The PLAN should be usingLIVERPOOL COMMIS

The PLAN should be usingLIVERPOOL COMMISSIONING GROUP FROM 2016-2019 IT COMES DOWN TO EXPLAIN Who you are Who partners are What your vision is (healthy/happy/productive) How you spend your money How your population is (old/young/men/) Whats wrong with them What your priorities are What are you going to do about them (intervention) What you hope to achieve (anticipated outcomes) When by (timescale) How will we know it worked (monitoring) What happens next (evaluation the cycle starts again) Remember this? The NHS Atlas of Variation series is intended to support local decisions making to increase the value which a population receives from the resources spent on their healthcare. It supports the search for unexplained variations, the identification and attention to unwarranted variation. Helping clinicians to understand what is going on their area and where to focus attention to improve the care they provide. Step by step Question: if these are my people and these are their issues/needs what should my priorities be? There are things I have to provide for everyone But there are things I need to specifically focus on Remember this?Commission for Value: A process that reviews existing, local health data to highlight the top priorities (opportunities) for transformation and improvement. REMEMBER THIS? Locality data JSNA, H&WBS, Census, GP registers, Public Health Observatory Data etc Services Activity Data Citizen Feedback Performance Material Quantitative Data; Qualitative Feedback Start by explaining Who you are We are?? What this is This plan sets out our?? Your values and vision Remember these? Fingertips Public Health Knowledge Gateway NICE THE BELOW SHOULD BE USED AS A SAMPLEOF HOW THE PLAN SHOULD BE STRUCTURED BLACKPOOL CLINICAL COMMISSIONING GROUPCommissioning Plan for 2015 to 2018 Index1. Welcome and Introduction2. About Blackpool CCG3. Our Partnerships4. Our Values5. Our Principles6. Our Mission7. Our Vision8. Our Population8.1 Demographics8.2 Population growth8.3 Ethnicity8.4 Deprivation8.5 Health inequalities8.6 Mortality8.7 Childhood Health9. Our Populations Health Issues9.1 Alcohol and drug abuse9.2 Smoking9.3 Mental Health9.4 Suicide10. Our Commissioning Portfolio10.1 National and Policy planning context11. Our Commissioning Objectives and Aims11.1 Strategic aims11.2 Priorities11.3 Our Challenges11.4 Commissioning Tables12. Measuring overall Outcomes using NHS Outcomes framework 2015/1613. Monitoring and Evaluation13.1 Comments and feedback1.Introduction and WelcomeWelcome to the commissioning plan for the Blackpool Clinical Commissioning Group (CCG) for 2015 to 2018. This plan sets out our intentions, visions and strategies for improved health services andoutcomesfor the people of Blackpool.Blackpool is a vibrant city, unfortunately however this vibrancy is not matched by our populations health which, in comparison to the rest of England, is low. Therefore we have been ambitious with this plan and have set out clearly defined health priorities that we intend to address as well as measures to ensure we meet our targetsand commission efficiently.The health needs of our population have been well illustrated in theBlackpool Joint Strategic Needs Assessment and we have utilised this information alongside patient feedback in this plan.We have focused on reducing health inequalities, improving the health and wellbeing of our aging population, mental health, improving access to services as well as providing better support for those with chronic diseases. We have also strongly concentrated on substance misuse, which is majorcontributor to poor health outcomes in Blackpool.We know that we face a significant challenge to meet the health needs of our population.However we are confident that by working with our partners, this framework can form the basis to create a more resilient community with improved long term health and wellbeing, with fewer health inequalities alongside high quality health care services. 2. About BlackpoolCCGWe are the Blackpool Clinical Commissioning Group (CCG) and consist of a consortium of 24 GP surgeries. We are primarily focused on improving the health and wellbeing of a population of over 142,065 (Census, 2011) people.We have a budget of ?230 million and commission for the following services: Community health services Maternity services Elective hospital care Rehabilitation services Emergency care including A&E, ambulance and out of-hours services Elderly healthcare services Healthcare services for children and youth Healthcare services for people with mental health conditions Healthcare services for people with learning disabilities Continuing healthcare Health promotion Treatment of infectious diseases 3.Our PartnershipsWe believe that the most effective outcomes can be achieved through collaboration and have endeavoured to build and will continue to develop strong relationships with clinicians, local organisations and voluntary groups. Most Notably:? 3.1 Blackpool Health and Wellbeing board who have a congruent vision with Blackpool CCG that includes: Actively involving the community in improving their own health Moving health services into the community Integrating and streamlining services through joint commissioning Preventing illness through self-care and early diagnosis Giving children the healthiest start in life Improving community services for older people to live healthier, more independent lives as they age? 3.2 NHS England- We work closely together for our shared goal of putting the patient at the forefront of every decision and modernising services. ? 3.3 Fylde and Wyre CCG- We collaborate with other CCGs nationally and locally. We work closely with our neighbours Fylde and Wyre CCG for joint commissioning, initiatives and shared services. Further to this though we are sharing plans, projects, visions and successesto learn from each. ? 3.4 Voluntary sector Blackpool has a variety of community and voluntary organisations that deliver excellent services, address specific health issues and promote wellbeing. They also offer a voice for communities and we have utilised this feedback in our commissioning plan.We highly respect and value these organisations and recognise that often financial restrictions limit their full potential. Therefore this commissioning plan has included an increase in funding towards commissioning services, on a contractual basis, from this sector.(Blackpool Clinical Commissioning Group, 2015)4. Our ValuesHonest and Transparent Be visible and approachable Be honest with the people of Blackpool about why we are making certain decisions, what we are trying to achieve and by when.Fair and Equitable All individuals will receive and have equal access to the same high level of care and service Fairin our commissioning decisions, without influenceRespectful We will respect every individual, group and organisation we encounter, we will aspire to treat everyone as we would like to be treated We will make informed decisions and never assume to know what is best without being inclusive and seeking views and feedback from our populationAccountable We will do what we say we will by our specified time frames We will be responsible for our decisions and the resulting outcomes We will be able to explain clearly our reasoning for all decisionsPassionate, innovative and Ambitious We will make bold aims and goals for ourselves and our teams We will refuse to stick with the status quo and drive towards new, innovative programs, services, technologies and partnerships We will be enthusiastic in our approach and strongly support the implementation of this plan 5. Our Principles To be consistent with decision making Listen to patients the public and staff and provide feedback Cost effective commissioning To be ethical with decision making6. Our MissionOur missionis toimprove the health and wellbeing of Blackpool. Core to this is engaging with local people, so that their needs are at theforefront of every decision we make. We will endeavour to empower our population to want to achieve better heath and we will budget efficiently to provide quality, innovative care and services to the highest possible standards. We will work in partnership with other health and social care services to create a holistic, streamlined approach to care for our patients.7. Our VisionIs to create a healthier community by reducing health inequalities, improving life expectancyand providing easily accessible health care services. We wish not only to extend peoples life but to improve the quality of their health and wellbeing so that everyone can live the healthiest, happiest life possibleat any age.Vision: High Quality Care, Health and Wellbeing for Everyone 8. OurPopulationBlackpool covers an area of 13.46 square miles and islocated in northwest England in the county of Lancashire. It is one of the most densely populated authorities in the UK and has a population of 142, 065 (Census, 2011). In addition to this Blackpool sees an estimated 11 million visitors to the resort per year. There is also a significant amount of transience, including movement into and out of town, as well as movement in the town itself.Within the resident population there are approximately 1,700 births and 1,900 deaths each year.8.1 DemographicsAccording to the 2011 Census 51% of the population are female and 49% male.Blackpool has an aging population with a larger proportion of residents aged 60 and above compared to the average nationally.The average age is 41 with a slightly higher median age of 42.The proportion of the population aged under 25 is belowthe national average (Census, 2011). Comparison to Englands Demographic Average AgeBlackpool % England %Aged 0 18 22 23Aged 19 -24 7 8Aged 25 59 45 47Aged 60+ 26 22 . (Census, 2011) 8.2 Population GrowthThe total population of Blackpool is projected to be 157,600 by 2025. The trend for an aging population is projected to continue with the biggest increases in adult population to be in the 70-74 and 80-90 age groups. However, there is also anticipated to be a significant decrease in the 65-69 age group by 2020.By 2020, it is expected the population aged over 65 will have increased by 5% to more29,000 people. The older age group, those aged 80 and over looks set to grow by 10%. The increase in the over 70 age will be considerable in comparison to other age bands in Blackpool.The main influences contributing to the projected increase include improved life expectancy and net incoming migration. This trend will increase the demand for health and social care, suitable housing options, create high rates of mobility, personal care and domestic needs, and increase demand for services for people with dementia (Blackpool Council, 2014)Blackpool adult population 2012-20202012 2016 2020 ChangeAge 18-24 12,100 11,900 11,100 -8%Age 25-34 16,600 17,600 18,100 +9%Age 35-44 18,100 16,200 16,000 -12%Age 45-54 21,100 21,300 19,500 -8%Age 55-64 17,300 17,200 18,500 +9 %Age 65-69 8,400 8,500 7,200 -14%Age 70-74 6,500 7,000 7, 800 +20%Age 75-79 5,300 5,400 5,700 -+8%Age 80-84 3,900 4,100 4,300 +10%Age 85-90 2,400 2,500 2,700 -2%Age 90+ 1,400 1,400 1,500 +7%Total 18-64 85,200 4,200 83,600 -2%Total 65+ 27,900 28,900 29,200 +5% (Blackpool Council, 2014a) 8.3 EthnicityBlackpool residents are mainly white ethnicity with only 3% of the population being from black and minority ethnic groups.This is low in comparison to the approximatedproportion for England of 15%. The majority of the population, 97.2%, speak English with Polish being the next most spoken language with 1.1% (Census, 2011) Ethnicity Blackpool % England %White 97 85Mixed/multiple ethnic groups 1 2Asian/Asian British 2 8Black/African/Caribbean/Black British 0.2 4Other ethnic group 0.2 1 Where Blackpool Residents were born (Census, 2011) 8.4 DeprivationBlackpool is one of the most deprived local authorities in England, ranking 6th of the indices of deprivation scale in 2010. This is the highest Blackpool has ranked compared to previous years where in 2004 it was ranked 24th and in 2007 ranked 12th. Furthermore in 2010 it was ranked 1st for concentration of deprivation.(JSNA, 2010) 8.5 Health and inequalitiesThe health outcomes forthe Blackpool population are significantly worse than the England average and there are inequalities both between Blackpool and the national average, as well as in the town itself.Men in Blackpool have the lowest life expectancy in England at 73.6 years and for females the 3rd worse nationally at 79.4 years. There is also a marked difference within Blackpool between the most deprived areas and the least deprived. Blackpool EnglandMales 73.6 years 78.6 yearsFemales 79.4 years 82.6 yearsLife Expectancy Most deprived areas Least deprived areasMales 73.6 83.9Females 79.4 86.1Life expectancy within Blackpool (JSNA Blackpool, 2013) Ranks of Blackpool LSOAs in the Index of Deprivation by Band 8.6 MortalityLife expectancy in general is improving in Blackpool however not as quickly as other localities nationally and the gap between Blackpool and the England average is widening. Furthermore people in Blackpool also spend a smaller amount of their life in good health and without disability and in the most deprived areas life expectancy without disability is approximately 50 yearsThe main causes of low life expectancy in Blackpool are alcohol related conditions and diseases, circulatory diseases, cancers (high rates of lungcancer), accidents and self-harm, and respiratory diseases.Major causes of early death in Blackpool (JSNA Blackpool, 2013)8.7 Childhood HealthThe health and wellbeing of children in Blackpool is generally worse than the England average. The level of children under the age of 16 living in poverty is 31.3%, worse than the national average andthis is more strongly correlated withthose in single parent families.Obesity amoung children in Blackpool is average with 10.6% of children aged 4-5 years and 20.2% of children aged 10-11 years being classified as obese.Blackpool North West England31.3% 22.5% 20.6%Children living in poverty (under 16 years) (JSNA, 2013) 9. Our Populations Health Issues9.1 Alcohol and Drug MisuseBlackpool has one of the highest rates nationally for alcohol related harm,for the size of the population, which includes damaging health effects. Thepopulation experience the highest mortality rates in England for liver disease in people aged under 75.This has a huge impact on NHS services with over 4,000 hospital admissions and more than 16,000 attendances at A&E per year related to alcohol. Blackpool has one of the highest rates of individuals receiving specialised treatmentfor alcohol. There are high rates of drug misuse within Blackpool. In 2012/13 the town had 2.5 times the national average of opiate and crack users, the 4th highest number in England.There were slightly more than1,000 injecting drug users in the same time period, almost four times the national average (Blackpool Council, 2014b )Prevalence Estimates (aged 15 64) Local Rate per 1000 populationNational Rate per 1000 populationOPC 21.89 8.69OPIATE 20.27 7.59CRACK 8.11 4.95INJECTING 10.77 2.71( Blackpool Council, 2014b)9.2 SmokingOver 30% of the adult population in Blackpool are smokers,the proportion of people smoking varies widely between social groups. The highest rates are seen among the lower socio economic groups, where, this rate jumps to 50% and families spend one seventh of their income on buying cigarettes.Every year in Blackpool approximately 400 people die prematurely as a direct result of smoking, and a further 8,000 from related diseases. Lung cancer is a major concern, each year there are approximately 130 deaths from lung cancer, and just over half are those aged under 75. Both incidence and mortality rates are significantly higher than the national average.Blackpool also has the highest rate nationally of women who smoke during pregnancy. In 2012- 2013, 30.8% of mothers who gave birth in Blackpool considered themselves smokers.(JSNA, 2013) 9.3 Mental HealthThe North West Wellbeing Survey done in 2009, indicated that Blackpool has the lowest average scores for wellbeing in Lancashire. According to a survey done by the Office for National Statistics in 2011 2012, Blackpool ranked in the bottom 5 nationally for public happiness score.Amongst the over 65s the two most common mental health problems are depression and dementia. There are approximately 34% of over of those aged over 65 requiring treatment for depression.The number of dementia cases is set to increase substantially in the future, with a predicted 154% increase in diagnoses in the UK by 2051. This equates to 1 in 3 people being affected by dementia, either by suffering from it or by caring for someone who does.(JSNA Blackpool, 2013)9.4 SuicideBlackpool has a mortality rate from suicide greater than that of the North West and England, and the highest rate nationally for males with a rate more than twice the average. Drug and alcohol misuse are often co-existing factors in Blackpool suicides.10. Our Commissioning PortfolioWe receive 280 million pound to commission the majority of healthcare services for Blackpool residents. The pie chart below shows how we intend to allocate funding. 10.1 National and Policy Planning Context? NICE Guidelines for Commissioning groups Commissioning in line with NICE can ensure our plan is cost effective as well as quality driven. We have utilised their support packages to assist with quality improvement and to gain information on key clinical, cost and service-related factors to consider during our commissioning planning process ( NICE, 2014 )? The NHS Mandate- We have commissioned in line with this mandate between the government and NHS England that lays out the ambitions and goals for the health service. It sets out a strategic direction for commission groups based on 5 main objectives: (Department of Health, 2014 ) ? Right Care and the NHS Commissioning for Value NHS England working in partnership with Public Health England and NHS Right Care have developed Commissioning for value to help CCGs transform the way they deliver care for their patients and populations.It is about identifying priorities in health populations which offer the best opportunities to improve healthcare by looking atclinical programmes, instead of organisational or management frameworks and boundaries.The approach has 3 distinct phases:Phase 1: Where to Look A review of indicative data, for example JSNA and Atlas of Variation, to highlight priorities and areas for transformation and improvement (NHS England, 2014)Phase 2: What to Change Building a case for change, deep dive reviews and reviewing service data to establish where change is needed.Phase 3:How to Change Driving through change with business processes, leadership and engagement.Identified in the Commissioning for Value: Pathways on a page, November 2014,Contents NHS Blackpool CCG were the following headlines for Blackpools health economy. (NHS England, 2014)However Commissioning for Value is not intended to be prescriptive rather a starting point for commissioners and area teams to use as an insight in to their population needs. It provides suggestions on where to look to help them deliver improvement and the best value for their populations. We have utilised this information in our plan.11. Our Commissining Objectives and Priorities11.1Strategic Aims1. Reduce Health inequalities2. Increase life expectancy3. Provide high quality primary care4. Improve care for Long term conditions5. Improve quality of care11.2 Priorities Cancer Alcohol abuse Drug abuse Smoking Mental health and Dementia Respiratory disease Heart disease and stroke11.3 Our Challenges Older than average population High rates of chronic conditions Social isolation Transience population High risk behaviour High levels of deprivation 11.4 Commissioning tables- For eachof the above commissioning priorities we have included: A brief description of ourstrategic aim A summary of the action Blackpool CCG intends to take over next three years A list of the outcomes and benefits expected to be achieved by delivering these Commissioning Intentions for the Blackpool population.CancerStrategic Aims Action Blackpool CCG will take Outcomes and Benefits Increase screening and early diagnosis of cancer Streamline services and information sharing between oncology specialists Improve care and patient experience Raise awareness of the signs and symptoms of cancer by working with health and wellbeing boards as well as the voluntary sector. This will include a mobile screening service to more deprived areas. Empower patients with knowledge to lower risk Increase opportunistic screening in health care settings Streamline care and referrals Utilise The National Cancer Patient Experience Survey (NCPES) annually and use the information to continually improve services 20% Higher cancer survival rates at 1 and 5 years 20% Higher rates of early diagnosis in comparison to late diagnosis Improved patient satisfaction with servicesand their care Drug and Alcohol AbuseStrategic Aims Action Blackpool CCG will take Outcomes and Benefits Improve the health ofthe Blackpool population by promoting and supporting treatment and recovery from drug and alcohol harms. Increase the number of patientscompleting their treatment and assist them with their re-entering into the community Lower the current high rate of alcohol and drug use in Blackpool Relieve pressure and hospital services from alcohol and drug related harms and resulting conditions and diseases Train frontline staff, to recognise, signpost and refer patientssuffering from harm due to drug and alcohol abuse to the correct treatment pathway Work in partnership with third sector charities and organisation for community support and services for treatment and recovery programs Have a system where vulnerable groups, for example the homeless and the elderly, have a separate pathway for treatment Develop a specialised program of recovery for those with co- existing mental health problems Community health promotion to raise awarness of the health consequences of drug and alcohol abuse Needle exchange services with trained healthcare staff Esatblish weekend satellite surgeries in tourist areas, during peak times, to deal with minor alcohol and drug related issues rather than have patients present to A & E A decrease in alcohol related hospital admissions of 30% A decrease of 15% in ambulance use for alcohol related injuries A decrease in Alcohol specific mortality by 20% A reduction in drug users and overdose rates A decrease of 50% in rates of liver disease SmokingStrategic Aims Action Blackpool CCG will take Outcomes and Benefits Reduce the number of people smoking in Blackpool Reduce the number of Blackpool pregnant women who are smoking Reduce the amount and cost of smoking related diseases and conditions Training staff to identify those that smoke and offer smoking cessation Targeted health promotion for more deprived areas The full range of pharmacotherapy options offered to support smoking cessation so that the individual can choose what they believe will be most successful. Training midwives to offer specific smoking support for pregnant women and a tailored quite program Reduce smoking rates by 15 people per week A 15% reduction in rates of lung cancer A 20% reduction in pregnant women smoking Mental health and DementiaStrategic Aims Action Blackpool CCG will take Outcomes and Benefits Provide high quality care for those with mental health problems Recognise dementia earlier Increase wellbeing for those with mental health problems We have opened a new psychiatric inpatient facility in Blackpool. This will now allow Blackpool residents to receive friendly, quality care in their local area Memory screening so that early cognitive issues can be detected and healthy lifestyles advice provided Links with the voluntary sector for support for the elderly and socially isolated Specialised home care so that those with mental health problems can have support at home when possible Train support staff to encourage community engagement Improve support for carers Increase hours for mental health services Targeted suicide and depression health promotion campaign for males Online support groups for depression, led by trained professionals Greatly improved mental health services Increased quality of life for those with dementia Earlier intervention for mental health conditions Lower suicide rates for males Respiratory diseaseStrategic Aims Action Blackpool CCG will take Outcomes and Benefits Reduce the number of premature deaths in Blackpool due to respiratory diseases Improve quality of care for those with respiratory diseases Improving access to respiratory services and disease management Patient education on how to best manage their disease Specialised telephone and internet support Specialised home nurses trained to deal exclusively with respiratory patients Referral to smoking cessation services for those continuing to smoke Reduce hospital admissions for those with Respiratory conditions Better self and home care for those with respiratory condition Heart disease and strokeStrategic Aims Action Blackpool CCG will take Outcomes and Benefits Reduce incidence of heart attacks and stroke rates in Blackpool Lower rates of blood pressure Identify those at risk in primary and secondary care and have information packs available to explain lifestyle choices that they can make to lower their risk Increase and promote blood pressure testing, mobile units at events Work in partnership with the third sector to encourage community physical activity events Lower mortality rates for heart disease Reduced hospital admissions due to heart attack and stroke We would welcome your feedback and opinions with our choice of priorities for the next three years to achieve our strategic aims and to deliver the expected benefits forour population of Blackpool. 12. Measuring overall outcomes using the NHS Outcomes Framework 2015/16To measure our overall achievements over the three years we have considered the seven outcome ambitions (in the NHS Outcome Framework), and set out improvement ambitions against each, having considered our current position and potential impact of initiatives.Outcome Ambition 1: Additional years of life for the people of Blackpool with treatable mental and physical health conditions. Blackpool has the lowest life expectancy for men and the third worse for women nationally. Additionally Blackpool has the third worse in England country in terms of potential years of life lost due to premature death. The rate is 3,019.4 per 1,000 population the main causes are in line with our priorities for heath improvement. Our ambition is to lower this figure by 10% to 2,717.46 per 1,000 population.Outcome Ambition 2: Improving the health quality of life of the Blackpool population with one or more chronic condition, inclusive of mental health conditions. Blackpool is in the lowest quarter nationally, having a score of 66.5 on the standard measure for quality of life. Our aim is to improve this to 70.9 by 2018.Outcome Ambition 3: Reducing the amount of time our patients spend in hospital when it is avoidable through more integrated care in community settings and patient home settings. The measure used for this is a reduction in emergency admissions,we are aiming for an overall 20% reduction by 2018.Outcome Ambition 4: Increasing the amount of older people living independently at home following discharge from hospital. This is measured by calculating the proportion of those aged 65 and over who were still at home 91 days after discharge from hospital into home care and rehabilitation services. While no current baseline measures exist working with Blackpool Health and wellbeing board we have developed a yearly measure to ensure that this is increasing. Outcome Ambition 5: Increasing the amount of patients having a positive experience of hospital care. The measure used is the number of people having a positive experience of hospital care. Currently Blackpool ranks lowly being in the third worst quartile nationally. Our ambition is to improve to be in the best quartile by 2018, which is the England average. Our ambition is to consistently score a high Friends and Family Test score to at least above the national average.Outcome Ambition 6: Increasing the number of our population, outside hospital care with mental and physical health conditions, having a positive experience of care in general practice and in the community. Blackpool CCG is currently performing in the top quartile in England but we will aim for a further 2% improvement, reducing from 4.3 to 4.14 on the measure used. We wish to ensure we keep building on the current positive outcomes in these settings.Outcome Ambition 7: Making progress towards eliminating avoidable deaths in our hospitals caused by issues and problems in care. The ambition here is to reduce avoidable hospital mortality by 10% and increase near miss reporting by 10%. Continual progress willbe put into achieving these ambitions and the CCG recognises that it is important to have good delivery and performance monitoring systems to ensure best practice.(NHS, 2014)13. Monitoring and EvaluationWe will use several methods and means to gain an understanding of our performance and to ensure we are meeting our targets and ambitions. We will review patient experience feedback, clinical data and statistics on physical health and wellbeing outcomes of our population. We will share all of findings from monitoring performance and patient experience with our Quality Committee.We have engaged with our public at every stage of the commission cycle to ensure that their needs are at the fore front of every decision we have made in this plan. We will continue to do this when evaluating the success of the programs we have commissioned.We will also engage with the people that provide services, nurses, doctors, carers and community and voluntary organisation employees to gain an in depth knowledge of how successful commissioning plan has been in relation to the service they provide.While this is a 3 year commissioning plan we will review at 3 months intervals the progress of all strategies commissioned and at the end of each year review and make any necessary changes. We will withdraw and reallocate funding to more appropriate pathways if this is deemed necessary, though appropriate consultations with our partners will occur prior to this. 13.1 Comments and FeedbackWe have created this plan with the Blackpool population at the forefront of every decision we have made to ensure that we can address our most pressing health challenges as well as improve quality of care.As previously mentioned we welcome any comments or feedback about this plan. If you would like to discuss further or make any suggestions please do not hesitate to contact us on ReferencesBlackpool Clinical Commissioning Group, 2015. About Us. [online] Available at:[Accessed 27 April 2015]BlackpoolCouncil, 2014 a.Public Health Annual Report an Independent Assessment on the health of the people of Blackpool. [pdf]. Available at:[Accessed 28 April 2015]Blackpool Council, 2014 b. Blackpool Drug and Alcohol Health Needs Assessment. [pdf] Available at: [Accessed 28 April 2015]Census, 2011.Blackpool Census Demographics United Kingdom. Available at: [Accessed 27 April 2015]JSNA Blackpool, 2013.Public Health Annual Report for Blackpool, 2013. Avaliable at: [Accessed 27 April 2015NHS, 2014. NHS Outcomes Framework 2015 to 2016. Available at:

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