West Sussex Health and Wellbeing Board Agenda Item 10a

Date of meeting: 2nd February 2017

Item Title: Wellbeing and Resilience Framework

Executive Summary:

Priority 2 of the HWB Strategy includes the development and system wide integration of a West Sussex Wellbeing and Resilience Framework. The Public Health Directorate, as part of a partnership approach, ran a Wellbeing and Resilience Workshop in November 2016, and is using the learning from this engagement and previous task and finish group activity, to develop and integrate a Wellbeing and Resilience Framework. The framework will support and guide the ‘entire system’ (including public, private, community and voluntary services, and communities themselves) to understand and strengthen the things that make people’s lives go well, so that people live the life they want. It will provide clarity on why wellbeing and resilience are important, and how they will be systematically improved and strengthened with West Sussex residents, and for all ages.

Recommendations for the Board:

It is recommended that The Health and Wellbeing Board support the work of the Wellbeing and Resilience Strategy Group in driving forward the Strategic Action Plan as set out in section 7 of the report.

Relevance to Joint Health and Wellbeing Strategy:

Priority 2 – Wellbeing and Resilience There are many organisations in West Sussex providing excellent services that promote and maintain wellbeing and resilience. However they are currently fragmented and the HWB want to develop a more systematic approach so that services can integrate more easily with treatment, and to reduce gaps and duplication.

Financial implications (if any):

This priority includes system wide transformational change. There are financial implications relating to officer resource, engagement and consultation, and relating to resource (Framework and associated tool kit) production.

Consultation (undertaken or planned):

Wellbeing and Resilience Framework workshop on 25th November 2016 - Over 60 attendees with leadership roles across sectors informed Framework,

associated products and committed to a systematic approach to embed approaches which improve wellbeing and strengthen resilience

Health and Wellbeing Board Sub-Group - Short term group which shaped the components and structure of the Framework Social Isolation Task and Finish Group - Chaired by the Cabinet Member for Adult Social Care and Health, cross sector group

made system wide & specific recommendations to reduce social isolation

Equality and Diversity statement (if appropriate):

Equality and diversity are core aspects of the Framework

Item author and contact details:

Graeme Potter, Public Health Lead – Start of Life Graeme.potter@westsussex.gov.uk 0330 222 2124

Public Health Consultant Lead: Dr. Ann Corkery

Agenda Item 10a

West Sussex Health and Wellbeing Board

West Sussex Wellbeing and Resilience Framework

Date: 2nd February 2017 Lead officer and author: Graeme Potter, Public Health Lead – Start of Life

Graeme.potter@westsussex.gov.uk Public Health Consultant Lead: Dr. Ann Corkery

Executive Summary Priority 2 of the HWB Strategy includes the development and system wide integration of a West Sussex Wellbeing and Resilience Framework. The Public Health Directorate, as part of a partnership approach, ran a Wellbeing and Resilience Workshop in November 2016, and are using the learning from this engagement and previous task and finish group activity, to develop and integrate a Wellbeing and Resilience Framework. The framework will support and guide the ‘entire system’ (including public, private, community and voluntary services, and communities themselves) to understand and strengthen the things that make people’s lives go well, so that people live the life they want. It will provide clarity on why wellbeing and resilience are important, and how they will be systematically improved and strengthened with West Sussex residents, and for all ages. Recommendation It is recommended that The Health and Wellbeing Board support the work of the Wellbeing and Resilience Strategy Group in driving forward the Strategic Action Plan as set out in Section 7 of the report.

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Glossary

Wellbeing - Subjectively, wellbeing includes satisfaction with life. The factors which characterise and influence wellbeing include mastery and a sense of control, having a purpose in life, a sense of belonging and positive relationships with others. Emotional wellbeing relates to the ability to understand the value of emotions and use them to move forward in positive directions. Everyday emotional wellbeing involves identifying, building upon, and operating from strengths rather than solely focusing on fixing problems or weaknesses. The greater the ability to master emotions, the greater the capacity to enjoy life, cope with stress, and focus on important personal priorities. Resilience - In the context of exposure to significant adversity, resilience is both the capacity of individuals to navigate their way to the psychological, social, cultural and physical resources that sustain their wellbeing, and their capacity individually and collectively to negotiate for these resources to be provided and experienced in culturally meaningful ways. Resilience is not just about ‘bouncing back’; it is also concerned with ‘bouncing forward’; being able to navigate life in a way that brings greatest reward. Resilience can be thought of as an essential component of wellbeing. Wellbeing and resilience share common causes. Five Ways to Wellbeing – These are evidence-based public mental health messages aimed at improving the mental health and wellbeing of the whole population. They were developed by NEF (the New Economics Foundation) as the result of a commission by Foresight, the UK government’s futures think-tank, as part of the Foresight Project on Mental Capital and Wellbeing. The five ways to Wellbeing, and an overview of their meaning, are to: • Connect… With the people around you, with family, friends, colleagues and neighbours. At home,

work, school or in your local community. Think of these as the cornerstones of your life and invest time in developing them. Building these connections will support and enrich you every day.

• Be active… Go for a walk or run. Step outside. Cycle. Play a game. Garden. Dance. Exercising makes you feel good. Most importantly, discover a physical activity you enjoy and that suits your level of mobility and fitness.

• Take notice… Be curious. Catch sight of the beautiful. Remark on the unusual. Notice the changing seasons. Savour the moment, whether you are walking to work, eating lunch or talking to friends. Be aware of the world around you and what you are feeling. Reflecting on your experiences will help you appreciate what matters to you.

• Keep learning… Try something new. Rediscover an old interest. Sign up for that course. Take on a different responsibility at work. Fix a bike. Learn to play an instrument or how to cook your favourite food. Set a challenge you enjoy achieving. Learning new things will make you more confident as well as being fun.

• Give… Do something nice for a friend, or a stranger. Thank someone. Smile. Volunteer your time. Join a community group. Look out, as well as in. Seeing yourself, and your happiness, as linked to the wider community can be incredibly rewarding and creates connections with the people around you.

Through engagement with a range of partners, the Five Ways to Wellbeing have been identified as the pillars on which to base the West Sussex Wellbeing and Resilience Framework.

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1. Background and Introduction

A Resilience and Wellbeing Framework is one of the three priorities of the West Sussex Joint Health and Wellbeing Strategy, 2015-18. The aim of the framework is to achieve a comprehensive system to support wellbeing and resilience for the whole of the West Sussex population that is locally based and better integrated. A Resilience and Wellbeing sub-group of the Health and Wellbeing Board has made 7 thematic recommendations and proposed an overarching framework for a system wide approach to improve wellbeing and strengthen resilience that built on the New Economic Foundation Five Ways to Wellbeing. The recommendations to reduce social isolation in the report of a WSCC Executive Task and Finish Group informed the focus on Resilience and Wellbeing. A Resilience and Wellbeing workshop was held on November 25th 2016 to gain input and support from a wider group of stakeholders, for the Resilience and Wellbeing Framework. The workshop was attended by over 60 participants and:

Shared how wellbeing and resilience research, evidence and approaches, across life course and settings can be translated into local delivery and how it has informed the Framework content

Gained commitment to a systematic approach to embed approaches which improve wellbeing and strengthen resilience and ensured that the Wellbeing and Resilience Framework is co-produced

Built a coalition of the people and organisations who will build on resident and community strengths across the whole system and co-create transformational change to improve the resilience and wellbeing of people and communities.

This report outlines the proposed Framework for Resilience and Wellbeing (pages 6 and 7); a Strategic Action Plan for implementation (pages 9 and 10); examples of existing and proposed programmes (page 8); an example of a tool to support a system-wide approach and the potential impacts on health and wellbeing outcomes (Appendix B).

2. The Wellbeing and Resilience Framework

Aligned to, and guided by, the activity to date, the Public Health Directorate are leading on the development of a Framework which will improve wellbeing and strengthen resilience for the whole of the West Sussex population.

The framework, Diagram 1 on pages 6 and 7, illustrates how consideration and integration of the Five Ways to Wellbeing will support system-wide approaches to support and improve the wellbeing and resilience of individuals and communities.

Embedded within the framework is a focus on improving the quantity and quality of social connections, and reducing social isolation; key tenets which contribute to improved wellbeing and resilience.

Implementation of the framework will be informed by recommendations within the Social Isolation Task and Finish Group report, and by thematic learning from the November workshop.

Running in parallel with, and supporting delivery of the framework and learning from the workshop, is a cross-sector strategy group (Appendix E) whose focus is to steer the framework’s strategic integration and apply transformation change theory (Appendix D).

Strategic integration as part of a system wide approach will support strategy, policy, commissioning, service delivery, communities and work with individual residents to embed approaches which improve wellbeing and strengthen resilience.

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As part of system wide integration, approaches will be embedded through both settings (i.e. schools, workplaces) and places (i.e. communities, localities).

The impact of the framework and systems wide approach to improve wellbeing and strengthen resilience will be measured through a mental wellbeing impact assessment and West Sussex case study.

On pages 9 and 10 there is a strategic action plan which demonstrates how operational activity will be influenced to improve wellbeing and strengthen resilience.

On page 8 there are examples of how the workshop and draft framework has influenced, and is aligned to system wide activity.

3. What the Framework will achieve

The framework will support and guide the ‘system’ (including public, private, community and voluntary services, and communities themselves) to understand and strengthen the things that make people’s lives go well, so that people live the life they want. It will provide clarity on why wellbeing and resilience are important, and how they will be systematically improved and strengthened with West Sussex residents, and for all ages. The framework aims to increase positive social connections; reducing the number of people socially isolated and experiencing feelings of loneliness. Lacking social connections is as damaging to health as smoking 15 cigarettes a day. Social networks and friendships reduce the risk of mortality and developing certain diseases. They also help individuals to recover when they do fall ill. We want communities and residents to flourish. Although wellbeing and resilience are already important outcomes for many of our services, there is more that can be done. By drawing together key priorities and working across geographical places and partnerships (including local Health and Wellbeing Partnerships), guided by a Wellbeing and Resilience Framework, we can make a long-term impact on the wellbeing and resilience of our communities and residents.

4. Framework outcomes

Outcomes resulting from a system-wide approach to improving resilience and wellbeing and potential measures affected will include:

An increase in the quantity and quality of social connections, and reduced social isolation and feelings of loneliness.- with potential measures being:

o % of adult social care users / carers in West Sussex have as much social contact as they would like

o % of residents who feel there are enough people they feel close to

Improved readiness for school. Potential measure being: o % of children achieving a good level of development at the end of reception

Improved population wellbeing. Potential measure being: o Demonstration that children, young people and adults of all ages are supported to

identify and apply their personal strengths Other specific and more granular outcomes will be identified at service, community and individual level.

5. Impact of the November workshop on the Wellbeing and Resilience Framework

At the workshop, attendees consulted on a draft Wellbeing and Resilience Framework (Appendix A) and how it can be adapted for local use. A Wellbeing and Resilience Analytical Tool (Appendix B) was used to understand how resident wellbeing and resilience is, and will be better, supported as a result of this systematic approach, at an individual, community, service, commissioning, strategy and policy level.

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The workshop was successful (see Appendix C) in building a guiding coalition as part of creating transformational change (see Appendix D) with regards to wellbeing and resilience. The Public Health Directorate are transcribing the information collected at the workshop and drawing out key thematic learning to inform and finalise the Framework structure, function and content, as well as to inform strategy and actions to embed a systematic approach to transformational change. Based on the early thematic learning, the Framework has been adapted from that in Appendix A so that the Five Ways to Wellbeing are core principles throughout, and yet a broad impact across wellbeing (including psychological, social and emotional) and resilience is maintained. The Framework will need to be user-friendly, and attendees have asked for a non-paper based product to support framework implementation (such as an interactive electronic toolkit). The following diagram shows the strategic framework layout and purpose, and demonstrates how settings, places and organisations will embed approaches to improve wellbeing and strengthen resilience. More specific operational information on Framework implementation will be informed by the thematic learning from the workshop.

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Diagram1. Revised Wellbeing and Resilience Framework following the November workshop

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6. Examples of the influence and impact of the November workshop and draft Resilience and Wellbeing Framework

The workshop gained wide commitment to taking forward the Framework. Examples of how the workshop and draft framework has influenced, and is aligned to system wide activity, include:

Impact on Systems An example of systems change is the WSCC Communities Directorate who, following the workshop, have proposed a move towards:

o A commitment to using the assessment framework as a ‘sense check’ for their work programmes and ways of working.

o A review of ‘grant’ bidding criteria, including focus on five ways to wellbeing, and to concentrate support to infrastructure organisations around wellbeing & resilience

o Raising awareness of the Wellbeing and Resilience agenda across their workforce o An exploration of effective mechanisms to collect evidence using a suite of relevant

tools including case studies.

Examples of key programmes and settings which already embed, or have the opportunity to use the framework to embed, wellbeing and resilience promoting approaches, include:

o The West Sussex Social Prescribing pilot programmes in Adur & Worthing and in Crawley

o Whole-school approaches to strengthen resilience for all pupils o Transformation programmes, such as Integrated Prevention and Early Help

Example of how the Framework embeds Social Isolation Task and Finish Group Recommendations

The Framework embeds a focus on increasing the quantity and quality of social connections at an individual, community, commissioning/provision and strategy level.

The Framework places a requirement and expectation on partners across the system to consider how they can increase positive social connections.

Social prescribing is a key way to impact on the determinants of wellbeing and resilience. All services should consider how they can support the Five Ways to Wellbeing, directly and indirectly (including through signposting and referral).

The Framework embeds wellbeing and resilience at a strategy and policy level. It requires: o Decision-making processes, in addition to the focus on reducing social isolation, to aim

to increase positive social connections for the whole population, including, but not exclusively, those who are socially isolated.

o Organisational leadership to identify how increasing positive social connections, and the Five Ways to Wellbeing, can be embedded throughout core business.

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7. Next Steps – Strategic Action Plan

Strategic Action Why this will improve wellbeing

and strengthen resilience Leads and timeframe

Strategic Action 1 – Develop and use tool kit to support system wide integration of wellbeing and resilience

1.1 Pilot the impact of, and finalise, the paper-based Wellbeing and Resilience Framework (pages 6 & 7), based on workshop engagement & activity to date.

The Framework will provide an easy to use paper based impact assessment tool for all on how their role/ organisation/ service will have maximum benefit on resident wellbeing and resilience.

Public Health Directorate, Strategy Group

January to March 2017 Pilot draft framework

April 2017 - Finalise co-designed framework

1.2 Develop and integrate an interactive and user friendly electronic Wellbeing and Resilience tool kit, tailored for settings, places and systems, based on workshop engagement and activity to date

A strong theme from workshop engagement is that the Framework must go beyond a paper document for it to be embedded. The Tool Kit will be adaptable to operationalise the framework and support integration into organisations, programmes, policy, strategy, services and place based activity.

Strategy Group, Guiding coalition

March to July 2017 – Development of toolkit

July to December 2017 - Strategy Group will support partners in the use of the tool kit, in order for it to become embedded

December 2017 – tool kit becomes ‘business as usual’

1.3 Collate & communicate system wide commitment to embed approaches. This will ensure the thematic learning & commitment made from partners at the workshop is incorporated into approaches to embed and take forward the framework

This will demonstrate coordinated system wide activity to improve wellbeing and strengthen resilience

Public Health Directorate, Strategy Group

May 2017

Strategic Action 2 - Drive system wide implementation

2.1 Engagement with the West Sussex Health and Wellbeing Board

The HWB will be able to support and drive forward the required systems wide approach

February 2017

2.2 Strategy Group to build on the work already done to drive system wide transformational change to improve wellbeing and strengthen resilience, through: Policy and Strategy

This is part of a system wide approach identified by nef (New Economics Foundation) to improve wellbeing and strengthen resilience for the whole population

Wellbeing and Resilience Strategy Group, Organisational leadership, Commissioners and service providers, Community teams and community and voluntary sector groups, All front line staff, volunteers working with all ages

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Commissioning and service delivery

Communities and Groups

Work with individuals 2.3 Settings based

approaches use the framework and toolkit to inform and drive activity:

Work with partners and schools to inform, influence and deliver whole school approaches to build pupil resilience

Settings would include schools, which require whole-school approaches to improve the resilience of all pupils.

Whole school resilience reference group

August 2017 – Communication, engagement and action plan for whole school approaches

2.4 Placed based approaches use the framework and toolkit to inform and drive activity: Work with district and

borough health, wellbeing and local strategic partnerships to incorporate a comprehensive local understanding of community strengths and joint action to improve wellbeing and strengthen resilience

Support the evaluation of social prescribing pilots in Crawley and Adur/ Worthing.

To develop place based and geographical activity through local partnership infrastructure

Strategy Group

Strategic Action 3 - Measure and demonstrate impact

3.1 Impact assessment of the Wellbeing and Resilience Framework, tools and resulting activity

To understand the impact of this work

Public Health Directorate, Strategy Group

3.2 Development of high level dashboard to demonstrate the impact of the framework and supporting tool kit

To understand the impact of this work

Public Health Directorate, Strategy Group

3.3 Write a West Sussex case study on the impact of a system wide approach to improve wellbeing and strengthen resilience

Public Health England, who presented at the November workshop, have asked that we write a case study which can inform national learning

Public Health Directorate, Strategy Group

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8. Recommendations

It is recommended that The Health and Wellbeing Board support the work of the Wellbeing and Resilience Strategy Group in driving forward the Strategic Action Plan as set out in Section 7 of the report.

Appendix A: Draft West Sussex Wellbeing and Resilience Assessment Tool This draft assessment tool was used to engage with workshop attendees on how services, organisations, programmes and communities

can work together to ensure strategy, policy, programmes, developmental approaches, services and projects have maximum equitable

impact on individual and community wellbeing and resilience. This draft assessment tool adopts Public Health England’s Mental Health

Assessment Tooli, and seeks to embed the Five Ways to Wellbeing, psychological and emotional skills and capacity development.

Question Issues to consider

1 How does the programme/ service/ organisation impact positively or negatively on different populations and the wider determinants of health?

a. Which populations’ wellbeing and resilience is impacted most and least, depending on age, gender, race & ethnicity, socioeconomic position, physical health & disability, sexuality & transgender or other groups?

b. What is the positive and negative impact on housing quality, physical environment, economic security, good quality food, leisure opportunities, poverty, local democracy, transport, public services, and education?

2 How does the programme/ service/ organisation impact positively or negatively to increase people’s control over their health?

a. How does it build personal control over health and self-determination?

b. How does it enable people to maintain independence and choice?

c. How does it empower communities and society to have more control over health?

d. How does it enable people and communities to shape and have influence on their environment and circumstances?

3 How does the programme/ service/ organisation impact positively or negatively to increase personal wellbeing, resilience and community assets?

a. How does the programme address individual psychological and emotional skills and abilities e.g. self-esteem, self-worth, optimism, problem solving, decision making, emotional intelligence?

b. How does it address health as a positive asset and protective factor (rather than disease, deficits, risks)?

c. How does it embed the Five Ways to Wellbeing at individual or community level?

Connect - how does it address the importance of social networks and relationships?

Be active - how does it incorporate or embed physical activity within people’s lives?

Take notice – how does it strengthen emotional intelligence and living life in the present?

Keep learning – how does it engage people in a situation or activity? How does it help people to have meaning and accomplishment (i.e. to have challenges, goals, plans, and to better ourselves in some way)?

Give – how does it enable people to see themselves, and their happiness, linked to the wider community?

d. What community development approaches are used to build community assets and healthy places?

4 How does the programme/ service/ organisation impact positively or negatively to facilitate participation and inclusion?

a. How is it influenced by the views of recipients and citizens?

b. How does it maintain and enhance people’s participation in society e.g. valued roles and identity?

c. How does it mitigate social exclusion and address it as a cause or consequence of ill-health?

5 What are the next steps? a. Is there anything you can do to make it more likely that your work will address the above factors?

b. Have your answers identified gaps in knowledge or evidence? If so, are these important gaps that need to be addressed and how will you address them?

c. Have your answers identified further deliverables that have the potential to improve wellbeing?

d. Do your answers have implications for workforce development?

Appendix B: Wellbeing and Resilience Analytical Tool Activity in West Sussex will impact on wellbeing and resilience either directly, or indirectly. Direct impact includes activity that promotes wellbeing and resilience as the main objective. Indirect impact includes an integrated consideration of wellbeing and resilience within the design of an activity, that may have main objectives relating to other areas. At the workshop, attendees identified their current and future direct and indirect impact on wellbeing and resilience for individuals, groups/communities, organisations and policies/strategies. The framework below, adapted from one designed by the New Economics Foundation (nef), provides information on how.

Point of engagement

Individuals Improvements to individuals’

wellbeing & resilience arise through their own deliberate

actions

Groups/Communities Improvements to individuals’ wellbeing & resilience arise as the result of activity affecting

the group / community of which they are members

Organisations Improvements to individuals’

wellbeing & resilience arise as the result of activity affecting the

organisation where they work or service with which they interact

Policies/Strategies Improvements to individuals’

wellbeing & resilience arise as the result of activities that influence the wider circumstances in which people

live and work

Pri

nci

ple

pu

rpo

se

Improving wellbeing & resilience directly Distinct and defined activities / interventions

that focus on improving wellbeing and resilience as the main objective

Application of an approach to improve wellbeing and resilience, that motivates individual action on wellbeing and resilience

Application of an approach to improve wellbeing & resilience, that motivates or facilitates action on wellbeing and resilience within groups / communities

Application of an approach to improve wellbeing & resilience, that motivates or facilitates action on wellbeing and resilience within organisational and service settings

Application of an approach to improve wellbeing and resilience, in developing strategies and policies targeted at improving wellbeing and resilience

Improving wellbeing & resilience indirectly A consideration for wellbeing and resilience is

integrated into the design and/ or implementation of activities / initiatives that

have other objectives

Integration of a wellbeing and resilience promoting approach within activities designed to galvanise individual action on non-direct wellbeing / resilience related issues

Integration of a wellbeing and resilience promoting approach within the design and delivery of initiatives designed to impact on groups / communities

Integration of a wellbeing and resilience promoting approach within existing systems, processes and activity designed to influence ways of working

Integration of a wellbeing and resilience promoting approach within strategy and policy

Appendix C: Workshop success in achieving objectives

Appendix D: Kotter’s 8 step change model

Appendix E: Wellbeing and Resilience Strategy Group Members The Wellbeing and Resilience Strategy Group will steer the strategic integration of the Framework and associated products. They will also have an active role in developing and finalising the Framework and these products. Strategy Group members include: - Alex Bailey, CEO, Adur and Worthing Councils - Tina Favier, Communities Lead, Adur and Worthing Councils - Mary D’Arcy – Director of Communities, Adur and Worthing Councils - Ann Corkery – Consultant in Public Health – WSCC - Graeme Potter – Public Health Lead – Start of Life, WSCC - Debra Balfour – Communities and Public Protection, WSCC - Rani Dillon – Clinical Lead for HWB Coastal CCGs - Chris Tuke – Commissioning Manager – Think Family. WSCC - Gabriella Oakley – Development Manager, BH Community Works - Jenny Musgrove – Manager, Carers Support - Lisa Phillips – Manager, Crawley CVS - Emily King – Principle Manager, Community Safety and Wellbeing, WSCC - Margaret Enstone – Senior Advisor, Sustainability Team, WSCC - Sally Tabbner – Contracts and Commissioning Manager, WSCC - Malcolm Bray – Programme Director, Crawley CCG - Jacqueline Clay – Principal Manager, West Sussex Public Health Research Unit, WSCC

i Public Health England. Mental Health Assessment Tool. Adapted from the MWIA Toolkit and Checklist 2001