ISLE OF WIGHT

HEALTH IMPROVEMENT & MODERNISATION PLAN

2002-2005

CONTENTS

	page
Introduction	1
What influences health and well-being	2
The people and the place – the local context for improving health	3
Joint principles for improving health and well-being	5
Key national and local objectives for improving health and modernising services	6
Partnerships for health improvement	8
Resource framework	10
The Action Plans:
1. Older people	13
2. Promoting the life chances and well-being of children	18
3. Physical and sensory disability	23
4. Learning disability	26
5. Coronary heart disease	31
6. Cancer and palliative care	35
7. Mental health	37
8. Drug and alcohol misuse	40
9. Oral health	43
10. Sexual health	44
11. Building healthy homes and reducing homelessness	45
12. Reducing health inequalities and building healthy communities	48
13. Tackling poverty and unemployment	56
14. Accident prevention	58
15. Improving community safety	59
16. Transport	61
17. The environment and health	63
18. Modernising acute services	65
19. Modernising primary care	68
20. Meeting the need of people who use services and carers	71
21. Developing the NHS and social care workforce	73
22. Information technology and communications	75
23. Capital and estate management	77
Glossary of terms	79
Abbreviations	85

INTRODUCTION

The Island Plan for Health & Well-being – the Health Improvement and Modernisation Plan for the Isle of Wight – commits partner agencies to improving the health and well-being of all local people by:

§ identifying and reducing health and social inequalities;

§ improving public services that affect health and well-being;

§ modernising services that treat ill-health and address social needs.

A large proportion of premature death and disease is linked to economic and social inequalities, such as low income and educational attainment. The wide-ranging programmes within this plan outline a challenging and dynamic agenda for partnership action to improve health and well-being by tackling the factors which perpetuate health inequalities and adversely affect health. The Plan also identifies action that needs to be taken to achieve the Government’s vision for modernising public services. Some of the programmes focus on meeting the needs of the most vulnerable groups in our communities, such as older people, those with mental health needs and disabled people.

The content of this plan has been strongly influenced by the NHS Plan, published in July 2000 as a blueprint for modernising the NHS over the next ten years.

In the coming months a Community Strategy will be published for the Island. This document will set an overarching ten-year vision for the Isle of Wight, with plans for action to improve the social, economic and environmental well-being of Island people. This Health Improvement & Modernisation Plan will link strongly to the achievement of the Community Strategy.

Although work on this plan has been led by the Isle of Wight Primary Care Trust, action needs to be taken forward by agencies across all sectors – statutory, voluntary, independent and with community partners. Each programme within this plan has been developed with officers of all the major agencies on the Island. These people are working with community representatives to identify problems and concerns, and agree plans for improvement. We gratefully acknowledge the contributions all these people have made to help us with the development of this plan.

We offer this draft plan for your comments. With your help we can shape a more positive future for all Island residents.

A feedback form is included at the end of this plan for your comments.

WHAT INFLUENCES HEALTH AND WELL-BEING

A wide range of factors influence health and well-being and they can be summarised as follows:

Fixed	Social & economic	Environment	Lifestyle	Access to services
Genes Sex Ageing	Poverty Unemployment Social exclusion	Air quality Housing Social environment Biodiversity	Diet Physical activity Alcohol Smoking Sexual behaviour Drugs	Education Social services Transport Leisure

Ill health is not spread evenly across society. The Government is especially concerned about inequalities in health; that is, the differences in health experienced by different groups in the community. Studies show that people who have low incomes and suffer social exclusion have the poorest health.

People’s health is affected by their circumstances. Unemployment, financial hardship and isolation from the community make it difficult for people to remain healthy. The aim is to create healthier environments, support people in maintaining healthy lifestyles and to provide appropriate services for when people become ill. This plan is the foundation for improving the health and well-being of people on the Isle of Wight and modernising health and social care services to meet their needs. It sets the agenda for the key local agencies who need to work together on health, social, environmental and economic programmes, particularly targeted at inequalities in health and social exclusion. Most of the determinants of people’s health are outside the realm of the NHS; this emphasises the importance of health being tackled by all partners, not just health agencies.

Health needs to be a major issues on all planning and policy agendas. National and local agencies in the statutory, voluntary and independent sectors need to work together to bring about improvements. People on their own can find it hard to make changes in their lives, but it is easier when individuals, families and communities work together to tackle some of the deep-seated problems.

The role of the community in influencing health and providing support needs to be recognised. An active local community can provide:

§ mutual support, through informal care networks for individuals and self-help groups;

§ a source of volunteers and voluntary support, such as through voluntary organisations;

§ opportunities, such as through employers and organisations such as churches;

§ a source of fund-raising to support local initiatives.

This plan draws together key strands of policy and action from all partners that will contribute to an overall integrated programme of action to improve health and well-being. Local sources for this document have include the Unitary Development Plan, the Children’s Services Plan, the Housing Strategy Statement, the Local Transport Plan, the Agenda 21 Strategy, the Community Safety Strategy, local regeneration strategies and community development programmes. All partners need to work together effectively to take forward detailed implementation plans which will underpin the improvements in health and well-being that are the goals of this plan.

THE PEOPLE AND THE PLACE – THE LOCAL CONTEXT FOR IMPROVING HEALTH

In determining our priorities for action, we need to consider how the factors that influence health and well-being impact on the Island and where our local action to achieve improvements should be targeted.

FIXED FACTORS

Fixed factors are those features of the local population which are not likely to change through intervention, such as the age and sex of local people and number of residents from minority ethnic communities.

Total population	§ The Island’s population in 2002 is estimated to be 127,600. This is expected to rise to 131,000 by 2011, when the next national census will be undertaken.
Pre-school population	§ The Island’s population of children aged 0 to 4 is estimated to be 6,500 in 2002, 5.1% of the total population. This figure is expected to fall to 6,000 (4.6%) in 2011.
School age population	§ The Island’s population of children aged 5 to 19 is estimated to be 22,000 in 2002, 17.2% of the total population. This figure is expected to fall to 21,400 (16.3%) in 2011.
Adult population	§ The Island’s population of adults aged 20 to 64 is estimated to be 69,600 in 2002, 54.5% of the total population. This figure is expected to be 70,700 (54.0%) in 2011.
Older people aged 65-74	§ The Island’s population of adults aged 65 to 74 is estimated to be 14,400 in 2002, 11.3% of the total population. This figure is expected to rise to 17,100 (13.1%) in 2011.
Older people aged 75 and over	§ The Island’s population of adults aged over 75 is estimated to be 15,100 in 2002, 11.8% of the total population. This figure is expected to rise to 15,800 (12.1%) in 2011.
People from minority ethnic groups	§ There are comparatively small numbers of people from minority ethnic groups on the Isle of Wight. At the time of the 1991 Census the total Island population who stated their ethnic group to be non-white was 0.7% compared to 5.5% in the rest of Britain.

SOCIAL AND ECONOMIC FACTORS

Social and economic factors are among the key determinants of health and well-being.

Composition of households	§ Analysis of the 1991 Census indicated that ‘traditional’ families of couples with children comprised less than one in five households. § At the time of the 1991 Census, 28.1% of households consisted of people living alone, compared to 10.6% in Britain as a whole. Over two-thirds of these single person households are pensioners.
Earnings and unemployment	§ The Island has the lowest overall earnings in the South East. § Unemployment rates on the Island in January 2002 were at 5.8% compared to 3.4% nationally and 1.7% regionally.
Local economy	§ The Island has the second lowest gross domestic product (GDP) in the South East and is 67% of the UK figure.
Indicators of deprivation	§ The Indices of Deprivation (IMD) 2000 were published by the then Department of the Environment, Transport & the Regions. It is a ward level index based on six areas of deprivation – income, employment, health and disability, education, skills and training, housing and access to services. All the wards in England are ranked out of a total of 8414 wards. Two wards on the Island appear in the 10% most deprived wards as measured by the IMD: Ryde St Johns and Newport Pan. No wards on the Isle of Wight feature in the top 40% of wards, i.e. the more affluent.
Other indicators	§ At the time of the 1991 Census 18.1% of households on the Island had two cars, compared to 19.1% nationally. § Of lone pensioners living alone, 32% of women and 46% of men have a car compared to 70% of all Island households.
Population distribution	§ At the time of the 1991 Census there were important differences in the distribution of pre-school children on the Island, ranging between 2.7% in the Yarmouth ward to over 7% in some areas of Cowes, Newport and Ryde. § People over pensionable age were clustered in West Wight, the Bembridge and St Helens area, and in Sandown and Shanklin at the time of the 1991 Census.

ENVIRONMENTAL FACTORS

The quality of the local environment has significant potential to impact on health and well-being.

Air quality	§ An air quality review published on the Island indicated that the Island has only one road which can be classified as having significant urban driving conditions (more than 25,000 vehicles per day, average speed less than 10 mph), so the Island’s air quality is likely to be good. However, ozone levels can be raised in hot sunny weather.
Housing	§ The current mix of housing stock on the Island is 82% owner occupation, 8% private rented and 10% Housing Association. The average percentage of owner occupied properties in Great Britain at the time of the 1991 census was 66%. § The 1997 Isle of Wight Housing Condition Survey estimated that over 5.5% of dwellings on the Island were unfit for habitation and over 11.5% were in substantial disrepair. It is estimated that the total cost of repairing unfit and defective properties is in the order of £28 million. A new Housing Condition Survey will be completed in 2002.
Water supplies	§ Fluoride is not added to public water supplies locally.
Physical environment	§ The Isle of Wight offers a largely unspoilt rural and coastal environment. As an Area of Outstanding Natural Beauty, the Island is an attractive holiday destination and this environment is felt to be a key factor by many residents in helping to maintain a positive quality of life.

These features have helped to inform our key national and local objectives for health improvement which follow.

JOINT PRINCIPLES FOR IMPROVING HEALTH AND WELL-BEING

The partners to this Health Improvement & Modernisation Plan recognise that a wide range of social, economic and environmental influences affect the health and well-being of individuals and the wider community. Many organisations ultimately have an impact on health, so it is essential that we work together to achieve change. This Health Improvement & Modernisation Plan represents a plan for partnership action designed to improve the health and well-being of the people of the Isle of Wight.

The document is underpinned by a set of principles supported by the partners to this document:

§ To add years to life by reducing premature deaths on the Island and to add life to years through an improvement in health and well-being, both for individuals and the community, and enhancing the quality of Island life.

§ To narrow the health gap by working to reduce inequalities in health and well-being between different socio-economic groups on the Island, and to reduce social exclusion and help people achieve their potential.

§ To recognise that partnerships to improve health and well-being need to extend into the community to enable local people to participate in decision making and have access to information to enable them to take responsibility for their own health and well-being.

§ To ensure people are valued as individuals and that services offer them choice and an opportunity to be involved in decision making about their care and the other services they receive.

§ To ensure access to services is based on assessed or clinical need, regardless of age, gender, ethnic group or sexual orientation.

§ To promote and encourage excellence in service provision through the modernisation of health and local government services, to ensure they meet the needs of individuals more effectively.

§ To work together and encourage growth in the local economy to provide employment, housing and facilities that improve the lifestyle of residents, while maintaining and enhancing the quality of the environment which is so highly valued by the Island community.

§ To work together in partnerships to ensure the resources available to all local organisations involved in improving health and well-being on the Island are used for maximum benefit, to secure effective responses which are co-ordinated between these agencies.

KEY NATIONAL AND LOCAL OBJECTIVES FOR IMPROVING HEALTH

AND MODERNISING SERVICES

The NHS Plan sets out an ambitious vision for high quality services that are designed around the needs of patients and delivered to national standards. The aim is for fast, convenient and modern services which are responsive to patients, offering them choice and involving them in decisions about their care. To achieve this vision, a programme of modernisation is needed. This plan contains proposals for local modernisation activities that will contribute to the national programme of reform for the NHS.

The Isle of Wight Primary Care Trust (PCT) was established on the Island in April 2001. The main roles of the PCT are to:

§ improve the health of the community;

§ secure the provision of high quality services;

§ integrate health and social care.

The Isle of Wight PCT now receives much of the NHS resource to purchase primary and community care and hospital-based services for Island people. Some of these services, such as District Nursing, Podiatry and Health Promotion, are now provided directly by the PCT itself. The PCT will involve local people in the process of shaping services for the future.

The Modernising Government White Paper was published in 1999 with the aim of ensuring national and local government services are reformed to ensure they deliver effective public services that are closer to people, are more responsive and promote better outcomes for individuals. Modernisation has been described as “making it simpler and easier for people to deal with Government and making it fit more closely with people’s real lives and not just with Government’s institutional boundaries”. The key themes for the modernisation of Government are:

§ to develop strategic policy making – focusing on resolving long term problems and working across organisational boundaries;

§ to deliver ‘joined-up’ services – organised around the needs of individuals, with more effective working between agencies and by all sectors;

§ to exploit the opportunities of new information technology to improve the convenience, efficiency and quality of services;

§ to value public servants, delegate to the front-line and encourage initiative, whilst monitoring performance.

The modernisation of local government is a key part of this agenda and actions to take this forward locally are reflected within this plan.

This national policy context sets local partners a challenging delivery agenda. For the NHS, the Department of Health has set out three major priority areas:

§ delivering emergency services when and where they are needed;

§ reducing waiting times and delays throughout the healthcare system;

§ improving the quality of services and outcomes for patients in the priority areas of cancer, heart disease, mental health and services for older people.

To achieve improvements in these areas for people on the Isle of Wight, NHS organisations will need to work with the Social Services & Housing Directorate, the wider Isle of Wight Council, voluntary sector organisations and local communities.

In recognition of the particular issues facing us on the Isle of Wight, local partners have also identified the following key areas for action, subject to our funding position:

§ the development of services for older people, particularly those which promote independence enabling people to continue to live at home, and mental health services for older people;

§ tackling health inequalities and social exclusion, targeting identified geographical areas of need and addressing issues such as teenage pregnancy, oral health of children, improving mental health, combating poverty and reducing the isolation of older people;

§ working to develop primary and community care services to enable services to be provided close where people live, wherever possible;

§ improving services for children, especially those who are looked after, those with special educational needs and those experiencing exclusion;

§ improving services for people with learning disabilities or physical or sensory impairments, including developing opportunities to use facilities in the community and for education, training and employment.

PARTNERSHIPS FOR HEALTH IMPROVEMENT

To improve health and well-being, we need to make sure these issues are on the planning and policy agenda of all key organisations serving Island people. Developing and sustaining partnerships are a key element of our framework for health improvement.

The Public Health Team and the wider public health network – Within the Isle of Wight Primary Care Trust (PCT), a public health team has been established under the leadership of a Director for Public Health. This team will work with other agencies across all sectors and with public service professionals and community representatives to identify ways of improving health, preventing serious illness and reducing health inequalities in the Island’s population. Many people have important roles to play in addressing these public health issues. The PCT’s public health team will develop ways of working with people such as Health Visitors, Environmental Health Officers, Transport Planners, Teachers and representatives of the Police and Fire Service to maximise the potential for improving the health of the Island. The team will also work closely with other PCT public health teams across Hampshire to share specialist knowledge and expertise.

Partnership Planning Groups – Five Partnership Planning Groups exist on the Island to bring together key partners to co-ordinate the planning, commissioning and provision of services for vulnerable client groups. The PPGs also provide advice on priorities and investment proposals for the Island’s Health Improvement & Modernisation Plan. The groups are for:

§ older people;

§ children and families;

§ mental health;

§ learning disabilities;

§ physical and sensory disabilities;

§ acute services (to be established shortly).

Each Partnership Planning Group has a number of project groups, convened to undertake work requiring additional time, expertise and representation. These project groups are usually time-limited.

HIMP Action Group – This group brings together officers of the Isle of Wight Council to develop, deliver and monitor the Council’s contribution to the Health Improvement & Modernisation Programme. This group forms an important element of the wider public health network on the Isle of Wight.

Partnership Board for Health & Well-being – This board brings together Councillors from the Isle of Wight Council and non-executive board members from the local NHS organisations, together with representatives of the voluntary sector. The board promotes joint working to ensure a common strategic direction of plans for the improvement of health and well-being of local people. The board links to the Island Futures Partnership.

Local Strategic Partnership – The Island Futures Partnership (the Local Strategic Partnership for the Isle of Wight) was established at the beginning of 2002. LSPs are being developed by all districts and are intended to bring together under one umbrella the different parts of the public sector and the private, business, voluntary and community sectors to rationalise and co-ordinate existing local alliances and prepare and implement a Community Strategy, which will set an over-arching ten-year vision for the Island. All other local plans, such as this Health Improvement & Modernisation Plan, the Unitary Development Plan, the Children’s Services Plan and the Local Transport Plan, will link to it.

The LSP will include Chair and Chief Executive level representatives of organisations who make strategic decisions about the allocation of resources on a range of issues including health, employment, education, crime and housing.

The overall purpose of the LSP is to “improve quality of life and well-being on the Isle of Wight”. The key tasks for the Island Futures Partnership will be to:

§ build a common purpose and shared commitment;

§ develop a shared longer term vision for the future of the Island;

§ agree a common agenda, key priorities, achievable outcomes and an action plan within the context of the Community Strategy;

§ represent the wider interests and needs of the area, both within the region and nationally, to secure the well-being of the area;

§ lobby on behalf of and help create a positive image for the Island;

§ promote and facilitate multi-agency working by helping overcome the barriers between organisations;

§ work towards the more integrated provision of mainstream services in partnership with the community;

§ improve the co-ordination of budgetary processes between partner organisations.

Associated Health Action Zone – In 2001, the Isle of Wight was granted Associated Health Action Zone status by Ministers in recognition of the deprivation suffered on the Island. There are ten AHAZs across south-east England, who work together in a partnership to develop new ways of working which address health inequalities and share good practice.

Healthy Living Programme – In 2001, the Isle of Wight was awarded a £1 million New Opportunities Fund grant to develop a programme of projects which would tackle specific health issues on the Island. Each of these projects has been developed to address identified health needs of specific groups of people across the Island. These projects link through a Healthy Living Network, both with each other and with other organisations working to improve health and well-being on the Island.

RESOURCE FRAMEWORK

Isle of Wight Primary Care Trust’s financial situation

The forecast year-end position for 2001/2 for the Isle of Wight Primary Care Trust was for an underspend of £23,000 against the resource limit of £105,954,000. Within the allocation was £1,536,000 non-recurring revenue support. This position however includes an overspend on prescribing which is anticipated to be nearly £1.4m and £193,000 on cardiology services on the mainland which was supported in year by a combination of recurring and no-recurring savings totalling £961,000 and underspends on other healthcare budgets. There is therefore a significant underlying recurring deficit of approximately £1,500,000.

The Isle of Wight Healthcare NHS Trust also experienced considerable pressures and is forecast to be £580,000 overspent at the year end. This is after considerable non-recurring savings and support and the underlying recurring deficit is about £4.2m.

Resource allocations for 2002/3 were issued to Health Authorities in December who in turn have had to allocate resources to Primary Care Trusts. The indicative allocation for the Isle of Wight Primary Care Trust is £120m. This includes a significant increase on 2001/2 of approximately 8.8% for the Island. Within this increase is a general uplift of 5.6% and earmarked funds to deliver the NHS Plan covering mental health, coronary heart disease, cancer, IM&T, Primary Care and capacity.

The establishment of the service and financial framework for 2002/3 has however proved to be one of the most difficult despite the substantial increase in new money and has still not been concluded. The combined effect of underlying deficits, in year overspending (in particular prescribing), pay and price increases, other cost pressures and new investment required to meet NHS Plan targets especially to deliver access targets will mean the need for challenging savings programmes to be developed.

The Primary Care Trust is currently working closely with both the Hampshire and Isle of Wight Health Authority and the Isle of Wight Primary Care Trust to finalise both the resource allocation for the Primary Care Trust and set budgets for 2002/3.

Social Services & Housing Directorate’s financial situation

In 2001/02 the Directorate has faced severe budget pressures, mainly from the areas of placements for children in public care, services for older people and people with a learning disability, and homelessness. This has resulted in a projected year-end overspend of approximately £570,000. The overspend has been kept to this level by an in-year package of measures to reduce spending.

At the budget setting meeting of the Isle of Wight Council in February 2002, an additional £2.7m of funds were allocated to the Social Services & Housing Directorate. The main pressures identified at this time included:

§ An urgent need to increase the fees paid to residential care and nursing home owners;

§ The very strong case for increasing the fees paid to Council foster carers, in line with the National Foster Care Association recommended rates;

§ Addressing the deficit in the budget for 2001/02;

§ Making provision for growth in demand for services for older people and people with a learning disability;

§ Increased homelessness levels compared with last year (estimated at 10%).

Included in the £2.7m net increase is a package of efficiency savings estimated at £193,000, a package of increased fees and charges to achieve a further £189,000 and service reductions estimated to total £517,000.

A further increase in funding has been in the form of specific grants from central Government, which have increased from £2.8m in 2001/02 to £7.6m in 2002/03. However, these grants bring with them corresponding new responsibilities which absorb all the increase.

The total budget for the Directorate for 2002/03 (including directly controllable items, central charges, building maintenance and asset rents) currently stands at £30,375,000. Measures to help prevent future overspending are being put into place, including closer gate-keeping and monitoring of budgets by devolved budget holders.

Social Services & Housing Directorate: Source and application of funds

	Estimate 2002/03 £ 000
A	SOURCE OF FUNDS
	Fees, charges and rents	9198
	Specific Government grants	7607
	Contributions and reimbursements	1781
	Interest	41
		18627
	Revenue Support Grant and Community Charge	30375
	Total funds available	49002
B	APPLICATION OF FUNDS
	Revised budget for previous year	26894
	Movements:
	Staff salaries: annual increments	67
	Inflation contingency	787
	JRIU transfer	-154
	Housing advance lost income	20
	Committed growth – as per committee Feb 2002	1681
	Essential service improvements – as per committee Feb 2002	25
	Service pressures – as per committee Feb 2002	1959
	Efficiency savings – as per committee Feb 2002	-193
	Increased income – as per committee Feb 2002	-189
	Service reductions – as per committee Feb 2002	-517
	Other	-5
	Total net budget	30375
	Add back: income other than Revenue Support Grant/Community Charge	18627
	Total gross budget (= funds available)	49002
C	ANALYSIS OF NET EXPENDITURE BY CLIENT GROUP (inc. overheads)		%
	Children & Families	7058	23.2
	Older People	14762	48.6
	Physical & Sensory Disabilities	2127	7.0
	Learning Disabilities	3497	11.5
	Mental Illness	1656	5.5
	HIV/AIDS	39	0.1
	Substance Misuse	84	0.3
	Mixed client groups (including specific grant income)	-626	-2.0
	Housing	1559	5.1
	Other	219	0.7
		30375	100.0

SECTION 1: OLDER PEOPLE
Ref no	Task	Lead agencies	Milestones and measures
1.1	Age discrimination
	Take forward the local action plan to address age discrimination in accessing health or social care services as a result of their age.	PCT/SSD/IWHT	§ Agreed action plan implemented and progress report made to PCT and Trust Boards and Social Services Committee in September 2002 and March 2003.
	Undertake benchmarking of local services using national data about tracer conditions (publication expected October 2002).		§ Local benchmarking completed following publication of national data and guidance.
1.2	Person-centred care
	Ensure that older people are treated as individuals and they receive appropriate and timely packages of care which meet their needs as individuals, regardless of health and social services boundaries. Local programmes will include: § Developing plans for an integrated continence service; § Progressing plans for the integration of community equipment services; § Taking forward full implementation of the single assessment process for older people, in line with national guidance.	SSD/PCT/IWHT	§ Integrated continence service in place by March 2004. § One-stop information service for community equipment services in place by November 2002. § Fully integrated community equipment service in place under joint management and pooled budget in place by April 2004. § Single assessment procedures piloted during 2002. § Systems to explore user and carer experience in place in health and social care organisations by April 2003.
1.3	Intermediate care
	Provide integrated services to promote faster recovery from illness, preventing unnecessary acute hospital admissions, support timely discharge and maximise independent living. Local programmes will include: § Consolidating and further developing the Rapid Response Team, to support the Medical Assessment Unit and discharge via intermediate care services, and provide crisis support to community practitioners. § Identifying scope for further development of community rehabilitation and intermediate care beds if resources are available.	SSD/IWHT/PCT	§ End to widespread bed blocking by 2004. § Additional intermediate care beds in place, compared to 1999/2000 baseline. § Keeping year on year growth of emergency admissions of people over 75 to under 2%.
1.4	General hospital care
	Ensure that older people receive the specialist help they need in hospital and that they receive maximum benefit from having been in hospital. Local milestones will include: § Developing an old age specialist multi-disciplinary team with agreed interfaces throughout the hospital for the care of older people;	IWHT	§ Team in place by September 2002.

SECTION 1: OLDER PEOPLE (continued)
Ref no	Task	Lead agencies	Milestones and measures
1.4	General hospital care (continued)
	§ Nursing leaders identified with responsibility for the care of older people; § Skills profiling of staff caring for older people completed and education, training and workforce planning completed to address gaps and develop new roles.	IWHT	§ Every patient to have a discharge plan on leaving hospital by 2004. § Older People’s Workforce Plan to be published in June 2002.
1.5	Stroke
	Ensure prompt access to integrated stroke services. Locally we will take forward a range of modernisation initiatives in stroke services, including: § A range of programmes to reduce the incidence of stroke by 2004; § Development of an Island Stroke Register; § Introduction of a neurovascular clinic; § Implementation of dysphagia policy and identification of additional resources for speech and language therapy for stroke patients; § Further development of community support for stroke patients via the Outreach Team, subject to available resources; § Development of a specialist stroke unit within St Marys Hospital; § Development of a stroke team.	IWHT	§ By 2004 GP practices using protocols for the identification, treatment and management of stroke, using rapid referral protocols for patients with transient ischaemic attacks and have established clinical audit systems for stroke. § Comprehensive stroke register in place by 2003. § Neurovascular clinic introduced June 2002. § Policy implemented in 2002. § Community support resource developed in 2002. § Stroke unit in place by 2003. § Specialist stroke service established at St Marys Hospital, IW by 2004.
1.6	Falls
	Reduce the number of falls which result in serious injury and ensure effective treatment and rehabilitation for those who have fallen. Programme to include: § Co-ordinated multi-agency approach to the identification of individuals at risk of falling; § Training for district and practice nurses in promoting physical activity for frail, older people; § Promotion of use of calcium and vitamin D to reduce risk of fractures; § Audit by local health care providers of procedures and risk management procedures put in place to reduce risk of falls.	IWHT/PCT/SSD	§ Accident Prevention Co-ordinator in post from 2002 to implement multi-agency programme. § Risk management procedures in place for providers of health and social care by 2004. § Integrated falls service established by April 2005.

SECTION 1: OLDER PEOPLE (continued)
Ref no	Task	Lead agencies	Milestones and measures
1.7	Mental health in older people
	Promote good mental health in older people and provide effective treatment for older people with dementia and functional mental illness, in line with NSFs for Older People and Mental Health. Local programmes will include: § Taking forward the integration of the Care Programme Approach and care management for older people, linked to the development of the single assessment process. § Completion of a mental health promotion strategy, including older people. § Ongoing work to support staff in primary care and the community in the early detection and management of mental ill health in older people. § Working to develop liaison between specialist mental health services for older people and general hospital services. § Improved information, support and respite for carers.	SSD/IWHT/PCT	§ Continue with joint day care pilot scheme and extend, subject to available resources. § Single assessment process piloted during 2002. § Mental Health Promotion Strategy completed 2002. § Protocols in place for the diagnosis, treatment and care of people with dementia by April 2004. § Protocols in place across health and social care systems for care and management of older people with mental health problems by April 2004. § 2 respite beds secured in residential care sector from 2002 onwards. § Integrated mental health services for older people fully established by April 2005. § Awareness training group re-established for carers in 2002, offering 10-week courses. § Liaison worker linking with residential and nursing homes to provide management advice on an ongoing basis.
1.8	Promotion of health and active life in older age
	Promote the health and well-being of older people through a co-ordinated programme of action, including: § Multi-agency Healthy Ageing Group to promote opportunities to improve health and well-being of older people; § Ongoing provision of mobile information bus in community settings around the Island by Age Concern; § Ongoing delivery of Health Walks programme; § Active Life Clubs and Tea Dances to be developed during 2002; § House Warmer training for primary care staff, to reduce fuel poverty in older people; § Develop peer mentor scheme for promoting physical activity; § Promotion of pre-retirement courses; § Continuation of flu immunisation programme.	PCT/IWC/ Voluntary sector	§ New information signposting leaflet for older people produced and circulated by July 2002. § Plan to promote healthy ageing in place by April 2003. § Year on year improvements demonstrated in flu immunisation, smoking cessation and blood pressure management indicators for older people from April 2004. See also Accident Prevention 14.3.

SECTION 1: OLDER PEOPLE (continued)
Ref no	Task	Lead agencies	Milestones and measures
1.9	Medicines management for older people
	Take forward a range of initiatives to ensure older people get the maximum benefit from their medication and do not suffer from illness caused by excessive, inappropriate or inadequate consumption of medicines. Projects to include: § Ongoing review of medication for older people in residential and nursing homes; § Involvement of community pharmacists working with GPs to assist in the medication review of people aged over 75 in the community; § Pilot scheme for monitored dose system for vulnerable people in the community; § Dispensing for discharge for all patients on rehabilitation wards at St Marys Hospital; § Introduce a self-administration of medicines scheme to help patients understand and manage their medicines; § Hospital discharge information to GPs to be improved to include a medication review summary; § Develop a pharmacy outreach scheme where a technician visits at-risk patients at home after discharge from hospital, and liaises with their community pharmacist and GP; § Provide Medicines Management Pharmacist consultant service at Laidlaw Assessment & Diagnosis Centre to help patients understand their medicines and changes to treatment; § A range of projects to improve medication management within the hospital (see 18.6 Medicines management in hospital).	PCT IWHT	§ Ongoing medication review programme. § Information leaflets for older people in place in pharmacies from 2002. § Schemes in place to enable older people to get more help from their pharmacists in using their medicines by April 2005. § Pilot scheme implemented and evaluated in 2002. § Scheme in place by December 2002. § Scheme piloted during 2002. § Revised documentation in place by December 2002. § Scheme in place by April 2004. § Service in place by April 2004.
1.10	Residential and accommodation options for older people
	Maintain existing nursing homes and encourage more capacity developed through fee structure and contract arrangements.	SSD	§ Ongoing work with proprietors.
	Maintain capacity for residential care homes for older people who are mentally infirm, through fee structure and contract arrangements.		§ Ongoing work with proprietors.
	Reduce the dependency on residential care and nursing homes by developing rehabilitative services and very sheltered housing schemes.		§ Ongoing work with proprietors and housing associations to develop schemes in 2002.

SECTION 1: OLDER PEOPLE (continued)
Ref no	Task	Lead agencies	Milestones and measures
1.10	Residential and accommodation options for older people (continued)
	Refocus domiciliary care on high dependency clients to support ongoing independent living in the community as an alternative to residential care.		§ Services reshaped during 2002.
	Maximise opportunities to build capacity in the independent sector to provide alternatives to hospital care, including intermediate care beds.		§ Plans to increase private sector intermediate care beds agreed in 2002/03.
1.11	Whole systems planning
	Use the Local Implementation Group (LIG) for the National Service Framework for Older People to identify opportunities for cross-agency sector initiatives to improve the quality of care and particularly integration of care for older people.	PCT	§ Progress reviewed quarterly during 2002/03 by LIG.
SEE ALSO: § Promoting Independence Prevention Plan – contact Martin Henson ( 823340. § Promoting Independence Partnership Plan – contact Martin Henson ( 823340. § Residential & Nursing Home Commissioning Strategy for Older People 2000-2004 – Contact James Lowe ( 535437. § Joint Community Care Commissioning Strategy for Older People 2000-2004 – Contact James Lowe ( 535437. § Joint Commissioning Strategy for Older People’s Mental Health Services 2000-2004 – Contact James Lowe ( 535437.

SECTION 2: PROMOTING THE LIFE CHANCES & WELL-BEING OF CHILDREN
Ref no	Task	Lead agencies	Milestones and measures
2.1	Early years (pre-conception to pre-school)
	Target information, advice and resources to improve awareness about sexual health among young people, reduce teenage conceptions and improve health in pregnancy through: § continued delivery of Sexual Health & Relationships Education (SRE) Strategy; § implementation of Teenage Pregnancy Strategy; § targeted smoking cessation advice to pregnant women and parents of young children.	LEA LEA PCT/IWHT	§ Increasing number of Island schools participating in National Healthy Schools Standard (NHSS) (over 51% at end of March 2002). § 10% reduction in under-18 conception by 2004. § 25% reduction in pregnancy rate of care leavers by 2004. § Reduce the number of women who smoke in pregnancy to 18% by 2005, with at least 1% annual reduction increments.
	Ensure good healthcare, preparation for childbirth and support in parenting, particularly for socially excluded groups, including teenage parents, through: § continue parent education programmes targeted at vulnerable parents; § increasing rates of breastfeeding; § implement Edinburgh Post-natal Screening; § appointment of Surestart Midwife undertaken.	IWHT	§ 20% reduction in post-natal depression by 2004. § Ante-natal screening reviewed in line with Dept of Health guidelines. § Increase rates of breastfeeding to 76% at birth, 60% to 10 days and 50% to 12 weeks, by 2004. § Implementation of Surestart projects.
	Provide a range of support services for children aged 0-4 and their parents, including: § implementation of 12 Surestart projects targeted at this age group; § increase in part-time early education and nursery places.	Surestart/LEA IWHT/Fire Service	§ Universal nursery education for 4-year olds by 2004. § Free part-time early education places for all 3-year olds whose parents want one, by 2004. § Home Fire Risk Assessment offered by Fire Officer.
2.2	Immunisation and vaccination
	Continue to ensure targets are maintained for vaccination of children against diphtheria, tetanus, polio, pertussis, MMR and Hib meningitis.	PCT	§ Maintain target of vaccination of 95% of population screened for childhood illnesses throughout 2002/2003. § Increase uptake of MMR vaccination to 90%.
2.3	Support for children aged 5-13
	Provide a range of support services for children aged 5-13 and their parents, as part of the Children’s Fund Development Plan.	LEA/IWHT	§ Children’s Fund Development Manager in post from April 2002. § Reduce the number of children who smoke to 11% by 2005. § Proportion of 5-year olds with no decay increased from 38% to 70% by 2003.

SECTION 2: PROMOTING THE LIFE CHANCES & WELL-BEING OF CHILDREN (continued)
Ref no	Task	Lead agencies	Milestones and measures
2.4	Support for young people aged 13-19
	Provide a range of support services to improve the health and well-being of young people aged 13-19, including: § working with primary care teams to increase appropriate access to health and advice services for teenagers; § reducing the time children wait to be adopted; § implement the Children (Leaving Care) Act 2000; § re-introduction of BCG programme of immunisation for TB; § school nurses providing immunisation programmes and individual support.	PCT SSD SSD IWHT	§ Milestones met in accordance with national timetable.
	Take forward a range of programmes to support children through transition phases, including: § joint work between Independence Support Project Workers, the Education Co-ordinator for Looked After Children (LACs) and the ConneXions service, to address under-achievement; § closer links developed with the Youth Offending Team and Drug Action Team to provide an integrated response to offending behaviour which includes access to training opportunities; § improve the level of education, training and employment outcomes for care leavers aged 19 to a level of 75% of all young people in the area by 2004.	LEA	§ Improve the educational attainment of LACs by increasing the proportion of children leaving care at 16 or later with GCSE or GNVQ qualification to 75% by 2003. § Maintain 60% care leavers involvement in education, training and employment by 31 March 2003. § Increase the rate to 85% of care leavers having suitable accommodation when they reach 19 years by 31 March 2004.
2.5	Children at risk
	Continue to implement a range of multi-agency initiatives to reduce the number of children at risk, including: § Review Area Child Protection Committee (ACPC) procedures in conjunction with Hampshire, Portsmouth and Southampton; § Implement Potentially Dangerous Offenders Protocol; § Develop and strenthen multi-agency partnerships in Child Protection training.	SSD/ACPC /LEA/IWHT	§ Reviewed procedures implemented. § Protocol in place by 31 May 2002.

SECTION 2: PROMOTING THE LIFE CHANCES & WELL-BEING OF CHILDREN (continued)
Ref no	Task	Lead agencies	Milestones and measures
2.6	Domestic violence
	Continue to implement a range of multi-agency initiatives to reduce the number of women and children at risk from domestic violence, including: § encouraging the reporting of incidents of domestic violence through support in school and by expectant mothers; § ongoing provision of Perpetrators Programme; § support to adults and children in violent families following disclosure.	SSD/IWHT/LEA Probation Service IWHT	§ Part-time domestic violence co-ordinator appointed by summer 2002. § 100% of ante-natal mothers to have private interviews with midwife on booking. § 10% increase in referrals to Domestic Violence Perpetrators Group. § Audit of numbers requiring support to inform support and education needs completed.
2.7	Children who are sick, disabled or who have special needs
	Take forward a range of multi-agency initiatives to improve levels and co-ordination of support to these children and their parents.	IWHT/SSD/ LEA/Early Years
	Continue to develop support services at Oak House Assessment Centre.		§ Increase number of severely disabled children receiving co-ordinated care packages by 10% by 2002/2003.
	Implement plans for new respite unit for disabled children (subject to available funding).		§ New 8-bedded respite unit to increase provision of short-term breaks from 14% of all LAC to 20% by 2003.
2.8	Children who offend
	Work towards implementing the standards of the Youth Justice Board.	YOT/IWHT/ PCT/LEA	§ Standards implemented in accordance with national timetable.
2.9	Young carers
	Continue to secure services which provide advice, support and respite services to all young carers on the Island.	SSD/Spurgeons Child Care	§ 40 and 60 young carers receiving a minimum of 120 and 150 outings/breaks/support sessions respectively in 2002/03 and 2003/04. § Project evaluated in 2003/04.

SECTION 2: PROMOTING THE LIFE CHANCES & WELL-BEING OF CHILDREN (continued)
Ref no	Task	Lead agencies	Milestones and measures
2.10	Reducing social exclusion of children and young people
	Continue to develop inter-agency programmes to ensure children in need and children looked after gain maximum life chance benefits from education, health and social care, including: § implement local action plan for supported accommodation for young people; § development of alternative education provision for young people who are permanently excluded; § agreement of fixed term exclusion strategies; § implementation of Young Persons Housing Strategy to address high support and move-on accommodation needs, in particular of look after children; § collaborative working with Connexions service to support young people towards employment.	LEA	§ By 2003 all teenage parents in supported accommodation provided with appropriate levels of support. § Maintain low numbers of permanently excluded children. § 25 hours of education provided for all permanently excluded children by September 2002. § Maintain a base rate of 80% of care leavers having suitable accommodation.
2.11	Child & Adolescent Mental Health Services (CAMHS)
	Continue to develop CAMHS in line with agreed local strategy, including: § local service mapping in readiness for Childrens National Service Framework; § development of increased support for looked after children and their families.	IWHT/PCT	§ Implement CAMHS Strategy. § Service mapping completed by September 2002.
2.12	Services for Looked After Children (LAC)
	Social Services
	Develop the range of services for supporting LAC, including: § implementation of national standards and guidance on fostering and adoption; § increase recruitment and retention of foster carers and adopters; § improve exit strategies for LAC.	SSD	§ Reduce the number of LAC by 16. § Increase number of foster carers from 150 to 164 by 2003. § Reduce the number of children in external agency placements by 25%. § Reduce the time children wait for adoption to 24 months by 2004.
	Health
	Take forward the development of a comprehensive health assessment protocol to ensure the health needs of LAC are met.	SSD/ IWHT/PCT	§ By 30 September 2004, 85% of LACs receiving up-to-date immunisations and annual oral health checks and health assessments.

SECTION 2: PROMOTING THE LIFE CHANCES & WELL-BEING OF CHILDREN (continued)
Ref no	Task	Lead agencies		Milestones and measures
2.12	Services for Looked After Children (continued)
	Education
	Take forward a range of education-based initiatives to increase educational opportunities for LACs, including: § reducing the number of fixed term exclusions; § developing Personal Education Plans for all LACs; § completion of pathway plans for care leavers.	LEA		§ By 2002 increase and maintain at 15% LACs achieving 5 GCSEs (grade A-C). § Reduce the number of unauthorised absences from school from 6% to 4% by 2002/2003. § Complete Personal Education Plans for all LACs by 30 September 2002. § Maintain permanent exclusions at nil.
2.13	Healthy Schools
	Continue the national accreditation programme for the National Healthy Schools Standard (subject to funding). Projects to include: § further recruitment of new schools into the programme; § increased participation in Rock Challenge drug use prevention scheme; § continuing to develop partnership and networking opportunities - locally, nationally and internationally; § ongoing meetings of the Learning Network of Teachers, which offers mentoring, sharing of effective practice and discussion of training needs; § developing links with local Sports Development Unit and the Sports Council; § continue to share information with other authorities as a recognised exemplar site.	LEA		§ Involvement of schools increased from 2001/2002 baseline of 58%. § Increase in partnership links developed. § Jointly funded programme of sports programmes delivered. § Reports of national pilot schemes submitted in accordance with agreed timescales.
SEE ALSO:
§ Childrens Services Plan – contact Pru Grimshaw ( 525790 § Education Development Plan – contact Keith Simmonds ( 823405 § ConneXions Pilot Business Plan – contact Ann Hendon-John ( 527565 § Early Years Development & Childcare Partnership Plan – contact Marian East ( 533523 § Teenage Pregnancy Strategy – contact Lisa Didier-Carter ( 0781 333 9456			§ Quality Protects Management Action Plan – contact Mary Brimson ( 525790 § Healthy Schools Standard – contact Marguerite Howick ( 533523 § Surestart Development Plan – contact Sue Erridge ( 568972 § Smoking Cessation Strategy – contact Liz Manning ( 535466

SECTION 3: PHYSICAL AND SENSORY DISABILITY
Ref no	Task	Lead agencies	Milestones and measures
3.1	Local Disability Strategy
	Work with disabled people locally to agree and implement a local strategy to improve services from 2003.	PCT/SSD	§ Strategy published in draft June 2002. Consultation completed September 2002 and implemented January 2003.
3.2	Access and Disability Discrimination Act (DDA)
	Work to ensure requirements of Section 21 of the DDA are met.	PCT/IWC/IWHT	§ Plans implemented for upgrading premises. § Staff training programmes undertaken.
3.3	Community equipment services
	Develop interagency plans for the integration of community equipment services under a single management structure from April 2004.	SSD/PCT	§ Action plan for integration of services published October 2002. § Signposting leaflet published 2002. § Single NHS and Social Services Inventory established April 2003. § Joint service management arrangements in place by April 2004. § 50% more people benefiting from community equipment services by 2004.
3.4	Direct Payments
	Continue to promote the uptake of the Direct Payments Scheme and explore ways the scheme can be improved to provide flexible support to people with fluctuating conditions.	SSD	§ Target of 25 people on Direct Payments scheme by 2004/05.
3.5	Employment and training
	Work through the Supported Employment Network to implement agreed Welfare to Work Joint Investment Plan to increase training and employment opportunities for disabled people.	SSD	§ Increased employment opportunities identified through Disability Employment Advisers, New Deal for Disabled People and other employment agencies. § Greater evidence of service user satisfaction with training and employment options checked through Supported Employment Network Reference Group.

SECTION 3: PHYSICAL AND SENSORY DISABILITY (continued)
Ref no	Task	Lead agencies	Milestones and measures
3.6	Accommodation
	Ensure the local Housing Investment Programme and ‘Supporting People’ programme addresses the identified needs of disabled people.	SSD	§ Housing Strategy for Disabled People agreed and fed into Housing Investment Programme by July 2002.
3.7	Diabetes
	Implement the National Service Framework for Diabetes, within the resources available to the Island.	PCT/IWHT	§ Local action plan to be formulated in summer 2002, subject to publication of national implementation guidance.
3.8	Disability Issues Forum (DIF)
	Continue to work with members of DIF to identify issues of concern about services and ideas for improvement.	SSD/PCT	§ Issues identified, prioritised and fed into service commissioning and review programme on an ongoing basis.
3.9	Access to public transport
	Work with Southern Vectis to promote good practice in responding to disabled customers.	PCT/IWC/Southern Vectis	§ Ongoing liaison. § Training programme delivered to Southern Vectis staff by disabled people in 2002.
3.10	Information
	Continue to work with people who use services to develop appropriate information in a range of accessible formats.	SSD/PCT	§ Ongoing development of tape and braille documents.
3.11	Respite care
	Continue to work with service providers to explore options for securing appropriate respite care for young disabled people.	SSD	§ Progress subject to new service provider coming on-stream.

SECTION 3: PHYSICAL AND SENSORY DISABILITY (continued)
Ref no	Task		Lead agencies	Milestones and measures
3.12	Parkinson’s Disease Management
	Take forward a range of initiatives, following the appointment of a Parkinson’s Disease Nurse, to improve the co-ordination of care for people with Parkinson’s Disease and their families, including: § Signposting information pack launched; § Develop more co-ordinated assessment, clinical management and preview processes for people with Parkinson’s Disease; § Develop more effective data sets to support the planning of services for management of Parkinson’s Disease.		PCT/IWHT	§ Pack developed and launched in 2002. § Clinical leadership identified by summer 2002. § Baseline information gathered to inform service planning by 2003/04.
SEE ALSO: § Intermediate Care 1.3 and Stroke 1.5.		SEE ALSO: § Welfare to Work for Disabled People Joint Investment Plan – contact Elaine Garrett ( 535437 § Isle of Wight Disability Strategy (forthcoming) – contact Elaine Garrett ( 535437 § Community Equipment Service Integration Plan (forthcoming) – contact Martin Henson ( 823340

SECTION 4: LEARNING DISABILITY
Ref no	Task	Lead agencies	Milestones and measures
4.1	Maximising opportunities for disabled children
	Ensure children with learning disabilities gain maximum life chance benefits from educational opportunities, health care and social care. Programmes to include: § Creation of a common multi-agency database to provide more detailed information about disabled children; § Development of multi-agency assessment, diagnosis and intervention processes for children with autism spectrum disorder; § Information handbook for parents of disabled children published and put on Council’s website; § Development of family support services and increased number of hours provided; § Promote inclusion of disabled children in mainstream schools wherever appropriate; § Ongoing provision of multi-agency assessment processes at Oak House for disabled children, involving health, education and social services, through agreed assessment framework.	SSD	§ Contribute to achievement of the national target of 6,000 severely disabled children receiving a co-ordinated care package from health and social services by 2002. § Ongoing work to develop database during 2002/03. § Project developed in accordance with ‘Invest to Save’ project milestones. § Handbook published and distributed by summer 2002. § 230 sessions on holiday play scheme programmes, delivery of Sun Ryders scheme through SRB and outreach service offered for 39 hours per week to enable young people to access activities without parent support during 2002/03. § Implementation of IW Council’s Development Plan for Pupils with Special Educational Needs by 2004. § Ongoing development of multi-agency assessment and support services.
4.2	Transition into adult life
	Ensure continuity of care and support for young people and their families to maximise the opportunities of young people to participate in education, training or employment. Programmes to include: § Multi-agency transition forum established by ConneXions; § Identification of personal advisers for young people; § Additional staff identified by child and adult teams to manage transitions.	SSD	§ Person-centred planning in place for young people moving to adult services in place by 2003. § Multi-agency transition protocol implemented by December 2002. § Additional staff identified and trained to provide service from September 2002. § Information pack to support transition in place during 2003.

SECTION 4: LEARNING DISABILITY (continued)
Ref no	Task	Lead agencies	Milestones and measures
4.3	Enabling people to have more control over their lives
	Enable people with learning disabilities to have as much choice and control over their lives as possible, through advocacy and a person-centred approach to planning. Programmes to include: § Develop citizen advocacy and a local People First Group; § Continue to promote Direct Payments Scheme and develop a pilot scheme for people with learning disabilities; § Develop person-centred planning in line with national guidance; § Implement UK On-Line Project in 2002/03 to improve access to computers for people with learning disabilities. This will support person-centred planning.	SSD/IWHT	§ Bid for BILD advocacy funding submitted by June 2002. § People First Group in place on the Island by 2003/04. § Local framework for person-centred planning implemented from April 2002. § Service co-ordinators in place for clients with substantial and long term needs by winter 2002. § UK On-Line Project implemented in 2002 to support person-centred planning. § Person-centred planning in place for people in large day centres, people living in the family home with a carer over 70 and people living in NHS residential accommodation by 2004. § Publicity material for people with learning disabilities re. Direct Payments re-launched.
4.4	Supporting carers
	Increase the help and support carers receive from all local agencies to help them fulfil their family and caring roles effectively. Priority programmes developed in consultation with carers to include: § Continue to identify and develop packages of support, including Direct Payments; support will be prioritised for older carers; § Develop range of respite options available locally; § Develop and information pack for carers; § Develop local support network for carers.	SSD	§ Information pack produced summer 2003. § Support network established 2002/03.
4.5	Good health
	Enable people with learning disabilities to access health services designed around their individual needs, with fast and convenient high quality care and additional support where necessary. Priority programmes developed in consultation with people who use services and carers will include: § Development of a staff training programme, including the private sector; § Improved links with general hospital acute care and community services;	PCT/IWHT	§ Training programme completed by summer 2002. Workforce Action Plan finalised December 2002. § Function and role of Community Learning Disability Teams reviewed by autumn 2002.

SECTION 4: LEARNING DISABILITY (continued)
Ref no	Task	Lead agencies	Milestones and measures
4.5	Good health (continued)
	§ Framework for Health Action Plans and health facilitators established; § Increased access to specialist therapy and psychiatric services; § Monitoring of uptake of screening programmes.	PCT/IWHT	§ Health Action Plans and Health Facilitators introduced by statutory bodies by summer 2003. § Additional resources identified for services by March 2003. § Ongoing promotion and monitoring of screening uptake.
4.6	Housing
	Enable people with learning disabilities and their families to have greater choice and control over where and how they live. Key priorities agreed with people who use services and carers are to: § Increase the range of accommodation options, including single units and three bedroom houses; § Develop a centralised list of people with learning disabilities who need accommodation; § Maximise support options through ‘Supporting People’. § Find ways of supporting people with learning disabilities who wish to live with their friends.	SSD	§ Local housing strategy for people with learning disabilities and plan for care and support services in place by winter 2003. § Increasing number of units available for people with learning disabilities.
4.7	Fulfilling lives
	Enable people with learning disabilities to lead full and purposeful lives in their communities and to develop a range of friendships, activities and relationships. Key priorities identified with people who use services include: § Developing support group to help people access social, relationship and leisure opportunities; § Reaching agreement on programme to modernise day services; § Improving support for parents with learning disabilities through co-ordinated approach by child and adult teams; § Improving transport arrangements and ongoing work to combat discrimination on public transport.	SSD/IWHT	§ Groups established subject to funding availability. § Modernisation programme for day services completed by October 2002. Contract placed by April 2003 and programme fully implemented by January 2006. § Increased number of parents with learning disabilities offered appropriate support and life skills training. § Reduced journey times from 2002 and improved quality of service on public buses.

SECTION 4: LEARNING DISABILITY (continued)
Ref no	Task	Lead agencies	Milestones and measures
4.8	Quality
	Ensure the commissioning and provision of high quality, evidence based services for people with learning disabilities, which promote good outcomes and best value. Programmes to include: § Development of Quality Assurance Framework; § New Adult Protection procedures finalised.	SSD/PCT	§ Inter-agency quality assurance framework group established by April 2002. § Procedures finalised and relaunched by summer 2002.
4.9	Moving into employment
	Enable more people with learning disabilities to participate in employment, wherever possible in paid work, and to make a valued contribution to the world of work. Programmes to include: § Promotion of New Deal for Disabled People (NDDP) programme – Mencap Pathway are local NDDP Job Brokers; § Work with local public sector employers to increase employment opportunities; § Use of information packs for employers about how to support workplace needs of people with learning disabilities; § Prepare people with learning disabilities to be work-ready through ‘No Barriers’ 6-week course programme.	SSD/Mencap Pathway/ No Barriers	§ Increased number of work experience and job placements in local public sector and wider job market. § Employment Strategy completed by winter 2002/2003, with agreed targets for increasing the number of people with learning disabilities in employment. § Local contact targets for NDDP achieved. § ESF bid submitted for extending ‘No Barriers’ employment scheme by June 2002. § Six programmes offered through 2002.
4.10	Workforce planning
	Ensure social and health care staff working with people with learning disabilities are appropriately skilled, trained and qualified, and promote a better understanding of the needs of people with learning disabilities amongst the wider workforce. Action will include: § New entrants to learning disability care services to be registered for qualification with Learning Disability Awards Framework (LDAF); § Increase number of staff achieving at least NVQ Level 2; § Agreement of way forward for health and social care team integration, in single location with single management structure; § Joint delivery of training programme, including links with private sector; § Joint working group to develop workforce plan.	SSD/IWHT	§ All new entrants registered with LDAF by April 2002. § 50% of frontline staff to have achieved at least NVQ Level 2 by 2005. § Team integration plans completed by October 2003. § Delivery of published annual training programme. § Social and health care workforce and training plan by summer 2002.

SECTION 4: LEARNING DISABILITY (continued)
Ref no	Task	Lead agencies	Milestones and measures
4.11	Working in partnership
	Promote holistic services for people with learning disabilities through effective partnership working between all relevant local agencies involved in the commissioning and delivery of services. Action will include: § Establishment of pooled budget arrangements; § Review scope for integrated provision under Health Act flexibilities, including agreement of way forward for health and social care team integration.	SSD/PCT	§ Pooled budget in place from April 2002.
SEE ALSO: § Learning Disability Joint Investment Plan – contact Elaine Garrett ( 535437 § Welfare to Work for Disabled People Joint Investment Plan – contact Elaine Garrett ( 535437

SECTION 5: CORONARY HEART DISEASE
OVERALL TARGET: To reduce the mortality rate from heart disease and related diseases in people under 75 by 40% by 2010.
Ref no	Task	Lead agencies	Milestones and measures
5.1	Smoking cessation
	Continue to implement local smoking cessation programme in line with ‘Smoking Kills’ White Paper and national targets for smoking reduction. Programme to include: § ongoing training and support for smoking cessation facilitators; § targeted programmes for pregnant women and socio-economic groups; § support in the development of workplace smoking policies and smoking cessation programmes; § promotion of smoke-free public places on the Island; § take forward midwife-led Parent Plus project under Surestart programme, including smoking cessation advice to parents; § nicotine replacement therapy (NRT); § under-age sales: ongoing work through Trading Standards to reduce under-age sales through Tobacco Alliance;	PCT/IWC	§ Smoking cessation clinic established for pregnant women from April 2002. § Ongoing provision of smoking cessation programme in Island prisons. § IW Council, PCT and Healthcare Trust workplace smoking policies reviewed, revised and implemented by April 2004. § Four week quitter targets to be inserted. § Smoking prevalence reduced to 26% by 2005. § Smoking prevalence in manual groups reduced to 26% by 2010. § Ongoing promotion of appropriate NRT prescribing. § Test purchase survey repeated with the target of a less than 10% failure rate.
5.2	Promoting physical activity
	Increase physical activity through promotion of exercise opportunities on the Island, including: § Ongoing development of Health Walks programme; § Development of exercise prescription programmes; § Promotion of concessionary ‘One’ leisure card scheme; § Take forward Active Communities programme in Ryde with SRB and Sport England funding, linked to regeration and community safety initiatives; § Develop sports facilities for disabled people on the Isle of Wight, including the installation of special fitness equipment at Westridge, Ryde; § Implement the Learning Through Landscape programme to develop play and use of open spaces with four schools.	IWC/IWEP/PCT IWC/PCT	§ Increased uptake of health walks programme in all areas of the Island. § Exercise prescription schemes in place at Medina Leisure Centre, The Heights and West Wight Leisure Centre. § IW Council ‘One’ leisure card offering concessionary rates for leisure activities to low-income families. § Westridge facilities available from end of July 2002 (subject to available funding). § Programme in place with four schools by end of 2002.

SECTION 5: CORONARY HEART DISEASE (continued)
OVERALL TARGET: To reduce the mortality rate from heart disease and related diseases in people under 75 by 40% by 2010.
Ref no	Task	Lead agencies	Milestones and measures
5.2	Promoting physical activity - continued
	Increase physical activity through promotion of exercise opportunities on the Island, including: § Use of New Opportunities funding for encouraging young people to take exercise. Projects to include zoning of all primary school playgrounds for areas for sports, fitness and health, and quiet areas and games areas in seven middle and high schools for school and community use. § Take forward a multi-agency bid for the Isle of Wight to become a Sport Action Zone; § Develop a physical activity strategy for the Island.	IWC/PCT	§ Zoning of all 42 primary school playgrounds and seven partnership projects in place for community facilities in schools, including 2 Health Trails. § Bid submitted July 2002, with needs assessment completed in 2003 if successful, including strong health focus. § Multi-agency strategy statement completed by July 2002.
5.3	Promoting healthy diets and reducing obesity
	Take forward a range of multi-agency projects to promote the consumption of fruit and vegetables, to increase access to healthy food and to reduce obesity.	PCT/RCC	§ Obesity programmes in place by 2004. § Healthy Eating on a Low Income programme implemented in 2002 (see item 12.8).
5.4	Preventing CHD in high-risk patients
	GPs and primary care teams to identify all people at significant risk of cardiovascular disease, or with established disease, and offer them appropriate advice and treatment by implementing a range of measures, including: § establishment of CHD registers; § protocols in place to ensure the systematic assessment, treatment and follow-up of people with CHD; § protocols in place to identify and follow-up people whose risk of CHD is greater than 30% over ten years; § link high risk patients into primary prevention programmes focusing on identified risk factors.	PCT	§ Clinical audit data no more than 12 months old available in each GP practice by April 2003. § Increase in patients referred to primary prevention programmes, such as exercise prescription, weight management and smoking cessation.

SECTION 5: CORONARY HEART DISEASE (continued)
OVERALL TARGET: To reduce the mortality rate from heart disease and related diseases in people under 75 by 40% by 2010.
Ref no	Task	Lead agencies	Milestones and measures
5.5	Management of heart attacks and other acute coronary syndromes
	Develop services to ensure patients receive timely treatment of proven clinical and cost effectiveness, to reduce their risk of disability and disease, including: § Ensuring patients with symptoms of a heart attack receive help from a person trained in the use of defibrillator within 8 minutes; § Improved access to thrombolysis and timeliness of treatment.	IWHT	§ 80-90% of patients discharged after heart attack to receive appropriate medication – aspirin, statins and beta blockers – from April 2002. § First responder defibrillation schemes in place. § 75% of eligible patients receiving thrombolysis within 20 minutes of hospital arrival by April 2003. § Ambulance service to meet 75% of Category A response times December 2001 and 90% 2003.
5.6	Improvement in the management of stable angina
	Take forward a range of projects to improve the care provided to people with angina, including: § Ensuring protocols are in place for the systematic assessment, investigation and treatment of people in primary care; § Establishing rapid access chest pain clinic; § Development of protocols for angiography referrals and subsequent treatment.	IWHT/PCT	§ Protocols in place and auditable evidence of assessment and treatment. § Rapid access chest pain clinic in place by the end of 2002, ofering specialist assessment for new onset chest pain within 2 weeks and hospital-wide protocol for the management of angina implemented and audited. § Protocols in place for cardiac network.
5.7	Improved access to revascularisation
	Ensure commissioning strategy delivers targets and hospitals providing cardiac surgery to local people meet the requirements of Standard 5 of the National Service Framework.	PCT/Brighton & Sussex Hospitals	§ 6 month maximum wait for revascularisation maintained.
	Protocols to be agreed for referral, investigation and treatment.
5.8	Workforce planning
	Develop Nurse Specialist roles to support secondary and primary care and training packages for nurses to develop structured CHD in primary care.	IWHT/PCT	§ 5-day CHD practice nurse training course undertaken by one nurse in each practice, commencing October 2002. § Skilled workforce in place demonstrated by audit data. § Specialist nurse and consultant nurse posts to be established (subject to available funding).

SECTION 5: CORONARY HEART DISEASE (continued)
OVERALL TARGET: To reduce the mortality rate from heart disease and related diseases in people under 75 by 40% by 2010.
Ref no	Task	Lead agencies	Milestones and measures
5.9	Improved management of heart failure
	Protocols for the systematic assessment, treatment and follow-up of people with heart failure agreed and implemented.	PCT/IWHT	§ Protocols in place for every primary care team by April 2002 and audit information available by 2003. § Hospital based audit data available on heart failure 2002. § Primary care based audit data available for every primary care team by April 2003.
	Community support available for those with established heart failure.
	Protocols for referral for heart failure agreed within cardiac network.
5.10	Extend access to cardiac rehabilitation
	Take forward a number of projects to improve access to cardiac rehabilitation, including: § Ensuring agreement is reached on who is offered rehabilitation, including people undergoing revascularisation. § Extending cardiac rehabilitation programme to include referrals of any coronary heart disease. § Developing a Heart Support Group to include clients, carers and families, providing education, social and physiosocial sessions for all.	IWHT/PCT	§ 100% of patients discharged after acute myocardial infarction (AMI) or coronary revascularisation are offered cardiac rehabilitation. § Future plans agreed to provide access to rehabilitation for all referrals by April 2003 (subject to available resources). § Audit of impact and continuance of rehabilitation after one year of discharge from service. § Volunteer counsellors trained by July 2002 and group launched September 2002.
5.11	Progress on implementing the National Service Framework
	Evaluate local progress towards achieving the ‘Saving Lives’ targets for reduction of coronary heart disease.	PCT/IWHT	§ Progress reviewed by April 2003.
5.12	CHD Collaborative
	Participate in the national facilitated CHD Collaborative programme in agreed target areas.	PCT/IWHT	§ Work progressed in 2002/03. PCT working on secondary prevention of CHD; IWHT working on heart failure, myocardial infarction and cardiac rehabilitation programmes.

SECTION 6: CANCER & PALLIATIVE CARE
OVERALL TARGET: Reduce mortality rates from cancer by 20% in people under 75 by 2010. (Achieve 12% reduction to 109 people per 100,000 by 2005, and 20% reduction to 99 people per 100,000 by 2010.)
Ref no	Task	Lead agencies	Milestones and measures
6.1	National Cancer Plan
	Work to maintain core national standards for all relevant cancers.	CSCCN/PCT/IWHT /mainland providers	§ Requirements of National Cancer Plan reflected in Service Level Agreements with providers and in service review programmes.
	Work towards reducing mortality rates from cancer in people under 75.
6.2	Prevention and screening
	Implement the PCT's prevention and screening strategy, including: § Ongoing review of screening programmes to ensure target rates are maintained and the services are accessible to disabled women and others in socially excluded groups.	PCT	§ Outcome of Regional review of equipment and facilities for breast screening pending.
	§ Specialist smoking cessation service. § Ongoing awareness programmes for general public, including Sun Know-How and promotion of fruit and vegetable consumption (see Coronary Heart Disease section 5.3).		§ Target rates to be inserted. § Smoking rates among manual workers to be reduced from 32% in 1998 to 26% in 2010.
6.3	Improving treatment
	Work with partners across the health community to agree protocols for the use of specialist cancer drugs.	CSCCN/PCT	§ Arrangements agreed and implemented in accordance with NICE guidelines for chemotherapy treatments.
	Ensure contracts with cancer unit and cancer centres reflect the requirements of all COG guidelines for gynaecological, upper gastrointestinal, urological and haematological cancers and local Cancer Network 3-year plan.	PCT	§ Contracts agreed for implementation from April 2002 – IW Healthcare Trust Business Plan published, supporting Cancer Network 3-year plan.
	Take forward the development of primary care elements of site-specific care patient care pathways, including diagnostic procedures and palliative care.	PCT/IWHT/mainland providers	§ Local programme of care pathways agreed as national site-specific guidance is issued.
6.4	Cancer information systems
	Facilitate the development of PCT cancer data sets to identify cancer patients at practice level and develop cancer registers.	PCT	§ Bid submitted for funding.

SECTION 6: CANCER & PALLIATIVE CARE (continued)
Ref no	Task	Lead agencies	Milestones and measures
6.5	Waiting times
	Work to achieve the 2-week outpatient waiting time target for cancer, including in new target areas of breast, testicular, leukaemia and child cancers.	PCT/IWHT/mainland providers	§ Maximum 2-month wait from urgent GP referral to treatment for breast cancer from 2002. § All referrals from GPs received within 24 hours of decision to refer. § By 2005 maximum 2-month wait from urgent GP referral to treatment.
	Booked admissions project in place to allow pre-booking for whole patient journey for cancer patients by 2004.		§ Every patient diagnosed with cancer to have pre-planned and pre-booked care by 2004. § Maximum 1-month wait from diagnosis to treatment for all cancers achieved by 2005.
6.6	Central South Coast Cancer Network (CSCCN)
	Contribute to the development of a collaborative approach to managing cancer across the Isle of Wight, Hampshire, West Sussex and Wiltshire.	PCT (CSCCN)	§ PCT Clinical Lead for Cancer appointed and agreed strategic service delivery plan achieved for 2002/2003, including workforce plans.
6.7	Palliative care
	Implement locally agreed palliative care strategic plan agreed in partnership with the voluntary sector and Palliative Care Network.	PCT/EMH/SSD	§ Primary care elements of palliative care patient pathway agreed and implemented. Other elements reflected in appropriate Service Level Agreements.
	Develop roles of PCT employed (MacMillan funded) GP and Nurse Facilitators from April 2002.
	Increase availability of palliative care consultant time, subject to available funds.
	Enhance palliative care at home service.
	Develop lymphodema service.
6.8	Quality assurance
	Use clinical governance arrangements to ensure cancer services available to local patients meet the standards within the National Cancer Plan and the Manual of Cancer Services Standards.	Trust/mainland providers (Cancer Network)	Clinical governance and peer review assessment programmes for cancer agreed, taking account of National Cancer Standards and recommendations of regional peer review.
	Establish cancer data sets at practice level to record incidence and prevalence of cancers at practice level.	PCT/practices	Data sets in operation at practice level, subject to funding, and feeding into clinical governance programme.

SECTION 7: MENTAL HEALTH
OVERALL TARGET: By 2010 reduce the mortality rate for suicide and undetermined injury by at least 20%.
Ref no	Task	Lead agencies	Milestones and measures
7.1	Home treatment and crisis resolution
	Develop an Island-wide home treatment and crisis resolution service by April 2004, as an alternative to inpatient admission and to provide greater support in the community. Programme will include: § Increase in staff and skills in existing Crisis Team to provide home treatment; § Securing increased funding to set up service prior to review of inpatient provision.	IWHT	§ Service plan in place December 2002 and full service operational in 2004. Improvements will be measured through reductions in admission rate, reductions in length of stay and reduced patient occupancy levels.
7.2	Early intervention
	Develop early intervention guidelines for Primary Care Health Teams to routinely provide earlier identification of mental illness.	PCT/IWHT	§ Guidelines launched and training in place for primary care teams by September 2002.
	Develop early intervention skills across mental health services to identify psychosis in younger people.		§ Workshop training events available to all staff in mental health services by September 2002.
	Ensure transition from child and adolescent services to adult services are safe and clearly communicated.		§ Protocols in place by April 2003.
7.3	Community support services
	Develop the range of community support services to include women-only services, support for minority groups, self help and out-of-hours services, and employment opportunities for people with mental health needs.	SSD/PCT/IWHT	§ Women-only services available as required by March 2004. § Out of hours services developed in 2002/03. § Employment Directory launched in 2002/03 and New Deal for Disabled Job Broker Scheme promoted.
7.4	Support for carers
	Undertake a review of carer needs and develop an action plan to address gaps in services identified.	SSD/Carers National	§ Review of carer needs completed by April 2003. § Carers assessments undertaken by Care Co-ordinators in Community Mental Health Teams. § Care plans to provide crisis contact for carers. § By 2004, carers to have seen the care plan of the person they care for and understand the nature of their illness.

SECTION 7: MENTAL HEALTH (continued)
Ref no	Task	Lead agencies	Milestones and measures
7.5	Mental health services in primary care and access to psychological therapies
	Develop the capacity of primary care teams to manage mental health, including: § The establishment of a Primary Care Mental Health Team to support existing primary care practitioners and to develop local community capacity; § Establishing arrangements for shared care of people with long term disabling mental illness between Primary Care and Community Mental Health Teams; § Reconfiguration of psychological therapy services to reduce waiting lists.	PCT	§ Primary Care Mental Health Team in place by September 2002. § Training in mental health for all primary care staff in place by April 2004. § Mental illness registers in place in primary care by October 2004. § Access to range of psychological therapies improved and waiting lists within 13 weeks by April 2003.
7.6	Care Programme Approach
	To ensure the Care Programme Approach (CPA) is operating consistently and Care Co-ordinator role is fully implemented.	IWHT/SSD	§ All people on CPA to have regular review of housing, employment and welfare needs by 2004.
7.7	Accommodation
	Take forward plans to reconfigure 24-hour staff and rehabiliation accommodation in the light of 2002 review findings.	PCT	§ Transfer of Milligan House to Supporting People project by September 2002. § Revised service specification for rehabilitation agreed and commissioned by April 2003.
7.8	Health promotion
	Take forward the development and implementation of a mental health promotion strategy, including programmes for primary and secondary health promotion, whole population approaches, targeted approaches for vulnerable groups and people with severe mental illness, and strategies to reduce discrimination against people with mental ill health.	PCT	§ Strategy completed and implementation initiated by December 2002.
7.9	User involvement
	Ensure people who use mental health services are fully involved in service planning and evaluation.	IWHT	§ User involvement strategy completed by April 2002 and implemented and evaluated with service users by April 2003.

SECTION 7: MENTAL HEALTH (continued)
Ref no	Task	Lead agencies	Milestones and measures
7.10	Mental health care in prisons
	Develop capacity to provide mental health care and after-care to the local prison population.	IWHT/PCT	§ Plan for prison in-reach team developed in 2002/03. § Prison HIMP published autumn 2002. § Team in place in 2003/04. § All prisoners with severe mental illness to leave prison with a care plan and care co-ordinator by 2004.
7.11	Medium and low secure services
	Develop local placements for people leaving high secure services in conjunction with the Wessex Consortium.	PCT	§ Steady reduction of inappropriate out of area treatments to zero by 2004.
7.12	Suicide and prevention
	Review protocol for assessment of people who self harm prior to discharge from A&E Department.	PCT/IWHT	§ Protocols reviewed and implemented by September 2003.
	Maintain and support the Suicide Forum.		§ Suicide Forum to hold two events annually to raise awareness of issues.
	Ensure audit of suicides undertaken and lessons learned in line with ‘Organisation with a Memory’.		§ Suicide and untoward incident reporting reviewed through Clinical Governance Committee processes.
7.13	Workforce issues
	Review all current services to ensure service delivery is prioritised and skills of limited workforce are targeted appropriately.	IWHT	§ Local solutions agreed to increase number of Section 12 doctors and improve recruitment of consultant psychiatrists.

SECTION 8: DRUG & ALCOHOL MISUSE
Ref no	Task	Lead agencies	Milestones and measures
8.1	Prevention programmes
	Implement locally agreed prevention programmes in line with national best practice.	DAT	§ Primary prevention programmes for general population, and primary and secondary prevention programmes for young people at risk commissioned by March 2004.
8.2	Adult treatment services
	Continue to work with a range of local agencies to provide a continuum of care, including: § shared care between GPs and CODA; § ongoing availability of detoxification in the community; § identification of providers for inpatient care where required.	DAT	§ At least 30% of GPs to offer shared care by March 2003. § Increase the numbers of people going through treatment by at least 15%. § Maximum waiting time targets agreed and achieved for each type of treatment to ensure performance in the top 25% by 2002. § Number of problem drug users in drug and treatment programmes increased by 66% by 2005.
8.3	Links with the criminal justice system
	Continue to progress arrest referral and drug treatment testing orders in the light of government guidance.	DAT	§ Arrest Referral Scheme evaluated in line with national guidance.
	Continue to work with prisons through the CARATS programme.		§ Joint training programme in place with Prison Service.
8.4	Community support
	Ensure a range of community services are available to support people with drug problems, both through the statutory and non-statutory sector.	DAT
	Explore options for the use of a Community Worker to act as a broker with Housing Associations, Residents Associations, the Community Safety Team and Young Offenders Team to reduce anti-social drug related behaviour.		§ National funding used to fund Community Worker post (subject to final inter-agency agreement).

SECTION 8: DRUG & ALCOHOL MISUSE (continued)
Ref no	Task	Lead agencies	Milestones and measures
8.5	Young people
	TIER 1 SERVICES	DAT/LEA	§ Ongoing delivery of Healthy Schools Standard programme.
	Continue to promote good practice guidelines.
	Further develop programmes within the Healthy School Network.
	TIER 2 SERVICES	DAT/LEA
	Continue to work through the multi-agency, multi-disciplinary Tier 2 Network of workers trained to carry out interventions.		§ Baseline information about numbers of young people experiencing drug and alcohol problems established through network.
	Ensure implementation of guidelines for drug-related incidents in schools, through teachers working party.		§ All schools have guidelines in place and training undertaken of relevant personnel by [date]. § Drug-related incidents policy packs disseminated to all schools by December 2002.
	TIER 3 SERVICES	DAT
	Further develop links between Child & Adolescent Mental Health Services and the Youth Offending Team through the funding of a specialist drugs worker post.		§ Effectiveness of post monitored and funding identified for continuation of post until 2004/05.
	Continue the range of community interventions available to young people, such as Vectis Vyper.		§ Proportion of young people under 25 reporting use of Class A drugs reduced by 25% by 2005.
	TIER 4 SERVICES	DAT
	Provide appropriate packages of care for young people in order to prevent off-Island placements or to provide support for people returning to the Island from off-Island placements.		§ Packages developed on a case-by-case basis, according to individual specialist needs.
8.6	Drug related deaths
	Implement the local action plan to reduce drug related deaths.	DAT	§ Level of drug related deaths to fall by 20% by March 2004.

SECTION 8: DRUG & ALCOHOL MISUSE (continued)
Ref no	Task		Lead agencies	Milestones and measures
8.7	Community safety
	Continue to work with the Community Safety Team to implement a range of initiatives to reduce misuse of drugs and alcohol, including: § Action to target those involved in the illegal supply of drugs and alcohol; § Reduce levels of drug/alcohol-related crime, disorder and nuisance.		IW Community Safety Partnership/ Crimestoppers (Police)	§ ‘Snap’ entertainments events for young people aged 11 and over held in West Wight area from September 2002. § Alcohol intelligence system established to target enforcement of alcohol laws. § Crimes committed to finance drug use reduced during 2002/2003. § Reduce the levels of repeat offending amongst drug misusing offenders by 25% by 2005. § Increase the number of problem drug misusers in drug treatment programmes by 66% by 2005 (increase of 15% in 2002/2003).
8.8	Hepatitis
	Develop an all-Island Hepatitis B outreach service to target groups, including intravenous drug users and their contacts, vulnerable young people and young offenders, to offer blood tests, vaccination, improve general awareness about Hepatitis B and work with other agencies.		IWHT/DAT	§ Expected first dose uptake of Hepatitis B vaccine in those not previously immunised reaching 80% by end of 2004 and 90% by end of 2006, with uptake of full course to reach 50% by end of 2004 and 70% by end of 2006.
8.9	Safeguarding children and young people from substance misuse
	Take forward multi-agency programmes to minimise the risk of substance misuse among young people, including: § continued work with schools through the Healthy Schools Standard and Rock Challenge programme; § establish co-ordinated Tier II service; § undertake a needs analysis of young people referred for services; § establish a supervised support programme for young people with high level needs.		DAT/LEA	§ 12 schools participating in Rock Challenge for 2003. § Arrangements in place from April 2003. § Reduce access to all drugs amongst young people aged 25 and under significantly by 2005. § Monitoring through reports to DAT, Community Safety Steering Group and Young People’s Drug Reference Group.
SEE ALSO: § Drug Action Team Adult Treatment Plan - contact DAT Co-ordinator ( 566011 § Drug Action Team Young People's Plan - contact DAT Co-ordinator ( 566011 § Drug Action Team Template - contact DAT Co-ordinator ( 566011		§ Drug Action Team Community Action Plan - contact DAT Co-ordinator ( 566011 § Drug Action Team Availability Action Plan - contact DAT Co-ordinator ( 566011

SECTION 9: ORAL HEALTH
Ref no	Task	Lead agencies	Milestones and measures
9.1	Oral health of children
	Continue the implementation of the local Oral Health Strategy with the aim of reducing levels of poor oral health in children, including the following: § Encouraging parent-toddler groups to give healthy sugar-free snacks and drinks to reduce frequency of sugar consumption; § Regular visits to baby clinics, working in close liaison with Health Visitors; § Encouraging parents and carers to ‘bin the bottle’ by 9 months to reduce the risk of bottle caries in young children; § Encouraging early use of tooth brushing, using correct amount of fluoride toothpaste and appropriate toothbrush; § Using the ‘Smile for Life’ pack to encourage pre-school groups to give only sugar-free snacks and drinks, and all other oral health messages; § Workshops for health visitors, pre-school workers and leaders; § Encouraging behaviour changes by promoting healthy eating policies in pre-schools and schools; § Liaison with Pabulum (school meals caterers) to discourage selling of sugary drinks in the break time (Department of Education developing new guidelines for the school meals service);	PDS/Surestart	§ By 2003 achieve: § a reduction in the dmft index of 5 year olds to 1.0; § an increase in the proportion of 5 year olds with no decay experience to 70%; § an increase in the proportion of 14 year olds with no decay experience to 60%.
	Ongoing intensive oral health promotion programme for children under 4 and their families, including: § Promotion at ‘Teenage Mums to Be’ group; § Regular visits to baby clinics and parent-toddler groups; § ‘Smiling For Life’ oral health and nutrition programme; § Free toothbrush exhange offered to all families with children under 4.		§ Achievement of 2002/03 Surestart delivery programme.
9.2	Availability of dental care
	Continue to use the Personal Dental Service to provide NHS dentistry to people who are unregistered who need treatment and special needs clients.	PCT	§ Ongoing provision of information about local NHS dentists through the local Dental Helpline and NHS Direct.
9.3	Promoting the oral health of older people
	Encourage older people to continue visiting the dentist or accessing dental care even though they may have false teeth (increase in incidence of oral cancer) and to ensure there is no discomfort when eating, as poor nutrition will increase risk of infection and poor mobility.	PCT	§ Ongoing programme of training for carers of older people in residential care homes. § By 2003 increase the percentage of adults aged 65-74 receiving dental care to 45% and aged 75+ to 40%.

SECTION 10: SEXUAL HEALTH
Ref no	Task	Lead agencies	Milestones and measures
10.1	GUM and sexual health services
	Continue to develop fully integrated sexual health services in line with the forthcoming National Strategy for Sexual Health & HIV, including the delivery of training programmes to ensure appropriate access to Level 1, 2 and 3 services.	PCT/Sexual Health Network	§ Local Sexual Health Network to identify unmet need and priorities for action in line with National Strategy, when published. § Targets to be set in accordance with national requirements.
10.2	Sexual health promotion and young people
	Continue to develop an holistic, multi-agency approach to health promotion for young people, which incorporates sexual health activity.	PCT/LEA	§ Linked programme implemented through Teenage Pregnancy Strategy, National Healthy School Standard Programme, ConneXions and the Youth Service.
10.3	Teenage pregnancy
	Implement the agreed local Teenage Pregnancy Strategy and review to ensure it continues to reach target groups, in order to achieve halving the conception rates of women under the age of 18 by 2010.	PCT/Sexual Health Network	§ Sexual health services directory launched 2002. § Targeted scheme in place for looked after children from 2002. § Ongoing development of support services for pregnant teenagers. § Scope explored for the delivery of contraception services in alternative venues. § Ongoing review of SRE programmes in conjunction with schools.
10.4	Vulnerable adults
	Continue to deliver services for vulnerable adults, including people with learning disabilities, through the CHOICES programme.	PCT/SSD/ IWHT/LEA	§ Continue to develop services in line with priorities identified in the National Strategy for People with Learning Disabilities, 'Valuing People'.
10.5	HIV/AIDS
	Work through the HIV Network and linked users group to continue to develop services for people with HIV and AIDS in line with the forthcoming National Strategy for Sexual Health & HIV.	SSD/IWHT	§ Joint local action plan developed in response to National Strategy.
SEE ALSO: § Teenage Pregnancy Strategy - contact Lisa Didier-Carter ( 0781 333 9456

SECTION 11: BUILDING HEALTHY HOMES & REDUCING HOMELESSNESS
Ref no	Task	Lead agencies	Milestones and measures
11.1	General housing need
	Support the completion of any unallocated phases of agreed Housing Association schemes and bids for 'for sale' schemes, including self-build and 'home buy' and rural housing bids, to reduce homelessness on the Isle of Wight.	IWC/Housing Associations	§ Ensure 100% of allocation from the Housing Corporation and DTLR is fully spent.
11.2	Housing advice
	Continue to work with partner organisations to ensure provision of homelessness prevention, assistance and specialist provision to those facing housing problems, including ongoing revenue support to Independent Housing Advice Centre.	IWC	§ Maintain independent housing advice service to at least 1400 clients per year.
11.3	Meeting local demand for housing
	Increase the supply of homes to at least 350 units per year, to meet expected demand from homeless people.	IWC	§ Housing Associations to build approximately 75 new homes annually. § Annual target of 25 units of affordable social housing achieved. § Annual target of 4 housing units achieved through land and property sales of IW Council-owned land achieved.
	Continue to develop a range of schemes to bring empty properties on the Island back into use.	IWC	§ Annual target of 25 empty properties brought back into use, all to be affordable social housing for target clients, achieved.
11.4	Homelessness
	Respond to the Homeless Act 2002 (subject to Parliamentary approval).	IWC	§ Homeless Strategy produced by April 2002. § Deal with at least 750 homeless enquiries, 450 homeless applications, 300 acceptances and 30 reviews/appeals each year.
	Work through the Housing Initiatives Officer to promote and develop the private, rented sector on the Island for affordable social housing, especially for young people.	IWC/IHAC	§ Annual target of additional 100 private rented sector placements achieved. § 100 placements achieved annually through IHAC Deposit Guarantee Scheme. § Quarterly meetings held of Private Sector Landlords Forum.

SECTION 11: BUILDING HEALTHY HOMES & REDUCING HOMELESSNESS (continued)
Ref no	Task	Lead agencies	Milestones and measures
11.5	Common Housing Register
	Establish a Common Housing Register in partnership with Housing Associations to ensure a more co-ordinated response to local housing need.	IWC/Housing Associations	§ Register established and fully operational by 30 June 2002.
11.6	Housing condition and fuel poverty
	Ongoing implementation of Home Energy Conservation Strategy 2002/2005 and development and implementation of Fuel Poverty Strategy. Programmes will include: § Continued promotion of Government Warm Front Grant; § Work with major utility companies to provide resources for energy conservation initiatives; § Continued provision of grants for renovation, facilities for disabled people, home repair and energy conservation; § Targeting energy conservation resources to wards with identified inequalities in housing conditions; § Loan scheme with the Credit Union to provide low cost loans for energy conservation measures. See also item 12.9.	IWC	§ Annual target of 25 renovation grants, 60 disabled facilities grants and 120 home repair assistance grants achieved. § Annual Report to DTLR by July 2002. § 140 Energy Conservation Grants awarded. § Strategy submitted July 2002.
11.7	Special needs housing
	Endeavour to ensure 20% of all available social housing grants are targeted for the development of new and additional supported housing, in accordance with priorities identified within: § Housing Strategy; § Black & Minority Ethnic Housing Strategy; § Domestic Violence Housing Strategy; § Young People’s Housing Strategy; § Older People’s Housing Strategy; § Supported & Special Needs Housing Strategy.	IWC	§ Delivery of 4-6 new units of supported housing per year.

SECTION 11: BUILDING HEALTHY HOMES & REDUCING HOMELESSNESS (continued)
Ref no	Task		Lead agencies	Milestones and measures
11.8	Supporting People
	Undertake a mapping exercise of all vulnerable client groups and develop a local 'Supporting People' strategy to ensure Transitional Housing Benefit is maximised for Island residents.		IWC	§ Strategy completed by March 2003. § Supporting People IT system in place by March 2003. § Information from ‘Supporting People’ mapping used to inform priority of special needs housing strategies and applications for revenue funding.
SEE ALSO: § Housing Strategy - contact Chris Binnie ( 823061 § Black & Minority Ethnic Housing Strategy - contact Chris Binnie ( 823061 § Domestic Violence Housing Strategy - contact Chris Binnie ( 823061 § Young People’s Housing Strategy - contact Chris Binnie ( 823061		§ Older People’s Housing Strategy - contact Chris Binnie ( 823061 § Supported & Special Needs Housing Strategy - contact Chris Binnie ( 823061 § Home Energy Conservation Strategy - contact Peter Griffiths ( 823058

SECTION 12: REDUCING HEALTH INEQUALITIES & BUILDING HEALTHY COMMUNITIES
Ref no	Task	Lead agencies	Milestones and measures
12.1	Social inclusion
	Implement the Isle of Wight Social Inclusion Strategy 2001-2005.	IWC	§ Targets achieved in accordance with published strategy.
	Continue to implement the social inclusion initiatives under the SRB V 'Island Inclusive' and SRB VI Ryde 2000 programmes.	IWEP	§ Outputs achieved in line with SRB delivery programmes, including: § Salisbury Way Project - including community safety initiatives for women and youth crime programme; § Brading Community Development Project; § Vectis Vyper Young People's Substance Misuse Project; § Interact Youth Crime Programme; § No Barriers training scheme for disabled people; § Ryde Young People's Inclusion Project; § Crossways Community Garden Project.
12.2	Community capacity building
	Continue to implement the community capacity building initiatives within the 'Altogether Wight' (SRB II) and 'Building a Community Bridge to Employment' (SRB IV) programmes.	IWEP	§ Outputs achieved in line with SRB delivery plans, including: SRB II § community capacity building and community confidence programmes; § links established between the Foyer and Crossways Garden Project; § continued development of cybercafe within the Foyer. SRB IV § Cowes Training & Employment Business Initiative between young people in school and local business; § 'Ladders' numeracy and literacy programme in East Cowes.

SECTION 12: REDUCING HEALTH INEQUALITIES & BUILDING HEALTHY COMMUNITIES (continued)
Ref no	Task	Lead agencies	Milestones and measures
12.3	Healthy Living Centre Network
	The Health Living Programme (HLP) is a series of projects which aim to reduce inequalities in health through a variety of services that would not normally be provided by mainstream Government funding to the NHS or other social welfare programmes.
	Take forward the agreed development of the £1m HLP, including: § Trustline: out of hours confidential telephone helpline offering young people access to trained counsellors so they can talk about all issues of concern to them (parents can also use this facility); § Soundbeam Arts programme for disabled people and older people – this project is being delivered in a number of institutional care settings, including residential homes and day centres; § Youth Leisure Access scheme, offering reduced cost activity sessions through the ‘One’ card scheme; § Healthy Environments and Creative Communities arts programmes providing arts on prescription, via medical professionals, initially in the Newport area; § Low cost access to complementary medicine through the Isle of Wight Natural Therapies Trust; § Ryde Young People’s Inclusion Project based at Ryde High School – this programme will focus on health topics through the Personal, Social & Health Education Programme in response to needs identified with students; § Ryde Healthy Living Centre, based at Ryde Sports Centre – work will focus on groups not using sports facilities and will develop ways of encouraging people to get involved in physical exercise programmes; § Safe Kids group – this project will work with a group of children aged five and over from a range of abusive situations, including domestic violence and bullying; § Green Gym, a project to encourage participation in exercise through conservation work.	HLP/IWEP	§ Ongoing implementation of schemes according to agreed milestones for each project. § Tools for monitoring and evaluating health impact developed 2002. § Signposting leaflet to be produced 2002. § All projects to target and reach new people each year. § Significant increase in the accessibility of services beyond current urban areas served by projects. § Increasing number of professionals referring individuals to HLP services. § Increased individual empowerment, demonstrated by a yearly increase in self-referral. § 30% of steering group to comprise community members by 2003/04, to increase to 50% by 2005. § Develop and maintain close links with complementary Government initiatives. § Additional £0.4m secured by August 2004 to extend the life of the programme. § Health impact demonstrated and project lifespan extended post-2006.

SECTION 12: REDUCING HEALTH INEQUALITIES & BUILDING HEALTHY COMMUNITIES (continued)
Ref no	Task	Lead agencies	Milestones and measures
12.3	Healthy Living Centre Network (continued)
	§ Active Life Clubs and Tea Dances across the Island, focusing on physical activity, health awareness campaigns and social opportunities for older people; § West Wight Sports for 0-12 year olds will provide access to additional out of school sports facilities for children – the project will be targeted to children in need; § Affordable gym facilities in Newport through the provision of fitness equipment at King James Youth Club, training for fitness instructors and access for local community members; § Families First parent/family/carer support programme based at Carisbrooke Primary School, offering a programme to the local community and support to the development of an Island-wide network of family support providers; § IW Foyer health promotion scheme, including cooking on a budget, anger management and gardening for Foyer residents and with links developing into the community – the programme will also provide training for staff to deliver health initiatives; § West Wight Healthy Lifestyle project offering a GP referral scheme to an exercise consultant with follow-up advice sessions; § Accident Prevention Forum co-ordination to develop multi-agency accident prevention initiatives; § Primary Care Liaison, which will develop a structural mechanism and means by which prescription exercise can be developed; § The provision of high support housing, including general and specific lifestyle skills, delivered through the High Support Hostel; § The support and extension of the Healthy School Standard at Carisbrooke High School, through the Sports College project.	HLP/IWEP	See page 49.

SECTION 12: REDUCING HEALTH INEQUALITIES & BUILDING HEALTHY COMMUNITIES (continued)
Ref no	Task	Lead agencies	Milestones and measures
12.4	Community development – Pan, Newport
	Ongoing work with the residents of Pan to reduce the experience of ill-health in the area, by undertaking a retrospective Health Impact Assessment and through the ‘Heart of Pan’ programme which will include the creation of a village square, safe road crossing and traffic management arrangements, and establishment of a youth drop-in facility in a renovated portacabin located at the entrance to Downside Middle School (subject to SRB funding).	IWC/PCT	§ Rapid appraisal Health Impact Assessment Workshops held in May 2002. § Multi-agency action plan developed with residents in the light of the Health Impact Assessment on the estate.
12.5	Community development - Ryde
	Continue to work with communities in Ryde to help them develop confidence and skills and access the services they need. Linked projects will include: § Healthy Young Persons Peer Advice (HYPPA) scheme - for contraception advice and pregnancy testing; § access to independent housing advice; § gardening schemes, including Quarr and Pell Lane community gardens and Toddlers Garden Club; § Ryde Women's Day; § parenting skills group.	SSD/IW Housing Association/IWEP	§ Uptake of HYPPA Scheme promoted in Ryde High School. § Increased housing advice sessions available. § Increased number of allotment plots brought into community garden scheme, linked to healthy eating activities. § Annual Women’s Day held with increased number of sessions. § Ongoing parenting skills programme.
	Develop Community Bungalow project at Ryde High School, including IT skills, 1 o’clock clubs, Dads & Lads projects and NVQ Childcare.		§ Bungalow Project on-line from September 2002.

SECTION 12: REDUCING HEALTH INEQUALITIES & BUILDING HEALTHY COMMUNITIES (continued)
Ref no	Task	Lead agencies	Milestones and measures
12.6	Community development - East Cowes
	Continue the community-based programmes to support people in East Cowes to develop confidence and skills, and access the services they need. Projects to include: § East Cowes Improvers Group – including citizenship skills and liaison with the media; § Re-opening of Re-Cycle Hut with East Cowes Community Partnership as a base for working with young people. § Provision of literacy programme (subject to available funding); § Transition planning for people made redundant from GKN Westlands, in partnership with the company; § Promotion of healthy eating and budgeting skills, working with local shop.	SSD	§ Fortnightly Improvers Group meetings. § Re-Cycle Hut reopened. § Transition planning and advice event held. § Meal Planners information and recipe folder published.
12.7	Surestart
	Continue to develop schemes within the agreed Surestart programme in Ryde, including: § Homestart outreach and home visiting service; § work through the play development co-ordinator and play worker to target play projects to areas of identified need; § support to parents and families, including parent workshops and One O'Clock Clubs; § signposting and information services; § first aid and accident prevention initiatives; § oral health programme for parents and children; § midwife-led Parent Plus programme of antenatal education, including smoking cessation; § health visitor-led programme including post-natal depression support group, parenting courses and healthy eating on a budget, and weaning courses; § access to dedicated speech and language therapy; § special needs family support, including parent and toddler group. Initial programme to run to 2004.	Surestart Partnership Board	§ 100% of families contacted by Surestart within two months of birth. § 10% reduction in number of women who smoke during pregnancy achieved by 2004. § 10% reduction in emergency admissions for gastroenteritis, respiratory infection or severe injury in children aged 0-3 in Surestart area, by 2004. § 5% reduction in number of children with speech and language problems requiring specialist intervention by age 4, achieved by 2004. § 75% of families reporting personal evidence of improvement in quality of family support services.

SECTION 12: REDUCING HEALTH INEQUALITIES & BUILDING HEALTHY COMMUNITIES (continued)
Ref no	Task	Lead agencies	Milestones and measures
12.8	Healthy eating on a low income (HELI)
	Take forward the multi-agency programme to develop nutritional awareness, food preparation skills and affordable healthy shopping opportunities.	RCC/IWC	§ Ongoing programme of action, including: § Support to community gardening initiatives across the Island; § publication of calendar, including delivery directory and recipes; § multi-agency bi-monthly network meetings; § proposed Food Poverty Conference in 2002; § support in establishing bulk-buying schemes; § research into pricing in food shops Island-wide; § development of food poverty strategy in 2003.
12.9	Anti-poverty programme
	Take forward a range of projects to combat the effects of poverty, including: § Wheels to Work; § Fuel Advisory Support Team (FAST) to tackle fuel poverty; See also item 12.8 re. HELI Forum. See also Section 13.	RCC/Countryside Agency	§ FAST Team established 2002.
12.10	Healthy Schools
	Continue the national accreditation programme for the National Healthy School Standard (subject to funding). Projects to include: § further recruitment of new schools into the programme; § continuing to develop partnership and networking opportunities - locally, nationally and internationally; § ongoing meetings of the Learning Network of Teachers, which offers mentoring, sharing of effective practice and discussion of training needs; § developing links with local Sports Development Unit and the Sports Council; § continue to share information with other authorities as a recognised exemplar site.	LEA	§ Involvement of schools increased from 2001/2002 baseline of 58%. § Increase in partnership links developed. § Jointly funded programme of sports programmes delivered. § Reports of national pilot schemes submitted in accordance with agreed timescales.

SECTION 12: REDUCING HEALTH INEQUALITIES & BUILDING HEALTHY COMMUNITIES (continued)
Ref no	Task	Lead agencies	Milestones and measures
12.11	Healthy workplaces
	Ongoing programmes undertaken to promote healthy workplaces in line with 'Our Healthier Nation', including: § provision of training to key personnel in small and medium enterprises in stress management, assertiveness and communication; § mental health promotion programmes in IW Council and school settings; § support the development of workplace green travel plans, including for the IW Council and the IW Healthcare Trust.	PCT/Chamber of Commerce/IWC	§ Full training package developed in stress and interpersonal skills to local businesses, by April 2002. § IW Council Healthy Workplace Strategy launched. § Green travel plans progressed with key employers through planning application and Local Transport Plan processes.
12.12	Improving health in Island prisons
	Establish a Prison Health Development Board to address the key health priorities within the three Island prisons and improve liaison and integration between internal and external health services. Target areas include: § development of multi-disciplinary health village models of primary care; § health promotion programmes, including for staff and proposals for Occupational Health Services; § modernisation of dental facilities; § modernising mental health care, including improved access to psychiatry and CPNs, and consideration of establishing a mental health team approach within the prisons, in collaboration with Probation.	PCT/HM Prison Service	§ Revised Prison HIMP published autumn 2002.
12.13	Welfare benefits uptake
	Continue to promote uptake of welfare benefits entitlements through a range of multi-agency initiatives, including: § Individual casework by Welfare Rights Officers; § Provision of benefits information and assessment service by Age Concern; § Support to disabled people trying to get into work by agencies within the Supported Employment Network (SEN).	SSD/Age Concern	§ Ongoing provision of individual service. § Age Concern service provided centrally in Newport and in 35 settings across the Island via mobile information scheme. § Ongoing individual support through SEN and national lobbying where benefits system obstacles identified.

SECTION 12: REDUCING HEALTH INEQUALITIES & BUILDING HEALTHY COMMUNITIES (continued)
Ref no	Task		Lead agencies	Milestones and measures
12.14	Tackling long-term unemployment
	Take forward the recommendations of the IW Long Term Unemployment Study and action plan, including: § Development of Leader Plus programme to include increasing access to employment and training facilities in rural areas; § Creating a basic skills action plan for the Island, especially targeting people suffering social exclusion; § Mapping Island training providers; § Development of cross-Solent loan scheme for people who have been long-term unemployed, subject to grant funding.		IWEP	§ Leader Plus programme project manager in post July 2002. § Basic Skills action plan in place by May 2002. § Training map completed by May 2002. § Loan scheme in place by December 2002. § Long term unemployment reduced by at least 30% by 2005.
12.15	Health Action Zone
	Continue to work with partner agencies, both locally and regionally, under the Associated Health Action Zone initiative, to develop programmes which target identified health inequalities and work towards delivering the national health inequalities targets.		PCT	§ Programme for 2002/2003 to be agreed.
SEE ALSO: § Child Oral Health 9.1 and Immunisation 2.2. § Reducing Teenage Pregnancy 10.3. § Smoking cessation 5.1.		SEE ALSO: § Isle of Wight Social Inclusion Strategy 2001-2005 – contact Sue Matthews ( 823400

SECTION 13: TACKLING POVERTY & UNEMPLOYMENT
Ref no	Task	Lead agencies	Milestones and measures
13.1	Welfare benefits
	Undertake local multi-agency action to maximise potential benefits uptake by eligible groups.	SSD/BA/ Voluntary sector	§ Ongoing individual casework to assess need and assist with applications. § Ongoing provision of information and advice at St Marys Hospital. § Age Concern mobile information service provided in over 30 locations across the Island.
13.2	Fuel poverty
	Set up Fuel Advisory Support Team to help people find cheapest energy options, support to include help with grant applications, outreach work in communities and home visits.	RCC	§ Support team established April 2002.
13.3	Healthy eating on a low income
	Take forward the multi-agency programme to develop nutritional awareness, food preparation skills and affordable healthy shopping opportunities.	RCC	§ Ongoing programme of action, including: § publication of quarterly newsletter; § development of community gardening initiatives across the Island; § publication of a Delivery Directory and recipe booklets; § establishment of bulk-buying scheme.
13.4	Credit Union
	Continue the development of the Isle of Wight Credit Union.	Credit Union	§ Credit Union accessible in 6 venues across the Island. § 4 new venues come on-stream during 2002/2003.
13.5	Welfare to Work for Disabled People
	Continue to implement the Welfare to Work for Disabled People Joint Investment Plan, to increase the number of disabled people in the employment market.	IWC/Employment Service/Voluntary sector/IW College	§ Employment directory for disabled people produced in 2002/03. § Continue to develop public sector employment opportunities for disabled people in 2002/03. § Continued development of courses for disabled students at IW College during 2002/03.

SECTION 13: TACKLING POVERTY & UNEMPLOYMENT (continued)
Ref no	Task	Lead agencies	Milestones and measures
13.6	Tackling unemployment
	Take forward the ‘Open for Business’ Plan for Jobs 2001-2005. See also item 12.14 re. long term unemployment.	IWEP	§ Plan targets achieved, including: § creation of 800 new jobs by 2005; § assist at least 100 unemployed people into work each year through the local New Deal programme.
SEE ALSO: § Isle of Wight Voluntary Sector Cabinet: Anti-Poverty Strategy - contact Maryse Plisnier ( 524058

SECTION 14: ACCIDENT PREVENTION
OVERALL TARGET: To reduce the death rate from accidents by at least 20% and to reduce the rate of serious injury by at least 10% by 2010.
Ref no	Task	Lead agencies	Milestones and measures
14.1	Accident Prevention Forum
	Continue to work through the multi-agency Accident Prevention Forum to develop local programmes to achieve national targets for reduction of deaths and injury from accidents.	Accident Prevention Forum	§ Needs assessment completed in 2002 and multi-agency action plan agreed.
14.2	Programmes for children and carers
	Take forward the Ryde Safety House Project to provide a specialised safety demonstration house as an interagency training facility, as a six-month pilot scheme.	Accident Prevention Forum	§ Six-month pilot scheme completed and evaluated in 2002/03.
	Explore funding opportunities for a permanent site for a safety house or a mobile outreach unit, to deliver outreach safety education, particularly targeted at vulnerable groups.		§ Bid developed and submitted by the Accident Prevention Forum during 2003/04.
14.3	Accident prevention for older people
	Take forward a range of initiatives to reduce the risk of falls and fractures for older people, including: § ‘Slips, Trips & Broken Hips’ campaign; § Use of a simple checklist for self-assessment of risk fracture; § Promotion of use of calcium and vitamin D supplements to reduce the risk of fractures; § Development of a Home Check/Home Handyman scheme to help older people to tackle small jobs in the home that have an associated safety risk; § Promote healthy physical activity through programmes including health walks, active life clubs, tea dances and use of the physical activity toolkit with District Nurses and Practice Nurses; § Ongoing programme of medication reviews in general practice, residential and nursing homes and hopsital.	PCT/Age Concern	§ Ongoing awareness campaigns. § Introduce risk assessment forms in 2002. § Ongoing promotion of supplements. § Home Check scheme in place August 2002, subject ot available funding. § Recruit a further 6 volunteer health walk leaders in 2002/03. § Active life clubs and tea dances developed in 2002. § Toolkit model training offered to nurses in 2002. § Ongoing medication review programme.
14.4	First aid training
	Secure local sponsorship for first aid resources for children aged 6-11 to promote the development of first aid skills.	Accident Prevention Forum	§ Sponsorship secured to implement project by July 2003.
SEE ALSO: § Transport 16.3 and Older People 1.6.

SECTION 15: IMPROVING COMMUNITY SAFETY
Ref no	Task	Lead agencies	Milestones and measures
15.1	Community Safety Partnership
	Targets/plans to be added after September development day.	IW Community Safety Partnership	§ Reduce all recorded crime on the Isle of Wight by 2% year on year by 2005.
15.2	Increasing inclusion and reducing offending of young people
	Promote use of local facilities and uptake of educational opportunities for young people.	IW Community Safety Partnership/	§ Achieve 5% reduction in youth crime in 2002/2003. § Reduce permanent exclusions and unauthorised absences by 2% in 2002/2003.
	Reduce levels of complaints about activities of young people and implement programmes to divert young people away from offending.	IW Youth Justice Strategy Partnership	§ Reduce the amount of repeat offending by young people by 5% by 2005. § Improve uptake of educational provision by young offenders. § Quarterly newsletter published on youth crime and youth justice services.
15.3	Reducing domestic violence
	Reduce the incidence of domestic violence on the Island by increasing level of reported incidents and providing appropriate facilities, counselling and support to victims and perpetrators.	IW Domestic Violence Forum/ Island Women’s Refuge	§ Training to ensure of IW Domestic Violence Interagency Guidelines adopted by all agencies. § Increase use of perpetrators course. § Maintain high profile public education/information campaign.
	Links established to the work of the Drug Action Team.
15.4	Integration and support of minority ethnic communities
	Use the ‘Integration in Our Island Network’ to provide ongoing training and support to members of local minority ethnic communities and promote racial equality with partner agencies.	Integration in Our Island Network	§ First stage of survey of issues and needs of local minority ethnic communities completed. § Inter-agency protocol for reporting and recording of racist incidents on IW agreed. § Facility to report racist incidents (other than at Police Stations) available 24 hours a day.

SECTION 15: IMPROVING COMMUNITY SAFETY (continued)
Ref no	Task	Lead agencies	Milestones and measures
15.5	Reducing level of crime and fear of crime
	Continue inter-agency work to reduce crime and fear of crime, including identification of design solutions, support to community crime-reduction initiatives and promotion of the Island as a safe environment.	IW Community Safety Steering Group	§ Reduce domestic burglary by 25% by 2005, vehicle crime by 30% by 2004 and crime rates during 2002/2003 by 6%, 7% and 2% respectively. Reduce the assault rate by 5% during 2002/2003.
15.6	Reducing anti-social behaviour
	Continue to develop a range of approaches to reduce anti-social behaviour on the Island.	IW Community Safety Partnership	§ Annual progress report to Home Office on reduction of anti-social behaviour, summer 2002. § Multi-agency training programme in 2002/2003 to identify roles and solutions to anti-social behaviour. § Increased use of physical measures such as CCTV, lighting and entryphones to reduce anti-social behaviour.
SEE ALSO: § Community Safety Strategy 2002-2005 (available on www.iowcrime_disorder.org) - contact Niki Haytack ( 822696.

SECTION 16: TRANSPORT
Ref no	Task	Lead agencies	Milestones and measures
16.1	Local Transport Plan (LTP)
	Continue to ensure the LTP addresses health and well-being and social inclusion issues.	IWC/transport providers	§ Identified health and inclusion issues fed into annual review of LTP.
16.2	Promoting cycling and walking
	Ongoing development of cycleway network, ‘park & ride’ schemes and evaluation of ‘Quiet Road’ initiative.	IWC	§ Ongoing improvement in facilities for cyclists in line with LTP. § Ongoing development of Ryde-Newport and Newport-Sandown cycleways. § Cowes to Southampton ‘park & ride’ scheme established. § New ‘Quiet Road’ development plans incorporated into the LTP.
16.3	Accident and casualty reduction
	Take forward a range of accident remedial schemes, including signage and visibility improvements, safety surfacing and improved junction layouts at identified traffic black-spots.	IWC	§ Schemes delivered in accordance with LTP.
	Participate in a partnership programme between Hampshire Constabulary and Hampshire, Portsmouth, Southampton and IW Councils to use income from speed penalty enforcements to fund appropriate traffic management schemes.	IWC/Hants Constabulary	§ Schemes implemented at sites where speed is identified as a significant contributory factor to accidents.
16.4	Safe Routes to School
	Ongoing development of ‘Safe Routes to School’ programme through work with schools, children and parents to identify engineering measures, coupled with education initiatives, which will encourage more families to walk to school.	IWC	§ Schemes developed in accordance with capital programme with the aim of reducing road dangers and congestion in the vicinity of schools at peak times.
16.5	Promoting traffic-free areas
	Continue to develop ‘traffic quiet’ areas in town centres and ‘home zones’ in residential areas, to promote safety for pedestrians and cyclists.	IWC/IWEP	§ Ongoing development of ‘Home Zones’ traffic-quiet cells within SRB programme.
16.6	Rural transport initiatives
	Rural Transport Partnership Officer to develop a strategy which meets identified unmet needs, particularly for socially excluded groups and people who are geographically isolated.	IWC/RCC	§ Strategy developed and used to secure funding. § Rural bus grants targeted to reduce social isolation.

SECTION 16: TRANSPORT (continued)
Ref no	Task	Lead agencies	Milestones and measures
16.6	Rural transport initiatives (continued)
	Funding secured for the ‘Wheels to Work’ scheme, which gives short-term financial assistance for bus and ferry season tickets or purchase of mopeds, to help unemployed people in rural areas get to new jobs.	IWC/RCC	§ Agreed ‘Wheels to Work’ targets delivered.
16.7	Cross-Solent travel
	Continue to explore options for subsidised travel with Island and mainland transport providers, to make travel for those travelling to the mainland for education, employment or healthcare more affordable.	IWC/IWEP/PCT	§ Ongoing discussions with local providers, GOSE and Government Departments.
16.8	Green Travel Plans
	Take forward the development of Green Travel Plans for St Marys Hospital and IW Council, incorporating improved facilities for cyclists, car sharing and increased use of public transport.	IWC & partners	§ Implementation of Travel Plan for IW Council. § Implementation of Travel Plan for St Marys Hospital.
16.9	User involvement
	Use the Quality Transport Partnership to bring transport providers and users together to identify transport priorities for the future and lead input into the development of transport section of the Island’s Community Strategy.	Quality Transport Partnership	§ Development of the Community Strategy. § Ongoing consultation and liaison.
SEE ALSO: § Local Transport Plan – contact Chris Wells ( 823640.

SECTION 17: THE ENVIRONMENT & HEALTH
Ref no	Task	Lead agencies	Milestones and measures
17.1	Preventing pollution
	Continue to promote policies within the Health Service which minimise the potential polluting effects of medical items, such as CFC inhalers, unused antibiotics and batteries.	PCT/IWHT	§ Continuing replacement programme as appropriate products come on to the market.
	Minimise the use of chemical pesticides and herbicides by council contractors and actively promote the use of alternatives where practicable.	IWC	§ Ongoing monitoring of chemical use.
17.2	Air quality
	Continue to work to improve indoor air quality by positively promoting ‘smoke free’ environments in homes, workplaces and public places.	PCT/IWC	§ Ongoing programmes of awareness raising, workplace policy development and availability of smoking cessation services.
17.3	Energy efficiency
	Work to take forward a range of initiatives to reduce CO^2 emissions and non-renewable energy consumption, and reduce the impact of fuel poverty, including giving energy conservation advice through media and care workers.		§ Annual target of energy conservation improvement grants for 140 properties achieved (check target with Peter Griffiths in Housing).
17.4	Promoting Green Tourism
	Enable local people to benefit from improved local economy and environment through increasing the number of tourists visiting the Island, within a framework of sustainable environmental management.	IWC/Island 2000 Trust	§ 20 businesses part of ‘Green Island’ award scheme and audited. § Post established to co-ordinate environmental management and rural regeneration aspects of programme (subject to SEEDA funding).
	Projects to include: § Developing an Island Eco-Trail. § Regeneration projects in Sandown Bay to focus on improving the natural beauty of the area. § Developing integrated and sustainable transport options to support tourism.

SECTION 17: THE ENVIRONMENT & HEALTH (continued)
Ref no	Task	Lead agencies	Milestones and measures
17.5	Local food networks
	Increase local initiatives to encourage the consumption of locally grown food and reduce food poverty on the Island, including: § development of community gardens; § promoting the use of allotments; § roll out Farmers Markets across the Island; § development of Healthy Eating on a Low Income Forum (see item 12.8); § promotion of local products.	RCC/IWC	§ Ongoing programme of project development.
SEE ALSO: § Isle of Wight Council Agenda 21 Strategy – contact Angela Mawle ( 823289 § Isle of Wight Council Unitary Development Plan – contact Ashley Curzon ( 823557 § Management Strategy for the Coastal Zone – contact Robin McInnes ( 823770 § Air Quality Review Plan – contact Barry Monks ( 823151

SECTION 18: MODERNISING ACUTE SERVICES
Ref no	Task	Lead agencies	Milestones and measures
18.1	Waiting times
	Work to achieve national waiting times targets for elective treatment through a range of modernisation initiatives, including: § Full commissioning of a sixth theatre, allowing 10 additional theatre lists and increase in day surgical capacity; § Increase in capacity in Medical Assessment & Admissions Unit to 16 beds and trolleys; § Bed capacity review undertaken; § Participate in the National Theatre Project as a pilot site to review theatre use and inform the development of national best practice guidance; § Implementation of project to centralise admissions and waiting lists for medical and surgical patients; § Develop a fully functional pre-assessment unit to provide pre-assessment for all surgical patients; § Take forward Booked Admissions Project.	IWHT	§ Increase in day case rate to 75% in 2003/04. § Maximum wait for patient treatment of 12 months achieved in 2002/03; 9 months in 2003/04; and 6 months by 2005. § 100% of day case patients pre-booked by March 2003; two-thirds of inpatients pre-booked by March 2004; and all appointments and admissions booked by 2005.
18.2	Outpatient services
	Take forward Outpatient Improvement Project to ensure national targets for reductions in outpatient waiting times are achieved.	IWHT	§ No patient waiting over 26 weeks as at March 2002. Maximum wait of 21 weeks achieved by March 2003.
	Take forward Booked Admissions Project.		§ Two-thirds of outpatient appointments pre-booked by March 2004. § 3-month maximum outpatient waiting time achieved by 2005. § 100% of all outpatient appointments pre-booked by December 2005.
18.3	Orthopaedic services
	Take forward a programme to modernise orthopaedic services, including: § Orthopaedic pre-assessment; § Development of triage with GP specialists and physiotherapists.	IWHT	§ Action plan for modernisation in place by July 2002. § Reduction in GP referrals requiring consultant appointments in outpatients.

SECTION 18: MODERNISING ACUTE SERVICES (continued)
Ref no	Task	Lead agencies	Milestones and measures
18.4	Diagnostic services
	Take forward initiatives to modernise diagnostic services, including: § Developing extended roles for radiographers; § Development of out of hours diagnostic services.	IWHT	§ Work undertaken during 2002/03 with Workforce Development Confederation to develop an ‘earn and learn’ programme for radiographers.
18.5	Improving the patient experience in hospital
	Take forward a range of programmes to improve patients’ experience of their visit to hospital, including: § Implementing the Patient Contract, which will ensure patients are made fully aware of the care they will receive in hospital and how to manage when they return home; § Taking forward improvements in hospital catering services, including introduction of 24-hour hot meals and leading chefs dishes. Progress will be monitored through Patient Satisfaction Surveys; § Introducing a ward base housekeeping service, supervised by the Charge Nurse, to improve cleanliness, maintenance, laundry and linen services on each ward. See also Capital & Estates 23.3.	IWHT	§ Year-on-year improvement in patient satisfaction with hospital cleanliness and food, demonstrated through independently audited local surveys. § Taking forward NHS Plan proposals, subject to additional funding. § Initial ward housekeeping service pilots commencing April 2002, with a view to further implementation by 2003. § Bedside televisions and telephones in place by 2004.
18.6	Medicines management in hospital
	Develop a range of projects, within existing resources, to ensure efficient and effective management of medication, including: § Integration of pharmacists into the clinical team; § Establishment of an Admissions Pharmacy Team in pre-assessment clinics and on admission to hospital; § Development of patient group directives; § Ensuring patients have an opportunity to discuss new medicines and any problems with existing medicines; § Programme of Pharmacy Technician development and pre- and post-registration training for pharmacists; § Self-Administration of Medicine Scheme introduced to encourage patients to have a level of control over their medication while in hospital; § Review of patient medication to minimise risk. Home prescription and discharge summary to be sent to GP within 24 hours of discharge;	IWHT	§ Pharmacist support in place for all consultant teams and ward based pharmacy teams by March 2004. § Pharmacist support to MAAU and pre-assessment in place by March 2003. § CPD post-qualification training programme provided for new prescribers. § All patients counselled on medicines during their hospital stay and on discharge by the pharmacy team by March 2003. § Student NVQ3 and competency pathway in place and pre-registration training for post graduate pharmacists in place by August 2002. § Programme in place by May 2002. § Implementation of revised discharge summary form by April 2003.

SECTION 18: MODERNISING ACUTE SERVICES (continued)
Ref no	Task	Lead agencies	Milestones and measures
18.6	Medicines management in hospital (continued)
	§ Discharge Pharmacy Team in place to ensure patients’ discharge from hospital is not delayed while waiting for medication.	IWHT	§ All medical patients discharged at ward level with counselling about medicines by March 2004.
18.7	Emergency care
	Take forward a programme of improvements to reduce waiting times for emergency care, in line with National Strategy for Emergency Care. Programmes will include: § Development of emergency nurse practitioner role; § Establishment of major and minor trauma streams in the A&E Department; § Development of regular A&E clinics; § Production of emergency care guidelines; § Development of community capacity to avoid admissions to hospital and to speed discharge. See also Primary Care 19.10 regarding out of hours services.	IWHT	§ Ambulance response targets achieved. § No-one to wait more than 4 hours in A&E by 2004, from arrival to admission, transfer or discharge. § Average waits of 75 minutes achieved in line with national targets. § All patients to be found a bed within 1 hour of decision to admit, by 2004.
18.8	ENT
	Work to agree the future model for provision of ENT services.	PCT/IWHT/ Portsmouth Hospitals	§ Plans agreed and implemented for future model of service.
18.9	GUM and Sexual Health Services
	Continue to develop an integrated sexual health service, incorporating GUM, family planning services, psychosexual advice and HIV/AIDS services in line with agreed strategy.	PCT/IWHT/SHA	§ Implementation of agreed programme for the achievement of a fully integrated sexual health service.
18.10	Patient records
	Explore options for the development of integrated records, particularly in areas where the care pathway approach is being adopted.	PCT/SHA/IWHT	§ Options considered and bid to Modernisation Fund developed if appropriate.
SEE ALSO: § Cancer Services – section 6 § Coronary Heart Disease – section 5 § Older People’s Services – section 1

SECTION 19: MODERNISING PRIMARY CARE
Ref no	Task	Lead agencies	Milestones and measures
19.1	Primary Care Trust development
	Review organisation’s current capacity and develop structure to enable the requirements of ‘Shifting the Balance of Power’ to be effectively discharged.	PCT	§ Review completed October 2002.
	Implement PCT Competency Framework and Controls Assurance requirements.		§ In line with national requirements.
	Develop internal communications to ensure PCT staff understand vision, values and objectives.		§ Quarterly staff meetings and staff handbook launched September 2002.
	Develop PCT website.		§ Website launched September 2002.
19.2	Modernising primary care
	Ongoing work to identify how the 2004 access targets for primary care can be achieved, including consideration of skill mix changes, new types of service and reducing inappropriate demand, including: § develop nurse triage services in practices to deal with requests for same day appointments; § explore use of healthcare assistants to reduce pressure on practice nurses and allow some development of nurse specialisms; § explore scope for GPs taking on more specialist work in collaboration with consultants; § practices matching demand and capacity more closely through adopting ‘Advanced Access’ appointment system.	PCT	§ All patients to see a GP within 48 hours and other primary care professionals within 24 hours by 2004 (90% by 2003). § New opportunities for outpatient consultations in primary and community care settings by 2004. § GPs maintaining patients within primary care with consultant advice, leading to fewer referrals in some specialties. § Specialist GPs taking referrals from colleagues; 3 specialists by 2003/04. § 30% of practices uses Advanced Access by 2003.
19.3	Preventative treatment and support
	Develop the range of preventative and support services which are delivered in primary care settings to support national policy objectives of the National Service Frameworks for Coronary Heart Disease, Mental Health, Older People and Diabetes, and the National Cancer Plan.	PCT	§ Annual targets achieved in Primary Care Incentive Scheme for 2002/03.
19.4	Salaried GPs
	Explore the scope for the development of salaried GPs.	PCT	§ Appropriate model for local schemes agreed and salaried GPs introduced by 2003.

SECTION 19: MODERNISING PRIMARY CARE (continued)
Ref no	Task	Lead agencies	Milestones and measures
19.5	Integrated working in primary care nursing teams
	Continue to support the development of team work between practice nurses, district nurses, health visitors and care managers to ensure a more integrated response to patient needs, particularly as the district nursing team moves into the PCT.	PCT	§ Single assessment piloted in 2002. § ‘Partnerships in Practice’ project completed in conjunction with Exeter University and evaluated by December 2003.
19.6	Prescribing
	Support practices in effective prescribing and medicines management through a range of initiatives, including: § provision of information and practical support to improve quality of prescribing and patient care and cost-effectiveness; § local agreements on introduction of new drugs and local formularies; § advice on good practice in repeat prescribing; § work with residential and nursing homes on medicines management; § introduction of patient group directives to enable pharmacists and nurses to take decisions about patient treatment; § supporting training for nurse prescribing where most appropriate.	PCT	§ Computer-based version of local formulary to be disseminated to all practices by March 2003. § Patient Group Directives for Chloramphenicol eye drops and Trimethoprim from pharmacies by January 2003, as well as ongoing provision of Levonelle. § Ongoing work with residential and nursing homes to review patient medication. § Baseline clinical governance review for pharmacists undertaken by May 2002.
	Develop local response to NHS Plan for Pharmacy, including: § increasing the health promotion role of pharmacists; § developing out-of-hours dispensing service; § developing patient group directions.		See also item 1.9 regarding older people.
19.7	Clinical governance in primary care
	Deliver the agreed annual clinical governance programme including, where appropriate, joint projects with the IW Healthcare Trust, with support from the PCT Training & Development Programme.	PCT/IWHT	§ All practices updating PPDPs by summer 2002 and annually thereafter. § Practices actively involved in risk management, including completion of practice risk assessment and implementation of consent policy during 2002/03. § Clinical supervision opportunities developed for practice nurses by April 2003.

SECTION 19: MODERNISING PRIMARY CARE (continued)
Ref no	Task	Lead agencies	Milestones and measures
19.8	Information technology in primary care
	Continue to develop the use of IT in primary care settings, including: § ongoing development of electronic health records; § develop Prodigy to enable all practices to use the system; § use NHSnet for direct booking of appointments and diagnostic test requests and results; § establish information links between health and social care organisations.	PCT	§ First 3 systems in place in 2002/2003. § Last system in place in 2003/2004. § Full training programme implemented for all primary care staff groups, including work towards European Computer Driving Licence (ECDL). § Electronic booking system implemented by 2003/04.
19.9	Workforce planning in primary care
	Continue to deliver comprehensive training programmes, funded through GMS, Workforce Development Confederation initiatives and sponsorship, including: § Practice Manager programmes, including employment law, recruitment and selection; § Receptionist programme; § Nurse training programme, including focus on triage skills, chronic disease management and sexual health; § all-staff programmes through protected time sessions; § healthcare assistant training programme.	PCT	§ Development of personnel guidelines.
	Develop occupational health services for primary care staff.		§ IDOC supporting six sessions of protected time in 2002/03. § Occupational health services in place (subject to funding).
19.10	Out-of-hours care
	Implement out-of-hours exemplar site project, providing foundation for single point of entry and triage service for IDOC and A&E, and thereafter development of urgent care centre, integrating other health and social care out of hours services.	IDOC	§ Single point of entry for IDOC and A&E established by 2003/04.
SEE ALSO: § Coronary Heart Disease 5.4. § Mental Health 7.5. § Older People 1.7. § Cancer 6.2 and 6.5. § Diabetes 3.7.

SECTION 20: MEETING THE NEEDS OF PEOPLE WHO USE SERVICES & CARERS
Ref no	Task	Lead agencies	Milestones and measures
20.1	Getting feedback from people who use services
	Continue to develop opportunities to ensure people who use services can be involved in giving feedback on existing services and in planning new or changed services. Initiatives will include: § Use of the media to promote awareness about services and proposed changes; § Links with established representative bodies, such as the Disability Issues Forum, Mental Illness Carers & Relatives Association, Older Voices and the Patients with a Disability Working Group; § Involvement of representatives of people who use services and cares on Partnership Planning Groups; § Ongoing links between the Rural Community Council,the Primary Care Trust and the Social Services & Housing Directorate to identify issues raised by the voluntary sector.	PCT/IWHT/IWC	Ongoing development of community involvement initiatives in 2002/03, including: § Establishment of Children & Young People’s Partnership Board with young people’s representatives, in 2002; § Scheduled programme of visits to groups; § Development of advocacy supoort for people with learning disabilities.
20.2	Patient Advocacy & Liaison Service (PALS)
	Develop a PALS service that meets the needs of the Island population, that can work across organisational boundaries.	PCT/IWHT	§ Agreed arrangements in place by September 2002. § PALS service operational from September 2002. § Outcome of pilot Patient Enquiry Service evaluated and future plans agreed, including agreement on relationship to PALS service. § Local arrangements for Patient Forums and Overview Scrutiny Panels agreed in 2002/03, subject to the forthcoming national guidance.
20.3	Expert Patient Programme
	Develop Expert Patient Programme in line with national guidance.	PCT	§ Diabetes programme in place; further work undertaken to roll out to other areas, including Parkinson’s Disease and other chronic diseases, by 2004.

SECTION 20: MEETING THE NEEDS OF PEOPLE WHO USE SERVICES & CARERS (continued)
Ref no	Task	Lead agencies	Milestones and measures
20.4	Services for carers
	Continue to implement the Carers Plan to develop the range of support services available to carers and programmes for increasing the amount of respite care available, including: § free emergency respite in a crisis; § free sitting service; § drop-in facility for ad-hoc breaks; § boarding-in scheme with live-in carers; § young person’s support project; § increasing carers awareness of Carers Association Isle of Wight.	SSD	Annual targets for 2002/03: § Respite care of 1,190 days and crisis care provided for 90 individuals; § 1600 two-hour free sits; § Saturday morning drop-in sessions for at least 12 people with dementia; § 20 weeks of live-in care; § Support provided for 40 young carers.
	Ongoing provision of assessments for carers in their own right.		§ Increased number of carer assessments undertaken in 2002/03 and ongoing awareness raising about availability of carer assessments.
	Provision of Emergency Alert cards in conjunction with Carers Association.	SSD/Carers Association IW	§ 250 cards provided in 2002/03.
	Counselling, advice, support and training project funded.		§ Further 45 carers receiving programme of sessions in 2002/03.
	Ongoing programme of liaison and consultation with carers groups.		§ Meetings scheduled throughout 2002/03.
SEE ALSO: § Learning Disability 4.1. § Young Carers 2.9. § Promoting Independence Carers Plan 2001-2004 - contact Martin Henson ( 823340. § Commissioning Strategy: Services to Carers of Older People – contact James Lowe ( 535437.

SECTION 21: DEVELOPING THE NHS & SOCIAL CARE WORKFORCE
Ref no	Task	Lead agencies	Milestones and measures
21.1	Developing human resources within the PCT
	Take forward a programme of initiatives to achieve national ‘Improving Working Lives’ standards and full accreditation by 2004. Actions will include: § Development of workforce planning skills as an integral part of service planning; § Identification of workforce issues through clinical governance processes and development of appropriate training programmes; § Processes in place to share good employment practice with GPs; § Harmonisation of pay and conditions in line with ‘Agenda for Change’; § Annual workforce plan submitted to Department of Health; § Development of occupational health services for all staff, including in GP practices; § Monitoring of workplace accidents and violence to staff; § Development of opportunities for involving staff in the implementation of ‘Improving Working Lives’ (IWL).	PCT	§ Pilot Older Person’s Workforce Plan published summer 2002 and methodology rolled out to other areas. § Annual review of progress against baseline indicators undertaken February 2003 and reported to PCT Board. § Joint training and induction programmes in place with GP practices by 2003. § Target date subject to national confirmation. § Plan submitted October 2002. § Services in place for GP staff by 2004. § National improvement targets achieved by 2003. § Regular involvement in IWL through Staff Consultative Forum and employment opinion survey undertaken summer 2002.
21.2	Modernising the NHS workforce
	Take forward a range of initiatives to achieve national workforce targets in the NHS Plan and other national workforce strategies, including: § Implement action plan for ‘Improving Working Lives’; § Develop and implement an action plan on recruitment and retention; § Develop an annual workforce plan and incorporate workforce planning issues as an integral part of service planning processes; § Achieve year-on-year improvement in sickness absence rates, workplace accidents and violence to staff, in line with national targets.	IWHT	§ Staff attitude survey undertaken by December 2002 and results reflected in business plans by March 2003. § Achievement of national targets for increase in nurses, consultants and specialist registrars by 2004. § Achievement of Working Time Directive for Junior Doctors. § Flexible Working Policy in place by September 2002. § Consultant appraisal linked to 5-yearly revalidation. § Systems for Continuing Professional Development reviewed; NVQ and ILA programme introduced by September 2002. § Development of additional nurse consultants by 2004 (subject to available resources). § Easily identifiable senior sisters and charge nurses accountable for groups of wards by 2002. § Equality & Diversity Strategy in place by June 2002.

SECTION 21: DEVELOPING THE NHS & SOCIAL CARE WORKFORCE (continued)
Ref no	Task	Lead agencies	Milestones and measures
21.3	Modernising the Social Services workforce
	Ensure training opportunities for local staff support the achievement of national requirements for qualification and post-qualification awards for Social Services staff.	SSD	§ 2-4 child care and 2 adult services staff to complete PQ1 Access Award training in 2002/03. § 2 staff to complete PQ Child Care award, 2 to complete NVQ 3 Children & Young People, 2 to complete NVQ 3 for Community Care Officers and 4 to complete Diploma in Social Work in 2002/03. § 10 managers to complete staff supervision child protection training in 2002/03. § Training provided in recognition and procedures for issues of adult abuse. § Finance training provided for all managers during 2002/03 to enable delegation of budgets. § Programme of good practice training events for all staff 2002/03.
21.4	Child care
	Appoint a child care co-ordinator to be the parents advocate and adviser to co-ordinate provision of nursery places and a network of provision for school-aged children, such as after school clubs and holiday play schemes.	PCT/IWHT	§ Joint child care and elder care co-ordinator appointed, and more staff benefiting from services by March 2003.

SECTION 22: INFORMATION TECHNOLOGY & COMMUNICATIONS
Ref no	Task	Lead agencies	Milestones and measures
22.1	Data protection
	Take forward programmes to ensure the security of data in NHS settings, including: § Departmental leads identified for Caldicott and data protection issues by March 2003.	PCT/IWHT	§ Training undertaken and leads in place by March 2003.
	Implement Caldicott standards regarding consent and access to personally identifiable information with the Social Services & Housing Directorate.	SSD	§ Caldicott audit completed and used to review information flows by September 2002.
22.2	Electronic health and social care records
	Take forward the merger of Isle of Wight and Portsmouth Patient Administration Systems (PAS) in order to implement electronic patient records on the Isle of Wight.	IWHT	§ Merger completed September 2003. § All patients have access to electronic personal medical records by 2004.
	Take forward a replacement programme for paper case notes in order to achieve electronic patient record targets.		§ Electronic patient records in place for all Trusts by 2005.
	Implement a new electronic client record database to replace the existing Social Services ACCISS system. This will provide more effective and efficient information sharing between professionals and partner agencies.	SSD	§ Provide full replacement of existing ACCISS Social Services system by 2004. § Achieve integration with directorate and corporate IT systems, tools and infrastructure, including MS Exchange, MS Office, document management, Call Centre (call handling technology) and customer relationship management.
22.3	European Computer Driving Licence
	Provide a comprehensive ECDL training programme to all staff using computers to reach internationally recognised IT user qualification.	IWHT	§ Target for training 626 staff by 2007.
22.4	Mental health information system
	Take forward the procurement of a new mental health information system, in collaboration with Social Services, to underpin the effective delivery of joint care delivery through the Care Programme Approach.	IWHT/SSD	§ System installed by 2004.

SECTION 22: INFORMATION TECHNOLOGY & COMMUNICATIONS (continued)
Ref no	Task	Lead agencies	Milestones and measures
22.5	Computer access for clinicians
	Take forward installation programme to secure computer access for all clinicians.	IWHT	§ All clinicians to have email, internet and computer access by [date].
22.6	Information systems to support diabetes care
	Take forward the use of the Vision information system at the Diabetic Centre at St Marys to allow electronic data transmission to GPs providing care to people with diabetes in the community, and producing a fully comprehensive diabetic register for patients on the Island.	PCT/IWHT	§ Links with GPs in place during 2002/03 (subject to available funding).
22.7	Electronic pathology results
	Implement the new pathology messaging system to enable all GPs to receive electronic pathology results.	IWHT	§ System fully operational for all GPs by December 2003.
22.8	Electronic prescribing
	Take forward the implementation of electronic prescribing at St Marys to increase safe prescribing practice within the hospital.	IWHT	§ Pilot programme implemented 2002/03. § Electronic prescriptions routinely used in hospital setting by 2004.
22.9	National Service Framework programmes
	Take forward a range of information technology initiatives which support the implementation of the NSFs, including: § Design of templates and protocols for data collection to facilitate audit and clinical governance of NSF requirements.	PCT/IWHT	§ Templates and protocols developed and implemented to support achievement of NSF requirements.
SEE ALSO: § IT in primary care 19.8.

SECTION 23: CAPITAL & ESTATE MANAGEMENT
Ref no	Task	Lead agencies	Milestones and measures
23.1	Primary care premises
	Continue to support improvement to premises, particularly those relating to compliance with the access requirements of the Disability Discrimination Act (DDA).	PCT	§ Improvement Grants used to complete general practice upgrading programme in line with DDA requirements.
	Work with practices to develop improvement programmes which support the modernisation agenda in primary care, including facilities for: § delivery of more specialist services in primary care; § team working with community staff, including therapists, mental health workers and social care staff; § delivery of preventative treatment and support services; § increased numbers of practice nurses.		§ Three major new practice developments taken forward between 2002 and 2005.
23.2	Estate Development Programme
	Continue to take forward the scheduled Estate Development Programme at St Mary’s Hospital, including: § completion of current phase of recladding; § refurbishment of Newcroft for Elderly & Rehabilitation Services, commencing August 2003; § Conversion of Newcroft west wing, enabling the Frank James transfer.	IWHT	§ Recladding completed by July 2003. § Refurbishment completed by December 2003. § Frank James transfer August 2002.
23.3	Modernisation of hospital facilities
	Take forward a range of modernisation programmes to enhance the experience of patients in hospital, including: § installing an entertainment and communication facility at every bed position; § eradicate Nightingale Wards.	IWHT	§ Completed January 2003. § Completed 2003/2004.

GLOSSARY OF TERMS

Activity	A measure of the amount of services provided to care for the local population.
Assessment	The process of identifying individuals' needs and determining eligibility for assistance against stated policy criteria. It is a joint process, involving the applicant, their carers and other relevant agencies.
Audit	Systematic critical analysis of the quality of medical, nursing and clinical care.
Augmentative Communication	Special communication systems involving the use of signing and symbols used for some people with moderate or severe learning disabilities or those with other communication impairments.
Capital	Money spent, for example, on land buildings and equipment that would have an expected life of more than one year.
Cardiologist	A doctor who has undergone special training in the diagnosis of heart conditions and their medical treatment. Cardiologists work closely with radiologists (x-ray doctors) and cardiothoracic surgeons (who undertake heart surgery).
Care Management	The process by which the IW Council’s care managers in collaboration with health care professionals and other agencies carries out an assessment of care needs with users and carers and designs a “care package” to meet assessed needs. It also includes making arrangements for the implementation of the care package, reviewing the outcomes of care and revising the services as necessary to meet changes in the needs of an individual client.
Care Pathway	An agreed and consistent clinical management programme which is followed for all patients presenting a similar pattern of disease, such as in stroke recovery.
Care Package	A combination of services arranged and purchased by a care manager to meet the assessed needs of a person requiring care in a range of settings.
Care Programme Approach	An approach to the care of people with significant mental health problems that standardises good practice. The approach consists of four key components: a detailed assessment of the clients needs, a written care plan setting out how the clients needs will be addressed, a key worker to oversee delivery of the plan and finally regular structured review/updating of the care plan.
Carer	This term is often used to describe a person who provides care to an individual person but who is not employed to do so. The carer is frequently the spouse (partner) or other relative.
Carer Support	Day care provided to meet assessed needs of both client and carer, where the client returns home daily, as distinct from respite care which is residential.
CHOICES	The Choices service is for anyone who would like support, advice or practical assistance in managing relationships, sexuality and personal aspects of their life. The service is tailored to individual user need and can offer support to people with learning disabilities, advice and support to carers and access to advice and information about HIV and AIDS.
Community Care	An approach to the provision of services in or near to people’s homes. It involves both social and health care with the mix varying according to individual need. This is a national initiative underpinned by the NHS and Community Care Act 1990.
Continuing Care	Services offering long term care provided in hospitals, nursing and residential homes or in the community.
Day Care	Care which is provided in a setting away from a person's usual home, during the day with paid or voluntary carers present.
Dementia	A condition resulting in a loss of independence skills and memory and the development of confused states of mind.
Diagnostic Imaging	Methods of obtaining internal images of the human body, including X-rays, ultra sound and magnetic resonance imaging (MRI).
Direct Payments Act	The Direct Payments Act 1996 allows Social Services Departments to make payments directly to clients to enable them to purchase the assistance they require to meet their assessed needs.
Dispensing for Discharge	Dispensing for discharge is when a patient is provided with all of their medicines labelled with full instructions and these are stored in a locked bedside medicines cabinet (one per bed) for use throughout their stay in hospital. These are combined with their own medicines wherever possible, to avoid confusion and errors. As prescribing changes are made to the medication regime during the stay, changes are made to the actual medicines, with 28 days supply being made at all times. When the patient is ready to go home, the pharmacist goes to the ward and releases the medicines, making any last minute changes where prescribed.
Domiciliary Care	Health and social care provided in people’s own homes to meet their assessed health and social needs.
Effectiveness	The provision of health and social care services in a way that best secures the desired outcome for the individual patient or population group within the resources available.
Efficiency	Securing maximum value from the resources used to purchase care.
Elective Admission	Planned admission to hospital which is not an emergency.
Elective Surgery	Surgery that is planned in advance.
Eligibility Criteria	Agreed rules against which a service user’s needs are assessed to determine the priority of their need and the degree of risk, in order to make decisions about the appropriate allocation of resources. Such criteria are designed to ensure services are targeted to people in greatest need.
Equity	Equal treatment for equal need.
Health Promotion	The process of enabling individuals and commentates to increase control over the factors which influence their health, thereby improving their health.
Housing Association	"A society, a body of trustees or company which does not trade for profit, and whose purpose or objective is to provide, construct, improve or manage housing accommodation." (Section 1 of the Housing Association Act 1985).
Independent sector	A general term for private or voluntary sector service providers.
Joint Commissioning	Where the statutory agencies e.g. Health Authority and Social Services Directorate of the Isle of Wight Council work together and with other organisations to co-ordinate activities and resources in order to purchase or commission an effective and complementary range of services.
Joint Finance	Resources from Central Government managed jointly by the Health Authority and Social Services Directorate for specific community based projects.
Partnership Planning Groups	Committees that take forward effective joint working, planning and commissioning for specific client groups involving the Health Authority, Social Services Directorate and GP representatives.
Lipid Lowering Drugs	Certain drugs that lower blood cholesterol levels and have been shown to reduce the incidence of heart attack and the death rate from heart attack. Lipid lowering drugs need to complement other preventative measures and be targeted at those who are at greatest risk of a heart attack/further heart attack.
Localities	Small defined geographical areas within a district.
Looked After Children	A term used in the Children Act to describe children who are accommodated by, or on behalf of, a local Authority, whether the accommodation is provided voluntarily or compulsorily.
Macmillan Nurse	A nurse specialising in the care of people who have a terminal illness, usually cancer, who work in the community and sometimes in hospitals, giving advice and support.
Morbidity	The number of cases of diseases reported in a population.
Mortality	The number of deaths reported in a population.
Myocardial infarction	A heart attack
Needs assessment	The process of assessing and monitoring the health status and health and social care needs of the local population and identifying and implementing changes to health care and other services which should lead to improvement in health and well-being. The term can also apply to the assessment of the need for care services of an individual client, patient and/or carer.
No Barriers	A scheme to enable people with a range of disabilities to access training and work preparation schemes to assist them in competing in the open employment market.
Non-elective admission	Emergency admission to hospital.
Outcomes	A measurable result, following an identified action where the benefit to an individual, derived from care services they receive can be measured.
Palliative care	Palliative care is the active total care of patients and their families by a multi-professional, multi-disciplinary team when a patient’s disease is no longer responsive to curative treatment. It provides physical, psychological, social and spiritual support, and will involve practitioners with a broad mix of skills, including medical and nursing care, physiotherapy, occupational therapy and related specialties.
Partnership	Working closely with service providers, co-purchasers and other agencies to achieve agreed common goals.
Primary Care	Services which are provided in the following care settings:- individuals' own home, residential care homes, workplaces, local clinical premises (e.g. GP, dental surgeries, opticians, health centres and pharmacies). Primary care offers co-ordinated personal care and a link with more specialised services.
Primary Health Care Team	The group of staff usually working from a GP's surgery or from a health centre and including the GP's themselves, community nurses, health visitors, care managers etc., who provide primary health care services.
Provider	Any person or organisation supplying a care service in return for payment.
Purchasers	Organisations responsible for identification of local need for services, the holding of budgets for the care required and the securing of the appropriate range of services through the negotiation of service agreements with service providers.
Quality	A quality service is one which meets the needs of users and carers in the most effective and efficient way.
Rehabilitation	To restore mobility and other skills through treatment or by training, especially after illness or because of disability.
Respite care	Services provided either within a residential or nursing home on a short-term basis to cater for the needs of users and enable the carer(s) to have a break.
Salaried Dental Service	A service where dentists are employed directly by the Health Authority to provide dental services, rather than the dentist working as a private contractor.
Secondary care	Services which are provided usually in an acute hospital setting on referral from a primary care practitioner or through accident and emergency admission.
Targeting	Process by which limited resources are prioritised towards certain care groups and services on the basis of information relating to the highest levels of need, risk and vulnerability.
Tracer conditions	Specific medical conditions which are used to monitor services and quality of treatment.
Triage	A system for identifying the relative urgency of patients’ needs, such as in the A&E Department.
User/client	Any person receiving or eligible to receive a service.
Value for money	Securing the best use of available resources in order to achieve high quality and effective services.
Voluntary sector	Organisations which are managed by management committees, trustees or directors who work on a voluntary basis.

ABBREVIATIONS

A&E	Accident and Emergency Department
ACPC	Area Child Protection Committee
APF	Accident Prevention Forum
BA	Benefits Agency
CHC	Community Health Council
DAT	Drugs and Alcohol Team
dmft	Decayed, missing and filled teeth
DoH	Department of Health
DPB	Dental Practice Board
EA	Environment Agency
EMH	Earl Mountbatten Hospice
ENT	Ear, nose and throat
ESF	European Social Fund
GPs	General Practitioners
GUM	Genito-Urinary Medicine
HEA	Health Education Authority
HSE	Health and Safety Executive
HV	Health Visitor
IDOC	Island Doctors on Call
IHAC	Independent Housing Advice Centre
IT	Information Technology
IWC	Isle of Wight Council
IWEP	Isle of Wight Economic Partnership
IWHT	Isle of Wight Healthcare Trust
LDAF	Learning Disability Awards Framework
LEA	Local Education Authority
LDC	Local Dental Committee
MRI	Magnetic Resonance Imaging
PACT	Prescribing Analysis and Cost Trends
PCT	Primary Care Trust
PDS	Personal Dental Services
PHCT	Primary Health Care Team
PPDP	Practice Professional Development Plan
PPG	Partnership Planning Group
RCC	Rural Community Council
SHA	Strategic Health Authority
SRB	Single Regeneration Budget
SSD	Social Services Directorate
SSI	Social Services Inspectorate
STG	Special Transitional Grant
SUHT	Southampton University Hospitals Trust
TEC	Training and Enterprise Council
YOT	Youth Offending Team

INDEX

A
Accident prevention:
Children	58
Older people	14, 58
Adoption	19
Advocacy	27
Age discrimination	13
Air quality	63
Angina	33
Arts and health	49
Assessment:
Older people	13
B
Breastfeeding	18
C
Cancer:
Screening	35
Waiting times	36
Care Programme Approach	15
Carers:
Carers of people with learning disabilities	27
Mental health	37
Services for carers	72
Young carers	20
Child Protection	19
Children:
Accident prevention	58
Autism Spectrum Disorder	26
Disabled	20
Learning disabilities	26
Oral health	43
Children and young people:
Drugs and alcohol	42
Children’s Fund	18
Community development:
East Cowes	52
Pan, Newport	51
Ryde	51
Community safety:
Drugs and alcohol	42
Connexions	19, 26
Continence services	13
Credit Union	56

Crime:
Fear of crime	60
Young people	59
Criminal justice:
Drugs and alcohol	40
Cycling	61
D
Day services:
Learning disability	28
Older people’s mental health	15
Dementia	15
Dental care:
Access	43
Diabetes:
General	24
Information technology	76
Diagnostic services	66
Diet	32, 53, 56, 64
Direct Payments	23, 27
Disability Discrimination Act	23
Discharge from hospital	14
Domestic violence	20, 59
Drug misuse	19
Drugs and alcohol:
Community safety	42
Community support	40
Criminal justice	40
Prevention programmes	40
Treatment services	40
Young people	40
E
Ear, nose & throat services	67
East Cowes community development	52
Emergency care	67
Employment:
Disabled people	23, 56
Learning disabilities	29
Equipment services	13, 23
Exclusions from school	21
F
Falls	14
Ferries	62
First Aid training	58
Food – see Diet
Fruit and vegetable consumption	35
Fuel poverty	15, 46, 53, 56, 63
G
GPs	68
Green tourism	63
Green travel plans	62
H
Health Action Zone	55
Health promotion:
Children and schools	22
Mental health	15, 38
Sexual health	44
Healthy Living Centre	49, 50
Hepatitis	42
HIV/AIDS	44
Homelessness	45
Hospital care:
Disabled people	24
Older people	13
Hospital services	66
Housing:
Condition	46
Disabled people	24
Learning disabilities	28
Mental health	38
Older people	16, 17
Special needs	46, 47
Young people	21
I
Immunisation:
Children	18, 19
Flu	15
Information:
Disabled people	24
Older people	15
Information technology	70, 75, 76
Intermediate care	13

L
Learning disability:
Adult protection	29
Day services	28
Employment	29
Family support	26
Health care	27, 28
Housing	28
Partnership working	30
Person-centred planning	27
Transitions	26
Workforce issues	29
Looked After Children	19, 21, 22
M
Maternity services	18
Medicines:
Medicines management in hospital	66, 67
Older people	16
- see also Prescribing
Mental health:
Care Programme Approach	38
Carers	37
Child and adolescent mental health services	21
Community support	37
Crisis	37
Home treatment	37
Housing	38
Information technology	75
Older people	15
Primary care	38
Prisons	39
Secure services	39
Service user involvement	38
Suicide	39
Workforce issues	39
Minority ethnic communities	3, 59
O
Obesity	32
Oral health:
Access to dental care	43
Children	43
Older people	18, 43
Orthopaedics	65
Outpatients	65

P
Palliative care	36
Pan (Newport) community development	51
Parkinson’s Disease	25
Partnership working:
Learning disability	30
Pathology	76
Physical activity	14, 15, 31, 32, 49, 50
Poverty programmes	53
Prescribing	69, 76
Primary care:
Estate issues	77
GPs	68
Mental health services	38
Modernising primary care	68
Nursing	69
Prisons:
Improving health	54
Mental health	39
Pollution	63
R
Rehabilitation:
Cardiac	34
Older people	13
Residential and nursing home care	16, 17
Respite care	20, 24
Road accidents	61
Ryde:
Community development	51
Safety House	58
S
Schools:
Health promotion	22
Healthy Schools	53
Transport	61
Screening:
Cancer	35
Service user involvement:
Mental health	38
Sexual health:
GUM and sexual health services	67
Health promotion	44
HIV/AIDS	44
Vulnerable adults	44
Young people	18

Single Regeneration Budget:
Ryde programme	48
Smoking	18, 31, 35
Social inclusion	48
Stroke	14
Suicide	39
Surestart	18, 52
T
Teenage pregnancy	18, 44
Tourism:
Green tourism	63
Training:
Disabled people	23
First Aid	58
Transport:
Disabled people	24
Ferries	62
Green travel plans	62
Rural areas	61, 62
Schools	61
U
Unemployment	55, 57
W
Waiting times:
Cancer	36
Orthopaedics	65
Outpatients	65
Walking	61
Welfare benefits	54, 56
Workforce issues:
Children’s services	74
Coronary heart disease services	33
Learning disability services	29
Mental health services	39
NHS and social care workforce development	73, 74
Older people’s services	14
Primary care services	70
Workplaces	54

Y
Young offenders	19, 20
Young people:
Crime	59
Drugs and alcohol services	41

ISLE OF WIGHT HEALTH IMPROVEMENT & MODERNISATION PLAN 2002-2005

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