Healthy, Safe Communities.

Challenges

Some of our key challenges relate the wider determinants of health in our communities:

• Devon has complex patterns of urban, rural and coastal deprivation, hotspots of urban deprivation are evident, with the highest overall levels in Plymouth, Torbay and Ilfracombe. Many rural and coastal areas, particularly in North and West Devon experience higher levels of deprivation, impacted by lower wages, and a higher cost of living.
• Housing is less affordable in Devon, and the age and quality of the housing stock poses significant challenges in relation to energy efficiency and issues associated with excess heat, excess cold and damp.
• Varied education, training and employment opportunities, workforce availability and wellbeing is impacting on success later in life for children, the health of our economy and our ability to deliver high quality, safe services.
• Access to health and care services varies significantly across Devon, both in relation to geographic isolation in sparsely populated areas, as well as socio-economic and cultural barriers. Poorer access is evident in low-income families in rural areas who lack the means to easily access urban-based services. Poorer access is also seen for people living in deprived urban areas, certain ethnic groups and other population groups, where traditional service models fail to take sufficient account of their needs.
• The Covid-19 pandemic has changed the pattern of infectious disease and along with increasing levels of healthcare associated infections and the risks posed by anti-microbial resistance. These diseases have disproportionately affected the most disadvantaged and vulnerable in our society and contribute further to health inequalities.
• Suicide rates and self-harm admissions are above the national average, anxiety and mood disorders are more prevalent, there are poorer outcomes and access to services for people with mental health problems.

Strategic objectives

To address these challenges, we have set the following strategic objectives:

• The most vulnerable people in Devon will have accessible, suitable, warm and dry housing
• People in Devon will be provided with greater support to access and stay in employment and develop their careers.
• Every suicide should be regarded as preventable and we will save lives by adopting a zero-suicide approach in Devon, transforming system wide suicide prevention and care.
• We will create a greener and more environmentally sustainable health and care system in Devon, that tackles climate change, supports healthier living (including promoting physical activity and active travel).
• Climate change poses a significant risk to health and wellbeing and is already contributing to excess death and illness in our communities, due to pollution, excess heat and cold, exacerbation of respiratory and circulatory conditions and extreme weather events.
• Everyone in Devon will be offered protection from preventable infections.

Housing

Our vision

Our vision for Devon is to create thriving communities with high-quality, affordable, and sustainable housing.

We want everyone to have a home that supports their health and wellbeing. This means improving housing conditions, increasing specialist housing for those most in need, enabling older and disabled people to live independently, ensuring key workers and residents have access to affordable homes, and taking a strong, proactive approach to preventing homelessness.

What Devon will see

1. People with existing health conditions being able to live in warm and dry homes which will result in a reduction in emergency attendances and admissions for a number of conditions.                             
2. People are supported to have warm and dry homes, regardless of the current health status, recognising that this will help to reduce the development of health conditions and/or support the management of them.
3. That no one will be without a home. There are a myriad of risks faced by people, including children, who do not have safe and secure housing, ranging from the obvious impact on low level mental health to the longer term development of physical health issues. 

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
By 2026 we will establish processes to systematically identify vulnerable groups with chronic conditions such as children and young people with asthma, living in substandard housing and direct them to appropriate support services.	X
By 2028, our aim is to decrease health issues arising from poor housing conditions. This will be achieved by increasing referrals of those living in inadequate housing to a variety of health, social, and VCSE support services.	X	X
By 2026, we will implement processes to identify vulnerable individuals in poor quality housing on admission and discharge. This will improve the efficiency of admission/discharge planning and enhance the referral process for additional support.	X
By 2028 the ICS will work to ensure that Local Plans reflect the needs of older people and those with health conditions, to support the delivery of suitable housing	X	X
We will reduce homelessness in Devon, through the implementation of comprehensive support systems, and the expansion of support services. Specific targets include:Ensuring no family stays in B&B accommodation for more than six weeks.Achieving a 10% reduction in the number of households in temporary accommodation.Increasing the success rate of preventing homelessness by 30%.Offering accommodation to 100% of individuals who sleep rough.	X	X	X

Employment

Our vision

Our vision in Devon is to create a supportive and inclusive employment landscape where those facing significant barriers, can access meaningful employment opportunities and career development.

Focused on empowering the most vulnerable groups, including young people transitioning into adulthood, those with disabilities, mental health conditions, or other health-related employment barriers, and residents from the most deprived communities, we aim to harness the health and social care sector as an inclusive employment destination.

This approach not only supports those in need of assistance but also strengthens our workforce, ensuring a healthier, more prosperous community for all.

What Devon will see

1. Fewer young people NEET– Reduction in the number of young people Not in Education, Employment, or Training (NEET), particularly those with complex needs, and improving transition into adulthood.
2. Inclusive employment opportunities – Increase in disabled people and those with mental health conditions gaining access to sustainable work, in roles which support fair career progression.
3. More inclusive employment opportunities– Fewer barriers to employment for vulnerable groups.
4. A diverse, skilled health and social care workforce – More resilient NHS and care services delivered by a representative, inclusive workforce.
5. Better support for unpaid carers – More flexible employment opportunities enabling carers to remain in or return to work.

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Seek to reduce level of 16-18-year-olds Not in Education Employment and Training (‘NEET’) in Devon by 1% by 2027.	x
Reduction in number of individuals with a disability or mental health need who are unemployed compared to the national average by 4% by 2027	x
Build on resources developed across the local authorities and wider partners to support more vulnerable people into employment, working closely with DWP and wider health partners.	x	x	x
Unpaid carers will be supported to remain in or re-enter employment	x	x	x

Suicide prevention

Our vision

In Devon is for all suicides to be considered preventable and that suicide prevention is everyone’s business. The ambition for suicide prevention is to deliver a consistent downward trajectory in the suicide rate for all areas of Devon, Plymouth and Torbay so that they are in line with or below the England average.

What Devon will see

1. Primary care clinicians with more knowledge and skills in supporting people with thoughts of suicide.                                       
2. More of the public and professional workforces aware of suicide and how to initially support others before professional help.                                            
3. Grassroots and community organisations supporting populations more at risk of suicide with their wellbeing.
4. More professionals in Devon aware of the links between domestic abuse and suicide
5. A responsive suicide bereavement service that has no waiting lists and can support anybody affected by suicide at any point in their lives.

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Local Suicide Prevention Groups to each have a published annual action plan based on the national strategy which sets out local delivery priorities for the year.	x	x	x
Local Suicide Prevention Groups to report annually on their suicide rates and their annual action plan to their respective Health and Wellbeing Boards.	x	x	x
Local suicide prevention leads to present local suicide prevention action plans and suicide rates for whole of the ICS area to NHS Devon Suicide Prevention Oversight Group.	x	x	x
One Devon Suicide Prevention Oversight group to consider development of a single One Devon Suicide Prevention Plan.	x	x	x
One Devon to prioritise provision of appropriate suicide prevention training to relevant workforces and the wider population to support system knowledge of suicide and suicide prevention. Identification of funding to progress this objective is required following utilisation of NHSE suicide prevention grant.	x	x	x
One Devon to prioritise the ongoing provision of a suicide bereavement service and a real-time suspected suicide surveillance system, coordinated across the whole of Devon.	x	x	x

Green plan

Our vision

We will create a greener, fairer and more environmentally sustainable health and care system in Devon, that adapts to and mitigates climate change and promotes actions to create healthier and more resilient communities. As an ICS we are committed to delivering the national ambition for the NHS to become the first net zero health service, ensuring that we respond to climate change while improving health outcomes for the population of Devon.

Aligned with the NHS Long Term Plan and the Greener NHS strategy, we will take local action to reduce emissions, embed sustainability into healthcare delivery, and drive system-wide transformation.

We will aim to achieve net zero for emissions we control directly by 2040 (NHS Carbon Footprint) and influence wider emissions to reach net zero by 2045 (NHS Carbon Footprint Plus). Our approach will integrate the opportunities and requirements in the NHS Net Zero Travel and Transport Strategy, Net Zero Building Standard, and the Estates Net Zero Carbon Delivery Plan into a local ICS Green Plan outlining our system-wide response to nationally determined targets.                        

What Devon will see

1. More products and services are bought locally promoting the concept of the Devon Pound across the ICS and its partners.
2. One Devon will achieve net zero for emissions we control directly by 2040 and influence wider emissions to reach net zero by 2045.

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Develop and deliver ICS Green Plan to reduce emissions, embed sustainability into healthcare delivery, and drive system-wide transformation (in response to NHSE Green Plan guidance, NHS Net Zero Travel and Transport Strategy, Net Zero Building Standard, and the Estates Net Zero Carbon Delivery Plan).	x	x	x

Health protection

Our vision

Protecting our population from preventable diseases, hazards and infections. This is set within the context of new and emerging threats, including antimicrobial resistance and climate change. Diseases disproportionately impact on our most vulnerable communities. We also know that some communities in Devon are less likely to access preventative services, and yet are more likely to experience the severe consequences of diseases and infections.

What Devon will see

1. More walk-in opportunities for winter vaccination to increase opportunistic vaccinations.
2. Improved insight to accurate vaccination for 0-5s uptake and identification of gaps to be addressed.
3. Proactive health campaigns that educate and empower people to make healthier lifestyle choices, preventing disease and promoting long-term health.
4. Targeted outreach to communities most affected by health inequalities, improving access to healthcare and encouraging positive health behaviours across society.    

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Reduce occurrences of healthcare associated infections (HCAI) (Clostridium difficile (C. diff), methicillin-resistant Staphylococcus aureus (MRSA) and community onset community associated (COCA) occurrences of HCAIs.	x
Ensure effective antimicrobial use in line with NICE guidance. Optimising outcomes, reducing the risk of adverse events and slowing the emergence of antimicrobial resistance. Ensure that antimicrobials remain an effective treatment for infections.	x
Providers to demonstrate a 100% offer to eligible cohorts for influenza and Covid vaccination programmes – with particular focus on Devon’s priority populations (CORE20PLUS5) for children and young people and adults, aiming to achieve uptake levels comparable for the previous year for influenza and ideally exceed them where applicable. Maintain current levels of access to influenza and Covid vaccination programmes and demonstrate improvement in year-on-year uptake levels of seasonal vaccinations.	x	x
Continue current access levels to eligible cohorts for influenza and Covid vaccinations across Community Pharmacies, GP Surgeries and VCs, supported by the Outreach model. Increase uptake among front line health and social care workers to reduce impact on providers during periods of peak demand. Halt decline in year-on-year uptake levels of seasonal vaccinations.	x
Achieve vaccine coverage of 95%+ (children under 5) of two doses of MMR, with particular focus on Devon’s priority populations (Core20PLUS5) by adapting to new MMRV vaccination and changes to the routine immunisation schedule. Work with Family Hubs and Early Years Champions to target barriers to uptake and General Practice to improve data quality.	x	x	x
Achieve vaccine coverage of 95% of the 4-in-1 pre-school booster by the time the child is five, with particular focus on Devon’s priority populations (Core20PLUS5) by working with Family Hubs and Early Years Champions to target barriers to uptake and General Practice to improve data quality.	x	x	x
Achieve recovery of School-aged Immunisation (SAI) uptake to pre-Covid levels, with secondary aim to achieve year on year improvement in uptake working towards the 90% target as stated in national service specification with particular focus on Devon’s priority populations (CORE20PLUS5) for CYP.	x	x	x
Halt the decline in cervical screening coverage and  improve uptake year on year towards a goal of 80%, with focus on first invitation and Devon’s priority populations (Core20PLUS5) for Adults. Continue the delegation of screening commissioning working with NHSE to support their delivery of this objective in 2025/26 and to plan for delegation in future years.	x	x
Work closely with NHSE commissioner, supporting the delivery of the national campaign to increase breast screening uptake.   Reducing areas of inequalities (NHS England and provider led) focussing on Devon’s priority populations (Core20PLUS5) for Adults. Continue to work with NHSE to support their delivery of this objective in 2025/26 and to plan for delegation in future years.	x
Address the commissioning and delivery gaps identified in the 2022 South West Gap Analysis project.  Ensuring that Devon has available pathways and capabilities responding to key pathogens, health protection related incidents and emergencies.  Minimising the impact across different communities in Devon.	x