Have your say on the health-related behaviour change service

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Closes 10 Mar 2023

Consultation overview

Background

One You East Sussex is an integrated health and wellbeing service for people living in the county. It helps residents make changes to health-related behaviours, such as eating well, managing weight, moving more, stopping smoking, and drinking less.

The contract for the service ends in March 2024. During the summer of 2023 we will be giving providers the opportunity to bid to run the service from April 2024.

We are thinking about changing how the service supports residents. The aim would be to get the best possible outcomes for residents and communities and make the best use of the budget we have. This consultation explains the proposed change and what it would mean for people.

How the service works now

Everyone living in East Sussex who is 16 or over can use the service. For stop smoking support young people aged 12 and upwards can use the service too. In 2021 the service supported over 5000 residents.

People can choose to be supported online through digital programmes and virtual support, over the phone or face-to-face. During the pandemic most of the support was delivered online and over the phone.

The service starts with a holistic health assessment to identify which areas of their health and wellbeing residents would like help with. Some people only access one programme when they use the service but many access more than one. Each behaviour-change programme typically lasts for 12 weeks.

Why we are proposing to make changes

Local authorities are responsible for the health of their local population and reducing health inequalities. We receive a ring-fenced grant from the Government to do this.

In 2019 we used Public Health England’s prioritisation framework to help us evaluate all our work in a fair and evidence-based way. The integrated health and wellbeing service was identified as an area where we could make better use of the budget by strengthening our focus on supporting residents who are most affected by health inequalities and premature death.

The Kings Fund defines health inequalities as avoidable, unfair, and systematic differences in health between different groups of people. They can include the status of people’s health, the differences in care they receive and the opportunities they have to lead healthy lives.

When we talk about health inequalities in this consultation our focus is on behavioural risks to health. Find out more information about health inequalities.

People’s behaviour is a major factor in how healthy they are. Smoking, poor diet, physical inactivity and harmful alcohol consumption are the main risk factors that lead to preventable ill health and premature death in England.

These behavioural risks to health are more common in some parts of the population than others. For example, the proportion of adults in England who were smokers and in the lowest income quartile was 27% in 2019 compared to 10% in the highest income quartile. Living in an area of deprivation, being in a lower income quartile, your gender and ethnicity are some of the other factors that can mean that people are more likely to experience poor health outcomes.

By targeting behaviour-change support at people who experience the poorest health outcomes, the evidence shows that we can make the biggest improvements to the overall population health of East Sussex.

What would change if the proposal went ahead

Everyone accessing the service would still receive a holistic health assessment and have access to online programmes that would help them make changes to their health-related behaviours. More intensive forms of support would only be routinely offered to those with the highest needs who could gain the greatest health benefits. Intensive forms of support might include face-to-face support from a health coach, or a weight management group delivered online or in person.

This would mean those facing the greatest health inequalities, such as:

  • people living in places which experience a high level of deprivation based on the Office for National Statistics’ Index of Multiple Deprivation (as we know that on average, unhealthy behaviours are higher in such places).
  • people living in population groups who face health inequalities, such as people with a disability or serious mental health issue, and
  • any individuals who are not in the groups above who the service provider identifies as needing this sort of support. 

Some residents in these groups may prefer online support to face-to-face and where possible we’d aim to meet people’s preferences. The provider who wins the contract will be required to work with the targeted communities and population groups to design a new service model which works best for them.

Residents already using the service when the new contract started wouldn’t be affected. They would remain on their programme until it finished.

The change also wouldn’t affect how people like GPs refer into the service. Anyone who wants to make changes to their health-related behaviours would still be able to be referred to the service for a holistic health assessment and get information about what support is available to them.

Why we are proposing to make this change  

Since we last commissioned this service in 2017 there have been national developments in the support available to people around their health-related behaviours. Some examples are the new free-to-use NHS Digital Weight Management programme and the Better Health Quit Smoking App. Local NHS services are also now delivering more prevention programmes to their patients.

These developments give us an opportunity to change how the service supports residents in the future. We think we can target the service at those with the highest needs and those who could gain the greatest health benefits, while still being confident that all our residents have access to health-related behaviour support.

Making the proposed change would reduce the cost per user to a level more in line with the average for the South East and bring us into line with nearby local authorities. For example, West Sussex County Council has already made a similar change to its health and wellbeing services, moving from a universal service for everyone to a targeted service. 

As we are keeping the same budget of just over £2 million per year, we would reinvest the savings made by the change back into the service. The spending options for these funds include:

  • meeting the anticipated increase in residents eligible for support,
  • being more flexible in how we deliver the behaviour change programmes (for example, having the option to offer more regular support or extending their length where appropriate),
  • building better links between the service and other services that support individuals with things that make a difference to their health and wellbeing, such as education, housing, and employment,
  • enabling people to achieve health related behaviour change by offering support for mental wellbeing where needed (such as those experiencing low to moderate anxiety, stress and depression within behaviour change programmes),
  • covering the anticipated higher running costs caused by increases in the cost of living.

Have your say

Local authorities are responsible for improving the health of their local population and reducing health inequalities. We think this proposed change to our future integrated health and wellbeing service balances this duty whilst getting the best out of our budget.

You may agree or you may think differently. This consultation is your chance to share your views, concerns, and ideas with us. We are keen to hear from everyone with an interest including:

  • residents who have used the service and those who have not,
  • those who refer people to the service such as GPs,
  • staff and organisations working in health and wellbeing,
  • voluntary and charity sector staff and organisations, and
  • our public sector partners such as other local authorities, and the NHS.

Please do share your views with us and help make our decision making as robust as it can be. The consultation closes on 10 March 2023.

What you tell us will be summarised in a consultation report and will inform the Equality Impact Assessment (EQIA). An EQIA is a tool we use to understand how particular groups and communities would be affected by a proposed change. A final decision on the proposed change to the service model will be made by the Lead Member for Adult Social Care & Health in June 2023.