The market position statement gives our position for the care of older people, adults with physical disabilities, mental health needs or learning disabilities.

This will benefit providers of care and support services in North Yorkshire. It will help identify what the future demand for care will be and form a starting point for discussions between us and those who provide or wish to provide care services.

We values our relationship with service providers. Any market position statement and following actions needs to involve providers. We work closely with the Independent Care Group (ICG) who represent North Yorkshire providers. A key area of work for 2018/19 is to move towards integrated commissioning arrangements.

Market position statement purpose

The market position statement includes key information for current and future providers to assist them with service development. It contains:

  • how North Yorkshire looks with current and future demographics and service provision;
  • our intentions as a facilitator of care for people needing adult social care;
  • our vision for how services might respond to the changing needs for care and support in the future; and
  • the emerging picture of services within an integrated health market.

This statement builds on previous discussions which indicated that we would develop reablement arrangements and that the bulk of domiciliary care services would be provided by the independent sector. This would assist us in our aim to reduce the number of people having to move into residential care. It builds in the market position statement published in 2013.

This market position statement looks forward to how we wish to meet the demands of providing social care across a rural and diverse county. We plan to add to the market position statement to take into account the specialist areas that are important to providers and ourselves. These will include:

  • services to self-funders;
  • joint commissioning with clinical commissioning groups;
  • specialist services; and
  • preparing for adulthood (previously referred to a transitions).

North Yorkshire is a large rural authority. The opportunities and difficulties this brings to service delivery and to people’s ability to access universal services are understood. As is people's ability to develop and maintain social networks, particularly for those from a minority group. Market development will be key to providing services in rural communities, including community solutions such as community hubs, micro providers and the involvement of user-led organisations. This needs to be combined with achieving a mix of health and adult services and independent provision. For commissioning and administrative purposes, health and adult services is divided into geographical areas of Harrogate; Craven; Scarborough; Whitby; Ryedale; Hambleton; Richmondshire; and Selby.

The five Clinical Commissioning Groups (CCGs) are responsible for the local commissioning of health services. They help to develop more integrated working arrangements between health and adult services and the NHS. This leads to fewer unnecessary hospital and long term residential care admissions by targeting people most at risk of losing their independence.

We offer support and a wide range of local social care services. We do this by either directly providing services or by offering information, advice and guidance about local services so people can arrange care and support themselves. We provide care and support to older people, people with learning disabilities, mental health conditions, physical disabilities, sensory impairment, those with substance misuse problems and other vulnerable groups. We also offer care and support to people’s carers. We have continued to encourage people to think about their own health and wellbeing and have supported community groups around the county to promote community resilience.

We commission and provide quality services to North Yorkshire residents, recognising that they wish to live independently in their own homes for as long as possible.

The Care Act 2014 is the biggest change to adult social care in recent times. It includes major changes in how the law on adult social care works, placing more importance on advice and information, prevention and market shaping.

The act introduces new challenges for commissioners and providers but also opportunities for service development.

Legislation makes it clear that future market shaping and commissioning must focus on:

  • provision of good information and advice;
  • the needs of a person and ability to achieve outcomes;
  • promoting a person’s wellbeing;
  • promoting quality services, including through workforce development and remuneration and ensuring appropriately resourced care and support;
  • supporting sustainability;
  • ensuring choice;
  • co-production with partners; and
  • effective engagement and joint working with providers.

The current and future levels of resourcing 

Like many councils across the country, we are still facing increasing pressure on finances.

What we spend on adult social care

In 2016/17 we spent £139 million on adult social care services, £130 million of this was spent on care services purchased from the independent or voluntary sector with the remainder spent on assessment and the provision of our own in-house care services, buildings, transport and running costs.

More financial information can be found in our local account.

Charging

People are required to pay towards the cost of their care. The amount that they pay is calculated by completing a means tested financial assessment. This is carried out by applying statutory guidance issued by the Department of Health and more specifically the Care Act 2014.

Details of how services are charged for are available here:

Personal Budgets

A personal budget is an amount of money allocated to a person who is eligible for social care services following an assessment of needs. While some people chose to take their personal budget as a direct payment and manage the money and support themselves, health and adult services has also explored other ways in which clients can spend their personal budgets without taking on the full responsibility of a direct payment.

In 2016/17 we provided services to 10,500 people.

In 2016/17 we received 72,000 enquiries relating to adult social care.

The adult social care customer profile at 31st March 2017, for active clients in North Yorkshire, shows that 2,970 people aged 18 to 64 receive a social care service, as well as 4,935 people aged over 65.

Within the 18-64 age group, there are 1,475 people who have a learning disability and 635 with a physical disability, including 75 people with a sensory impairment. People with mental health or substance misuse problems make up the remaining 670 of the 18-64 group.

For further population data visit the Joint strategic needs assessment website.

North Yorkshire social care market

For more information about the adult social care market in North Yorkshire see  2018/19 state of the care market (pdf / 3 MB). This presentation outlines a number of care market headlines and challenges which health and adult services need to address.

The demand on the adult social care market in North Yorkshire:

  • North Yorkshire has an older population profile than the country as a whole. This is forecast to result in 25,000 additional people aged 65+ who will be unable to manage at least one self-care activity on their own by 2035.
  • The large, rural nature of the county and it's sparse population makes access to services and meeting clients' needs more complicated.
  • Low levels of income deprivation and benefit receipt amongst older people, but the highest level of fuel poverty in the region.
  • Higher than national rates of adults with physical disabilities, learning disabilities, mental health problems and older people supported throughout the year.
  • 33% of dementia cases are estimated to be undiagnosed.
  • Increasing numbers of older people with a learning disability.

Commissioning intentions

Extra care commissioning intentions

We will:

  • Work with providers on our extra care housing framework to develop and deliver new extra care schemes across the county.
  • Encourage and support proposals for new extra care housing schemes outside of the framework where such a scheme would be consistent with our needs, aspirations and requirements for extra care housing and would not require any form of financial contribution from the Council.
  • Continue to work with the market, partners and stakeholders to consider how extra care housing schemes can contribute to the challenges faced by us and other public sector partners. These challenges include integrated service delivery with the NHS and the increasing number of people living with dementia.

Where we are now

Extra care housing is the basis of our approach to keeping people healthy and able to live at home in supportive local communities, so reducing the demand for more intensive services.

There are currently 22 extra care schemes across the county providing 1,111 units of accommodation with further schemes planned or in the pipeline.

Extra care housing provides high quality accommodation enabling people to live independently, in their own home, with access to care and support 24 hours a day, 7 days a week. There is also access to other facilities such as restaurants, hairdressers, shops and library facilities. For example, Sycamore Hall in Bainbridge provides a village shop, library and post office as well as accommodation with care and support.

Extra care housing is a vital part of our programme of prevention; by addresses one of our key challenges, an ageing population. However, it's impact spreads far wider than this. It brings employment opportunities, resilience and regeneration to our communities.

Our care and support strategy Where I Live shows our vision to meet people’s needs now and into the future. It sets out proposals for transforming services to ensure people can remain safe and independent in their own homes. In addition to improving the amount and quality of accommodation with care and support across the county by 2020 and meet financial savings.

A key element of the strategy is to build on the success of the extra care programme so far by:

  • Expanding the number of extra care housing schemes provided across the county.
  • Ensuring schemes meet the requirements of future generations. Better placed to meet the needs of people living with dementia, the changing aspirations of the wider population and play a pivotal role in the community to ensure North Yorkshire towns and villages are active, thriving and stronger places to live.

In 2015 we appointed six organisations to our Extra Care Housing Framework. Work is already underway to commission and procure new extra care housing schemes through the framework.

Work is also taking place with clinical commissioning groups and extra care housing providers in a number of areas across the county to consider the use of units with schemes to deliver intermediate care, rehabilitation and respite services where appropriate.

Additional information

View a list of extra care housing schemes in North Yorkshire or see their locations on a map.

Commissioning Intentions

  • To ensure the availability of statutory advocacy services that meet the expectations of the Care Act 2014 and Mental Capacity Act 2005. 
  • To provide, within resources available, non-statutory advocacy for vulnerable groups.

Where we are now

An independent advocate supports and works alongside people who find it difficult to have a say in their care and services, and do not have someone to help them with this. Independent means the service is not controlled by health and adult services and only thinks about what the people they are supporting want.

Independent advocacy is about giving people as much control as possible in their lives. Advocates help people understand information, say what they want and what they need and ensure this is achieved.

We have commissioned a contract with Total Advocacy which runs until 2021. The contract covers the range of statutory advocacy with an element of non-statutory advocacy.

We have issued a short questionnaire to the market around interest in future advocacy services which can be accessed through YORTender.

Demand for the service is monitored regularly. The demand for independent mental health, independent mental capacity and RPR has continued to rise over the period of the contract. This means the capacity for non-statutory advocacy is becoming more limited.

We are also planning for the introduction of Liberty Protection Safeguards, replacing Deprivation of Liberty Safeguards.

Additional information

Carers

Commissioning intentions

The North Yorkshire Carers strategy  Carers for Carers 2017 - 2022 (pdf / 956 KB) sets out a vision on behalf of partners on the Health and Wellbeing Board that people in all communities in North Yorkshire have equal opportunities to live long, healthy lives.

This will mean carers can live long and healthy lives and be able to continue to care as long as possible and as long as they want to. We want to encourage more carer friendly communities and promote carer issues across wider society.

Where we are now

Our Caring for Carers strategy outlines our commitments within 6 priority areas: 

  • improving identification of carers;
  • improving information and advice;
  • enabling carers to take a break;
  • improving carers health and wellbeing;
  • enhancing financial wellbeing; and
  • involving carers as experts.

Carers are recognised and supported by a number of our commissioned services. We also commission 2 services that are solely focussed on carers. The Carers’ Support Service provides support in:

  • identification and recognition of carers;
  • information provision and undertaking short carers assessments;
  • assisting the mental & physical well-being of carers;
  • helping carers to have a life outside of caring;
  • promoting carers as expert care partners; and
  • support for young carers transitioning into adult carer support.

The Carers Break Service gives carers a chance to have a break from their caring responsibilities while a trained volunteer sitter accompanies the person they care for. It helps carers to have a life of their own, participate in activities and goals they have for themselves, and promotes their wellbeing.

We are currently looking at ways in which people with a caring role can feel supported, ensuring that appropriate community services are in place, we are also looking at the carer pathway. 

Additional information

Commissioning Intention

The anticipated benefits of targeted prevention are:

  • people will be safe and independent;
  • people will experience wellbeing;
  • people will experience economic wellbeing;
  • prevention will be the norm across health and social care; and
  • carers will be healthy and experience wellbeing.

The intention is to commission services that support delivery of these benefits.

It is expected that there will be savings accruing from a reduction in the number of people receiving support from our social care teams resulting in on-going care and support.

Delivering these benefits will come from a range of approaches within Health and social care, across the Council and from commissioned services. All these areas are overseen by an internal targeted prevention board.

  • livings well operational service (in house);
  • prevention and wellbeing (commissioned service);
  • income maximisation service (in house); and
  • promoting strong and resilient communities (stronger communities - in house)

Where we are now

The living well service has been operational since October 2015 working with individuals (and their carers) who are on the cusp of becoming regular users of health and social care services. The service helps them to access their local community and supports them to find their own solutions to their health and wellbeing goals.

Living well supports adults who are currently not eligible for on-going social care support and who:

  • are lonely and/or socially isolated;
  • have had a recent loss of a support network (including bereavement);
  • have had a loss of confidence due to a recent change/event; or
  • require face to face information, advice and guidance.

This may be older people or people with physical, learning disabilities, sensory impairment or mental health needs.

They aim to identify opportunities in their local community to help keep them as independent as possible. This includes social activities, volunteering opportunities, healthy lifestyle activities and support with practical advice and skills.

Promoting strong and resilient communities (stronger communities). In the first year the aim is to:

  • gain an understanding of the range, capacity, resilience and diversity of the existing community asset base;
  • pilot some new and innovative approaches;
  • invest in existing VCSE groups to build capacity and organisational strength; and
  • support services in the implementation of ambitious restructuring and efficiency programmes (libraries, universal youth services, community transport and adult targeted prevention).

During 2016/17 there was greater emphasis on utilising local intelligence and closer working with other targeted prevention services, and national research, for a more targeted approach to investment in new and existing community led prevention services to reduce, prevent or delay demand in social care. 2016/17 saw over £700k invested in voluntary and community groups providing services across the county, this is around 65% of our total investment.

A new community based physical activity service has been commissioned on behalf of public health. To provide age and physical ability appropriate activities across North Yorkshire for adults who are at risk of falls, increasing frailty, or loneliness and social isolation.

Stronger communities complements the work of living well by enabling a strong and vibrant voluntary and community sector. This will remain a key focus during 2017/18, with support being progressively directed at activities and services that are evidence based to promote wellbeing, in accordance with the investment prospectus.

Health and adult services currently commission a small number of community-based wellbeing and prevention services. Primarily supporting older people, these contracts cover a range of different types of services across the following key delivery areas:

  • support to address social isolation and loneliness;
  • supporting people’s independence in their own homes; and
  • information and advice.

New arrangements for delivery of services will need to be in place for when the current contracts end on the 1 October 2018.

Stronger communities

Commissioning intentions

  • Commission a long term (circa 5 years) evaluation of the new stronger communities investment programme – Inspire, Achieve, Innovate. Timescales for commission is approximately the next 3-6 months. The value is roughly £100k for the whole life term.
  • To publish and award Innovate (contract and grant). This has replaced the Innovation Fund. Each year a small sum of money will be available to deliver a countywide project that supports one of the key themes or priorities of the programme. The first year around new models of care and targeted particularly at social enterprises. Timescale for the commission is approximately the next 3-6 months.
  • Stronger communities have been heavily involved in the prevention contracts review, which is currently out for consultation. Current contracts are due to expire in September 2018 and depending on the outcome of the consultation, and the proposed form of future investment, stronger communities may be asked to take the lead on their re-commission. Timescales for the commission is approximately the next 6-9 months. The future value is roughly £50k for the whole life term (commissioned annually).

Where we are now

A grant agreement for community based targeted and universal physical activity services for older people was signed with North Yorkshire Sport in November 2017. This is currently in it's implementation period with a value of £300k for the whole life term. It is a three year agreement to expire in December 2020 and is not up for renewal.

An approved provider list for specialist consultancy support for the voluntary, community and social enterprise sector was established in November 2016. Interested providers can apply at any time and applications are reviewed every two months. The approved provider list expires at the end of March 2020.

Additional information

View the approved provider list for grant funded consultancy support for stronger communities.

Commissioning intention

To provide effective support and initiatives across North Yorkshire that support wellbeing, enable people to have good mental health and recover from mental health problems. 

Where we are now

The North Yorkshire mental health strategy 'Hope, Control and Choice' sets out North Yorkshire's overarching strategy for developing mental health services and promoting wellbeing from 2015-2020.

The strategy sets out a number of commitments under three priority areas of resilience, responsiveness and reaching out.

These commitments include:

  • public health awareness-raising campaigns to tackle stigma and discrimination;
  • working through the county council's stronger communities programme to introduce a range of local wellbeing initiatives;
  • new programmes to promote good mental health from birth onwards to help children and young people stay strong;
  • working with employers to promote good mental health in the workplace;
  • improving access to "talking therapies" in North Yorkshire;
  • timely diagnosis of dementia and the introduction of dementia-friendly communities across North Yorkshire;
  • working in new ways in both health and social care to take into account the full range of people's needs, including their physical health; and
  • bring together annually North Yorkshire mental health champions to share best practice and to offer challenge.

We currently provide a range of secondary care mental health services across North Yorkshire in partnership with other local mental health trusts - Tees Esk Wear Valley and Bradford District Care Trust.

We also commission a range of wellbeing and community support mental health services. These include housing-related support, mental health resource centres and day services, employment support services and befriending schemes.

We have reviewed commissioned adults mental health community support provision, taking into account local needs and programmes of mental health improvement.

We are currently undertaking a full review of our mental health supported housing contracts, of which there are nine across the county, to inform our future commissioning intentions. The current contracts are due to end on 31 September 2020.

Additional information

Hope, Control and Choice strategy.

Commissioning intentions

  • To commission domiciliary care services that move beyond the traditional 'time and task' model and instead focus on outcomes for the person receiving care and support.
  • To develop new approaches to support people in their own homes.
  • To become a variable market with different commissioning models operating in each area to best reflect local needs and demands. Frameworks have been implemented in Harrogate and Selby but it should not be assumed that this will be the approach elsewhere in North Yorkshire.
  • To drive the use of family and community support alongside traditional care and support elements through the use of Individual Service Funds.
  • Look to co-commission with or work closely alongside health commissioners, especially in areas of low population density. We will expect providers to expand their staff skill base to include generic health tasks as laid out in the Domiciliary Care Service Specification.
  • In areas where care is particularly difficult to source we may look to increase our in-house presence and will, where necessary, become the default care provider for directly commissioned care.

Where we are now

We expect providers to be flexible, forward looking, aware of changing legislation and policy, innovative in delivery and pro-active in seeking to promote independence and wellbeing.

We expect providers to work closely with our reablement service to ensure people remain as independent as possible. We expect providers to identify people with reablement potential and work with us to ensure everyone achieves their potential.

We held a care summit to share our thinking with current and prospective providers. We explored new approaches which could benefit the people we support and the market. We captured ideas put forward by providers and made links with providers who want o pilot a new way of working. This was the first step of many to encourage innovation, starting positive dialogue with the market and creating ideas which will challenge us all. There was great enthusiasm to work together to make positive changes.

As is the case in many local authorities the majority of care hours are delivered by a small group of large providers with a large number of smaller providers operating in distinct localities and communities.

The current market operates under an open approved provider list which was renewed in 2016. Whilst having an open list on this scale has led to an abundance of choice for people receiving services it has also meant that the task of managing and monitoring all providers has become increasingly difficult. Over the past two years we have taken initial steps towards creating a more structured and controlled market for domiciliary care. In two of our more urban areas, Harrogate town and Selby District, we have awarded framework contracts.

The decision to implement framework contracts in these areas was based on the specific needs of the localities and the opportunities this offered providers, however the decision also reflects a more substantial shift in how we commission and monitor services and the standards we expect from providers – not just in terms of traditional quality and monitoring but also in ethos and approach.

There is extremely limited provision in some of the more rural parts of the county, for example in the Dales and south Ryedale. In these areas alternative approaches are being considered which, if successful, could be expanded to other parts of the county. This includes a group of providers working together to determine the best way of delivering a service to a group of people in a specific locality.

We are also exploring the potential of using e-MAR charts to record administration of medication and how this could aid and improve the quality of care.

87.8% of older people aged 65+ are still at home 91 days after discharge from hospital into reablement or rehabilitation services as reported by the Adult Social Care Outcomes Framework (ASCOF) 2B(1)).

Commissioning intentions

A range of health and social care services that aim to:

  • reduce the numbers of unplanned admissions to hospital;
  • develop new ways of working;
  • support people to remain independent in their own home for as long as possible; and
  • share information across agencies to help reduce duplication and enable services to work more effectively together, for the benefit of people using services.

Where are we now

The North Yorkshire Health and Wellbeing Board, made of partner organisation form across the county, updated the Joint Health and Wellbeing Strategy. The updated strategy restates the board’s commitment to improving health and wellbeing and sets out how we want to continue to improve services.

The five themes, connected communities; start well; live well; age well and dying well set out a number of outcomes aimed at ensuring people in all communities in North Yorkshire have equal opportunities to live full and active lives from childhood to later years.

To help deliver these improvements, the strategy recognises the importance of developing a new relationship with people who use services. The board wants people to have a bigger say over their own care and how they manage their lives.  

Getting this right means that as our needs change we can look after ourselves and each other for longer and that people can get the right help at the right time.

There are some things that have a direct impact on how well partners deliver this strategy, for example, having a skilled, motivated and flexible workforce, effective technology and economic prosperity across the communities that live and work within North Yorkshire.

Partners have principles to support delivery of the changes described in the strategy including the need to join things up to make life simpler. An example of how this is already happening can be seen in the establishment of the North Yorkshire Better Care Fund.

Additional information

Our vision for the 'Live Well, Live Longer' strategy 2017-22 is:

"People with a learning disability should have the opportunity to live long and healthy lives. They should be supported to exercise choice in their daily lives, feel happy, safe and supported, be active and fulfil their potential, enjoy the best health and wellbeing possible and, be respected and treated with dignity."

Throughout the lifetime of the strategy, we aspire for people to live longer, healthier and more independent lives. The strategy action plan has the following priorities:

  1. Personalisation and choice - People will have real choice and control over how their personal outcomes are achieved.
  2. Prevention, early help, treatment, support and care - A greater focus on early intervention and prevention in terms of health treatment will help to tackle health inequalities and reduce premature deaths.
  3. Right care in the right place; maximise and enhance community support - We will maximise support available in the community using a person-centred approach to service delivery.
  4. Empowerment and enablement - We will provide advice and support people to do things for themselves rather than 'doing it for them'.
  5. Caring for the carers - We want to ensure that carers in North Yorkshire receive the right level of support.
  6. Preparing for adulthood - pathways into adulthood, including local personalised learning for young people from the age of 19 with the most complex needs and ensure that they are equipped with the right skills to achieve their individual outcomes.

Where we are now

Our strategy action plan will give the actions needed over the next five years to deliver the strategy with the resources available. 

This action plan and it’s implementation is co-produced with people with a learning disability. We are also working with the market to make sure that we develop the right response to meet the outcomes identified in the strategy. 

The strategy action plan is overseen by a multi-disciplinary steering group, which includes providers and health colleagues. We use indicators and performance measures to establish how well we are performing and report on our progress on an annual basis to the North Yorkshire Health and Wellbeing Board, and more frequently to the North Yorkshire Learning Disability Partnership Board, Self-Advocates Strategy Group and Provider Engagement Forums.

The outcomes we aim to achieve are:

  1. Increased choice, control and independence.
  2. People with a learning disability to live longer and healthy lives.
  3. Increased opportunities for independent living locally.
  4. Improved quality of life and wellbeing.
  5. Raised awareness and understanding of future adult world for young people their families or carers.
  6. A transformed model of Supported Living across North Yorkshire to meet the needs of people both now and in the future.

Additional information

 Learning disabilities strategy Live Well, Live Longer (pdf / 7 MB)

Public health support everyone to live happy and healthy lives by protecting individuals and local communities from illness and environmental hazards and promoting good health by encouraging people to adopt healthy behaviours.

The main aim of public health is to improve and protect the nation's health and wellbeing, and improve the health of the poorest fastest. There are two key outcome measures for the whole public health system.

Commissioning Intentions

We are undertaking the re-procurement of 2 services that are funded through the public health grant:

  • Stop smoking service - The current stop smoking service, Smokefreelife North Yorkshire was commissioned in January 2016 and consisted of a single contract with Solutions4Health Ltd. It is is commissioned to offer an open access service with a particular focus on identified priority populations for North Yorkshire.
  • Specialist adult drug and alcohol service - The current adult substance misuse service, North Yorkshire Horizons, was commissioned in October 2014 and consists of 2 contracts:
    • Recovery and mentoring service, provided by Change Grow Live (CGL)
    • Drug and alcohol treatment service, provided by Developing Initiatives Supporting Communities (DISC).

These contracts end on 30th September 2019. We wish to re-procure a comparable service to begin on 1st October 2019. The service will continue to be called North Yorkshire Horizons.

All healthy child services are currently under review and a new model will be launched starting from the 1st April 2020. Current services are:

  • The 0-5 healthy child service is the early intervention and prevention public health programme that lies at the heart of universal services for children and families.
  • The 5-19 healthy child service is a progressive universal programme which includes services appropriate for all children and young people, and additional services for those with specific needs and risk factors.

We are in the early planning stages for the reprocurement of the integrated sexual health service, intending to have a new service in place by 1 April 2020. This is currently provided by YorSexualHealth. Read the  sexual health framework (pdf / 477 KB).

Where we are now

In order to achieve our aim of improving and protecting the health of our residents, the our public health team commission several services and programmes of work.

Local government public health commissioning responsibilities include:

  • tobacco control and smoking cessation services;
  • alcohol and drug misuse services;
  • public health services for children and young people aged 0-19 (including the 0-5 healthy child programme and the 5-19 healthy child programme);
  • the national child measurement programme;
  • interventions to tackle obesity such as community lifestyle and weight management services;
  • locally-led nutrition initiatives;
  • increasing levels of physical activity in the local population;
  • NHS health check assessments;
  • public mental health services;
  • dental public health services;
  • accidental injury prevention;
  • population level interventions to reduce and prevent birth defects;
  • behavioural and lifestyle campaigns to prevent cancer and long-term conditions;
  • local initiatives on workplace health;
  • supporting, reviewing and challenging delivery of key public health funded and NHS delivered services such as immunisation and screening programmes;
  • comprehensive sexual health services (including testing and treatment for sexually transmitted infections, contraception outside of the GP contract and sexual health promotion and disease prevention);
  • local initiatives to reduce excess deaths as a result of seasonal mortality;
  • the local authority role in dealing with health protection incidents, outbreaks and emergencies;
  • public health aspects of promotion of community safety, violence prevention and response;
  • public health aspects of local initiatives to tackle social exclusion; and
  • local initiatives that reduce public health impacts of environmental risks.

Additional information