South Tyneside Joint Health and Wellbeing Strategy

We are pleased to introduce our new Joint Health and Wellbeing Strategy for South Tyneside, which sets out our whole system plan for supporting those who live, learn, work, and play in our borough to live healthy and happy lives.

While ambitious in scope, it is no secret that our Strategy comes at a time of unprecedented challenge. Over the last two years, COVID-19 has had a significant impact on life and livelihood but also provided several useful lessons which have informed our planning and aspirations ^[1].

First, the pandemic has shone a harsh light on persistent health inequalities, serving as a poignant reminder of the many ways through which our unequal society translates into unequal health. In highlighting the importance of the wider determinants of health, COVID-19 has challenged us to focus our efforts ‘upstream’ through prioritising the factors – such as housing, employment, education, and community safety – which we know are fundamental to a healthy life.

Second, our response to COVID-19 has demonstrated the value of building on the strengths, insight, and aspirations of our communities. Inspired from the learning gained through recent initiatives such as our COVID Community Champions, we engaged a range of seldom-heard groups when developing our Strategy, using a local research project to solicit ideas on what we should do to make our borough a happier and healthier place ^[2]. We are grateful to all those who have taken the time to share their views, which have shaped our planning and made this document immeasurably better.

Third, the pandemic has showcased the potential of partnership and collaboration. From our third sector partners delivering food for shielding residents to the volunteer marshals at our vaccination clinics, these past two years have shown us how much farther we can go when we go together. Our task is now to build on this momentum, leveraging our local assets as well as the partnerships we have fostered during the pandemic to help us deliver at pace and scale.

Finally, we have witnessed first-hand the importance of supporting local responses to local need. Whether through our mobile vaccination clinics, targeted community testing sites, or tailored support for businesses, our place-based partnerships have been instrumental in translating national policy into approaches that are effective with our unique population. As ongoing reforms are poised to place Integrated Care Systems on a statutory footing, local forums such as our Health and Wellbeing Board will remain as important as ever to keeping us focused on what matters – and what works – in South Tyneside.

Although the acute phase of the pandemic is now subsiding, we know that the challenge is far from over. The ongoing risk of new variants coupled with wider economic instability pose a further threat to health, with increasing inflation and costs of living expected to push many into poverty. Addressing these challenges amidst reductions in real-terms public health funding will require us to work more creatively and collaboratively to make best use of the finite resources we have available – a concept we refer to locally as the ‘South Tyneside Pound’.

In that regard, our Strategy is not a standalone document but brings together planned and ongoing work from across the South Tyneside Partnership, providing the opportunity to align our efforts under a single vision and plan our work based on what is best for the system. It is likewise more than just a statutory requirement or a plan on a page. Rather, it is a call to action - compelling us to work in a more joined up way, defining clear measures against which to assess progress, and serving as a means for our communities to keep us accountable.

While the context is much different from when we developed our first Strategy nearly 10 years ago, our vision remains the same: to work in partnership to improve the health, wellbeing, and quality of life for our children, adults and families and reduce health inequalities, to help people live longer and healthier lives.

The South Tyneside Joint Health and Wellbeing Strategy is our high-level plan for how we intend to tackle the biggest health and wellbeing challenges facing our borough.

Building on the achievements of the previous Strategy ^[3], it sets out an ambitious vision for a healthier, happier South Tyneside and outlines the key outcomes which we will focus on over the coming years to improve health and reduce health inequalities. In contrast to previous versions, we have intentionally not set a date range for our Strategy, recognising that our outcomes have broad applicability and that their relevance should not be determined by a pre-established timeframe but rather an ongoing assessment of need.

Responsibility for the development and delivery of the Strategy rests with the South Tyneside Health and Wellbeing Board. As a local forum bringing together leaders from across health and social care, Health and Wellbeing Boards have a statutory obligation to assess the needs of their local population and develop a Health and Wellbeing Strategy ^[4]. Our Strategy in turn forms the foundation of our local planning, helping us collaborate more effectively and make best use of the finite resources available to improve the health of our area. It is owned by all partners, who share a collective commitment to deliver against it.

With the COVID-19 pandemic arriving in 2020 and the previous Strategy ending in 2021, now is an opportune time to reflect on progress and review our goals for the future. The past two years have had a profound impact on health and wellbeing. Whether through the virus itself or the knock-on effects of social restrictions, the consequences of COVID-19 have been severe and far-reaching. Sharp increases in child excess weight over the first year of the pandemic is a particularly sobering example, with local school data indicating that more than three in ten pupils ages 4-5 years and over half of pupils ages 10-11 years are now classified as overweight or obese, representing the largest increase observed since measurement began in 2006 ^[5].

Worsening performance has also been observed across a wide range of other health and social indicators.

Despite the unprecedented challenges of the past two years, there are reasons to be hopeful. In South Tyneside, adult smoking prevalence continues to fall as does the percentage of pregnant women smoking at the time of delivery. Hospital admissions due to child injuries have reduced by more than half since 2013/14. Coverage of local screening and vaccination programmes remain high and, in many cases, better than the national average ^[6]. These successes are in addition to the catalysing effect that the pandemic has had in increasing volunteering, strengthening community pride, and building new ways of partnership working which are grounded in pragmatism and focused on delivering results. Together, these changes will provide a strong foundation on which to deliver the next Strategy.

South Tyneside has a diverse range of people and communities who live, work, and learn in the borough. The pandemic has demonstrated that a one-size-fits-all approach is not always appropriate, and it is important to work directly with more disadvantaged populations.

For instance, those experiencing economic deprivation, low health literacy, preexisting health conditions, or other forms of social disadvantage, to ensure that our strategies and services are equitable and inclusive. Often the same factors which place individuals at risk of adverse health also impede participation in public consultations. As such, we commissioned a ‘Community Insights’ project to proactively involve several marginalised and under-represented groups in the development of this Strategy ^[2].

Their voices – as well as those of young people, elected members, and a broad range of community partners – have collectively informed the Strategy’s four outcomes and two cross-cutting themes described below.

Above all, we believe that our Strategy is a means to an end and not an end in itself. We clearly recognise the linkages between health and wealth and how important the wider determinants of health are to creating a happy, healthy South Tyneside. To ensure that we remain focused on delivery and results, an action plan is being developed which outlines the key priorities under each outcome, the actions we will take to achieve them, and the indicators we will use to measure progress. The action plan will be updated as required throughout the life of the Strategy to enable our work to remain flexible and adaptive to changes in local need as well as broader shifts in national policy.

National context

The pandemic has added to the growing recognition from the Government to address inequalities in both health and a range of other domains. The Government’s Levelling Up White Paper outlines 12 medium-term policy objectives aimed at reducing geographic inequalities in areas such as health, education, productivity, public transport, crime, and digital connectivity ^[7]. Further details on the Government’s strategy to tackle health inequalities are expected in an upcoming White Paper on Health Disparities, while a new Tobacco Control Plan and Food Strategy White Paper are also expected this year.

What ‘Levelling Up’ means for education has been outlined in the Government’s White Paper ‘Opportunity for all: strong schools with great teachers for your child’ which include an ambition for a fully led Academy Trust education system ^[8]. In addition, the Government’s has published a Special Education Needs and Disabilities and alternative provision Green Paper which sets out its vision for a single, national special educational needs and disabilities (SEND) and alternative provision system that will introduce new standards in the quality of support given to children across education, health, and care ^[9]. With further reforms expected in Children’s Social Care following ‘The independent review of children’s social care ^[10].

There are also significant transformations to the health and adult social care system. At the national level, this includes the newly created UK Health Security Agency and Office for Health Improvement and Disparities now assuming the health protection and health improvement responsibilities, respectively, that were formally held by Public Health England ^{[11, 12]}. The Adult Social Care White Paper sets out a 10-year vision which centres around three key principles of people having choice, control, and support to live independent lives, accessing outstanding quality and tailored care and support, and finding adult social care fair and accessible. The reforms include changes to the way individuals and local authorities pay for care, funding for improvements and workforce development and an assurance framework ^[13]. At the regional level, passage of the Health and Care Bill will place the North East and North Cumbria Integrated Care System on statutory footing and build on the ambition of the NHS Long Term Plan ^[14] to strengthen NHS action on population health, a commitment further underscored by the new Core20PLUS5 inequalities initiative ^[15].

Our Strategy will be implemented at a time of increasing awareness of the disproportionate concentration of poor health and wellbeing in coastal areas. This was highlighted by the Chief Medical Officer’s Annual Report 2021 ^[16]. It showed that areas, such as South Tyneside, continue to experience a higher burden of many physical and mental health conditions than their inland neighbours, even after controlling for several factors. This phenomenon is referred to as the ‘coastal effect’.

The report calls for a national strategy to improve the health of coastal communities as well as further investment into research and healthcare staff training and deployment in these areas.

These changes to national policy commitments and as well as changes to the health, care, and education systems, if backed up by sufficient local investment, may offer new opportunities to support and advance work toward the outcomes outlined in our Strategy. However, these changes will require adjustment and more joined up working with a range of organisations and systems. These will likely require greater place-based partnerships, such as Health and Wellbeing Boards, therefore our Strategy is more important than ever to ensuring that local planning is reflective of and responsive to the needs of our borough.

Local context

The Strategy will be implemented during a period of considerable organisational change at South Tyneside Council, which is currently undergoing a major transformation programme following the establishment of new political and senior officer leadership teams as well as the recent completion of a Local Government Association Corporate Peer Review Challenge ^[17].

The transformation programme will be both structural and cultural, with key elements including the production of a new Council-wide 3-Year Strategy, a review of the current South Tyneside Partnership structure, and the development of a refreshed long-term vision for the Council accompanied by a set of values to underpin ‘the way we do things here’.

Occurring as part of this transformation is a growing commitment within the Council to place local intelligence and research at the heart of our decision making. Through developing our research capabilities both internally and with key partners, we can increase the health impact of the South Tyneside Pound, that is our finite, collective resources, while also improving transparency, inclusivity, and accountability. Although the Community Insights project ^[2] is a positive step, our aspiration is to create a system culture in which the generation and use of research is embedded into all that we do, from needs assessment and strategy development through to commissioning and evaluation.

Achievements

This Strategy represents a continuation of our commitment to improve the health of our borough and builds on the notable successes achieved across the South Tyneside Partnership in recent years.

Key accomplishments over the life of the previous Health and Wellbeing Strategy 2017-2021 ^[3] include:

• Launching the Let’s Talk approach within adult social care, which connects residents with the support available in their community to maximise their independence and achieve the things that matter to them
• Developed and launched a multi-agency response to need at the front door – Integrated Safeguarding Interventions Team (ISIT) – ensuring the right support and the right time for those who need it
• Transitioning the South Tyneside and Sunderland NHS Foundation Trust to a completely smoke-free organisation
• Implementing the Best Start in Life voucher scheme, which has helped reduce the proportion of new mothers smoking at the time of delivery by around a third since it was launched
• Commissioning a range of new services providing specialised support to children and young people, including the Autism Hub, LGBT+ support service, Kooth and Qwell online counselling services, and Healthy Minds Teams
• Scaling up a local social prescribing model that takes a holistic view of health through using link workers to connect individuals to appropriate community and statutory support
• Launching the Healthy Start Vitamins scheme providing free vitamins to pregnant women and mothers of young children
• Establishing an Alcohol Care Team at South Tyneside and Sunderland NHS Foundation Trust which offers specialist care and treatment for patients with alcohol misuse
• Creating a Suicide Prevention Training Hub providing courses in mental health, emotional resilience, and suicide prevention to staff from key agencies across six local authorities, with South Tyneside serving as a lead local authority

As the biggest public health crisis in living memory, the COVID-19 pandemic has had a profound effect on health and wellbeing

It has also exposed and amplified existing inequalities – having a disparate impact along the lines of age, ethnicity, occupation, and deprivation ^[22]. These inequalities have carried over to the vaccination programme, with data indicating lower uptake in minority ethnic groups and more deprived areas, which are already at higher risk of infection.

In addition to the harm caused by the illness itself, the pandemic and social restrictions have contributed to a wide range of indirect effects. At the national level, these include:

• Severe strain on the health system, leading to growing backlogs for elective procedures, longer waiting times, and reduced coverage of some screening programmes
• Loss of learning opportunities, which has disproportionately impacted pupils from deprived areas and widened gaps in educational attainment
• Worsening mental health, with surveys reporting increased rates of loneliness, anxiety, and depression
• Increased rates of economic inactivity as people leave the labour market (due to illness, caring responsibilities, retirement, or other factors)
• Increases in higher risk drinking and alcohol-specific deaths
• Increased reports of domestic violence and child abuse coupled with a reduction in child safeguarding referrals due to school closures
• Rapid rises in the prevalence of overweight and obesity among children
• Continued increases in the proportion of children living in low-income households

Continued pressure on the South Tyneside Pound

Increasing strain on the health and social care system coupled with long-term decreases in local authority funding will continue to place pressure on the ‘South Tyneside Pound’. The funding that we receive from the national public health grant alone has fallen by over 20% in real terms since 2015/16 ^[23], requiring us to work more efficiently and creatively to maintain services. The challenge to do more with less is likely to persist in the coming years as record government borrowing, economic disruption, and the lasting effects of the pandemic further stretch funding for the public sector.

National health reforms

The Health and Care Bill is currently undergoing Parliamentary review. It will place the North East and North Cumbria Integrated Care System (ICS) on statutory footing and offer new opportunities for more joined up working between local authorities, the NHS, and other partners. As a key place-based partnership, the Health and Wellbeing Board will work collaboratively within the new ICS to ensure that its work is reflective of and responsive to the needs of our borough ^[24].

Ongoing workforce pressures

Workforce shortages in the health, social care, and education sectors have been a persistent challenge over recent years both locally and nationally and will likely remain so in the years to come. Rising demand for care among an ageing population combined with the increased risk of staff illness and burnout due to COVID-19 will make attracting and retaining a resilient workforce more important than ever ^{[25] [26]}.

Health-related behaviours

Whilst this Strategy has a broader focus on the wider determinants of health, we also continue to have poor rates of health-related behaviours. Namely, our high rates of smoking, particularly those in routine and manual occupations, alcohol and substance misuse, obesity, especially in children, and low physical activity ^[6]. We therefore need to continue to implement evidence-based policies and intervention which can tackle these health issues in the short-term whilst delivering on the Strategy’s main outcomes which will create the conditions for long-term prevention.

Rising costs of living

Economic disruption caused by the COVID-19 pandemic, Brexit, and global political instability has increased costs of living, with inflation reaching its highest level in 30 years and the energy price cap recently increasing by more than 50% (and expected to increase further) ^[27]. Spiralling costs will disproportionately affect lower income households – which spend a higher proportion of their earnings on energy and food – and could lead to significant increases in poverty as well as a range of adverse effects on health and wellbeing.

The ambition of our Health and Wellbeing Board, in developing the Strategy, was to ensure that it was community-informed and reflective of what truly matters to local people.

Recognising that the burden of ill health is not evenly distributed across our population, the Board commissioned a Community Insights research project to solicit the views from a range of marginalised, disadvantaged, or otherwise under-represented populations across the borough as to what could be done to make South Tyneside a healthier and happier place ^[2]. The insights collected through this project were then used to directly inform the Strategy outcomes and accompanying action planning.

Detailed findings from the project are available in a report published on the South Tyneside Council website.

The following provides a brief overview of the project and Strategy development process.

Phase 1: Preparation and mapping

A mapping exercise was undertaken to identify recent public engagement work related to health and wellbeing in South Tyneside to identify underrepresented groups and select target populations for inclusion in the Community Insights project. Funding for the project was provided by the National Institute for Health Research Clinical Research Network and South Tyneside Council.

Phase 2: Community insights research

Academic partners from Newcastle University and Northumbria University conducted 16 focus groups with 119 people recruited from voluntary and community sector organisations working with a range of disadvantage and under-represented groups. Community ‘insight sheets’ - asking people to write or draw what a healthier, happier South Tyneside would look like – were distributed at venues across the borough and generated responses from 115 individuals.

Phase 3: Stakeholder engagement

Findings from the Community Insights project were analysed and presented at a workshop with over 60 local stakeholders from across the public, private, and third sectors. Stakeholders collectively developed a set of prioritisation principles for use in selecting a refreshed set of Strategy outcomes. Separate workshops were also held to solicit input from elected members and young people.

Our prioritisation principles

The following are the principles which stakeholders said we should work towards when identifying the priorities for the Strategy:

• Starting with what matters to people
• Focusing on the people who need the most help
• Prevention first
• Interventions with the biggest impact and benefits
• Sustainability
• Responsive and inclusive
• Consequences of inaction
• Best use of South Tyneside pound
• Evidence-based

Phase 4: Action Planning

The outputs from the workshop were reviewed by a multi-agency steering group and used to develop the outcomes for the Strategy. Leads for each outcome were nominated by the Health and Wellbeing Board and are working to produce a detailed action plan which works together with this overarching Strategy.

We have included quotes from participants involved in the project throughout this Strategy to highlight how their voices have directly informed our priorities for the coming years.

I like that you've got the fair, you've got the beach, you've got pretty much everything that you would normally have in a holiday camp just on the doorstep.

Food bank user

Our Health and Wellbeing vision:

Work in partnership to improve the health, wellbeing and quality of life for children, adults and families and reduce health inequalities, to help people live longer and healthier lives.

To achieve this, we have committed to achieving the following outcomes with the population:

What happens during pregnancy and early childhood can powerfully shape an individual’s trajectory in life.

Adverse experiences during this critical period affect both the child and the person they will become, negatively impacting educational attainment, and earning potential as well as physical and mental health throughout adolescence and adulthood. Conversely, being raised in a safe, stable, and nurturing environment sets a child up for success, building the foundation for a healthy life ^[28].

As the highest priority objective in the Marmot Review, giving every child the best start in life is widely recognised to be the most effective means of improving long-term health outcomes ^[29]. Investing in early childhood development is essential to reducing health inequalities across the life-course and should be followed by ongoing support to help young people flourish through adolescence and into adulthood. Universal services should be complemented by targeted, specialist support, proportional to the level of need to ensure that all families receive the right help at the right time ^[29], ^[30].

Why is this important in South Tyneside?

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What assets do we have in our communities?

A wide range of local assets are already in place which can be built on to deliver this outcome. From the home visits provided by our Health Visiting team to the family-oriented interventions offered by our Early Help Service to our 12 children’s centres providing health advice and preventative services, a wealth of support is currently available to support both parents/ carers and children. This support is set to further increase, with the Council currently advancing plans to establish Family Hubs that will co-locate a range of key services into shared community facilities. The Hubs will act as ‘one-stop shops’ for families with children up to the age of 18 years (or 25 for those with special educational needs), making it quicker and easier for them to access the help they need.

There should be more dad groups and parent groups out there, like single parent groups. They don’t encourage dad groups or anything. I think there was one dad group and it got closed down.

Young mum

I think just more of an incentive to get out… because more and more young people are actually staying indoors. Sometimes, it is a lot better to stay indoors and game than it is to go out and be active because there isn’t a lot to do.

Young person

Support for local children continues into their school years, with 91% of our educational providers – including 45 primary schools, 8 secondary schools, 5 special schools and 1 college – currently classed as good or outstanding by Ofsted. ^[31]

Current initiatives to promote healthy lifestyles among school-aged children range from our Healthy Schools Programme to peer-led forums such as the Young Health Ambassadors and Young People’s Parliament, which offer young people the opportunity to become involved in informing new services and organising health campaigns. The health of our children is further supported by our physical assets – including our beaches, climbing gym, skate parks, and outdoor play areas – which promote social connectedness and encourage physical activity.

Who will we be linking with on this outcome?

The following are a few of the key groups who we will work with on this outcome:

• Best Start in Life Alliance
• Children and Young People’s Mental health and Wellbeing Alliance
• Early Help Network Consortium
• Children and Adults Safeguarding Partnership
• Youth Justice Board
• Community Safety Partnership
• SEND Leadership Board
• Domestic Abuse Partnership Board

Which key plans and strategies relate to this outcome?

• Early Help Strategy
• Children and Adolescent Mental Health Strategy
• Mental Health Strategy
• Learning Disabilities Strategy
• Alcohol Harm Reduction Strategy
• Domestic Abuse Strategy
• Oral Health Strategy
• Physical Activity Strategy
• SEND Commissioning Strategy

It’s nothing for kids. Well, there’s parks, but the kids don’t want to go in parks these days…So, they go out and commit crime. It’s anti-social behaviour. They don’t mean to do it, probably, but it’s just… they’re stuck like that.

Food bank user

Access to safe and secure employment and a decent living wage has considerable health benefits.

Good jobs provide the financial means necessary to live a healthy life, whether that’s having enough money to heat your home, purchase healthy food, access transport, or participate in leisure activities.

Employment also serves as a source of social support and provides a sense of identity and purpose, helping to build self-esteem and protect against social exclusion ^{[32] [33]}. Conversely, low pay, unstable employment, unemployment, and financial insecurity are linked to poor outcomes across virtually all aspects of health. Individuals with insufficient income have shorter life expectancies on average and spend more of their life in ill health. Those with long-term conditions are likewise less able to secure and maintain stable employment, further contributing to their poor health ^{[32] [33]}.

In adopting this outcome, we acknowledge that improving the wellbeing of our borough will require us to broaden our focus beyond health services to address the root causes of ill health. While we cannot do this alone, it is only through improving the underlying social and economic conditions can we create an inclusive and sustainable economy in which the benefits are distributed fairly across all our communities.

Why is this important in South Tyneside?

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What assets do we have in our communities?

A major programme of regeneration is underway across South Tyneside, with over £1 billion invested into housing, schools, community and leisure facilities, transport infrastructure, and economic growth projects over the last decade. Efforts to diversify and attract investment into South Shields have included renovation of the marketplace, construction of a new Transport Interchange, and recently announced plans to relocate South Tyneside College to the heart of the town centre. Regeneration has also been ongoing in Hebburn and Jarrow in the form of recently opened modern leisure facilities ^[35].

There are positives in South Tyneside but not for the deprived. And I do think it is difficult – you wonder how the deprived people, the people without any money for enough food are going to get themselves to the parks and to the beach and so on.

Older person

I wouldn’t like to be looking for a job now, full stop, because there are zero-hours contracts or they’ve only got part-time. Single parents, they haven’t got somebody else to depend on, another wage, so the poverty starts. With poverty comes ill health.

Support worker working with vulnerable women

With good transport links, affordable housing, outstanding natural assets, and specialisms in areas such as advanced manufacturing and offshore wind, South Tyneside is well positioned to attract additional private sector investment in the coming years. One such project is the International Advanced Manufacturing Park, a joint venture between South Tyneside Council and Sunderland City Council which has the potential to create over 7,000 new jobs over the next 10 to 15 years ^[36]. The combination of ambitious regeneration with the aggressive pursuit of outside investment has the potential to both spur economic growth and improve health outcomes through reducing unemployment, increasing wages, and raising living standards.

Who will we be linking with on this outcome?

The following are a few of the key groups who we will work with on this outcome:

• Economic Regeneration Board
• Universal Credit and Welfare Reform Strategy Group
• Inspire South Tyneside
• People Select Committee’s Commission on Tackling Poverty
• Poverty Truth Commission
• Poverty Reduction Coordination Group

Which key plans and strategies relate to this outcome?

• Economic Inclusion and Skills Plan
• Economic Recovery Plan
• Integrated Housing Strategy
• Fuel Poverty Strategy
• Digital Infrastructure Strategy
• South Tyneside Pledge
• Adult Social Care Strategy
• South Tyneside Carers Strategy

It is a struggle, day-to-day life, honestly it is. Even going to work, you get a full-time job, by the time you’ve paid out your bills, you’ve paid out your outgoings, like if you’ve got a car or anything like that, and you’re back to square one again…It feels like vicious circles.

Vulnerable man

In the UK, mental wellbeing is used to refer to the positive end of mental health in terms of the sense of feeling good as well as functioning well ^[37].

In South Tyneside, we embrace a holistic view which sees mental well-being not simply as access to services but as a person’s broader ability to cope, connect, adapt, and thrive.

In South Tyneside, mental ill health contributes more to the total years of life lived with disabilities than cardiovascular disease and cancer ^[38]. In England, mental health conditions are estimated economic cost of over £100 billion per year ^[39]. By enhancing mental well-being can prevent both mental disorders and physical ill-health, including the exacerbation of long-term conditions, as well as promote recovery in individuals with mental health problems ^[40]. Preventing mental ill health will in turn prevent its social consequences, which range from stigma, discrimination and social isolation to unemployment, poverty, and homelessness ^[41].

Good mental wellbeing builds the foundation for a healthy lifestyle and cuts across all aspects of life. The importance of strong social connections was a major finding of the Community Insights project, which emphasised the value of community groups in improving self-esteem, providing a sense of purpose, and acting as a critical source of information, advice, and support ^[2].

Why is this important in South Tyneside?

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What assets do we have in our communities?

Our borough benefits from a range of assets which promote mental health and wellbeing, from our award-winning parks and beaches through to our modern leisure centres and growing arts and cultural offer. These physical resources are complemented by the more intangible qualities of South Tyneside – such as our tight-knit communities and strong social capital – which are exemplified by our thriving local voluntary and community sector. Supported under the umbrella organisation of Inspire South Tyneside, our third sector partners play an invaluable role in fostering social inclusion and providing their members with a sense of identity, purpose, and belonging.

I’m gregarious. I need people to talk to and to mix with. And I’m on my own all my life and it’s no joke. So you just get sick of life sometimes.

Older man

They actually struggle to ask for help because it is one of those things, do you know what I mean, especially within the man’s situation they think, ‘I can do everything myself,’ sort of thing. But sometimes you just have to suck it in, basically, and go, ‘Do you know what, let us have the help because, do you know what, it will probably get me somewhere

Vulnerable man

South Tyneside also continues to benefit from significant investment into mental health services. These range from our Lifecycle service – offering a single point of access to talking therapies for individuals of all ages – to initiatives such as Healthy Minds Teams and Mental Health Champions, which provide early mental health support to children and young people. More recently commissioned services include the Autism Hub, LGBT+ service, and Kooth and Qwell online counselling platforms. A broad range of specialist services are also available locally for individuals with more complex mental health needs.

Who will we be linking with on this outcome?

The following are a few of the key groups who we will work with on this outcome:

• Mental Health Strategic Alliance
• Children and Young People’s Mental Health and Wellbeing Alliance
• Mental Health Champions Network
• Social Prescribing Steering Group
• Cleaner, Greener Communities Board
• Children and Adults Safeguarding Partnership
• SEND Leadership Board

Which key plans and strategies relate to this outcome?

• Mental Health Strategy
• Children and Adolescent Mental Health Strategy
• Autism Strategy
• Learning Disabilities Strategy
• Domestic Abuse Strategy
• Loneliness and Social Isolation Strategy (in development)

It’s having the support where it’s needed at the time when I need it, instead of getting to a point where I’m screaming for the help but I can’t find it anywhere. It’s having the balance between support and self-care. If self-care doesn’t work I’ve then got the support around me to help me get to the place that I need to be so I don’t end up in the crisis circle.

Young mum

When we think about health, we tend to focus on the choices we make.

What we eat, how often we exercise, and whether we drink or smoke are undeniably important, but living a healthy lifestyle is not simply a matter of personal choice. In fact, the decisions we make are shaped to a large extent by the natural and built environments in which we live, learn, and work ^[42].

That is why those who live along Sandhaven Beach or across from Temple Park may find it easier to be active. Or why someone with a good salary and normal working hours will find it easier to eat healthy than those who don’t have the time or resources to cook fresh food. A recent Food Foundation report found that the poorest 10% of UK households would need to spend 74% of their disposable income on food to meet the government’s healthy eating guidance ^[43]. In the words of Sir Michael Marmot: “It is not ignorance or the inability to cook that is the problem. It is poverty” ^[44].

Building a healthy environment is about creating the conditions which enable people to take control over their lives and improve their health now and for a sustainable future. This requires affordable, energy-efficient housing and good public transport links as well as access to healthy food, clean air, safe outdoor spaces, and leisure activities. In turn, this will support us to reduce our carbon emissions and adapt to the impact of climate change ^[45]. Achieving this in South Tyneside will require us to work in a joined-up way with partners across the borough and within the Council itself to ensure that health promotion is embedded into all that we do.

Why is this important in South Tyneside?

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What assets do we have in our communities?

South Tyneside benefits from its beautiful coastal location, numerous parks, and green spaces, and five leisure centres, all of which provide ample opportunity for residents to meet up and stay active. The Council’s recent commitment to become carbon neutral by 2030 is set to spur increased investment into walking and cycling routes in the coming years while our participation in the North East Community Forest scheme will result in over 3,000 new trees being planted across the borough each year ^{[45] [50]}. In addition to physical activity, closer partnership between the public health and licensing teams has meant that applications for new alcohol and fast-food outlets are now assessed more thoroughly about their potential health impacts, thus helping to improve the wider food environment.

There’s too much fast food and just unhealthy stuff in general, whereas if it was just healthy stuff, maybe people would change their minds.

Vulnerable young person

There is quite a lot to do in South Tyneside and South Shields but a lot of it costs money. It’s not cheap to take your kids to the fair. Yes, they’d have a cracking time but it’s not cheap to do that…So I think it’s just lack of opportunities that are free.

Food bank user

Local health promotion initiatives have also been successful at improving health within the classroom and workplace. The Healthy Schools Programme, launched over 15 years ago, has led to the adoption of a range of school-based health activities – from the introduction of physical activity programmes such as the Daily Mile to the provision of healthy breakfast clubs. Meanwhile, the Better Health at Work Award has been successful at encouraging local employers to establish the infrastructure to support their employees in adopting healthy behaviours, with 32 local organisations signed up to date reaching a total of 6,700 employees.

Who will we be linking with on this outcome?

• Cleaner Greener Communities Board
• Economic Regeneration Board
• South Tyneside Homes Board
• Local Plan Steering Group
• Community Safety Partnership Board
• Domestic Abuse Partnership Board
• Health Protection and Emergency Preparedness Resilience and Response group
• Alcohol Alliance
• Smoke-free Alliance

Which key plans and strategies relate to this outcome?

• Integrated Housing Strategy
• Local Plan
• SEND Commissioning Strategy
• Fuel Poverty Strategy
• Community Safety Partnership Plan
• Domestic Abuse Strategy
• Local Air Quality Strategy
• Alcohol Harm Reduction Strategy
• Physical Activity Strategy
• Local Walking and Cycling Infrastructure Plan
• Cultural Strategy
• Sustainable South Tyneside Strategy

I ride my bike a lot, but half the time there’s no designated cycleway for people to go on towards Shields town centre. There are no designated paths, so you’re on the road nearly getting hit by cars.

Young person

Stakeholders agreed that the following cross-cutting themes should underpin our work across all Strategy outcomes.

Fair delivery of services

Health inequalities refer to systematic, unfair, and avoidable differences in health which occur between different groups of people due to social, geographical, or other factors ^[51]. Reducing health inequalities has been a priority in South Tyneside since our first Health and Wellbeing Strategy was launched nearly 10 years ago and remains as important to us today as it was then ^[52].

However, there has also been growing recognition of the role that some interventions aimed at improving health overall can widen inequalities. This phenomenon – known as ‘intervention-generated inequalities’ – occurs when a service disproportionately benefits more socially advantaged groups, causing their health to improve while the health of more disadvantaged groups falls behind. This can occur for several reasons. For instance, the lack of appropriate representation and systematic bias in baseline data and evidence and subsequent evaluations. This could lead to a failure to understand and address the needs of different population groups when planning and delivering services in a way that it is not appropriate, accessible, or acceptable to those who need them most ^[53].

The importance of fair service provision cuts across all four Strategy outcomes and is crucial to tackling the inequalities which exist in our borough. In practice, this could mean prioritising our services to those with the greatest needs or providing a range of delivery mechanisms to ensure they are appropriate to different populations and communities. To develop this, we will seek to partner with the public and communities to co-produce services fit for their purposes. In addition, we will evaluate service accessibility through analysing data on features such as wait times and uptake as well as using tools such as health equity audits and health impact assessments to identify and address gaps. We have already begun to incorporate these considerations into our service planning and will accelerate this work in the coming years, refocusing our efforts to ensure that our support is provided in a way that is fair, proportionate, and accessible to those in greatest need.

Public involvement and community engagement

This Strategy is testament to the deep knowledge, experience, and insight of our residents regarding the health of our borough and the actions needed to improve it. It is also evidence of our vibrant and thriving voluntary and community sector, which catalyses collective action, builds community spirit, and provides invaluable support to our more disadvantaged and marginalised groups. The voices of these individuals and organisations have been instrumental in informing the development of the Strategy and they will be even more important for its delivery.

While we have laid out an ambitious vision for improving the health of our population, we are also aware that we cannot do it alone. Tackling the complex and deep-rooted challenges facing South Tyneside - particularly considering ongoing cuts to public sector funding - will require us to work more collaboratively than ever. In practice, this will mean investing the time to listen and engage with our residents, partnering with communities to co-produce services where appropriate, and using an assets-based approach which acknowledges and builds upon the local skills, expertise and structures that are already in place. Existing forums, such as HealthNet, provide an excellent foundation from which to build this approach and we will redouble our efforts to further strengthen public involvement and community engagement going forward.

Stakeholders agreed that the following cross-cutting themes should underpin our work across all Strategy outcomes.

Action Plan

The implementation of the Strategy will be guided by a set of action plans which identifies a set of key priorities under each outcome together with the activities necessary to achieve them and a selection of high-level indicators to measure progress. The detailed action plans will be published in a separate document and will be refreshed as required over the life of the Strategy. This to ensure they remain relevant to local needs and responsive to any changes in policy and systems.

Rather than replace existing plans or strategies, the Strategy aims to build on the excellent work which is already ongoing across the system. This includes the South Tyneside Vision and Council Strategy. Where possible, we will seek to align our planned work to that which is already underway in order to create areas of synergy and avoid duplication.

Governance arrangements

The Health and Wellbeing Board has a statutory duty of developing a Health and Wellbeing Strategy and is responsible for its delivery. The Board is also part of the wider South Tyneside partnership arrangements. These arrangements, while long-standing they are also agile. They have successfully adapted over the years and will be refreshed in line with the new South Tyneside Vision and Council Strategy.

In delivering this Strategy, and other programmes of work, there is commitment from partners to working more closely to tackle cross-cutting issues together. This will include more shared resource, risk and effort, and joint decisions with better intelligence and data sharing. The Strategy action plans specify the partnership arrangements who are most appropriate to progress the implementation of each outcome. If necessary, changes to membership and Board structure will be made to enable this.

In addition to Board-level governance arrangements, the Health and Wellbeing Board has also nominated individuals to serve in a set of newly-established ‘delivery roles’ which have been created to improve accountability and promote more integrated working. These include:

• Operational Leads work with Strategic Leads to develop the action plan and coordinate the day-to-day delivery of the activities for their assigned outcome.
• Strategic Leads have overall accountability for their assigned outcome. They set strategic direction, ensure plans align with existing work, and report progress back to the Board.
• Outcome Sponsors act as a ‘critical friend’ to their assigned outcome through monitoring progress, providing constructive critique, and ensuring that work is reflective of the cross-cutting themes highlighted above.

Our partnerships include:

• Living Better Lives
• Public Health South Tyneside
• NHS North East and North Cumbria
• Northumbria Police
• STC Regeneration and Economy
• South Tyneside Primary Care Networks
• Healthwatch South Tyneside
• South Tyneside Children's Social Care
• HealthNet
• Inspire South Tyneside

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