working with Active Essex to promote physical activity, promote access to green spaces and active travel plans, seek to influence planning to tackle the obesogenic environment, ensure equity of provision across Essex of weight management services (tier II) and continue to commission specialist (tier III) clinical services for people who are morbidly obese who have failed to respond to other initiatives. We will continue to promote flu immunisation to those aged 65+, pregnant women and those deemed as in a clinically high risk group, and pneumococcal immunisation for those aged 65+ and we will seek to increase coverage. In conjunction with the people of Essex, we will build strong and resilient communities through commissioning a range of initiatives including primary care based social prescription programmes, programmes to promote and support volunteering, provision of tool kits and training to empower communities, improving the Essex Connects portal to provide better information advice and guidance to local Council for Voluntary Services organisations, planning civic engagement sessions, and continuing to commission Community Agents Essex. We will review current Information Advice and Guidance at Essex and CCG locality level across health, local government and the third sector with a view to agreeing a joined up and coordinated approach to commissioning future IAG provision, together with shared agreed messages to the public in a range of formats. We will commission an Information Portal to provide Essex citizens with information and advice relating to care and support, that is accessible and proportionate to their needs. We will also conduct regular media campaigns on health and social care issues that promote local services. We will assist front line staff to act as agents for prevention by developing an e-learning package to train our workforce in Making Every Contact Count, allowing them to identify and make appropriate referrals to commissioned services 5.2 Secondary Prevention We will continue to commission and promote NHS Health Checks and Senior Health checks programmes In order to reduce the number of strokes in our population we will role out an innovate pilot programme on hypertension across Essex that has been shown to help GPs to identify and treat those who were previously unaware that they had high blood pressure and continue to commission programmes that assist GPs to identify and treat those patients who have Atrial Fibrillation. We will reduce the risk of further strokes for patients on GP Stroke/TIA registers by supporting GP practices to improve clinical management of this cohort of patients. In partnership with GP practices and front line social care staff, we will systematically screen older people for depression and offer a range of treatment options to those identified as being depressed We will seek to expand the provision of, and reduce waiting times for IAPT (Increasing Access to Psychological Therapies) services across Essex We will commission a wide range of programmes to improve housing and housing related support to the most vulnerable in Essex including a Housing Brokerage Service, Crisis Response Service, Housing for those with physical and learning disabilities, Extra Care Housing for Older People, Supported Housing programmes for vulnerable young people aged 18-25, a floating support service and services that support single homeless and homeless families. We will also work to address fuel poverty across Essex and ensure more integrated commissioning of housing related services between ECC, CCGs and District and Borough Councils. We will implement a new model of support for carers by 2017 that will operate at four levels relating to community, locality, social care assessment and professional engagement. We will work in partnership across Essex to improve the health of offenders.

19. 19 5. Commissioning for Prevention 5.3 Tertiary Prevention We will further develop the potential of Assistive Technology as a way of supporting vulnerable people. We will expand the provision of older people’s falls prevention programmes across Essex and work across the health and social care system to make referral into them more proactive. We will commission Integrated Continence services across north and south Essex to support people with continence issues and reduce demand on residential care services We will increase the provision of Early Supported Discharge services for patients that have recently suffered a stroke, in order to promote independence and recovery In conjunction with GP practices, we will improve the diagnosis and management of Chronic Obstructive Pulmonary Disease (COPD) in Primary Care We will commission integrated, preventative health and social care services aimed at frail elderly people that proactively identify those who may benefit from early intervention and seek to reduce hospital admissions. We will procure a new reablement service in 2016 that will be tailored to local need and seek to improve outcomes for those who are referred into future services. We will commission a new pathway of delivery for people with sensory impairments We will develop a new service offer for working age adults with physical disabilities with a greater emphasis on community support and promoting independence We will improve services for people with learning disabilities integrating health and social care provision and ensuring that those living with learning disabilities can live as independently as possible We will improve the support and treatment of patients with mental health problems to promote independence and prevent relapse. We will refocus mental health service commissioning on the prevention agenda and commission a range of new services that support independence and promote recovery including supported housing, benefits, employment and debt advice, Intensive Enablement, Floating Support, Specialist Health Trainers and Recovery Colleges. We will improve support to people with dementia and improve diagnoses rates.

20. Monitoring Outcomes

21. 21 6. Monitoring Outcomes (1/2) The breadth of the prevention agenda and of this strategy captures a wide range of strategic commissioning priorities that are captured in other ECC, CCG and District and Borough Council Strategies. As such, delivery of the many of the initiatives previously described will be monitored through the agreed performance management structures of the lead commissioning organisation and the range of extensive KPIs already agreed within specific commissioning intention business cases. The table below suggests some high level outcome measure that can be used to measure the overall success of delivery of this strategy. This is not intended to be an exhaustive list. PRIMARY PREVENTION SECONDARY PREVENTION IndicatorSource Breast feeding prevalence at 6-8 weeks2.02ii Public Health Outcomes Framework Smoking prevalence2.14 Public Health Outcomes Framework Percentage of physically active adults2.13i Public Health Outcomes Framework Percentage of adults who are overweight or obesePublic Health England Alcohol related hospital admissions2.18 Public Health Outcomes Framework Flu vaccination coverage, adults aged 65+INFORM, Public Health England IndicatorSource Health Checks DeliveredLocal commissioned providers Senior Health Checks DeliveredLocal commissioned providers Incidence of strokeSUS via Medianalytics % of patients on QOF Atrial Fibrillation register with a CHAD 2 score >1 not anticoagulated or excepted.Quality Outcomes Framework (QOF) Completeness of Hypertension registersQuality Outcomes Framework / Public Health England % of patients on QOF Hypertension register with a blood pressure recorded in the previous 12 months <=150/90Quality Outcomes Framework (QOF) HYP2. Percentage of families living in safe and suitable housing % of older people on CHD QOF register screened for depressionLocally commissioned provider % of adult carers who have as much social contact as they would like1.18ii Public Health Outcomes Framework

22. 22 5. Monitoring Outcomes (2/2) TERTIARY PREVENTION PREVENTION IndicatorSource Number and rate of falls in population aged 65+Falls Activity Dashboard for Essex CCGs Number and rate of falls resulting in fractured neck of femur as Primary Diagnosis in population aged 65+Falls Activity Dashboard for Essex CCGs % of GP stroke registers who have a record of anti-coagulation or exclusion in the last 12 monthsQuality Outcomes Framework (QOF) STIA 7. % of stroke discharges that result in Early Supported DischargeLocal commissioned NHS Providers Completeness of GP COPD registersQuality Outcomes Framework (QOF) + Public Health England Rate of unplanned hospital admissions for those aged 75+SUS via Medianalytics % of population in ECC funded registered careECC Performance and Business Intelligence Team % of clients self caring following reablementECC Performance and Business Intelligence Team % of adults with a leaning disability who live in stable and appropriate accommodation1.06i Public Health Outcomes Framework Gap in employment rate between those with a learning disability and the overall employment rate1.08ii Public Health Outcomes Framework % of adults in contact with secondary mental health services who live in stable and appropriate accommodation1.06ii Public Health Outcomes Framework Gap in employment rate between those in contact with secondary mental health services and the overall employment rate 1.08iii Public Health Outcomes Framework

23. This report has been prepared by Essex County Council’s Public Health Team If you have any questions on this report please contact Lead Commissioner By email at: Ian.wake2@essex.gov.uk Or by telephone on: 07921 397119 Or by post at: Essex County Council, PO Box 11, County Hall, Chelmsford, Essex CM1 1QH