London Boroughs of Richmond and Wandsworth: Embedding a health in all policies approach

The public health team for the London boroughs of Wandsworth and Richmond launched a prevention framework focussed on addressing health inequalities three years ago. By working closely with council colleagues, the public health team has ensured it has had maximum impact. It has led to a series of initiatives by a range of different departments that are focussed on prevention, including targeted work by the weight management service to engage those with the highest rates of unhealthy weight, a self-harm prevention toolkit for frontline staff and a scheme to improving healthy food options at local catering outlets.

 We are optimistic we will continue to see progress – we have truly become a prevention council” - Shannon Katiyo, Director of Public Health

Richmond upon Thames and Wandsworth councils’ joint public health team - part of a wider shared staffing arrangement between the two London boroughs - launched a prevention framework in summer 2022. The aim was to embed a health-in-all-policies approach across the councils with a specific focus on reducing health inequalities and embedding prevention as a system tool to affect this.

Public Health Consultant Dr Nike Arowobusoye said: “While both are relatively affluent London boroughs, they do have pockets of significant deprivation. We know to address these goes beyond health promotion on things like obesity, smoking and physical activity, it needs to incorporate the socio-economic determinants of health including education, housing, crime and employment too.”

The framework that was developed has at its centre the aim of cementing prevention as a system delivery tool at three levels - people, community and environment. And to help embed it across the council, the public health team ran workshops for councillors, staff, and individual teams as well as with key partners such as the local NHS. 

A toolkit was also developed covering key concepts and principles, practical examples of where prevention is embedded at all the levels and a checklist and worksheet for staff to consider how to apply framework to their work. 

Dr Arowobusoye said: “The workshops and toolkit were really important exercises. I think when we launched it many initially felt it was rather academic – they did not see how it could be used practically. But by talking them through it and giving practical examples we managed to bring it to life.

“The councillors in particular have been essential – they have become prevention champions in many ways. They are now asking what is being done on prevention and how can new policies and plans make sure prevention is taken into account. That helps to drive it.

“You do need to spend the time at the start to get it really embedded. The risk is departments see it as something public health is telling them to do – and then they expect public health to do it for them. You want them to just see it as part of their work – and that is what we really tried to stress and show them when we launched it.”

One of the most significant steps on a strategic level was taken in early 2023 when the councils voluntarily adopted the socio-economic status as a new duty alongside the nine protected characteristics set out under the Equality Act 2010. It led to an updated equality impact needs assessments approach for all new policies and plans.

Assistant Chief Executive Jon Evans said: “It means that all services now proactively consider how they can reduce the impact of socio-economic disadvantage through the policy or service delivery changes. 

“This reflects a positive step change and ensures that the councils are considering how they can make services fairer and accessible to all by considering prevention at the earliest stage of policy development.”

That in turn has paved the way for a wide range of initiatives by individual departments to address health inequalities.

• The winter warmth home service is using the making every contact count (MECC) approach to assess wider health and wellbeing needs and signpost clients to relevant services.
• The tier two adult weight management service has started specifically targeting people from deprived areas, those with learning disabilities and those from BME communities who all have higher rates of obesity.
• Through the Homes for Ukraine scheme, council staff have taken a health-in-all-policies approach during their visits to hosts and guests by assessing wider health and wellbeing needs and signposting to services including welfare and benefit support, counselling and health services rather than just focussing on safeguarding.
• A mental health event was held by Richmond's Youth Service in July 2023 to promote the five steps to wellbeing - give, be active, take notice, connect and keep learning.
• A community toilet scheme has been launched in Richmond with a particular focus on increasing wheelchair-accessible facilities and changing facilities.
• The cost-of-living programme delivered by the resources directorate has used the MECC approach to discuss with residents their wider health and wellbeing needs and signpost them to local services.
• In adult social care a newly commissioned learning disabilities contract in 2024 was signed to provide employment support, work experience and training opportunities to help build self-esteem, reduce social isolation and enhance life skills.
• Public health, regulatory services and environmental health created a healthy catering accreditation scheme to support food businesses. The scheme targets areas of higher deprivation with a higher concentration of fast-food outlets.
• A self-harm and suicide prevention toolkit has been developed for frontline staff including GPs, social workers and teachers, as well as parents, guardians and children and young people themselves. It includes guidance on where to go for support and how to address concerns.
• The environment and community services directorate has developed a new five-year leisure strategy with a focus on engaging people who are living with health conditions and disabilities. It includes discounted access to facilities, physical activity programmes on council estates and a new site for Parkrun.

Director of Public Health Shannon Katiyo is delighted with what has been achieved so far. “It has been fantastic to see the way the prevention framework has been embraced. When we launched it, we committed to producing a progress report one year on for each council and by that stage we had really strong evidence of what has been achieved and that has been built on since then.

“We are continuing to do some bespoke work with housing, transport and planning as we feel that the potential for addressing the social determinants of health with those services are so significant. We are optimistic we will continue to see progress – we have truly become a prevention council.”